University Place

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Voiceover

Welcome everyone to Wednesday Nite at the Lab. I'm Tom Zinnen I work at the UW-Madison biotechnology center, I also work for UW-Extension, Cooperative Extension and on behalf of those folks and other co-organizers, Wisconsin Public Television, Wisconsin Alumni Association and the UW-Madison Science Alliance. Thanks again for coming to Wednesday Nite the Lab. We do this every Wednesday night, 50 times a year. Tonight it's my pleasure to introduce three people who are gonna talk about dealing with rural noise and protecting your hearing. The first person is Tim Kuckuk, he grew up in Plymouth, Wisconsin and went to UW Oshkosh where he got a degree in music. He plays trombone, he's now getting his doctorate of audiology here at UW-Madison. The second speaker is Rachel Jocewicz and she's from De Pere, Wisconsin. Went undergrad here, studied three things that I can't remember, Spanish, biology, and disorders. I remembered the disorders part. She's also getting her doctorate in audiology and the lead-off speaker is gonna be Melanie Buhr-Lawler. She's from Viroqua, she went to Viroqua high school, went to the University of Wisconsin, Madison here for bachelors, went to University of Iowa for masters, and then got her doctorate of audiology at the University of Florida in Gainesville. So, please join me in welcoming the three of them. They're gonna be talking about horsepower and hearing, taking on rural noise.

audience applauding

Thank you. All right, I want to start tonight by saying that every one of us, every one of us in this room is surrounded by a noisy, noisy world. And the word "noise", itself, has a couple of definitions. The first definition of noise is a sound that's unpleasant, a sound that you just don't want to be around. And the second definition of noise and it's actually the definition that I prefer, it's any sound that someone or something makes. And I would like to argue tonight that all of us are surrounded by many, many noises in our daily lives. All of the time. And some of those noises are wanted, and some of them are unpleasant or unwanted. So, in our noisy world we drive in cars and walk down the street. There's a lot of construction this time or year. We fly on airplanes, we eat out at restaurants, we use hair dryers or common appliances around our homes. We go to sporting events, we mow our lawns, we listen to lots of music, classical music, rock music. We are surrounded by a cacophony of sound all the time. So tonight we are going to touch on some really real reasons why I feel that all of us should care about the noise in the world around us. And I'm going to talk about some projects that I and the other members of the audiology department here on campus, and we're part of the Department of Communication Science and Disorders. Some projects that we're doing to try to spread the word about concerns about noise and noise-induced hearing loss within our community here and across the state of Wisconsin. So, other than being an annoyance to experience, why do we even care about noise levels in the world? Well, we know that there are a lot of effects of noise exposure. The primary effects of noise exposure are noise-induced hearing loss and that type of hearing loss, it can be temporary or permanent, and it can include acoustic trauma to the ear and tinnitus. And that's another word for ringing in the ears. The focus of this talk today is going to be on the primary effects of noise exposure and how to prevent them. And so we're going to come back to those in a few minutes. But, I also want to mention that noise exposure can cause some other real, real significant problems in our lives. So another issue is that noise exposure can cause difficulty with communication and performance. Either in the work place, or at play. Noise exposure can cause annoyance. It can cause difficulty concentrating. If you can imagine some of those noises that we just heard, it's hard to concentrate when you're listening to a jack hammer in the background. It can cause absenteeism from the workplace. It can cause accidents, and it also can cause the sensation of isolation. Noise exposure also has been linked to more global, physiologic and mental effects. So, studies show that noise exposure can cause increased stress, it can cause muscle tension, it can cause ulcers, it can actually increase our blood pressure, and it can cause hypertension. Hearing loss, itself, has been shown very recently to be linked to depression. And some recent studies have shown that untreated hearing loss over a period of years is actually associated with an increase in dementia. So all of the effects that I just described, the primary effects of tinnitus, the communication and perfomance effects, and those overall effects on our minds and bodies, they can be caused by prolonged noise exposure, but they can also be caused, in some instances, to very brief periods of noise exposure. And what really speaks to me about all of this is that these are issues that are very significant in people's lives and they are completely preventable. So, we are going to spend some time talking about those issues and what causes them in our bodies, our physiology. But first I want to say a few words about how loud is too loud? So, the fact behind loud sound is that whether it is something that's wanted.

orchestral music

Or something that's unwanted.

