National Protect Your Hearing Month – Time to Fill the “Know-Do” Gap

Posted on by Christa L. Themann, MA, CCC-A

When it comes to health, a large gap often exists between what we know (for example, we know that eating too much sugar is bad for our health) and what we still do. Hearing loss prevention is no exception. We have been aware of the harmful effects of overexposure to noise for over a century. Governmental recommendations and regulations have been designed to protect against these effects for decades, and we have a large body of research pointing out effective ways to prevent noise damage, yet noise-induced hearing loss still ranks among the most common occupational illnesses in the US. One reason may be that hearing researchers and government bodies have not effectively communicated what we know to those in a position to put this knowledge into action. Over the past several years, NIOSH researchers have focused on narrowing this “know-do” gap by trying to improve our communication and dissemination efforts with safety and health professionals and the public through available communication channels and social media.

One of the great tools that NIOSH has made available for scientists and researchers to communicate with our stakeholders is The NIOSH Science Blog which allowed us to tackle some interesting and fun subjects. Since its launch ten years ago, the hearing loss prevention team at NIOSH has published nearly thirty blogs on various noise and hearing loss prevention topics. We covered topics such as the risk faced by specific groups of workers, ways of measuring the societal burden of this condition, and specific strategies and tools to help avoid the effects from loud noise. As we wrap up National Protect Your Hearing Month, we will revisit some that illustrate the range of topics covered. We hope that you will find at least one tip in these blogs that will help you close the “know-do” gap in hearing health. If you have an idea to share, please comment below so others also can give it a try!

So How Accurate Are These Smartphone Sound Measurement Apps? (2014)

This has been the most successful NIOSH blog ever, with over 254,000 views and 166 comments. These days, it seems that almost everyone has a smartphone, and there is a smartphone app for almost everything – including noise measurement! At our last count, well over 200 sound measurement apps are available. To help everyone understand their usefulness, NIOSH conducted a study to examine the accuracy of some of them — we wanted to know whether they could be used to reliably measure noise levels in the workplace. Only a few apps met our test criteria, especially if used in conjunction with a calibrated external microphone. As a result of that study, we noticed that most apps did not provide noise measurement metrics commonly used in occupational noise monitoring. So we decided to develop and make available our own NIOSH SLM app. The app has been the most successful NIOSH mobile application launch, with over 92,000 downloads since its release less than 9 months ago. We’ve written a blog on the app as well. Check it out here – New NIOSH Sound Level Meter App (2017).

Measuring the Impact of Hearing Loss on Quality of Life (2016)

Hearing loss can have a profound impact on quality of life. Hearing loss makes it difficult to understand what others are saying, especially in group situations or when there is background noise. As your hearing loss progresses, certain speech sounds become harder and harder to hear, and you find yourself needing to ask others to repeat themselves, which quickly becomes frustrating for everyone. Social gatherings, meetings, restaurants, theaters, and even church can become isolating activities because of the trouble understanding what people are saying and the inability to contribute to the conversation. Depression, anxiety, and social withdrawal can result, impacting an individual’s quality of life. One way to measure this impact is to calculate disability-adjusted life years (DALYs), which estimate years of good health lost due to a disability. NIOSH has found that 2.5 healthy years are lost each year for every 1,000 noise-exposed U.S. workers because of hearing impairment.  Nearly every occupational hearing loss is preventable; hopefully, closing the “know-do” gap will reduce the number of DALYs suffered by US workers.

Vuvuzelas: What’s the Buzz? (2010)

Remember the 2010 World Cup in South Africa? Vuvuzelas (a type of plastic horn) took center stage at the competition with their energetic sound, but raised concerns because of the potential for very high sound levels. Just how loud were they? As we reported in our blog, average vuvuzela output is 131 dB and can reach a peak sound pressure level of 140 dB (about as loud as a jet engine during takeoff). With thousands of vuvuzelas being blown simultaneously, noise levels are certainly hazardous. Soccer fans may not experience a high risk for hearing loss if they only attend one or two games; however, athletes, referees, stadium workers, broadcasters, and others could be over-exposed during the course of a season. NIOSH recommends that everyone use hearing protection when attending events where vuvuzelas will be blown by spectators in the grandstand.

Higher Speeds, Higher Decibels (2010)

World Cup soccer isn’t the only loud sporting event. Stock car racing is a popular spectator sport with more than 8 million spectators attending over 90 racing events each year. “Noise is part of NASCAR,” fans often say, but if you are a driver, crew member, or a worker at these facilities, that noise can be hazardous to your hearing in the long run. NIOSH measured noise levels at the Indianapolis Motor Speedway in Indianapolis, Indiana, the Bristol Motor Speedway in Bristol, Tennessee, and the Kentucky Speedways. We found that noise levels at these racetracks often exceed those found in some of the loudest industrial settings. Noise and administrative controls and hearing protection not only minimize the risk of noise-induced hearing loss, but can also be a competitive performance advantage by improving communication between drivers and crew. Our efforts aimed to raise awareness among drivers, crews, event workers, and spectators to make sure that activities they enjoy today don’t impair their ability to hear and enjoy other activities in the future.

