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Attorney Mark Gilfix Spoke at Autism Society Conference

Attorney Mark Gilfix of the law firm Gilfix & La Poll Associates was invited to speak at the prestigious San Francisco Autism Society of America Annual Conference (SFASA). The November 17, 2018 all day conference was aimed at the informational needs of parents, caregivers and professionals who have the responsibility to support and help make plans for teens and adults with autism or related developmental disabilities. The event took place at the beautiful, state-of-the-art Li Ka Shing Center on the Stanford University campus.

Attorney Gilfix was one of the 50 featured speakers at the event. Mr. Gilfix understands the challenges of families with loved ones with special needs and taking care of them financially in the future. His discussion, titled “How Much Is Enough?” focused on the creation and funding of Special Needs Trusts. He spoke in detail how much is needed to adequately fund these trusts and the financial tools available, including life insurance and other investment structures.

In what is coming to be seen as the greatest public health and social services crisis of our time, California is facing an unprecedented, staggering surge in the number of residents with the developmental disability of autism. SFASA is committed to improving the quantity and quality of lifespan care options in our communities. Californians are facing unprecedented problems that demand unprecedented solutions and courageous leadership. SFASA is an all-volunteer organization and needs all autism families to share in the work ahead.

Gilfix & La Poll Associates has over 35 years of experience in the area of Special Needs Planning for families with children with Autism, and Attorney Gilfix is very proud to had been given the opportunity to contribute to this wonderful conference.

More detailed information on the conference can be found here.

New autism app shows potential for in-home screening of children

Early detection and intervention are important for individuals with autism, which is one of the most common childhood neurodevelopment disorders in the United States. However, many children do not get diagnosed until they are around four years of age due to factors such as lack of public awareness and long clinical appointment wait times.

A new iPhone app aims to change that by enabling parents to conduct in-home screenings to identify autism risk among children earlier in life. Autism and Beyond is a free app that was developed on Apple’s ResearchKit platform in an effort to address the lack of reliable tools for analyzing children’s behaviors and emotions outside clinical settings.

A recent study described the app as an innovative, easy-to-use and scalable way of identifying signs of autism and gathering accurate data in a child-friendly environment. Currently, autism screening occurs in clinical settings under the supervision of medical professionals. Parents can use the data from the app to determine whether clinical help is necessary for their child.

Autism and Beyond uses the smartphone’s camera to capture videos of how children react to movies that aim to prompt autism risk behaviors on the device’s screen. Behavioral coding software then automatically monitors the child’s facial expressions and converts them into data.

The app can help track a child’s changes over time. Not only can it potentially allow for earlier autism intervention, but the technology can also benefit underserved areas. The goal of the app developers is to provide parents with information about their child’s mental health that is easily accessible and scientifically sound.

Report warns of lottery scams targeting senior citizens

The Better Business Bureau (BBB) recently released a report that found the elderly population is frequently targeted in lottery, sweepstakes and other prize-related scams. Seniors between the ages of 65 and 74 are particularly vulnerable to such scams. According to the BBB, the majority of schemes originate in Costa Rica, Jamaica and Nigeria. They can take various forms such as text messages, phone calls, mail or social media.

Last year, such scams resulted in monetary losses amounting to at least $117 million. Wire transfers were the most common form of payment. U.S. and Canada law enforcement received almost 500,000 complaints of fraud related to lotteries, sweepstakes or other prizes from 2014 to 2017. Social media scams comprised about one-third of reports received by the FBI.

“It is devastating that certain individuals have lost entire life-savings to these scams, especially when they need it most — during retirement,” said Phylissia Clark, BBB Vice President of Public Relations in North Central Texas. There are several steps seniors can take to protect themselves from scams and identify fake prize notices from genuine ones. Here are some tips:

  • Remember that if you have not purchased a lottery ticket or entered a contest, it is not possible for you to win something. The person contacting you about a prize is likely to be a fraudster.
  • Real sweepstakes or lotteries will not require winners to wire money to claim the prize, whether it is for taxes, shipping or customs. If someone asks for money, chances are they are running a scam.
  • If you are unsure about having won something, directly contact the lottery or sweepstakes company.
  • Use the internet to look up the name or phone number of the individual getting in touch with you about the prize.
  • Talk to a trustworthy friend, relative or your bank. They may be able to help protect your finances from scams and fraudsters.