jackhammer hammering

Like that jackhammer, again. Is that if you're exposed to enough of that sound over time, or even if you're exposed one time to a very loud level, it can do permanent damage to your auditory system. And our auditory system is a very crucial component in our ability to connect with other people. So I want to just give a brief overview of what sound levels are safe to listen to and what can be damaging to our auditory systems. And in order to know and understand safe listening levels. I just want to say a few words about the decibel. Because that's the unit of measure. So the decibel is the unit of measurement that's used to quantify the intensity of sound. Decibels are quantified on a logarithmic scale and so, they are not linear. An increase in 10 decibels actually means a change in sound power by a factor of 10. So, how many decibels of sound exposure is too much for us? Fortunately for me, there's been a lot of work done on this. The Occupational Safety and Health Administration, they are the government, the federal body that governs safety in the workplace. They've done a lot of work on this topic. And also the National Institute for Occupational Safety and Health, that would be NIOSH and the other one is OSHA. They have helped defined safe listening levels in the workplace, and those can be more generalized to the general listening experience. So, as I eluded to before, there are actually two factors that determine risk from noise exposure. The first is the length of time you're exposed to a certain sound. And the second is the intensity of the noise. So you could be exposed to a very loud sound for a very short period of time and do the same amount of damage as being exposed to a softer sound for an extended period of time. It's called the time intensity trade-off. And OSHA actually gives a permissible noise exposure level and that is 90 decibels. That's kind of OSHA's benchmark. So, if you are in a 90 decibel sound level for an eight hour day in the workplace, it is federally mandated, if you're a workplace that's covered by OSHA, and not all of them are, it's federally mandated that you are offered, and hopefully you are wearing, hearing protection. There's also a 5 dB time intensity trade-off. So, if you increase that sound level to 95 decibels, your time that you can spend in that level of noise is cut in half. So at 95 decibels you can only be in it for four hours, at 100 decibels, two hours, and so on. And OSHA's criteria is actually less strict than the NIOSH criteria and we, in this profession, and in the hearing sciences we tend to side more with NIOSH. They're a little more conservative. They have a three decibel time intensity trade-off and they tell us that people should be wearing hearing protection at slightly softer levels. But just for the sake of simplicity, I'm gonna stick with OSHA and this is an OSHA graph I'm using here and I want to show some every day sounds on this chart. So we have decibels, that unit of measure across the bar from left to right, soft to very, very loud. So a refrigerator hum comes in around 45 decibels. That's manageable, a lot of us are experiencing sounds like that even right now and not even noticing them. Average conversation, 60 decibels. Traffic noise comes in at 85 decibels, so you're starting to get louder. And it obviously depends on what type of traffic, but we're starting to get some increases in sound level now. The noise of a motorcycle, 95 decibels and I just found a study, today, that shows peak levels of motorcycle noise to go all the way up to 128 decibels. So those really loud engines that you hear can get even louder than this. Tractor noise, and this is going to come in to play in a few minutes, 100 decibels. So that's the same as working with tools in a wood shop. We're starting to get very loud. If you have a hobby and you work in your wood shop, and that was actually your job and you worked in a factory at that level, OSHA would be saying, your employer would be mandated by OSHA that you would be wearing hearing protection, so hopefully that is a situation where people are thinking about ear plugs or ear muffs to protect themselves. This was one I find really interesting. MP3 players at peak volume are 105 decibels. And that is something that many, many young people are listening to for extended periods of time every day. And sometimes at that peak volume level. And what is happening is we're starting to see an noise induced hearing loss epidemic in the younger population that's starting to mimic what was showing up for people who had worked in factories their whole lives. So we're starting to see a shift in noise-induced hearing loss to the youth of today. And people-- we're doing it to ourselves. And so it's something that I'm going to talk about later, we're trying to spread the word on this topic as well. A rock concert, 110 decibels, chainsaw, the same level. A siren, 120. And then with the firecracker we have the fourth of July coming up soon, so stay a little ways away from those or use your ear plugs, we're reaching the threshold of pain. And that's the same for firearms, too. So some of these are noises that we willingly welcome into our lives. But, many of these we would consider somewhat unpleasant. But I want to emphasize the fact that there are some sounds in our world that we are welcoming that we may not realized could actually, potentially, damage our auditory systems. So, at close range, the instruments in the symphony can measure anywhere from 85 to 102 decibels. The