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Last winter, I was one of eight people on a Sunday long run. We spent most of the run in four groups of two. When I got home and my wife asked about the run, I said I’d spent most of it beside Erin, an ob-gyn who loves to discuss books. My wife asked about Erin’s recent work and reading list. I said I didn’t really know, even though we’d just spent more than an hour talking with each other.
That is, unfortunately, the norm for me on group runs. I have a form of severe hearing loss One manifestation is that it’s extraordinarily difficult for me to follow a conversation when there’s competing background noise. That includes restaurants and movies with music atop dialogue. But it also means something like that group long run, where Erin and I were sandwiched by lively conversations ahead of and behind us.
Hearing loss intrudes on nearly every aspect of my life. Some consequences are trivial (not hearing beeps from my running watch), some are moderately annoying (always seeking the quietest parts of public spaces), and some are depressing (regularly missing sounds and experiences that bring joy to others). There’s also the knowledge that my hearing is likely to continue to deteriorate, which puts me at risk for other conditions that could further erode my quality of life.
As the world gets increasingly louder, hearing loss is a growing problem. Here’s what it’s like to be a runner with hearing loss, what can be done about it, and, probably most importantly, how to lower your risk of winding up like me.
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Running and Hearing Loss
Running’s health benefits are extensive and, in some cases, unexpected: Did you know that runners tend to have fewer cataracts and are less likely to develop glaucoma? Unfortunately, there’s no evidence that regular running helps lessen your chances of developing hearing loss. Indeed, as we’ll see, one key aspect of many runners’ routines can elevate their risk.
The most common type of hearing loss is sensorineural, in which there’s permanent damage to the inner ear or the nerve that connects the ear to the brain. Noise exposure and age are the two leading causes of sensorineural hearing loss. Between the din of much modern life and an aging population, it’s not surprising that 15 percent of Americans 18 and older report trouble hearing.
It’s also not surprising this is no longer just an older-person issue. “We’re seeing more kids high-school age with noise-induced hearing loss than in previous generations because it’s so prevalent to have things in your ears,” says Carissa McCauley, a runner and doctor of audiology at Rutland Regional Medical Center in Vermont. Research published last fall estimated that more than 1 billion people aged 12 to 34 are at risk of developing noise-induced hearing loss.
Hearing loss is inconvenient, for those with the condition and the people they try to communicate with, and, in some environments, unsafe. Untreated hearing loss increases your risk of cognitive and functional decline, social isolation, and depression, especially in middle age and beyond, according to Sarah Hill, a runner and audiologist who works for a hearing-aid manufacturer in Boston. McCauley adds that untreated hearing loss will likely get worse faster.
One tricky aspect of hearing loss is that it’s insidious. Without regular testing, you’re left with subjective experiences of poor communication: the restaurant’s music was cranked, it’s loud inside a car on the highway, your partner likes to conduct conversations from two rooms away. It’s easy to convince yourself the mishearing was a one-off rather than part of an increasing pattern. This is a different form of coming to grips than, say, realizing words on a page or screen are blurry enough that you need glasses.
The cause and progression of my hearing loss are fairly typical. As I teen, I played drums while wearing maxed-out headphones several hours a week. In my 20s and 30s, I saw hundreds of indie rock shows in bedroom-sized clubs. I often had tinnitus for a day or two after these exposures. (Tinnitus is usually defined as high-pitched ringing in the ears, which is an adequate description of mine, but it can present in many ways.) The tinnitus became permanent around 15 years ago. Then I had increasing difficulty following nearby conversations in loud environments. Also, being in such environments started to cause days-long spikes in the severity of my tinnitus. Finally, I found myself straining to understand my wife from even a few feet away in our quiet house.
Now, in my late 50s, I have profound loss at higher frequencies. This means not only that I miss out on things like bird songs and running watch beeps. I also struggle to distinguish certain higher-pitch consonants, such as “s,” “f,” and “h,” especially at the beginning of words. These problems compound when there’s a lot of background noise. It’s not that I can’t hear what others are saying as much as that I can’t quickly make out what’s being said. I guess at some words to see if they make sense in context. But by then people are on to the next sentence, and I’m still processing the previous one while trying to catch the gist of the current one and seeing if it’s reasonably linked to what I think the previous one was. It’s frustrating and exhausting. Sooner or later, I check out.
On runs, I often interject “uh huh” and “right” and “hmm” more in reaction to the tone of what others are saying than the content. If there’s reason to run single file, I scoot to the front to have any chance of following the conversation. If we’re running two abreast, I try to stay farther from traffic to lessen competing sound. If it’s just two or three of us, running with others can be my best hearing experience of the day. Rhythmic breathing tends to introduce pauses in conversation, giving me a better chance to process what’s being said. Large group runs are another matter. I’ve skipped many simply because I don’t feel like having to concentrate so hard just to follow along.
Are you on the road to hearing loss? McCauley and Hill agree that tinnitus is a major warning sign that you’ve been overexposed to noise. “That ringing is noise-induced damage, whether it goes away quickly or two days later,” Hill says. McCauley says that if you experience tinnitus after a given environment, “next time you need to wear hearing protection or avoid it if you can.”