ODE TO MY O.R. TEAM

ODE TO MY O.R. TEAM [and my defunct hip]

Hello! My name is Myra.
You’ll be helping me today.
I’m new to having surgery,
And I’d just like to say…
As you likely know I’m pretty scared
So I truly appreciate that you’re so well prepared.

I’ve lived quite well for all these years
Despite my hip’s deformity
(Or perhaps more correct politically,
Its congenital abnormity).

Now I find myself in this predicament:
No longer can I hike and dance
With ease; without a moan.
Time wears on and so do ligament[s],
And cartilage and bone.

So now it’s time to face
That I need you to replace
The worn out hip that tried to serve me
But kind of, sort of did desert me.

When you clear out all that joint debris
I hope the pain is history.
If you amplify my range of motion,
To you I’ll owe my great devotion.

So goodbye sweet acetabulum,
Femur, ossified tissue, and labrum
Hello new prostheses.
I know you’ll fit in well.
Welcome to my body
Where thriving you will dwell.
Help me back to hikes and bikes,
To dances and romances.
Bring me to a renewed life
Full of second chances.

I put my trust in all of you
To keep me safe and sound.
I know that life is ephemeral
But I’m counting on you
to protect my femoral
Nerve and its surround.

Thank you for those years of study,
Sweat and tears and getting bloody.
Of your awesome skill I am aware,
So I thank you for your loving care.

With gratitude,
Myra Gerson Gilfix

Advising Clients About Hospitalization And Operations

As attorneys working with the older population and with individuals with disabilities, we frequently encounter clients and client family members who face hospitalization and operations. Because this isn’t a “legal environment,” we’re typically not involved beyond the preparation of an advance directive or other document appointing health care surrogates.

Patient advocacy is nevertheless a growing need. We’re particularly well positioned to develop guidelines, at minimum, for our clients who face medical challenges.

I’m not suggesting that this type of support and advice is in fact or should be deemed legal advice. It isn’t. Rather, it’s vitally important information that we’re well equipped to offer in light of our experience dealing with health care systems and the vagaries of aging.

Patient Advocate’s Role

The hardiest among us find it difficult to be assertive and independent or to gather facts when we’re ill. The stress and anxiety of being ill are enough to keep us from functioning optimally at best. In addition, the hospital environment itself, perhaps unintentionally, strips us of our normal life role. We wear hospital gowns that are uncomfortable and too revealing. The most sophisticated and erudite among us are suddenly called by our first names, infantilized. A Nobel Prize winning client of my office, revered in the scientific community and always referred to as “Professor,” was suddenly called “Jim” by nurses, certified nursing assistants and other well-meaning hospital staff members.

So, it’s a multi-faceted challenge to ask the right questions and to protect ourselves.

While there are professional patient advocates who work in myriad settings, my focus is on helping families and friends with some tips about how to “be there” for their loved one when he’s facing hospitalization. To understand how important this is, one unfortunately has to understand that hospitals aren’t always safe havens. Far from it.

Clients Facing Hospitalization

Our clients are of all ages and health statuses—healthy, ill, injured, chronically ill, dealing with disabilities and/ or providing care for others.

We counsel all of them about end-of-life decisions. We help them express how they want to be treated when they can no longer make decisions. We encourage them to think about whether they want to be home or in a hospital when end of life is near; whether they want to be kept on life support and under what circumstances. We bring up many other issues that arise when someone has permanently lost capacity.

We push them to communicate to those closest to them, as well as to their medical professionals, their assumptions, thoughts, values and feelings.

The Basics

We often know whether a client has a chronic or life-threatening illness, is about to undergo surgery and/or is facing an imminent hospitalization. These experiences are in the medical realm, and we may not be involved unless a specific legal problem arises or long-term care (LTC) costs are on the horizon. However, we’re in a position to offer help. Knowing at least some of the basics about patient safety allows the opportunity to provide practical, possibly life-saving advice at a time when it can accomplish the most.

Medical error. The unintended down side of medicine is the very real risk of being harmed by errors and certain practices that may occur in medical care and the institutions that provide it. The estimated number of deaths in the United States resulting from preventable medical error differs. But, whether we accept the Johns Hopkins patient safety experts’ number of 250,000 (or 700 deaths per day)1 or the Journal of Patient Safety estimate of 440,000,2 either number is too high.