piccolo is actually the loudest one, if you can believe it, at the ear level. Some recent research has been coming out on the noise levels in NFL stadiums and we are seeing that they are very loud, just from crowd noise alone. So 95 to 105 decibels. And along those lines, a couple years ago we had a Au.D. student working on a research project and she was looking at noise levels and hearing loss in sporting stadiums around this area, and she measured levels in Camp Randal and I believe there were about 80,000 people in attendance that day. It was a nice, lovely October day and she was measuring levels of 96 decibels from the crowd noise there. And I just want to point out, I'm foreshadowing, that area that you see pop up, that 126 decibels is the level that we measured last weekend at a tractor pull that we went to here in the state. So that last slide illustrated the wide variety of sounds in the world around us. There's a lot of different sound levels. And as we saw there's things like classical music, or even rural noise like tractors that can damage our hearing. And I'm an audiologist, by profession, and as an audiologist I'm really interested in hearing and hearing loss and in hearing loss prevention. We call that hearing conservation. So if I use that term, that's what I'm talking about. I became particularly interested in hearing conservation because I've been working clinically my whole career and I have seen many, many people with hearing loss caused by noise exposure. And this type of hearing loss can be prevented. And so that is one of the reasons I became interested in this type of, this part of our field. I've worked in both rural and urban areas professionally. And when I moved back to Wisconsin about four and a half years ago to take the position I have now at the University, I started thinking a lot about rural noise in Wisconsin and across America. And the reason for that is because I grew on my family's dairy farm in Viroqua, as Tom said, and my father is still a dairy farmer. And it's very beautiful and bucolic and pastoral in the country, but sometimes this very beautiful calm area can be extremely noisy. Noise is just part of that culture and it's something that is accepted and not really thought about. At least in my background and the background of the people around me growing up. So, that puts farmers and other rural workers at risk for noise-induced hearing loss. But farmers, unlike a lot of the other groups out there with noise in the workplace, are not necessarily regulated by OSHA. So OSHA doesn't necessarily apply to small farmers like my father. And further, as I mentioned, there's often the culture or the mindset that the use of hearing protection is just not really necessary. And it's not just farmers with unexpected noise exposure, the same applies to classical musicians like that piccolo player or anyone using an MP3 player. So, we're going to dive more into noise exposure, hearing conservation projects that we've done across this state in a few moments. And ways we're trying to change that culture and help prevent hearing loss. But first I'm going to turn it over to Rachel Jocewicz and she is going to give us some background on our amazing, our complex, and our very vulnerable auditory systems. Thank you Dr. Buhr-Lawler. Am I, do I sound okay? So, like Dr. Buhr-Lawler mentioned, it's probably clear by now that our ears are vulnerable to loud sounds. But to truly understand why that is, and the consequences of hearing loss, we first kind of have to understand how the normal, healthy, typical ear works. So, this is a diagram of a model ear. Showcasing the way we like to split it up. We often talk about the outer ear, the middle ear, and the inner ear. And the only thing that's missing that's actually very important is our brain. But, that doesn't fall so much into the conversation about noise exposure. And, our ears, when functioning at maximal capacity, are really amazing, you know. Some of us can probably tell the difference between the first violins and the second violins in that symphony. We can accurately localize a sound to the nearest single angular degree. It is truly amazing and what we're gonna talk a little bit about the functions of those three different parts that we saw on this diagram. So the first is the outer ear. And you might notice, you probably notice all your life, your outer ear has lots of folds and bumps and ridges. But, if you've ever wondered why that might be, part of that reason is localization. So we use those folds to help us localize an elevation. So, if we didn't have any pinna's, any outer ears, we could still tell where a sound is coming from, from left to right, but we wouldn't be able to tell if it was coming from up or down or from directly in front or directly behind. It also helps us amplify sounds. So, as sound energy travels through the air, it spreads out a larger funnel, a larger ear collects more of that energy and actually amplifies the sound by about a factor of three. Traveling down the outer eat a little bit is the ear canal. And that serves the purpose of amplification as well because of the way it acts like a resonating tube. It also serves the important function of protection of your delicate ear drum or tympanic membrane because of the way it is shaped. It's shaped like an S as well as in conjunction with the production of ear wax that we like to call cerumen which helps to keep out foreign matter and bugs and sand and dirt. To protect what's coming next which is the middle ear. So, once that sound