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Review by Dr Eric LePage,
Senior Research Scientist, National Acoustic Laboratories

Hearing Health Kit for Kids, 2nd ed, 1997

Hearing Health Awareness and Prevention Through Behavioural Change: A Teaching program for Primary School Children
By Jen Burnley for Australian Tinnitus Association (NSW) Ltd.
(includes cassette, $49.95)

This excellent teaching manual gathers together a lot of very useful material on hearing for teachers and is divided into four main sections: "About this kit", "Information for Teachers", "Key Lessons and suggestions for extension work across the curricula", and "Teaching Support Ideas"

In the first section the rationale for raising awareness in primary school children of hearing health issues is presented, followed by consideration of learning outcomes and comparison with successful education programs which serve as the model here, such as the "Slip, Slop, Slap" program.

Identifying signs and symptoms

This is followed by a description of the human ear and its basic parts at an appropriate level for children. Then follows a section on noise-induced hearing loss and tinnitus, which describes the two conditions resulting from noise, and the role of the hair cells in the damage process. It might be good to supplement the section on the inner ear and the later section of blackline masters with some nice pictures of hair cells so that children have a clear mental picture of what a hair cell looks like (itís not just the hairs which are damaged - the cells tend to pop like a balloon) and what they are mimicking with the play-acting exercises in the next section. Then come sections on conductive hearing loss and sensorineural hearing loss and what a huge problem is hearing loss amongst the aboriginal people. The section on identifying signs and symptoms for children with hearing problems is very good, as are the recommendations of how to support students with problems. We now believe that once these listed telltale signs are evident to the teacher, the person may already have suffered considerable inner ear damage. It is to be hoped that before many years elapse, teachers will not have to rely upon detecting these subtle symptoms, but that a hearing problem will have been recognised much sooner, at least by entry to primary school, using the new detection method of ear emissions. This technique is in common but not widespread use and should become a standard procedure for school nurses.

"Cover, avoid, retreat"

The importance of the next section cannot be over-emphasised - "Cover, avoid, retreat" and the descriptions of how bad it is to have a hearing loss and tinnitus. Iíd be inclined to supplement the exercises with some form of game of surprise, to teach children that hearing problems can creep up on you. Part of the big problem of trying to educate young people about the hazards of noise is the possibility that the message may be interpreted negatively by the time the students get to high school. If children are repeatedly warned to avoid loud sound (shouldnít be just "noise") and they find that ten years later a lot of loud noise hasnít affected them it could result in a credibility gap. So the idea of a gradual build up followed by a relatively sudden surprise is a good concept to get across. During the lead up the damage is accumulating and while it is not causing any real disability it can result in tinnitus and is therefore something to bear in mind. The second message to get across is that not all loud noise or music is bad. Loud unamplified music can be wonderful in small doses! It is loud sound for long peiods, and sudden noise or loud bangs which should be avoided. The third message to get across is "How loud is loud?" The answer is that if you have to shout over the noise to make someone understand you, itís way too loud - mostly the case with people wearing personal stereos. Loud sound should be taken in small doses and extremely loud sounds avoided altogether.

Tinnitus is a warning

Overall, I heartily applaud Australian Tinnitus Association for producing the book and for targeting the group who will most benefit from the message before their levels of ear damage grow too large. I think tinnitus should be discussed as something worth avoiding, but most practitioners these days would agree that we should also convey the message that it is not something to be feared. Tinnitus sometimes occurs with nausea or serious illness, but doesnít mean that something really serious is wrong with oneís health, because one can get it at other times. Rather, if tinnitus occurs it should be protrayed as a warning that the ear has received too much sound and that it is the only real sign that trauma has occurred. To talk to children about the ear becoming "tired" and needs rest is quite close to the truth. The outer hair cells are like little muscles and they cramp down when subjected to loud noise.

Rules for "Walkmans"

We have developed some general rules which should be observed when using "Walkmans". Firstly, donít have them loud, which mostly means having the volume over (about) halfway. If there is a lot of background noise, then their use should be avoided altogether, because listeners get a double dose; the background noise itself, and because of the desire to turn up the radio to mask out the background noise. The normal ageing effect is doubled with personal stereos. If you work a noisy job and wear personal stereos on the job or travelling to and from work, the ageing effect is more than trebled. Children should be taught not to wear personal stereos for long periods (e.g. over an hour) without a break for a couple of hours. Be aware that jogging or aerobics with them on is a situation where the internal body noise drives the desire to raise the volume. Donít go to sleep with them on. If your ears develop a dull ache, or tinnitus, youíve had enough! It follows that on airplanes, which are very noisy (82-85 dB SPL - much noisier than a noisy office) the wearing of the earphones and turning up the sound to mask out the noise is a case where the ageing effects are substantial, but probably not too consequential unless one is a frequent flier.

Earplugs for cinemas

The wearing of ear protection has often been associated with a disability or weakness but these days cinemas are now so loud that I wear ear plugs and, remarkably, I hear everything very well; I also wear them on airplanes. If I get funny looks from people, I smile and say "Sunglasses for my ears" or "Iím saving my hearing to keep me young when Iím old". In other words, I think it is important to try to put a positive, even humorous, slant on protection measures, rather than just saying "noise is bad".

Recent References

LePage, E.L. : Occupational Noise-Induced Hearing Loss: Its Origin, Characterisation and Prevention (1998). Acoust. Aust., 26(2) 57-61 (in press);

LePage, E.L. and Murray, N.M. : Latent cochlear damage in personal stereo users: a study based on click-evoked otoacoustic emissions (1998), Med. J. Aust. (in press);

Australian Hearing Brochure : Noise! Itís murder on your ears (1998). Call Robyn Procter (02 9412 6824) for copies;

Australian Hearing : Damage your hearing and it wonít come back. Hear & Now, Youth services National Newsletter, Issue 4, 1998. Call Marg Anderson (02 9412 6948) for copies.

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