These Go to Eleven (2011)

Nearly everyone enjoys music. However, both musicians and audiophiles can find themselves with hearing loss or tinnitus if they listen too long to music louder than the recommended exposure limit. Once hearing loss sets in, music will never sound the same again. Musicians and entertainment workers have been an overlooked sector in terms of occupational safety and health. Hearing conservationists need to present safe listening tips from an artistic rather than a workplace safety point of view to meet the needs of these individuals. Special types of hearing protectors are available for listening to music without distorting the sound quality or interfering with the experience. Read about these and other NIOSH recommendations for reducing music-induced hearing loss in our follow-up blog – Turn it Down: Reducing the Risk of Hearing Disorders among Musicians: (2015).

NIOSH HPD Well-Fit™: The Future is Fit-Testing (2013)

Perhaps one of the biggest “know-do” gaps in hearing loss prevention is in the area of hearing protection. We know that the labelled Noise Reduction Ratings generally overestimate the amount of noise reduction that a worker receives from his hearing protector. We also know that each worker receives a different level of protection based on how well the device fits a particular ear, how deeply the worker inserts it, the type and condition of the protector, etc. So how can we know if a worker is adequately protected? The solution is individual fit-testing. Hearing protector fit-test systems have been around for a while now, and several commercial systems are available. However, some barriers exist to the widespread implementation of fit-testing. To address these barriers, NIOSH developed HPD Well-FitTM, which uses standard technology available on just about any computer to fit-test any earplug in 5 minutes or less. Proactive safety and health professionals have begun using fit-testing as a part of their hearing loss prevention programs, ensuring that more and more workers are adequately protected.

Even a Dummy Knows October is Protect Your Hearing Month (2012)

Introducing Nick… a NIOSH training mannequin used to raise awareness of hazardous sound levels among teenagers and young adults. Nick travels around to health fairs, conferences, meetings, and other events to measure sound levels produced by personal music devices. He is very popular and has traveled over 30,000 miles across more than ten states and two countries, educating young workers about the risks of hearing loss. Nick has many siblings all over the world who do the same thing. Check out our blog for a link with instructions for building a training mannequin of your own.

Introducing the Hearing Loss Prevention Program Evaluation Checklist: (2017)

Noise-induced hearing loss continues to be one of the most common occupational disorders, even in workplaces where workers are enrolled in hearing loss prevention programs. We have the knowledge to change this. A good hearing loss prevention program requires several elements: noise measurement, noise control, hearing protection, hearing testing, education and training, record-keeping, and periodic program evaluation. A team of NIOSH-funded researchers from the University of Washington, University of Michigan, and Yale University have created two tools to help workplaces implement effective hearing loss prevention programs – a checklist to measure regulatory compliance and adoption of best practices, and a calculator to estimate program costs. Download these tools to close the “know-do” gap at your worksite and let us know what you think so we can continue to improve them.

Speaking of improvements, check out our Noise and Hearing Loss Prevention webpage (or follow us on Twitter at @NIOSHNoise) for additional information about our research and other resources to help with your hearing loss prevention efforts.

Do you have an idea for the next blog on hearing loss prevention? Let us hear from you. Also, please share your tips for closing the know-do gap on occupational hearing loss.

Christa L. Themann, MA, CCC-A, is an audiologist with the NIOSH Division of Applied Research and Technology.

Posted on by Christa L. Themann, MA, CCC-A

10 comments on “National Protect Your Hearing Month – Time to Fill the “Know-Do” Gap”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    For future NIOSH attention, the work of Otolaryngologist FR Lin of Johns Hopkins merits attention: Hearing loss is also associated with risk of dementia, falling and loss of brain substance, as published in peer-reviewed articles. For now, thanks for this October’s “gap-fillers,” Christa! Larry

    How much work has been done in the restaurant industry? My favorite restaurant had over 90 dB for most of the 1 hour and 15 minutes we dined. Thanks.

    Hey there,

    Great post! The best and effective way to help lessen the growing number of people with hearing loss is by education. And educating in ways that could reach as many people as possible through communication and social media is by far the most effective. Blogs like this will surely reach people from all over the world. Raising community awareness on hearing loss is a goal for a hearing health advocate like myself. Thanks for sharing!


    Is there anything that can be done about excessively loud, amplified church bells. I live across the street and around the corner from two churches who after I moved in began ringing excessively loud and frequent (36,000 times a year for the church across the street – ringing a 1,500 lb. amplified bell; and 8 am hourly till 8 pm for the other church around the corner) bell programs impacting me and my family. I’m trying to do everything I can, I’ve spoken with the churches, the town, state agencies and finally I’m in court over it, It’s just on and on, I don’t think those who attend these churches understand the impact the church, especially its bell noise, has on the neighborhood where the church is located.

    Thank you for your concern. NIOSH works primarily to reduce occupational noise exposures. Environmental noise exposures are typically managed through local noise ordinances. It sounds like you have done all the right things… talking to the churches, meeting with local officials, etc. Since you have been so proactive, you probably are already aware of the noise ordinances in your area; but – in case it helps – you can search for them at the following site: Choose your location and search on “noise.” You have probably also already measured the sound level of the bells, but – if you have not – NIOSH has a free sound measurement app that might be helpful to you. You can download it here:

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Page last reviewed: October 26, 2017
Page last updated: October 26, 2017