When it comes to being exposed to extremely loud sounds at concerts, researchers have long warned about the consequences for your hearing.
But these risks may also come with playing video games, according to new research published on Tuesday in the British Medical Journal of Public Health.
The research studied nearly 54,000 adults and children worldwide, finding that when participants played video games, average sound levels often exceeded permissible sound exposure limits, with the risks growing the longer people are exposed.
"Those who game regularly, as compared to those who do not, are more likely to experience tinnitus, measured high-frequency hearing loss, and self-perceived difficulties hearing," said audiologist and epidemiologist Dr. Lauren Dillard, who is the first author of the study.
"One study showed that individuals who play video games for longer times are at higher risk of developing hearing loss or tinnitus."
Tinnitus refers to an internal sensation of a ringing, buzzing or roaring sound in one or both ears, impacting 10 to 25 per cent of adults.
Gaming is one of the most popular leisure activities worldwide, according to the study, and its fans often play for hours at loud volumes.
The study explores the relationship between hearing loss and tinnitus, especially since many games have loud sudden sounds such as gunshots or engines revving.
Listening to video game audio through headphones, instead of the device's speakers, is also common, putting loud volumes closer to ears.
"This study is an eye-opener, highlighting the often-ignored issue of sound-induced hearing loss among the youth, particularly in relation to gaming," said Dr. De Wet Swanepoel, a professor in speech-language pathology and audiology at the University of Pretoria in South Africa.
"According to the WHO, over one billion youth globally are estimated to be at risk of hearing loss due to unsafe listening habits."
"While the evidence is still evolving … (the study) is a critical addition to our understanding of hearing health risks in modern digital lifestyles."
What are safe sound levels?
Exposure to loud sounds can affect hearing by causing fatigue to the sensory cells in the ear, said Dillard, a consultant at the World Health Organization.
"This can result in temporary hearing loss or ringing in the ears," she said.
"While these sensations may resolve in a few days as the sensory cells recover, regular or prolonged exposure to noise can build up and result in permanent hearing loss over time."
According to the WHO, the noise exposure safety limit is 80 decibels - the measurement of sound intensity - over 40 hours per week.
That sounds like city traffic you hear when driving, or gas-powered lawn mowers and leaf blowers, according to the US Centers for Disease Control and Prevention.
Sound intensity has a "time-intensity trade-off, known as an exchange rate, for permissible levels and duration of exposure," the authors wrote.
This means the louder the sound, the shorter the time you can listen to it.
For example, for every 3 decibels above the safe limit of 80 decibels for 40 hours per week, the permissible exposure time is cut by half — so if the sound level is 83 decibels, the permissible exposure time would be 20 hours per week.
For children, however, permissible levels are lower at 75 decibels for 40 hours per week.
"Under this definition," the authors added, "children can safely listen to … an 83dB sound for approximately 6.5 hours, an 86dB sound for approximately 3.25 hours, a 92dB sound for 45 minutes and a 98dB sound for only 12 minutes per week."
A 98-decibel sound is equivalent to the noise of a motorcycle, a car horn from five meters away or an approaching subway train.
Safer ways to game
For many people, gaming can be a hobby or fun source of stress relief or community.
But hearing damage is permanent, and exposure to high-intensity sounds when young could make kids more vulnerable to developing age-related hearing loss later, with the authors urging the importance of prevention.
"When possible, monitor the amount of sound (you're) exposed to," Dillard said.
Some smartphones now have features that display the number of decibels coming through their speakers or earphones, said Dr. Janet Choi, an assistant professor at the University of Southern California's Keck School of Medicine.
According to Dillard, there are also apps that can help you monitor your hearing and measure environmental sound intensity, such as hearWHO.
If you don't have a way to measure specific levels, "keep the game volume at a comfortable level, no higher than 60 per cent of the maximum," Swanepoel said.
"If you're using headphones, get a pair that fits well and blocks out background noise, so you won't be tempted to crank it up."
Don't forget to take breaks to let your ears rest and make sure you pay attention to changes in your hearing, experts said.
"Key warning signs of hearing loss include experiencing tinnitus, difficulties hearing high-pitched sounds or difficulties following conversations," Dillard said.
If you're experiencing symptoms, contact your doctor or an audiologist, experts said.
Adopting safe listening habits early on is crucial, Swanepoel said.
"It's not just about preventing loss; it's about preserving the richness of sound in our everyday lives," he said.