Preventable medical error may now be the third leading cause of death in the United States—more than respiratory disease, accidents, stroke and Alzheimer’s.3

Countless others suffer illness or injury as a result of medical errors.4

Dr. Martin Makary, professor of surgery at Johns Hopkins University School of Medicine in Baltimore and leader of the Johns Hopkins research 5, explained that the category of “medical error”6 includes a wide variety of ills, both systemic (such as failures in communication during patient transfers to another staff) and individual (such as individual doctors’ mistakes). “It boils down to people dying from the care that they receive rather than the disease for which they are seeking care,” he said.7

The Leapfrog Group8 underscored the need for hospitals to make patient safety a priority. However, more importantly from our perspective, the authors indicated that it’s in our sphere as patients, family members and friends to “…protect [our]selves and [our] families from harm…”9

As a practical matter, family members and friends are well positioned to serve as patient advocates. They may be named in advance directives or other documents appointing surrogates in the context of medical care decision making. However, if they are, the directive can indicate the desire for help with the medical world even when capacity isn’t impaired or absent. Perhaps you can suggest a document that allows Health Insurance Portability and Accountability Act (HIPAA) authorization for those whom the client/patient trusts the most.

Prominent geriatrician Dr. Mark Lachs asserts, “As perilous as hospitalization can be … I firmly believe that there is no health-care venue where laypeople—patients, families, concerned friends and neighbors—can have a greater impact on improving outcomes of care.” 10

That’s because many of the dangers of hospital care aren’t a result of technical procedures and tests. Most of the time those are done well. The devil, as they say, is in the details—those that occur before, after or in between the procedures or surgeries. Errors, as noted above, aren’t the only way that harm can be done.

The effects of hospitalization itself. Patients often suffer from being kept in bed too long, from confusion, even from malnutrition—all of which impair recovery. Concerned lay people can, among many other things, help to ensure that the patient is as mobile as soon as and as often as possible; they can facilitate communication and help to coordinate multiple medical professionals. Even a reminder to a staff person or a visitor to wash hands can be lifesaving. This simple measure can prevent a virulent hospital-acquired infection.

When family members or other caring individuals take such steps, they’re acting as patient advocates.

The Attorney’s Role The sheer number of clients we see who are facing medical issues, together with our awareness of the avoidable dangers of dealing with medical care, puts us in an opportune position to give practical tips and information that—while not legal advice—are uniquely valuable.

We can be proactive when a client or client family member faces hospitalization. We can encourage him to identify the best individual(s) who can help him survive a hospitalization and enjoy an effective rehabilitation experience. We can alert clients to their own and their family’s ability to facilitate recovery and avoid harm.

Sometimes it takes a village. A client may not have the perfect individual to advocate and otherwise watch out for her. Or, she may have one ideal advocate, but one individual alone can’t be there 24/7. Friends and family, as well as church and synagogue groups may be called into play to help. A professional patient advocate may be needed if no other resources present themselves.

Elder law and estate-planning attorneys routinely counsel clients and family members about health insurance, Medicare, Medicaid, HIPAA, medical malpractice, asset preservation in the context of LTC and other matters. Attorneys tend to become involved in the health care setting only when problems arise. They become involved reactively.

I suggest that attorneys become much more proactive, offering clients practical, fact and research-based advice and information to equip them to serve as advocates for their family members. Give this advice and information, in particular, to individuals named in advance directives. Family members who’ll be present in the hospital room or at doctor visits should be similarly educated and empowered.

In addition, you should add “patient advocacy” to your arsenal. Nothing prevents you from including it in your consultations, your correspondence or even your document preparation. It will expand your practice. It will add to the quality of health care for your client community as well.

Sample Documents

With this in mind, I share a typical handout for you, the practitioner, to expand, edit, adapt and distribute to appropriate clients and family members. (See “Sample Handout,” this page and “Sample Pre-hospitalization Letter” )

Endnotes

1. “Medical error—the third leading cause of death in the US,” BMJ 2016; 353:i2139 (May 3, 2016), http://dx.doi.org/10.1136/bmj.i2139. Analyzing medical death rate data over an 8-year period, Johns Hopkins patient safety experts calculated that over 250,000 people die each year due to medical errors in the United States.

2. http://journals.lww.com/journalpatientsafety/Fulltext/2013/09000/A_New,_ Evidence_based_Estimate_of_Patient_Harms.2.aspx.