energy travels through the outer ear and ends up hitting the middle ear on your ear drum, those three bones, which you probably heard referred to as the hammer, anvil, and the stirrup which we like to call the malleus, incus, and the stapes. The manubrium of the malleus is connected to the ear drum. The three bones are coarticulated, so connected together, and that plate of the stirrup looking bone, the end one, hits on the oval window which is the entrance to the fluid filled cochlea. And it transmits the sound energy from the outer ear to the middle ear extremely efficiently. Which is very important because of this problem that's called impedance mismatch. The problem arises because we have this energy that's traveling though the air that is striking a fluid boundary. And there is an acoustic impedance difference between air and fluid. Such, wherein, 99% of the theoretical-- Theoretically, 99% of the energy is lost because of the sound waves reflecting off that fluid boundary. And so, just by the anatomy of this middle ear, we are able to overcome that impedance mismatch due to the conical shape of the ear drum vibrating, and the way those three middle ear bones act like a lever system. This actually provides amplification on the order of 30 decibels, which is like going from a soft whisper to a normal conversation. And, these bones are really tiny. You can see here that they fit very comfortably on a penny. So you probably have heard that the smallest bones in your body are located in the ear. What you maybe haven't heard is that the smallest muscle is also located in the middle ear. And you can see it on this diagram here, the red arrow is pointing to the muscle represented in that blue color. And this muscle, it's called the stapedius, is really relevant to our conversation today about noise because its purpose it actually to help protect us from loud noises. Mostly some that we make ourselves, like when we're chewing, and when we're speaking. The one thing is doesn't do, however, is protect us from loud transient instantaneous noises. So, for example, it would not protect you against the sound of a gunshot or a fire cracker. And it does fatigue out. And the way it helps protect us from noise exposure, in a way, is that when that muscle tightens, it makes those bones not able to vibrate. It dampens the vibrations of the bones. Which means that less energy is transferred on into the system. And, part of the reason that, as people get older, they tend to report that loud sounds, they kind of annoy them more than they maybe did in the past. It's because of the stiffening of the system and that muscle can't as effectively dampen that noise. However, please don't think that this is adequate for hearing protection, it's not. We'll talk about some other options for hearing protection soon. So, moving right along, we get to the inner ear. Those little loops on the pink snail guy, those are kind of the home to our balance system. And then the snail like structure, which is the sensory organ of hearing. And, here we have a 3D cross section where you can see that the cochlea actually spirals upward. And why it's so important is it acts like a frequency analyzer. So, certain areas of the cochlea will only respond to certain frequencies. For example, there we go. When the sound energy comes in, if it's a high frequency sound, the cells here at the base will be stimulated and respond. And if it's a lower frequency sound, the cells at the apex respond, and this is called tonal topicity. So, if we continue zooming in on one of these 3D cross sections, you can see these three chambers, or vestibule which are filled with fluid. And then if we zoom in again on this organ of corti, which people like to call the actual organ of hearing, we see these beautiful hair cells. So, the hair cells are depicted in this diagram on the left, we have one row of inner hair cells, and then three rows of outer hair cells. And these cells play different purposes, have different functions in our ear. What happens when we hear a sound is like we talked about, the sound energy travels down the outer ear, it's transmitted through the middle ear bones, those bones pow pow pow on the cochlea. This sets the fluids in motion in the cochlea and this vibrates one of the membranes within the cochlea, this basilar membrane. And when that membrane starts moving, the hair cells start bumping up against this other membrane on top. And, when that happens, the hair cells get bent and that's the impetus for the nerve impulse to our brain for the perception of hearing. The inner hair cells serve the role of being the sensory cells, so they're afferently innvervated. They're sending that message up to the brain. The outer hair cells have a slightly different role. Which is amplification of the sound. And they do this by, and it's not entirely the mechanics and physics of it isn't entirely understood, but what scientist theorize is that these outer hair cells actively pump and contract which adds energy into the system of this inner ear. And causes additional bending of those inner hair cells. And that's extremely important. If we do not have outer hair cells, we typically have a hearing loss on the order of 40 to 50 decibels, minimally. And the reason that these are also so important to our discussion today is that these hair cells are typically the place where noise causes damage. Which I'm going to pass over to my fellow student, Tim to talk a little bit more about. Thank you. Alright, good evening. As Rachel said, my name is