Gamers at risk of irreversible hearing loss and tinnitus, study suggests | Hacker News Reader

Gamers at risk of irreversible hearing loss and tinnitus, study suggests

bbc.com

49 pointselorant52 comments

PUBG is infamous for this problem. Much of the game is predicated on hearing quiet sounds like footsteps, while there are often loud sounds like gunshots, or even louder sounds like the C4 explosion.

Because of the assumptions based around what constitutes "cheating", players are not only strongly disincentivized from compressing and equalizing the game's audio: they are often outright banned for doing so. If you play PUBG competitively, then you are either damaging your hearing, or you are "cheating".

This is one of many reasons that anti-cheat systems do more harm than good. Once upon a time, anti-cheat simply meant choosing which players you are willing to play with. That system had no trouble accommodating accessibility. Today, that's practically impossible, because servers are hosted and moderated exclusively by the game studios themselves.

The idea of amplifying the footsteps wav file is from early counter strike

Compression can be had entirely in analog, and it the compressing amplifier could be built discreetly into a headset.

Yes, but that's too much of an expense to expect from the average gamer. Compression (and other signal processing like EQ) really ought to be a feature in the OS by now.

But my understanding from this thread is that you get busted for cheating if features in the OS are detected.

>This is one of many reasons that anti-cheat systems do more harm than good. Once upon a time, anti-cheat simply meant choosing which players you are willing to play with. That system had no trouble accommodating accessibility. Today, that's practically impossible, because servers are hosted and moderated exclusively by the game studios themselves.

uh what?

or maybe game devs could realize that this is an issue and provide some better configurability for such stuff?

They don't want to. They have chosen their path. It's likely they don't even recognize the advantages of player-based server hosting (moderation) that they threw away.

Their biggest motivator is planned obselescence. By monopolizing the server software, they can eliminate (or shrink) the player base from an older game during the release of its sequel.

For example, Battlefield 4 has a thriving online community (with player-hosted servers), but its sequel Battlefield 1 definitely struggled to keep servers full during the release of Battlefield 5.

I would say PUBG in particular, having downloaded the game again recently. I've noticed that the difference in volume between a gunshots and footsteps is very different. I need to turn the volume down quite a bit to not jump when my gun fires, then hearing footsteps suffers greatly.

PUBG is the only game where gunfights seem overly loud in contrast to everything else.

Playing other Battle Royale games the volume difference isn't anywhere near as big.

I don't know how valid this study is but you do not want tinnitus. I have it pretty bad and it's getting worse as I age. I wouldn't say it's ruined my life but it has severely decreased my quality of life and severely increased my anxiety and depression that lead to multiple anxiety attacks and 1 trip to the emergency room.

I didn't even get mine from loud noises, I was only 11 at the time, I'm just here to encourage everyone to not take silence for granted.

I agree that you do not want tinnitus, but you also do not want worsening eyesight and hearing, less nimbleness, etc and you get all of that as you age anyway.

The difference is that tinnitus is easily preventable.

> The difference is that tinnitus is easily preventable.

That is categorically NOT true.

I'm not a rocker. I've have earplugs on my keychain. I have over the ear hearing protection for the shop. I have no detectable hearing loss relative to my age.

I still have tinnitus. Nobody knows where or why I got it. And there is no treatment.

Apparently, compression on the audio nerves can also cause it. There is a doctor in Massachusetts doing research on this right now.

Makes sense. For mine they suggested one blood vessel makes a weird turn near my ear nerves and it might be the cause. The fact that it increases with stress (higher blood pressure) makes me think it's true. Who knows.

I agree things in your list are also important, but I’d say for anyone having tinnitus would agree that nothing in that list compares to the constant torture of what tinnitus is.

On one hand, it is not that bad, one is not disabled by having it.

On the other hand, it is always there, there’s nothing you can do to make that easier, not even for a moment.

It’s not about ability, but what it does to you mentally.

No cure for tinnitus, not mentioned in article.

Only current options are: masking, which can make it worse if noise is played too loud to mask the tinnitus for too long.

Cognitive behavioral therapy, which is about adjusting your feelings toward tinnitus.

Hearing aids, which can have masking sounds built in, seem to help by amplifying other sounds going into the ears.

Some people develop hyperacusis also from masking with sounds too loud when masking sounds should be as low as possible to provide relief then be reduced further. Hyperacusis makes it difficult to live with everyday sounds.

There is also evidence that cochlear implants reduce tinnitus. IIRC it's around 75% of people suffering from tinnitus who get cochlear implants report improvement ranging from reduced severity to complete relief.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2740131/#bib-00...

