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Ambient Noise

A Disability Rights Issue

Fink, Daniel, MD

doi: 10.1097/01.HJ.0000554357.99563.e9
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Dr. Fink is the board chair of The Quiet Coalition based in Lincoln, MA. He is an expert consultant to the World Health Organization on its Make Listening Safe program, and a subject matter expert for the Centers for Disease Control and Prevention on noise-induced hearing loss in public.

The Americans with Disabilities Act (ADA) defines a disability as “a physical or mental impairment that substantially limits one or more major life activities.”1 It also defines major life activities to include “caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, lifting, bending, breathing, learning, reading, concentrating, thinking, communicating, and working.”1 Clearly, people with moderate to severe auditory disorders meet the ADA standard for disability, making ambient noise a disability rights issue for those who have auditory disorders and need quiet to understand speech and function in society.

The theoretical framework for disability rights is also clear: People with disabilities have the same fundamental rights as those without disabilities, and the goal of people with disabilities and their communities is to fully enjoy life with active inclusion and equal participation.2 It is time to extend these rights to those with auditory disorders.

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LIMITATIONS OF THE ADA

The ADA is a civil rights law that prohibits discrimination of individuals with disabilities in all areas of public life, including jobs, schools, transportation, and public spaces. The ADA states that “no individual shall be discriminated against on the basis of disability in the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations of any place of public accommodation.”1 The “full enjoyment” standard has been upheld at the appellate level3 but has not yet been tested in the U.S. Supreme Court.

ADA Title III requires public accommodations such as restaurants, hotels, and retail stores to be accessible to individuals with disabilities. New construction and structural alterations must meet federal accessibility standards, and existing public accommodations must remove barriers to allow persons with disabilities access goods, services, and facilities. The removal of barriers is required to the extent that access is readily achievable, i.e., accomplished without too much difficulty or expense. ADA Title V mandated the U.S. Access Board to develop design guidelines to ensure that buildings and other facilities are accessible to individuals with disabilities. These ADA Access Guidelines were developed into enforceable standards by the U.S. Department of Justice, which issues architectural and communication standards to meet the needs of disabled people. For the deaf, these include workplace modifications to allow gainful employment and mandated auxiliary aids and services, such as fire alarms with strobe lights, teletype communication devices, and sign language interpreters when needed.4 However, there are no ADA Access Guidelines for ambient noise levels in places of public accommodation.

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AMBIENT NOISE PROBLEM

Why is ambient noise a problem? Auditory disorders are common in the United States. Approximately 48 million adults (15% of the U.S. population) have hearing loss, 35 million (10%) have tinnitus, and 19 million (5.9%) have hyperacusis.5 High ambient noise levels make it difficult, if not impossible, for those with hearing loss to understand speech, worsen tinnitus, and are painful for those with hyperacusis.6 Ambient noise particularly affects the older population, where hearing loss is more prevalent. Approximately 25 percent of people between 65 and 74 years old and 50 percent of those over 75 have disabling hearing loss.5

Ambient noise levels appear to be increasing. Noise levels once limited to factories, construction sites, or rock concerts are now a common feature of everyday life. A recent study found that ambient noise levels in restaurants in Manhattan averaged 77 dBA, with 53 percent having an average sound level above 76 dBA.7 About 50 percent of bars have an average sound level of 81 dBA, while 90 percent are above 76 dBA.7 Even people with normal hearing have difficulty conversing in places with high ambient noise levels.

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ADVOCATING FOR DISABILITY RIGHTS

Many people with hearing loss have difficulty understanding speech in noisy environments. To understand speech, people with normal hearing need a 3 dB difference between ambient noise and speech. Although there is significant variability, hearing-impaired listeners generally need a higher speech-to-noise ratio than those with normal hearing to achieve the same amount of speech intelligibility. This ratio is based on incompletely understood peripheral and central processing issues, and can be around 7 to 15 dB for those with moderate to severe hearing impairment.8 Since average speech only measures at 55 to 65 dBA, people with hearing loss, including those who wear hearing aids, need low ambient noise levels, in the 60 dBA range, to be able to understand speech.

While people with hearing loss clearly meet the ADA definition of having a disability, they have no legal protections under the ADA. As such, legal action may be necessary to afford them the statutory protections guaranteed by the ADA. Environmental modifications are mandated by the ADA to remove access barriers and allow people with disabilities full and equal enjoyment of public facilities and accommodations. For people with auditory disorders, full and equal enjoyment requires lower ambient noise levels.

Reducing ambient noise levels will likely require government action, as will implementing architectural changes needed to make public accommodations accessible to those with impaired mobility. Existing standards for classroom acoustics could be adapted for restaurants, retail stores, and malls. Alternatively, laws and regulations could specify a functional measure, e.g., indoor sound levels low enough to allow people to converse without straining to speak or be heard. This is approximately 70 to 75 dBA for those with normal hearing, and near 60 dBA for those with hearing loss. With appropriate enabling legislation, crowd-sourced sound level measurement and reporting smartphone applications, such as iHEARu and SoundPrint, could provide data for local communities to initiate enforcement of action against noisy establishments.

The technologies for reducing and controlling noise have been known for at least half a century: Design mechanical devices to be quieter through engineering specifications and material choices, or isolate, insulate, reflect, deflect, or absorb the sound. For the built environment, noise control techniques are also well understood and can be used in new construction and remodeled spaces. Relatively inexpensive retrofitting solutions such as ceiling panels, wall hangings, carpets, and draperies can help control noise and reduce reverberation. The simplest environmental modification costs nothing: Turn down amplified sounds.

Reducing ambient noise benefits all—but it goes a long way in helping those with auditory disorders. The basic principle for ambient noise, adopted from the Nuclear Regulatory Commission for radiation exposure, should be “As Low As Reasonably Achievable or ALARA.” Hearing health care professionals should advocate forcefully for quieter public accommodations.

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REFERENCES

1. ADA National Network. https://adata.org/learn-about-ada
    Disability Studies Quarterly. 2003;23(1):33-61. http://dsq-sds.org/article/view/399/545
      3. United States Court of Appeals,Ninth Circuit. https://caselaw.findlaw.com/us-9th-circuit/1693736.html
        4. https://www.hearingloss.org/wp-content/uploads/2010ADA Standards for Accessible DesignDOJ 9 95 2010pdf.
          National Institute on Deafness and Other Communication Disorders. 2016. https://www.nidcd.nih.gov/health/statistics/quick-statistics-hearing
            6. Disability rights aspects of ambient noise for people with auditory disorders under the Americans with Disabilities Act. Proc. Mtgs. Acoust. 31, 015001 (2017); https://doi.org/10.1121/2.0000657
              8. Killion MC, et al J Acoust Soc Am. 2004 Oct;116(4 Pt 1):2395-405.
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