3. Supra note 1; www.hospitalsafetyscore.org/newsroom/display/hospitalerrors-thirdleading-causeofdeathinus-improvementstooslow. Some argue that this estimate is too high, but that the real problem is a failure of the medical system to handle complex care. Seehttp://blogs.scientificamericancom/guest-blog/the-real-cause-of-deadly-medical-errors/.

4. www.washingtonpost.com/news/to-your-health/wp/2016/05/03/researchers-medical-errors-now-third-leading-cause-of-death-in-unitedstates/?utm_term=.a84018518677.

5. Dr. Martin Makary’s research involves a more comprehensive analysis of four large studies, including ones by the Health and Human Services Department’s Office of the Inspector General and the Agency for Healthcare Research and Quality that took place between 2000 and 2008.

6. “Medical error” has been defined as an unintended act (either of omission or commission) or one that doesn’t achieve its intended outcome, the failure of a planned action to be completed as intended (an error of execution), the use of a wrong plan to achieve an aim (an error of planning) or a deviation from the process of care that may or may not cause harm to the patient. Patient harm from medical error can occur at the individual or system level. The taxonomy of errors is expanding to better categorize preventable factors and events. I focus on preventable lethal events to highlight the scale of potential for improvement. See supra note 1.

7. Ibid.

8. www.leapfroggroup.org/.

9. www.hospitalsafetyscore.org/newsroom/display/hospitalerrors-thirdleadingcauseofdeathinus-improvementstooslow.

10. Mark Lachs, M.D., What Your Doctor Won’t Tell You About Getting Older: An Insider’s Survival Manual for Outsmarting the Health-Care System (2011).

Preserve Your Hearing! Practical Wisdom And Preventive Steps

  • According to the National Institute on Deafness and Other Communication Disorders (NIDCD), 15% of Americans (26 million people) between the ages of 20 and 69 are afflicted by hearing loss due to exposure to loud sounds at work or during leisure activities.
  • Every day, we are exposed to noises and sounds that damage our ability to hear.
  • In order to prevent this damage we first have to be aware of the danger and harm. Any sound above 85 decibels can potentially injure hearing.
  • We can prevent hearing loss and tinnitus caused by toxic levels of noise by avoidance or by simple, yet powerful steps.

Avoid loud noises, reduce the amount of time you're exposed to loud noise, and protect your ears with ear plugs or ear muffs. These are easy things you can do to protect your hearing and limit the amount of hearing you might lose as you get older.

We are all in danger of experiencing hearing loss as well as the misery of tinnitus. But some hearing loss is preventable.

“Preserve Your Hearing” is intended to be a wakeup call. We can easily implement practical solutions for ourselves and our loved ones.

PRESERVE YOUR HEARING

In Judaism, one of the seven wedding blessings praises God for creating joy and gladness, loving couples, mirth, glad song, love, loving communities, peace, and companionship and asks that the sound of joy, of gladness, the voice of the loving couple, their jubilance, and of the youths from their song-filled feasts be heard.(paraphrased ecumenically)

I have to admit that this article came to be partly because of a pet peeve of mine. I love celebrating weddings and other festive occasions. I love the experience of community coming together in mutual joy, excitement, and support of the people who are celebrating an important life milestone – or just having a great time. We come together to enjoy music, song, dance, laughs, good food, drinks, and conversation. Friendships are formed and nurtured. Memories are created.

What I don’t love, putting it mildly, is the inability to carry on a conversation and the pain of poundingly loud music. And I love music.

Instead of enjoying the chance to dance and to talk with others, I find myself yelling to be heard, fighting a headache, and generally feeling somewhat miserable. Yes, I know many find the loudness itself exciting, exhilarating, and even intoxicating. Well, it turns out that the loudness is, indeed, intoxicating. At least it is toxic to hearing.

This loud music is literally poisoning our hearing.

We want our guests to enjoy themselves. We take care to provide food that is fresh. We’re careful to make sure the dance floor is free of hazards that could cause a fall. We provide for separate space where people who want to smoke can do so without exposing the rest of our guests to second-hand smoke. But when it comes to noise, I’ve found it difficult to get far enough away for comfort without leaving the party altogether.