The title of the article literally says "irreversible"

I am glad that there are people doing research on this.

For a long time, I have suspected that people of my generation and younger (i.e. people under 40), are going to have a lot of hearing problems. As a musician, I have always been a bit paranoid about my hearing, so I use ear plugs when exposed to loud noises.

But the amount of people I know that are already having hearing issues is shocking. Looking back, I can only assume it is because they always had headphones on, and the were always far too loud. It was worse once we started driving. People would blast music as loud as the speakers would allow.

My favorite quote from the linked article, Table 1 Row 1:

> Gaming was associated with poorer self-reported hearing. Use of hearing protection is uncommon (<5%) among gamers.

The study quoted by the featured study is very reasonable in finding this given its context, but I think it's a little ridiculous the featured study suggested that gamers might use hearing protection as opposed to turning the sound down.

In any case, this is interesting to see. I never turn my volume up past about 20% because it becomes physically painful at that point, but I thought maybe some people might have insensitive hardware that needs higher power to create reasonable audio? Are folks just leaving their volume on the default 50% or 100% or whatever it is?

> but I thought maybe some people might have insensitive hardware that needs higher power to create reasonable audio? Are folks just leaving their volume on the default 50% or 100% or whatever it is?

A few reasons I can think of:

* Less sensitive headphones (as you mentioned). A lot of fancier headphones have much higher impedance and need more power to drive.

* People playing competitive games want to be able to hear quiet and farther away sounds like footsteps approaching. Then sounds like gunshots are dangerously loud.

* Earbuds that seal poorly (think the original AirPods as opposed to the Pro version) make you turn up the volume in order to hear any bass (or shove them deeper into your ear canal if you want to listen at a more reasonable volume, which is also uncomfortable).

I have a mild case of tinnitus - most of the time I'm blissfully unaware of it unless it's very quiet. 20 years ago I used to play video games (PC) for long periods with headphones. I never liked loud music so I don't think I set the volume too high, but maybe with headphones the damage can accumulate over time even within the safe limits.

Doesn't this apply to all audio? So people listening or watching BBC with sound set too high risk irreversible hearing loss?

As long as it has a lot of short and loud sounds, and is played via the headphones, then yes. I don't think that's the common scenario for watching BBC though. From the paper itself:

> Headphones are frequently used, and individuals may increase the volume to higher levels than their preferred listening levels to overcome the background noise that is common in these settings. While gaming centres and PC rooms exist worldwide, the vast majority are in China and other Asian countries. Third, electronic sports, termed esports, involve competitive, organised gaming and are rapidly growing in popularity. Some esports players are professional gamers, and therefore may practice for many hours a day, often using headphones, and compete regularly in online or in-person competitions or tournaments.

https://bmjpublichealth.bmj.com/content/2/1/e000253

BBC pulls in some clickbait study and keeps the clickbait title.

If you turn the volume up too loud, you'll get hearing loss long term. But not because you're a "gamer".

Some games provide important sound cues, if you turn your volume up you get an advantage over players that don't turn their volume up. This is very different from listening to music or podcasts.

You don't want the "jump scares" though.

Are there no headphones with AGC or a limiter? Seems like a good product to have.

My kids have. They look like kiddo stuff and thus no Fortnite enthusiast will wear them dead.

Some games and systems have a "night mode". It's more a question of decreasing the dynamic range, not just adjusting gain up or down. A footstep is much quieter than a gunshot, for example, so you'd want to compress the range so you can hear both without going deaf.

The BBC and you are unaware that a great majority of computer games are not competitive multiplayer?

Agreed. Discos, walkmans, ... This is just BBC doing its bit for the nanny state.

The new review suggests that gamers play for long periods of time *with the volume turned up, beyond safe limits.*

I love when the title omits the point in leiu of clickbait.

Loud sounds cause hearing problems? I’m shocked!

Right but they mention the decibel levels in the article. I’ve never actually measured the levels that come through my headphones so it’s possible I’ve set them too loud.

Some form of this has been a problem since the invention of headphones. Kids were blasting music on their walkman, then cd-player, iPod, portable DVD player, gameboy, etc.

The bigger issue I think is bluetooth headphones have made it easier to be exposing your ears to noise at all times. And I tend to see way more of the under ~25 generation wearing AirPods at seemingly all times now.