Tim Kuckuk and I'm also a student at the UW in the doctorate of audiology program. So continuing on. We've talked so far about noise and our normal hearing system, so what I'd like to do is let's combine the two and let's talk about how noise can damage our hearing. So, above, I have pictured this grassy field on a beautiful day. And the grass represents our hair cells. Where they're standing tall and dancing in the breeze. But that path down the middle that has been trampled over and over again cannot bounce back up and stand tall. So that represents an area in our cochlea where the hair cells have been overworked and overused over and over and over again. I do have a short anecdote to help illustrate this point. A previous employer of mine, Russ, used to work at a television studio in his high school and college years during the 1970's and the production room of that studio was full of those big, bulky CRT, or Cathode Ray Tube television sets. And as many of us probably remember, those TVs would let off a high frequency hum at about 15,000 hertz. Well, having the studio, or that room, full of those, it was very loud in the whole building. So when Russ, on his first day, walked through that front door, he heard it. All the way at the other side of the building. And he brought this fact up to his boss and he's like, "Hey, this is really really loud." And his boss simply said, "You'll get used to it." So, after a while, sure enough, Russ eventually stopped hearing that sound. Which wasn't just him getting used to it, but it was actually a noise-induced hearing loss at that particular frequency. And still, to this day, Russ cannot hear those TV's, or at least that frequency for those TV's. So on this slide, I have an electron microscope image of our hair cells. On your left side are the normal hair cells. So those are standing tall, just like the grass, blowing in the breeze. And then on the right side are the damaged hair cells. So those are the ones that get overused and overworked. So it does actually look like grass that has been trampled. And what's going on here is called a permanent threshold shift. So, what threshold means in audiology terms is the lowest level at which you can hear a sound. So, a shift is generally an increase in volume. So what that all means together is as your hearing worsens, your threshold has to increase for you to hear it. As we talked about with Russ, the permanent threshold shift happens over many exposures to that noise. So a lot of overworking and overusing of those hair cells creates that type of damage. There are other types of hearing loss as well, other types of noise-induced hearing loss. One of which is a temporary threshold shift. And this is when you temporarily lose your hearing. Or things become softer for a while. And it generally comes back after about 24, maybe 48 hours. And many of us have probably experienced this after, let's say, a concert or a fireworks display, for example. Now the hearing generally seems to get better, but, in the long run, this could actually lead down the path toward a permanent threshold shift and start causing some permanent damage. We do have another type of noise-induced hearing loss and that is called acoustic trauma which is caused by very, very loud sounds, such as a gunshot or an explosion. And this causes physical damage to our system, such as rupturing our ear drum or damaging those tiny bones in our middle ear. And this can be, this can be immediate and permanent damage. As soon as that sound goes off. And when I say permanent, I really mean it. There is work that's being done on trying to regenerate hair cells, actually work that's being done at this university, but so far, we haven't been able to do that. So, before diving into the affects of hearing loss on us as individuals, let's talk about a few statistics to really understand this type of hearing challenge. 48 million Americans experience hearing loss. Now that's about 35 million more people with hearing loss than with vision problems. And I thought that was particularly interesting because I wear glasses. Also, 60% of our veterans coming home from Afghanistan and Iraq have hearing loss. It's listed as the number one war wound for our veterans. A 2006 study stated that 20% of teenagers have some sort of hearing loss. Which is an increase of about 5% since 1994. Which means that, today, this could even be higher than just one in five teens. But, what's the big deal? Surely your hearing loss is just turning down the volume so all we have to do is just turn it back up, right? Unfortunately, no, and I'd like to explain and demonstrate what a noise-induced hearing loss sounds like. Now, I know some of you have experienced a hearing loss first hand, but for those who haven't, I like to demonstrate a few different degrees of a common noise-induced hearing loss. First, I'll orient to you what's going on on the slide. This blue box in the middle over here, is a graphical frequency analyzer. So what it's showing is on the X-axis, from left to right, we have 20 hertz all the way up to 20,000 hertz, which is our normal range of hearing. From the Y-axis, up and down, is a relative decibels in sound pressure level. So, visually, what we'll be able to see is what frequencies are present in these sound examples at what volume. So let's go ahead and listen. This first example is what we consider a severe hearing loss. Now, it's going to be quiet, I'll give you that much and It's probably going to be very difficult to understand but, let's try it anyway.