Bands, orchestras and DJs have been raising the volume at celebrations of all kinds.  They believe the high volume creates high energy and excitement. In general, sporting events and concerts are also getting louder. And modern sound systems reach a higher decibel level than older ones, one that is damaging to ears at even brief exposures. While some people seem to crave loud music, many react to loud noise with anxiety and irritability, an increase in pulse rate and blood pressure, or an increase in stomach acid.  (Those people might quietly leave your party way too early because they don’t want to complain.)

Sadly and ironically, the more such joyous events we attend, the more damage to our hearing.

Remember, hearing loss usually develops over a period of several years. Since it is painless and gradual, you might not notice it. But you may have trouble understanding what people say; they may seem to be mumbling, especially when you are in a noisy place such as in a crowd or at a party. Ironically, you may become less able to enjoy music.

TINNITUS

I don't go to see bands any more because I've got tinnitus, so I have to avoid loud music. You get used to it, but when it's quiet you hear a constant ringing. - Linton Kwesi Johnson

You also might notice a ringing or other sound in your ear (tinnitus), and that can become permanent. Tinnitus increases a person’s risk of serious mental health issues, including depression and anxiety. It can trigger episodes of extreme anger and suicidal ideation, according to the Hearing Health Foundation. No doubt most of us would become irritable if we lived with a constant ringing or buzzing in our heads.

Lesson of “A Star is Born”

For a vivid depiction of the devastation that tinnitus can cause, go see “A Star is Born.” The portrayal of Jackson Maine is much more than subtext for the love story and wonderful soundtrack. Jackson, who suffers from hearing loss and tinnitus, is seen consulting with an otolaryngologist who, along with Jackson’s manager, urge him to wear in-ear monitors. These are custom-molded ear plugs that musicians use to protect their hearing, while being able to hear themselves play. Sadly, Jackson refuses, and, as the story illustrates, perhaps it was already too late for him to save his hearing. More than 12 million people in the United States suffer from some degree of tinnitus, according to Stanford Health Care. At least 1 million experience ringing in their ears so severe that it affects their daily activities.

In any case, take no chances with excessive noise – the hearing loss it causes is permanent.

With healthy, well-functioning ears, we can detect sound from the softest whisper to the loudest thunder clap. Our ears are a miraculous gift. Needless to say, many people live full, happy lives without hearing. But, if given a choice, most of us would elect to be able to hear.

WE CAN PREVENT HEARING LOSS AND TINNITUS – EXCESSIVE NOISE IS OUR ENEMY

Many things that we cannot control or prevent, including age, cause hearing loss. However, noise, not age, is the leading cause of hearing loss. And it is in our power to prevent it from stealing our hearing. Protecting our hearing will not only prevent or delay hearing loss, it will also benefit our mental wellness.

According to Dangerous Decibels, a project of the Oregon Health and Science University in Portland, approximately ten million Americans are victims of noise-induced hearing loss. Noise-induced hearing loss is a permanent hearing impairment that results from exposure to high levels of noise for an amount of time that exceeds our ears’ ability to withstand damage. When noise is too loud, it begins to kill cells in the inner ear or cochlea (called “hair cells” or stereocilia). These are the cells that respond to mechanical sound vibrations by sending an electrical signal to the auditory nerve. Different groups of these hair cells are responsible for picking up different frequencies.

A healthy human ear can hear frequencies ranging from 20 Hz to 20,000 Hz.  Loss of hearing can be caused by a one-time exposure to loud sound (that exceeds 124 decibels, called acoustic trauma), but more typically, as the exposure time to loud noise increases or repeated exposure occurs, more and more hair cells are destroyed. As the number of hair cells decreases, so does your hearing.   And since this damage can happen without pain, we don’t even know when to stop or get away from toxic noise levels.

The average person’s pain threshold for noise is approximately 120-140 decibels, but damage can be caused by prolonged, sustained exposure to 85 decibels – the noise level of midday city traffic. This means that your ears could be sustaining damage at a wedding party even if you are enjoying lively music and having a fabulous time. The fact that you find the amplification tolerable, or even pleasurable, does not mean you are safe.

Fifteen percent of Americans between the ages of 20 and 69 experience high frequency hearing loss as a result of leisure or occupational activities, by the everyday noise that we take for granted as a fact of life.

