The Cases of Hearing Loss Among Young Adults in Malaysia

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It has been estimated that 1.1 billion young people (aged between 12–35 years) are at risk of hearing loss due to prolonged noise exposure in recreational settings. So, we can see that youths are having unsafe listening practice in the world today and hence they are putting themselves at risk for noise-induced hearing loss. According to American Speech-Language-Hearing Association, noise-induced hearing loss (NIHL) happens when humans are exposed to loud sound. The sound can be short or long in duration of time. Today, NIHL has become the second most common form of acquired hearing loss after age-related hearing loss. In addition, a study has pointed out that the region comprising Malaysia, China, Philippines and other sub-regions has the highest attributable fraction (AF) of 21% for occupational noise exposure among adults compared to only 16% average worldwide. For 15 to 29 young age group particularly in this region, the AF of male is 34% whereas AF of female is 21%. Therefore, I believe that NIHL among young adults in Malaysia is a concerning issue. In this article, NIHL among young adults in Malaysia will be discussed in terms of causes, mechanisms, general symptoms, impacts, managements and preventions.

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First of all, NIHL among young adults in Malaysia is not only caused by exposure to loud sounds in occupational setting but also in recreational settings. The most common recreational activity that put young adults at risk for NIHL is listening to music at high volume through personal audio devices. Other examples are attending loud music dance club and playing in band. On the other hand, occupational NIHL is caused by loud noise exposure in workplace such as working at a construction site and working with heavy machinery without wearing any hearing protection. Besides, NIHL can be temporary or permanent. It depends on the intensity of noise exposure and duration of time. When the noise exposure is not experienced for enough intensity and duration, temporary threshold shift (TTS) occurs in which hearing level will return to normal over time. Hearing loss is said to be temporary. However, when noise exposure comes with sufficient intensity and excessive duration, threshold shift becomes permanent. Permanent threshold shift can be due to repeated exposure or a single exposure to extremely loud sound which then leads to acoustic trauma. In this case, hearing loss is irreversible. NIHL can be due to noise exposure in occupational or non-occupational setting, meanwhile it also can be momentary or permanent.

In terms of mechanisms that contribute to hearing loss associated with noise damage, NIHL is typically a consequence of sensory cells damage. Sensory cells are also known as hair cells that can be found inside the cochlea. These hair cells respond to mechanical sound vibration by bending of cilia and then transmit electrical impulse to auditory cortex. NIHL causes overstimulation of hair cells and leads to hair cells damage. Because of that, they can no longer create and transmit electrical impulses to the auditory cortex via auditory nerve for sound interpretation. It is important to highlight that these hair cells do not grow back. In short, NIHL affects auditory function primarily through cochlear damage resulting in sensorineural hearing loss.

The general symptoms when young adults are having NIHL includes they may have difficulty in understanding conversation in a crowd and keep asking people to repeat themselves due to muffled hearing. Besides, one of the significant symptoms is they are being complained that they watch TV or listen to music at high volume. In addition, they may have ringing in the ears or sudden hearing loss. Both are the early signs of hearing damage. As a result, NIHL causes various negative impacts among young adults. It can lead to communication difficulties and learning difficulties. Hearing impairment limits communication ability which in turn leads to social isolation, depression, embarrassment and poor self-esteem. Noisy situations also lead to further worsening of social problem. If young adults have tinnitus, it also affects sleep quality. Furthermore, NIHL causes economic burden when some of the young adults cannot afford to buy hearing aid as one of the management options. As a result, the very fact that NIHL brings many negative impacts among young adults from the aspects of socio-economic and emotion. In order to overcome them, they have to look for a proper management.

Proper management is needed in order to deal with hearing impairment. The most effective management is to wear clinically prescribed hearing aid (HA). A scientific study has found that by using of HA brings a remarkable boost in mental health quality of life. HA improves hearing by amplification of sound and this in turn can improve communication ability. Secondly, another management option is to use assistive listening device. There are different types of assistive listening devices to improve quality of life from the aspects of safety, occupational and social. Phonak roger pen is an example of assistive listening device that is likely to be used by listener during a meeting or at school. Phonak roger pen helps the listener to understand speech in noise or over distance. It is a microphone that can be placed on a surface. It picks up the speech, reduces the background noise then amplifies the sounds to HA that has been connected. If the young adults have symptom of tinnitus that disturbs quality of sleep, they can have a pillow masker to make tinnitus much easier to tolerate. Moreover, counselling is also a common management option for young adults with NIHL who are severely distressed. Counselling provides a safe and confidential place for them to release their frustrations. During counselling session, counsellors guide them in coping with the effects of hearing impairment on emotional aspect. If young adults are having NIHL, they must seek for a proper and effective management so that to restore quality of life.

Since NIHL is preventable but once developed is not reversible, the most effective strategy for young adults is prevention. One of the ways to prevent NIHL is to wear hearing protection devices such as earplugs and earmuffs in order to reduce the intensity of sound exposure. Besides, young adults should avoid prolonged exposure to loud sound. They should move away from the loud sound source when they are not wearing hearing protection as it can damage their hearing. Apart from that, they should lower the volume of sound from personal devices or if they are in a restaurant, they should not be afraid to ask the staff to turn the volume down. They can tell them that it causes hearing discomfort. Young adults should be a local advocate to raise awareness among family, friends and colleagues. Moreover, school-based healthy hearing campaign should be held to improve children’s knowledge on the importances to protect hearing and educate them on tips to prevent hearing loss. It is important to make sure that they have safe listening practices since they were small. For instance, audiology students from The National University of Malaysia as certified educators of Dangerous Decibels Organisation will enter local school to educate NIHL prevention among children by providing fun and interactive presentation. It has proven that school-based programs can effectively increase the awareness and the use of hearing protection among students. Lastly, young adults in Malaysia should have regular hearing check-up that enables early identification of hearing loss and early intervention if they are diagnosed with hearing loss.

In conclusion, NIHL among young adults in Malaysia is a serious issue but it can avoidable by following the tips of prevention. If young adults continue to expose themselves to loud sounds in occupational or recreational settings, they will have progressive hearing loss and at risk to develop irreversible NIHL. All of the young adults in Malaysia must have a positive attitude towards hearing health and make efforts on hearing protection. 

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