If you’re concerned about your teens or loved ones spending too much time playing online games, here’s something else to worry about: hearing loss. A systematic review¹ of sound levels reported in studies involving more than 50,000 people found e-gamers are exposed to sound levels often near, or exceeding, permissible safe limits—80-89 dB in commonly used computer gaming systems with impulse sound levels up to 119 dB.

The new study published by Lauren Dillard and colleagues in the British Medical Journal (BMJ) Public Health suggests video gamers worldwide who play their games for extended periods may be risking irreversible hearing loss and tinnitus. While music played through headphones and earbuds has been recognized as a potential cause of noise-induced hearing loss (NIHL), little attention has been given to e-gaming platforms that are extremely popular among youth worldwide.

In 2022, there were an estimated 3 billion gamers globally, and they frequently engage in lengthy gaming sessions at elevated sound volumes. A 2022 review² points out, “…headphones have become almost ubiquitous amongst the youth of developed and developing nations. Not only that, but high-quality headphones are also used during gaming, which involves the simulation of loud and sudden noises, such as those of gunshots, blasts, screams, and car crashes, delivered to the ear at close proximity, which are usually reasons for premature hearing loss.”

The new BMJ paper by Dillard et al reviewed databases for studies, white papers, and so-called “grey literature” (newsletters, reports, and proceedings) in English, Spanish, or Chinese to establish a comprehensive evidence base. Included were 14 peer-reviewed studies across North America, Europe, Southeast Asia, Asia, and Australasia, involving 53,833 individuals. A total of 11 were epidemiological observational studies, with 6 focusing on the link between hearing and computer/video games, 4 on gaming centers or personal computer rooms, and 1 on mobile devices.

Sound levels ranged from 43.2 dB in mobile devices to 80-89 dB in gaming centers, with variable exposure duration (daily to monthly) averaging 3 hours per week. Impulse sounds lasting less than 1 second reached up to 119 dB during gameplay, exceeding permissible exposure limits for kids (100 dB for children, 130-140 dB for adults).

The International Telecommunication Union and World Health Organization (WHO-ITU) has outlined a time-intensity trade-off, with exposure time decreasing as noise levels rise. For children, permissible exposure levels are 75 dB for 40 hours a week, with exposure times decreasing at higher dB levels. WHO has developed its Make Listening Safe initiative to ensure everyone can protect their hearing.

Studies reported video gaming prevalence among young people (20% to 68%), gaming center use prevalence (about 60% in South Korean studies), and associations between gaming and self-reported hearing issues. Some studies linked gaming center use to increased odds of severe tinnitus and high-frequency sound hearing loss.

One study reported that over 10 million people in the USA may be exposed to “loud” or “very loud” sound levels from video or computer games. Sound levels of various video games averaged close to the maximum permissible levels, indicating potential risks.

Additional sources mentioned gaming as a source of excessive sound exposure, with one noting that gaming headphones could reach unsafe listening levels, risking sound-induced hearing loss. Three studies explored gender differences, revealing that boys played games more frequently, for longer durations, and at higher sound intensities than girls.

The researchers acknowledged the inclusion of studies dating back to the early 1990s, with only two in the past decade objectively measuring average sound levels from video games or gaming centers, both reporting high sound levels.

However, they state: “Although the data provided in this review are limited, they suggest that some gamers, particularly those who play frequently, and at or above the average sound levels described by papers included in this review, probably exceed permissible sound exposure limits, and are thus engaging in unsafe listening practices, which could put them at risk for developing permanent hearing loss and tinnitus."

They add that there are also several key gaps in the available evidence. For example, the impact of esports, geographic region, sex, and age on hearing loss is still unknown. They say further research is essential to inform preventive measures and global policy initiatives.

They conclude, “The findings suggest that there may be a need to prioritise interventions, such as initiatives focused on education and awareness of the potential risks of gaming, that can help promote safe listening among gamers.”

Source: World Health Organization (WHO)

References

1. Dillard LK, Mulas P, Der C, Fu X, Chadha S. Risk of sound-induced hearing loss from exposure to video gaming or esports: A systematic scoping review. BMJ Public Health. 2024;2:e000253. doi: 10.1136/bmjph-2023-000253

2. Dehankar SS, Gaurkar SS. Impact on Hearing Due to Prolonged Use of Audio Devices: A Literature Review. Cureus. 2022; Nov 12;14(11):e31425. doi: 10.7759/cureus.31425. PMID: 36523704; PMCID: PMC9747083.