Alarmingly, recent studies show an increase in youngsters’ hearing loss. Evidence suggests that loud rock music along with increased use of earphones may be responsible for this phenomenon. Twelve to fifteen percent of school-age children already have permanent hearing loss – enough to make it more difficult to understand even normal speech. Note: The rule of thumb for the use of earphones for music listening is that if you can’t hear someone talk to you while you have headphones or ear buds on, or if someone else can hear your music while your earphones are on, it’s too loud and is causing damage.

There are no mandated protections for professional music providers (or guests!) at parties or for teens listening to their phones. Nor are there restrictions on how loud music can be performed or played at parties and concerts. But we can exert control over how much noise we expose ourselves to and protect our ears.

THE DECIBEL SCALE – HOW LOUD IS TOO LOUD; HOW LONG IS TOO LONG

To interpret the sound receiving process, a scale, known as decibels, was created. Sound intensity is measured in decibels (dB). Like a temperature scale, the decibel scale goes below zero. The average person can hear sounds down to about 0 dB, the level of rustling leaves. If a sound reaches 85 dB or stronger, it can cause permanent damage to your hearing. The amount of time you listen to a sound affects how much damage it will cause. The quieter the sound, the longer you can listen to it safely. A decibel is a logarithmic scale of loudness, so a difference of 1 decibel is perceived as a minimum change in volume, 3 decibels is a moderate change, and 10 decibels is perceived by the listener as a doubling of volume.

EVEN COMMON SOUNDS CAN CAUSE DAMAGE

So, how loud is too loud? Here are some guidelines outlining the maximum allowed exposure time for different decibel levels. Noise below 85 decibels is generally considered safe even for sustained, long-term exposure. This includes the humming of a refrigerator (40 decibels), bird chirping (50 decibels), a normal conversational voice (60 decibels), the noise of a typical vacuum cleaner (70 decibels), and a crowded restaurant (80 decibels). At 85 decibels – which, as mentioned, is the noise level of heavy city traffic – damage can begin to occur after eight hours of sustained exposure.

Once the noise is at or above 85 decibels, it takes drastically less time to suffer hearing damage. For every five-decibel increase in sound intensity, the time you can be exposed before you risk hearing loss is reduced by half or more. You can be exposed to 90 decibels for four hours, 95 decibels for two hours; a volume of 100 decibels is considered harmful after just 15 minutes of exposure. Studies have shown that movie-theater sound peaks in the 100-decibel range at some theaters. This level of sound can cause tinnitus and hearing loss. If you are cringing during the previews, it’s too loud.  In a nightclub, where noise can peak above 110 decibels, without hearing protection you risk hearing loss in less than five minutes. Bands and DJ’s typically play music exceeding 100 decibels, and often keep turning up the volume as the event progresses in order to sustain the “vibe” in the room. The “safe” exposure time before damage occurs at 115 decibels is three minutes. Music may be exciting, melodic, harmonious, and fun, but it’s still noise.

HOW CAN WE KEEP OURSELVES SAFE FROM TOXIC NOISE?

Many of us voluntarily expose ourselves to harmful noise recreationally (musical concerts, movies,  disco bowling, eating at restaurants with loud music and conversation,  parties to celebrate weddings and coming of age ceremonies, use of power tools, hunting or target shooting with loud firearms, and, of course, simply listening to music with earphones. To protect ourselves and our children, we should take special care to avoid these toxic noise levels, just as we would avoid toxic smoke.

While there are sound-level apps that can measure noise exposure and indicate whether the volume exceeds safe noise limits, we only need to use common sense.  If you have to shout to someone 6 feet away to be heard above the music, or you feel the vibrations in your body, or if the music is painfully loud, you can be pretty sure the sound level has exceeded a safe limit and is damaging your hearing.

To protect yourself, at least periodically leave the room and go to a quiet place to allow the ear to recover from the noise and avoid sustained exposure to dangerous sound levels.  Better yet, wear earplugs. They are common among those who work with noise but should help avoid damage for party-goers’ ears at celebrations, as well.   Properly fitted earplugs or muffs reduce noise 15 to 30 dB. To be effective they must totally block the ear canal with an airtight seal. Earplugs must be snugly sealed so the entire circumference of the ear canal is blocked. An improperly fitted, dirty or worn-out plug may not seal and can irritate the ear canal. Ordinary cotton balls or tissue paper wads stuffed into the ear canals are very poor protectors; they reduce noise only by approximately 7 dB.

LOWER THE VOLUME.  WHAT A CONCEPT!