It was considered rude/inappropriate to wear headphones while working less than 10 years ago. But now I often see retail workers, delivery drivers, etc. wearing AirPods while working. I would think exposing your ears to noise all day long, even at low volumes can't be healthy. Just like when exercising, you need to give your muscles a break.

For a couple months I lived in an apartment right next to the crashing waves of the ocean- it was loud.

Imagine our ancestors camping there for months or years, 24/7, without windows to close.

Would they all have suffered from tinnitus and hearing loss?

You’d think our ears would have evolved to be more resilient than that.

It’s possible our ears never evolved to handle that. Instead we evolved to move around, build shelters, protect our ears etc. and generally take defensive measures against excessively loud environments.

How is gaming any different than anything, like watching movies?

It has nothing to do with gaming and everything to do with volume levels...

I game all the time and I have my volume levels really low. Like way lower than I listen to music at for example.

I'm a gamer and have tinnitus. Not sure what caused it though (I don't play first person shooters), but I do wear a headset all day, for ages (gaming, then work).

What about the open-office workers that can only work by putting on noise-cancelling headphones and pumping noise in their ears?

Is taht not equivalent to gaming 8 hours a day?

What do folks do to prevent these? Set a hard-limit, say 20% of maximum volume? Are there software that help on this?

Set a reasonable limit, which will vary wildly based on the hardware and software involved.

I'm sure there's companies out there selling high-tech solutions, but you already come equipped with a pair of incredibly sensitive instruments attached to your head. A comfortable listening volume is a comfortable speaking volume, so pop an earbud out and talk to yourself! If you feel you'd need to raise your voice to be heard over your game/music, it's too loud for extended listening.

Take breaks, and if it hurts at any point, take a long break. Video games have lots of small, quick and sharp sounds (gunshots and such), and in a competitive environment, you probably want to have the volume high enough to hear footsteps from far away, but that'll also make all the "bad" sounds very loud.

That brings to mind automatic gain control. It seems like there could be a market for headphones that have their own AGC to prevent a computer or music player from overriding such things. Perhaps a button to switch to AGC Normal, AGC Safe, AGC disabled? Maybe even default to AGC Safe, so one could crank up a game to where they can easily hear footsteps but then a 50 BMG next to the head would be the same volume. AGC Disabled to bring back the dynamic range of music that has a known loudness. Or perhaps it's a silly idea.

[Edit] Per liminalsunset I should be referring to this as Dynamic Range Compression or DRC

This isn't a bad idea at all! Typically, this technique is actually known as dynamic range compression (DRC), which is a form of AGC and a technique for reducing the difference between quiet and loud sounds [by reducing the volume of sudden loud sounds]. Many computer monitors already do a version of this for vision (Black Equalizer, etc). Many audio drivers and audio accessibility features include some form of this, including iOS/(macOS?)[1] and plugins are available for other platforms. On iOS there is also a feature specifically that automatically turns down only audio that exceeds a user chosen safe decibel limit. AirPods are capable of measuring their dB output live, which can be monitored in Apple Health. [2]

[1]https://support.apple.com/en-ca/HT211218

[2] https://support.apple.com/en-ca/guide/ipad/ipade8c21895/ipad...

This technique is called Dynamic Range Compression and has been used (abused?) by the music industry for the last century. You're right though, weird that I don't tend to think of it on the device side. One issue I've run into is that it's surprisingly hard to hijack your computers outgoing audio stream for processing. OS level audio routings honestly sucks.

The better place to implement this (in my opinion) is in the games themselves. I've seen a few games (wish I remembered which) recently that offered a few choices in their audio settings so that you can request reduced range for more consistency in noisy listening conditions or full dynamics for people with nicer setups.

On Windows, Equalizer APO can be used for this — it has the capability to apply any VST across the computer's outgoing audio stream, including compressors.

How do various anti-cheat technologies work with that? One could imagine that developers would see that as tampering with the "native experience", if some people use limiters/compressors/filters and similar.

The ideal method would be a compressor. You want quiet sounds relatively louder, and loud sounds relatively more quiet.

As far as software goes, that's where it gets tricky.

These exist for the military and hunters. The ones I saw long ago were probably hard/firmware based. SW must be possible but you’ll get artifacts.

does anyone know if it still damages the ear at below decibles, let say 80dbs, for long periods of time (10+ hours a day for 3-5 days straight)

In other news, if you attend Zoom meetings with your headphones set too loud, you will probably also get hearing loss and tinnitus.

BREAKING NEWS ALERT: REMOTE WORKERS AT RISK OF IRREVERSIBLE HEARING LOSS AND TINNITUS

WHAT?

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