inaudible

All right, so that was very difficult to understand. And, even for me, who knows exactly what this guy is trying to say. But, what we could see on here, let's talk about that, is the frequency range of this particular example was about 100 hertz to about 1,000 hertz. And the volume was not very robust, it was right around this area, and remember this is a Relative dB scale. So let's continue on, what about another example? So this is our classification of a moderate noise-induced hearing loss. Let's try that. -

Computer, slightly louder

Oh rainy days people say, "What a dull, gray day. "When clouds cover the sun, the whole world seems "dull and gray. "The sky is gray, the water in the rivers and lakes "looks brown and muddy. "The grass is a dark, dull green. "Even the flowers seem pale and faded." All right, so it's getting a little bit easier to understand. You may have picked out a couple words, you may have gotten a little bit of what he's trying to exactly say. But, looking at the frequency and the volume as well, the frequency seems to be getting a little bit wider, up to about 2,000 hertz. And the volume was getting a little bit higher, as well. So continuing on, what about what we consider a mild hearing loss? -

Computer, even louder

"On rainy days people say, "What a dull, gray day. "When clouds cover the sun, the whole world seems "dull and gray. "The sky is gray, the water in the rivers and lakes "looks brown and muddy. "The grass is a dark, dull green. "Even the flowers seem pale and faded. So that was much easier to understand. And even the topic of his speech is not really going along with that beautiful scene that I had displayed at the beginning, but nonetheless, we still understood what he was trying to say. So looking at the frequency range and the volume again, it's continuing to grow and the volume is continuing to increase as well. But what about-- Before I talk about that, I would like to mention that these particular frequency ranges of these last three examples, I'm sure you noticed that it's all taking place between 100 to 1,000 hertz. And those are what we consider move of the low frequencies. And there's really nothing on the far right side of our graph, the high frequencies. And that's because our high frequencies seem to be lost first for this particular noise-induced hearing loss. But, what about normal hearing? Let's give that a shot. Or what we consider "normal" hearing. -

Computer, normal audio

: "On rainy days people say, "What a dull gray day. "When clouds cover the sun, the whole world seems "dull and gray. "The sky is gray, the water in the rivers and lakes "looks brown and muddy. " The grass is a dark, dull green. "Even the flowers seem pale and faded." So that's a substantial difference in clarity. And that's generally due to that increased frequency range. In this example we got up to almost 10,000 hertz which is way higher than the other examples. And what this means is that the clarity of speech increases. So the S's and the T's become much more crisp and easier to understand. And I also wanted to emphasize, again, that hearing loss is not like turning down the volume. And noise-induced hearing loss does damage to the hair cells which makes it harder for our brain to interpret the information as it gets sent along the rest of the pathway. Now, with all of that being said, I'm sure you can understand that any type of hearing loss creates communication difficulties. Not only in your personal life, but also in the workplace. There was a study done by David Young, who's associated with Harvard, and he stated that people with hearing loss typically earn about 25% less than their normal hearing counterparts. And this is just the people who are able to work because people with hearing loss suffer 35% unemployment rates. Now, that's only one reason to protect your hearing for the future. So, Dr. Buhr-Lawler will continue with other ways to promote hearing protection and conservation. Great, thank you, thank you Rachel. Am I on? Yeah, thank you, let me clip on here. Okay, so thank you to Rachel for that excellent description of the auditory system and to Tim for those wonderful examples and discussion of hearing loss. As I previously mentioned, many of us are in noisy environments and we don't usually get this kind of warning in our daily lives. Unfortunately. So a goal that has been very near and dear to my heart is to raise awareness in the public, especially in this state, of ways to prevent hearing loss through noise exposure, and to give people simple, concrete ways to do so. So I've been fortunate to be able to do so through clinical outreach projects and I'm gonna say a few words about them now. Protecting our hearing from noise-induced hearing loss can actually be quite simple. And that is the message that we are trying to spread. So when I was formulating my ideas for clinical outreach, and this is something that we do a lot of in our program, I started thinking about where we can make the most impact. And out of that grew the first idea for the first goal for our Wisconsin Idea, audiology outreach projects. And that goal is to focus on groups of people who are not already getting traditional hearing conservation services. As I mentioned before, I've thought a lot about rural noise and when I was thinking about these projects I went to my dad, the farmer, and I said, "How can I reach a big group of people who are exposed "to rural noise?" The farmers, the hunters, the machine workers. And he gave me the idea to go to the Tomah Tractor Pull. And that's what you see here. I took a group of students last year and we did some hearing conservation that I'm gonna talk about and I also did some brief measures of noise levels. And we measured levels of 109 decibels, just really preliminaryly at the very lightest tractor pull division. And when I say lightest, they get like five engines on the tractors and that was just with one engine. So, that was enough-- So this is the group I took the first year. And I just want to acknowledge that's me with the longer hair and the no glasses. And to my left is my wonderful colleague, Amy Kroll and her children. And I want to acknowledge everyone that came that first year. That was enough reason, that 109 decibels, to make us want to go back to the tractor pull. So we actually just went back to the Tomah Tractor Pull. It was this past weekend and, once again, we returned this time with a really nice sound level meter to measure sound levels and measure levels at the lightest tractor division, again, of 126 decibels that I mentioned earlier on that noise scale. So, if you remember that chart, that is very very loud and everyone there reported it just gets louder and louder from that point.

