The use of headphones and earphones has become the norm in modern life, particularly in younger generations. At the same time, younger people are increasingly complaining of early signs of noise-induced hearing loss, and headphones are being blamed. So, should you use headphones with hearing aids?

What is the difference between headphones and earphones?

Headphones come in a few different shapes and sizes. On-ear headphones sit directly on the external part of your ear while over-the-ear headphones surround your ear. In-ear headphones are also called earbuds or earphones and they sit just inside or at the opening of your ear canal. The differences between headphones and earphones also highlight their respective advantages and disadvantages.

Headphones

Advantages

• Over-the-ear headphones are best at reducing background sounds and so prevent the need to increase the volume when in a noisy area.
• As a result, research shows that over-the-ear headphones are less likely to increase the risk of hearing loss.
• With their soft padding, headphones are generally more comfortable than earphones.
• The greatest advantage is their sound quality; because they are bigger, headphones have space for more technology for a richer, detailed sound.

Disadvantages

• Headphones are big and cumbersome to carry around.
• If used while exercising, headphones may make ears hot and sweaty.
• When wearing on-ear headphones, sound can escape more easily, allowing everyone to hear what you’re listening to.

Earphones

Advantages

• Earphones are light, unobtrusive, and easy to carry with you.
• They are best for exercise and are generally water-resistant.

Disadvantages

• Earphones generally have no noise canceling function (except for some newer options). This means that you are more likely to increase the volume to dangerous levels when in a loud environment.
• The ear canal acts as a protective mechanism by marginally reducing the intensity of loud sounds entering the ear. Earphones reduce the space in the ear canal and so remove this protection1. Thus, the sound reaching the inner ear can be up to 10dB louder than the same sound from headphones.
• Earphones are generally less comfortable and can be difficult to keep in the ears.
• Going forward, when talking about ‘headphones’, this refers to on-ear, over-the-ear, and in-ear headphones or earphones unless otherwise specified.

Is it okay to use headphones?

There are many benefits to using headphones; for some people, it is the escape from the rest of the world and a chance to be with your thoughts. For others, they are crucial for staying motivated during exercise. In a fast-paced convenience-driven modern life, headphones also allow us to speak on the phone hands-free. Many jobs, especially in the sound engineering and entertainment industries, rely on them as they allow one to hear subtle sound details more clearly.

Even better, the more technology evolves, and society’s awareness grows regarding the harmful effect of loud sound on our hearing, so headphones are developed that aim to provide healthier listening experiences. Ultimately, it is more how headphones are used that causes problems, as opposed to the headphones themselves.

Why are headphones a problem?

Headphones can have a few serious negative consequences. They are seen as promoting antisocial behavior as you cut yourself off from those around you, and also a safety risk as you are not as aware of your surroundings and may not hear a warning alert.

Using headphones can also increase your chance of developing eczema or an outer ear infection, particularly if you are not cleaning the devices and are sharing them with others.

However, the most concerning impact of irresponsible headphone use is the increased risk of permanent noise-induced hearing loss. Research has found that as many as 10% of people who listen to loud music via headphones for over an hour a day will develop hearing loss.

The volume of the sound combined with how long and how often you are exposed to it will determine the likelihood of eventual hearing loss. Regulations say that it is dangerous to be exposed to 90dB sounds (approximately the volume of a lawnmower) for eight hours and 100dB sounds (such as a nightclub speaker) for only two hours. These levels may seem much louder than headphones but most headphones have a maximum output of 115dB, a level that would be dangerous if exposed to for more than just 15 minutes.

When using poorer quality headphones with no noise reduction, as your environment gets louder, you will want to increase the volume of what you’re listening to. Particularly in areas of public transport, where levels up to 100dB have been recorded, you may be unwittingly exposing yourself to harm.

If you experience one of the following symptoms after listening to music, the volume you’re listening at may be placing you at significant risk of hearing loss one day:

• Tinnitus (ringing in the ears)
• A sensation of fullness in the ears
• Sensitivity to loud sounds
• Dizziness
• Needing to increase the TV volume
• Regularly ask people to repeat themselves
• Increased difficulty hearing speech in a noisy environment

How to use headphones safely

Headphones are only a problem if not used properly and awareness of your listening habits is key. Below are some tips to make sure you do not experience any harmful effects of using headphones.

• Try to use good-quality headphones with a noise-canceling feature. If this is not an option, avoid using headphones in a noisy environment.
• Only use your headphones in a safe place and be constantly aware of your surroundings. Do not use it while in a public area such as the street.
• If your device indicates that the volume is getting too high, reduce it immediately.
• If you get any hearing loss symptoms after wearing headphones, be sure to reduce the volume and shorten the time you use them.
• Follow the 60/60 rule: keep your listening device at 60% of its possible volume for a maximum of 60 minutes. Thereafter, take a 30-minute listening break.
• While wearing headphones, you should still be able to understand a conversation and speak at a normal level with someone nearby.
• No one else should be able to hear what you are listening to. Test this by setting your preferred volume and removing the headphones; if you can still hear sound coming from them, it’s too loud.
• Do not wear a headphone on only one ear – this will make you turn up the volume and harm that ear’s hearing.
• If using earphones, don’t push the earbuds too far into the ear canals as this can cause damage.
• Clean and sanitize your headphones regularly.

Can I use headphones with hearing aids?

Using headphones if you wear hearing aids can be problematic as hearing aids will produce feedback and distortion if in close contact with the headphone speakers. Nevertheless, there are a few ways to get around this.

Earphones should never be used with hearing aids. However, if you wear invisible-in-the-ear or completely-in-canal hearing aids, you may be able to get away with using on-ear or over-the-ear headphones as normal. If you use receiver-in-canal (RIC) or behind-the-ear (BTE) hearing aids, you will need to experiment with some over-the-ear headphones and position them so that they do not come into contact with the microphones in the BTE component. Whether this will be possible will depend on the size of your ears and hearing aids compared with the headphones.

You may also be able to improve the sound quality by using your hearing aids’ music program. Most important would be to look around and try out different options to determine what is best for you. Either way, always ensure that the listening device volume is reduced to account for the amplification from your hearing aids.

There are also bone conduction headphones that sit behind or in front of your ears and send the sound via your skull bones to your inner ear. However, the sound quality is not always ideal and the sound will not be amplified so the volume will need to be increased to compensate for your hearing loss.