Another warning sign is what’s known as a temporary threshold shift. “That means your hearing sensitivity has declined,” McCauley says. “Everything seems temporarily muffled. That’s another blaring red flag that you were doing something damaging and probably need to stop doing that.”
Constant tinnitus merits getting a hearing test from a licensed audiologist. “Most folks who have tinnitus have some degree of tinnitus,” Hill says. Other signs that you’re a good candidate for a hearing test include:
- You frequently ask people to repeat themselves. (Or the people you talk with the most say you keep asking them to repeat themselves.)
- You struggle to follow conversations when there’s background noise, such as other conversations, music, an air conditioner, or a television.
- You have a harder time understanding children and women, who tend to have higher-pitched voices. Losing the ability to distinguish higher-frequency sounds is often where hearing loss starts.
- You turn up the television volume but still can’t understand everything.
- You feel like you hear better in one ear than the other.
- You have issues with balance or dizziness.
Runners’ Risks of Hearing Loss
In a 2016 Runner’s World survey, 61 percent of respondents said they listen to music or other audio while running. That’s great, given the research showing the performance benefits of running with music. But that can also be problematic if you pump up the volume too much.
“If you have any ringing in your ears after running with music, it’s absolutely too loud,” Hill says. “Also, if you notice that, outside of being tired from running, you’re mentally fatigued in conversations or having trouble paying attention to somebody, it’s probably too loud. Those are signs that your brain is a little overstimulated.”
These recommendations, which are valid at all times, deserve a running tweak: Research presented at a 2014 conference on noise and public health looked at temporary threshold shifts after people listened to music while not exercising, exercised while not listening to music, and listened to music while exercising. The threshold shifts were significantly greater after listening to music while exercising, and included losses at high frequencies. The researchers speculate that decreased blood flow to the cochlea (part of the inner ear with a key role in hearing) during exercise can compound the problems associated with noise alone.
“My thought is, it should be a little lower than you want it to be,” McCauley says about the proper volume for on-the-run audio. “I tell my active patients to put the volume where you want it, and then turn it down at least a click.” This lower setting comes with a safety bonus of greater awareness of what’s going on around you.
Hill offers another solution: bone conduction headphones, which are worn outside your ears and transmit sound while avoiding potential damage to your inner ear. “It’s really hard to make those too loud,” she says. “They kind of max out naturally, so there’s much less of a risk of overexposure to noise.” Hill also appreciates how bone conduction headphones give her greater environmental awareness in busy Boston.
Hearing Aids for Runners
I haven’t been completely forthright so far in this article. The examples of struggling to hear are accurate—if I’m not wearing my hearing aids.
I had my first hearing test in 2007, after two intercontinental flights in three days made my tinnitus constant and more pronounced. The audiologist told me I had mild hearing loss at high frequencies and that it was likely I’d need to learn how to live with the tinnitus. I then waited 10 years for a follow-up. That visit resulted in a prescription for hearing aids.
This part of my story is also typical. Hill says that, when she was in private practice, everyone she recommended hearing aids for should have gotten them earlier, usually by a factor of several years. It’s estimated that at least 28 million Americans who could benefit from hearing aids don’t have them.
So why, as someone with hearing aids, did I struggle to hear my friend Erin during that large group run? Because I wasn’t in the habit of running with them at that point. The audiologist who fitted me with my first pair cautioned against getting them wet. When I told her I’m a ridiculously prolific sweater, she recommended not running with them. Over time, I wore them less and less in everyday life, because the inner ear portion made me feel like I was constantly being tickled by a Q-Tip.
This summer, I learned that, as with running shoes, a lot has changed with hearing aids in recent years. Water resistance is now a common feature. Smaller domes over the inner ear portion eliminate the tickling sensation. I’ve worn my new hearing aids on hours-long hikes and forgotten I had them in until I realized I was catching everything my wife said.
Most importantly, sound quality has improved dramatically. There was a metallic clang to what much of what I heard through my previous hearing aids. (Imagine water dripping on a taut piece of aluminum foil.) Now, I hear what I assume most people hear. Conversations are crisp. Music sounds full rather than compressed. I can sit on the patio and actually hear the birds and crickets that I know are just yards away. Restaurants are still annoyingly loud, but I can understand the people I’m with.
The hearing aids I have, the Phonak Audeo Fit, are also noteworthy in how they reflect two demographic trends—people are getting hearing aids at younger ages, and people are staying active later in life. The Audeo Fit tracks heart rate, daily steps, and time spent in different exercise-intensity zones.
Like most modern hearing aids, the Audeo Fit can connect to phones, televisions, and other gadgets, and it has Bluetooth connectivity. The latter is great, if that’s your thing. But I mostly value them for the human connectivity. Erin, the next time we run together, I promise I’ll really listen.
Scott is a veteran running, fitness, and health journalist who has held senior editorial positions at Runner’s World and Running Times. Much of his writing translates sport science research and elite best practices into practical guidance for everyday athletes. He is the author or coauthor of several running books, including Running Is My Therapy, Advanced Marathoning, and Meb for Mortals. Scott has also written about running for Slate, The Atlantic, the Washington Post, and other members of the sedentary media. His lifetime running odometer is past 110,000 miles, but he’s as much in love as ever.