upbeat music

I'm gonna pause that for a second. Sorry about that. So, bare with me for just a moment. So people participating in the tractor pull are generally the people who may have noise exposure in other aspects of their lives. As I mentioned, you are seeing hunters, machine workers, people who go to a lot of concerts, and so on. That's not the only type of group we like to focus on. I like to focus on musicians because of those reasons that we mentioned before. We also reach out to people who have already experience hearing loss, be it do to noise exposure or for other reasons. So, we go to senior centers and talk about hearing technology, we go to schools and talk to younger people about things they can do to protect their hearing. I just want to share with you a very brief video. It actually is very timely because it was just a lovely article in the Milwaukee Journal Sentinel, a front page, actually, on Monday, on this project. And this is the little news clip that they put online and there was a video in addition to that article. And there's a little too much of me in the story, so I apologize in advance! But the reason I want to show you is because I think it really illustrates the high noise levels of the tractor pull and it also gives you an example of some of the things that we did there. So we'll see if I can get it to play now.

upbeat music

loud engine noise

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Video

We are here handing out ear plugs and talking to the pullers and the people here at the tractor pull to try to help them avoid preventable hearing loss because we know, because of the measurements that we're doing that these noise levels are loud enough to cause permanent hearing loss. And not only that, we're trying to reach people so that they can carry what they're learning about hearing loss prevention and wearing ear plugs and ear muffs into their daily lives. Because a lot of the people that come to the tractor pull are people that work in noise. They might be farmers or self-employed or work in the machine shop and a lot of those professions are not regulated by OSHA, or more likely regulated by OSHA. Especially small farmers or people who are self-employed. I'm doing noise measurements and the sound levels that I'm measuring right now from the tractors are quite loud!

loud tractor engine

So we're measuring pretty loud levels here at the tractor pull, we just measured levels of 120 decibels in the light tractor divisions, so some of the softest tractors and we know from OSHA that it's only safe to listen to that level of sound for about seven minutes in an entire day before you're at risk for permanent hearing loss. So, as you can imagine, it's really important for everyone here at the tractor pull to wear their hearing protection that we're handing out. Do you guys need any ear plugs? Thank you. Do you guys need any more? Thank you. Sometimes there's a little bit of resistance to wearing ear plugs, there might be part of the macho culture not wanting to have them in their ears or wanting to really experience the sound, or just that feeling that, "Oh this isn't gonna happen to me." And so what we're trying to do is make change by getting people to take the ear plugs and wear the ear plugs to prevent the hearing loss and then maybe think about it more broadly in their daily lives. There's a couple goals to this Wisconsin Audiology Outreach project and the short term goal is to have...