The most effective solution, of course, is to simply avoid the problem in the first place by ensuring that music is played at safe levels. That includes the “silent parties” where people can wear earphones to hear the music. At these parties others can converse without shouting, and each person can control the decibel level or take off the earphones. And for those wearing them, note that ear buds and exterior headphones are safe if the volume you are using doesn’t keep you from hearing someone talk to you. If someone else can hear your music while you are wearing them, you are definitely in the danger zone. Remember, the input from a personal music system at maximum volume into stock earphones can generate a sound level of over 100 dB.

If you think you have grown used to loud noise, your ears have likely been damaged. There is currently no treatment – no medicine, no surgery, not even a hearing aid, that truly corrects your hearing once it is damaged by noise. This doesn’t mean you should just turn up the music to louder and louder levels. You can still protect what remaining hearing you have. While it may seem silly and obvious to point this out, usually the best way to prevent future injury from noise is to avoid exposure to noise!  If you are exposing yourself to the unsafe level of noise, stop doing it!

BOTTOM LINE

Avoid loud noise when possible.

Stop going to excessively loud venues, such as concerts and restaurants where the “background” music already challenges hearing and conversation is correspondingly louder. Share this information with your friends and family.

If you are forced to endure loud noise, use ear protectors properly. Wear earplugs when attending concerts, loud group-fitness classes, working with loud machinery, such as lawn mowers. The plugs need to fit properly. In a pinch, disposable foam earplugs (available in stores or online) may help a little, but follow directions to place them properly.

For louder sounds, or prolonged exposure to moderately loud sounds, invest in musicians’ earplugs, which can reduce the volume by 30 decibels, or in protective earmuffs. Remember that 85 decibels is the cutoff for what you can safely be around for eight hours. For every 3-decibel increase above that, the safe listening time drops significantly.  For very loud sounds, use both earplugs and earmuffs. There are earplugs that allow for you to enjoy the music without destroying your hearing.

Your general health matters. If you smoke, quit. Smoking harms hearing because it impairs circulation.  Some conditions, such as high blood pressure, heart disease, thyroid disorders, and diabetes can contribute to hearing loss by compromising blood flow. Research shows that consuming excessive amounts of alcohol can cause further hearing loss and make tinnitus more noticeable.   Treat Ménière’s disease (a disorder of the inner ear) and shingles; these can take a toll on your hearing. And some medications — including some chemotherapy drugs, antibiotics, erectile dysfunction drugs and high doses of aspirin — can be toxic to the ear. Tell your doctor if you notice any change in your hearing.

Assess the volume. Maybe you can avoid the noise. In addition to common sense indicators – such as too loud to be able to hear someone who’s talking 6 feet away; feeling the vibrations in your body; finding yourself shouting to be heard --  there are good-quality sound level apps you can download onto your smartphone to gauge the noise levels wherever you are.

Take care not to be the source of loud noise, such as by hosting a party or event at which music is played at decibels toxic to the human ear. This may entail a serious conversation with the band or DJ you have hired. For a sample letter or email to your DJ or band, click this link

We indeed hope and pray that we all can participate in many joyous celebrations that will allow us to hear the festive, exuberant sounds of happiness, well into old age.

Further Resources

For further reading on the subject of hearing safety, see the following.

American Hearing Research Foundation: http://american-hearing.org/disorders/noise-induced-hearing-loss/

Dangerous Decibels: http://www.dangerousdecibels.org

Deafness Research UK: http://www.deafnessresearch.org.uk

Maximum noise exposure chart: http://www.engineeringtoolbox.com/noise-exposure-level-duration-d_717.html

Marek Roland-Mieszkowski, Ph.D., “Common Misconceptions About Hearing”: http://www.digitalrecordings.com/publ/pdfs/misconceptions_he

https://hearinghealthfoundation.org/blogs/protecting-your-hearing-means-protecting-your-mental-health

https://www.hearnet.com/   offers risk assessments, referral links and information about custom earplugs, which are far more effective in preventing damage and evenly conveying sound frequencies than conventional earplugs.

https://www.aarp.org/health/conditions-treatments/info-2018/musicians-hearing-loss.html

Marek Roland-Mieszkowski, Ph.D., “Common Misconceptions About Hearing”: http://www.digitalrecordings.com/publ/pdfs/misconceptions_hearing.pdf