Environmental Noise and Health: The Latest Evidence Professor Deepak Prasher Institute of Laryngology and Otology University College London

Day and Night Noise Levels Typical Noise Level LeqdBA Day Night Acoustical Quality 35 35 natural sounds only 50 40 quiet rural environment 55 45 suburban neighbourhood 65 50 urban noise situation 75 75 very noisy, unfit for permanent habitation

Noise Level and Effect <55dBA Desirable level outdoor Suburban neighbourhood 55-65dBA Urban “Grey Areas”: Annoyance >65dBA Black spots: Stress effects, sleep disturbance, communication performance deficits >75dBA Unfit for Human habitation, hearing loss, cardiovascular effects

European City Noise Desirable Indoor Comfort Leq <65dBA New Residential Areas outdoor levels <55dBA Urban “Grey Areas” Levels 55-65dBA Black Spots Levels >65dBA Large European Cities:Number of People exposed to high levels 3 times national average Percentage living in “grey areas” increasing (OECD 1991)

Noise Levels in Environment Normal Conversation 45-55dBA Car 50km/h 60-80dBA HGV 50km/h 80-95dBA Motorcycle 50km/h 75-100dBA Train 200km/h 95-100dBA pk Discotheque(Leq) 85-100dBA Jet (Take off,100m) 110-115dBA Military low level flights 105-120dBA

Speech Communication in Noise Socially people talk at 2-4m distance: Noise should not exceed 55-60dBA Outdoor recreation people talk at 5-10m: Noise levels should not exceed 45-55dBA At work people can converse at 1m with difficulty with noise at 78dBA. For prolonged conversations noise level must be lower than 78dBA at work

Hazardous Noise Levels Level Hazardous if communication not possible when in the sound Tinnitus (ringing in ears) after sound exposure Sounds muffled after leaving sound exposure area

Noise Environment in Europe 450million (65%) exposed to >55dBA 113 million (17%) exposed to >65dBA 9.7million (1.4%) exposed to >75dBA No systematic differences across Europe Eastern European Cities noisier than Western Data poor from Central and Eastern Europe

Costs of Noise to Society Estimate: 0.2 to 2% GDP 0.2% equates to 12Billion Euros annually

Noise Sources in Europe Road Traffic Air Traffic Rail Traffic Industry Recreational Activities Construction Sites Traffic on Waterways

Auditory Effects Acoustic Trauma: Sudden hearing damage Tinnitus: Ringing in the Ears TTS:Temporary threshold shift PTS: Permanent threshold shift Interference with Communication

Non-Auditory Effects Annoyance Sleep Disturbance Attention Motivation Stress reactions Cardiovascular problems Endocrine problems

Annoyance Noise is annoying Generally the louder the noise the greater the annoyance But there are non-acoustic factors affecting annoyance Degree of annoyance not directly related to adverse health effects

Annoyance from Street Noise West Germany (UBA 1988) Inhabitants Percentage Annoyed < 5000 14-16 5-20,000 17-19 20-100,000 19-25 >100,000 22-33 Annoyance increases with increase in Population

Factors affecting Annoyance Primary Acoustic: Sound level, frequency and duration Secondary Acoustic: Spectral complexity, fluctuations in frequency, level, localisation of noise source Non-acoustic: Adaptation and past experience, listener’s activity interference, predictability of noise, individual personality

Noise and Sleep Increases time taken to fall asleep Causes awakenings and changes in sleep stages; reduces REM and slow wave sleep Sleep disturbance in turn may lead to poor performance and change in modd next day Noise sensitive individuals and elderly more vulnerable Chronic exposure leads increase of cortisol Adaptation possible but not complete habituation

Noise and Sleep In Europe 10-26% (55-143 m) : Severe difficulties falling asleep or staying asleep Chronic Sleep disorders lead to loss of efficiency, psychological well being, learning in childhood, social interaction and driving ability Drivers falling asleep cause 20% of accidents on German Roads

Noise and Performance Distracting effects of Noise impair performance especially in children, noise sensitive and anxious people Type and degree of control important in degradation of performance Learning in Schools impaired due to outdoor and/or indoor noise levels Memory: Recall impaired in children

Noise and Hormones Prolonged exposure to stress leads to immune dysfunction and increased vulnerability to disease Environmental stress leads to production of stress-related hormones Hypothalamus-pituitary-adrenal (HPA) axis plays a crucial role in this Cortisol is closely associated with stress related health problems

Noise and Hormones Noise can affect the HPA function Salivary cortisol enhanced during mental work under 90dBA noise and NOT under quiet conditions Circadian decline in cortisol NOT seen in chronically exposed workers to noise >85dBA but did with use of headphones Noise exposure during gestation leads to enhance HPA responses to stressors in later life

Noise and Cardiovascular Effects Acute noise effects: increase in heart rate, blood pressure and peripheral vasoconstriction Heart rate changes to noise during sleep do not habituate No epidemiological evidence of relationship between noise exposure and blood pressure in adults BUT consistently seen in children Increased risk of ischaemic heart disease with outdoor levels >65-70dba Association shown between noise and serum lipids in women and young men

Noise and Mental Health Community based Studies show high levels of environmental noise associated with depression and anxiety Aircraft noise in children impairs quality of life but no depression or anxiety

Noise and Fatigue Increased fatigue and irritability after work in noisy environments Fatigue and headache more common among noise exposed workers in a survey of 50,000 workers Reaction times prolonged after one week in high noise levels increasing gradually compared to controls which improved

Noise and Children Aircraft noise : Difficulties in attention, communication, learning and memory Concentration, motivation and language acquisition affected by increased outdoor and/or indoor noise levels Raised blood pressure seen with prolonged noise exposure to traffic noise

Leisure Noise Risk to hearing and tinnitus from: Loud music : Concerts, discotheques, Personal cassette players Noisy toys, arcade and computer games Sports activities and venues DIY activities

Social Noise induced hearing impairment Audiometric thresholds may be within normal limits but impairment may be present Inability to decipher speech in noisy conditions Tinnitus: An early warning signal? Early onset of presbycusis?

Loud Music and Hearing Percentage of young people reporting dulled hearing and/or tinnitus Rock Concerts (100-120dBA) 63-73% Night Clubs ( 95-110dBA) 47-66% Personal Stereos( 80-110dBA) 17%

Strategies EC 5th Environmental Action Programme No Person should be exposed to noise levels which endanger health and quality of life Exposure to 65dBA night Leq should be phased out At no time should a level of 85dBA be exceeded No increase in level for those affected by 55-65dBA

These groups may constitute 30% of Population Special Groups Children Elderly Sick People Hearing Impaired People These groups may constitute 30% of Population

Noise measures and Health Noise measures based only on energy summation NOT sufficient to : characterize noise environments health effects or predict health outcome Noise fluctuations, number of noise events and inclusion of low frequency components is important