tractor engine revving

...to have an immediate effect on the lives of the people that we're interacting with here at the tractor pull. So the pullers and the people that are coming to attend the pull and work at the pull. And the long term goal is to create a lasting impact for at least some of those people that we're interacting with maybe to encourage them to take the hearing protection into their daily lives and their recreation and their jobs. And, hopefully, also to have a positive effect on our students where they can take what they're learning in this type of outreach into their future clinical work and remember how important it is to reach out to the community. Okay, I just want to say, for the record, that I was wearing ear plugs for the whole interview. Which made it really interesting, but it was really impossible to be comfortable without them on. The second goal, and I mentioned it briefly in the video, the second goal of this type of outreach is to make an immediate impact in the community. And one way to do that is to simply just make personal contact with people and talk to them about protecting their hearing, hand out the ear plugs, show them how to put them in. And I actually want to acknowledge our she's actually sitting right in the back of the room, Ariel Young, that is on the Whisk homepage right now. So it's kind of a big deal for our department. We're really proud of this project. To elaborate just briefly on what you saw in the video, the first year we went we were supported by Wisconsin Idea Outreach grant through University relations and we were able to hand out 2,000 pairs of ear plugs. We walked around with signs and made lots of connections. We went again this past weekend and handed out 4500 pair of ear plugs, we had a very generous Baldwin mini grant through UW-Madison. It's another Wisconsin Idea outreach grant. And it supported us in getting a booth where people could come and talk to us. That's what you saw with that crazy guy with the mohawk. We did the sound level measures, it supported the purchase of that. So we've really been able to expand upon this project, it's been very exciting. We have had many, many thank you's, many grateful people. Some people that don't want the ear plugs. And my very favorite part of this is the people that are using them, and especially, we reached a lot of children who would not have actually had ear plugs otherwise. So the third goal of this type of outreach is the loftiest goal and it is to work on creating long-term positive impact in the populations that we focus on. We are working to create that type of impact through education. So actually, projects like this one, but also working in one on one and group activities all across the state of Wisconsin. We're out talking to individuals, talking to groups about hearing loss prevention. And also what to do if you already have a hearing loss. We go to tractor pulls, as you saw, this coming next week we're going to, I'm taking a group of students and another clinical professor to a motorcycle rally. That should be interesting, that's gonna be a first. We're doing the same kind of project there. We go to local and state clubs, like senior clubs, or Kiwanis Clubs, as I mentioned, schools. We talk to people about living and working in noise, about how it is never too late to protect their hearing because that's a common misconception that we hear directly from people. "Well I can't hear anyway, I don't need your ear plugs." So we try to spread the word and I do feel, just anecdotaly, we weren't able to measure, but anecdotaly I feel we were more positively received at the tractor pull this year. Although, I think we were positively received last year. I think we just had more yes's to the ear plugs this year. We also are talking to teens and the people with whom we work about using their MP3 players at safe levels. And to musicians about the risks of noise-induced hearing loss. I just want to point out, this is another type of outreach project that we're doing. We are hosting, now annually, in our department, it's planned by our graduate students, a symposium on hearing and hearing loss. And they pick a topic. This years topic was tinnitus. And we bring in some experts and have experts from out own program and it's been well received and it continues to grow, it's free. You guys can all come. And this is a break-out session with some graduate students on the left talking to a smaller group of people about hearing technology available for people with tinnitus. So that's something we're very excited about and it's in its third year. So we don't, I'll get to this, I skipped ahead a little early, but I also want to mention that we want to also create lasting effects in our students. And so I and the rest of my wonderful department firmly believe that this type of clinical outreach is unsurpassed in teaching skills for the future. You know, there's no replacement in graduate education for experiential learning. So we're hoping through projects like the ones that I've described, our students who are going to be clinical audiologists, will take this type of experience and use it to shape their future experience and maybe bring this type of project into their own clinical practice someday. So as the title of this slide states, and contrary to what my daughter is showing in this picture, hearing protection really never hurt anyone and now you know it can make a huge impact. I want to just say that there is a lot of great media about hearing technology these days. And I am a huge believer in hearing technology. I work everyday with people with hearing aids, and with cochlear implants, and it's really wonderful. I actually, also, get to spend time doing research and Dr. Litovsky, Ruth Litovsky is binaural hearing and speech lab on cochlear implant work. It's one of the premier labs for that kind of work in the world. So I love hearing technology and working with people who have hearing loss, but I want to mention that, reiterate what Tim said that if you can prevent hearing loss before it occurs, there's actually no substitute for natural hearing. Even the most high technology that we have these days can't restore the auditory system to its previous function, yet. So the best possible method to ensure best hearing in the future is very low cost, it's low technology, it's ear plugs, ear muffs. And these come in different shapes and styles and at the end of this we're gonna hand those out to you to take home as a little bonus. If they are uncomfortable you can purchase them over the counter, you can get them custom made to be comfortable and look good for your body. I just want to briefly say, there's also specialty hearing protection for people like hunters. So those are really special in that you can carry on a normal conversation, so they have a little way to allow sound in, but then they detect the sound of a gunshot and almost instantaneously provide hearing protection for that type of sound. So it's pretty neat. Another type of specialty hearing protection that was designed for musicians. So our foam ear plugs we're going to hand out today just muffle the sound and they tend to actually muffle those high pitches that are so important for speech. As you heard on the example, they muffle those a little more. And if you can imagine, when you listen to music, you really want to hear everything in it's, kind of, full glory. And so the musicians ear plugs have special filters in them that turn the volume down, but maintain the fidelity of the sound. So that's something that we work with in our clinic. You can also protect your hearing one last plug, by reducing noise at the source. So if you have kids or grand kids, or you yourself, listens to music with ear buds or ear phones, you can actually use commercially available software like iTunes to set the limit of your device so that it is a safe listening level and you cannot exceed that level. And for kids, you can actually purchase special headphones, or even for you, that limit the sound level to a safe level. You know, for those farmers out there, it helps to be in the cab tractor. If you're working in your machine shop and there's a really noisy motor, you know, to put some sort of isolation around it. All of those things help at the source of the sound. And if you know someone that has a hearing loss, or who has tinnitus, or just has concerns about their auditory system or their ears, please feel free to send them our way. So, I teach at the University, but I also work clinically. And we actually have a teaching clinic for our students and now you know how wonderful they are. It's for our Au.D. Program, but we see people all throughout the public and it's located at Good Night Hall right across campus on the Lakeshore path. It's called the UW Speech and Hearing Clinic. So, please feel free to come and see us or send people or way, if you like. We work with hearing technology and also with lots of great rehab and communication strategies to help people at all points of this journey. And now that you are armed with all of this awesome information, please spread the word to your friends and family and people you meet on the street about how to protect their hearing and on hearing loss prevention. So, that's all I've got, thank you.

audience applauding