[Ed: At the Second Amendment Foundation’s Gun Rights Policy Conference September 27, Associate Director and ENT surgeon Hayes Wanamaker spoke to the importance of suppressors as a medical device to protect hearing for shooters and bystanders. He and DRGO founder Tim Wheeler (also an ENT surgeon) spearheaded their recent endorsement by the American Association of Otolaryngology and Head & Neck Surgeons. The speech can be seen in its entirely at the DRGO YouTube channel here, with his slides.]
I’m very grateful for the opportunity to speak to you all this afternoon on behalf of my colleagues at Doctors for Responsible Gun Ownership. Now, don’t let that name fool you, because our idea of responsible gun ownership is a little bit different than you might typically hear.
I was really excited to get the invitation to speak, and then I looked at the list of featured speakers. And it’s a who’s who, and I’m a sort of a “who’s he”. So let me just address that.
I’m going to give you a little bit of my background.
I’ve been very blessed to have a 35-year career as an Ear surgeon and have had a lot of wonderful opportunities along the way. A few years ago, Tim Wheeler, who’s also an ENT and founded DRGO, encouraged me to get involved. And he and our director, Robb Young, who’s also here, took me under their wing and have been bringing me along to be part of the DRGO. So thank you.
I’m also one of the coauthors of the American Academy of Otolaryngology Head and Neck Surgery position paper that we recently came out with on suppressors and the importance in preserving hearing. I’m also a Certified Range Safety Officer and Volunteer Instructor. And like many of you in this room, I have high-frequency sensorineural hearing loss and tinnitus, and I live in one of those hateful eight banned states where protecting my hearing is a felony. So this isn’t just professional for me, it’s personal.
This could be a really long talk, and I have 15 minutes, so I’m going to move kind of quickly.
I’m going to summarize, I’m going to simplify, and I hope you guys are okay with that.
You’re born with the best hearing that you are ever going to have. Noise-induced hearing loss is cumulative and permanent. After injury, you may have some recovery at milder levels, but you are not going to have repair, regrowth, or regeneration. Noise-induced hearing loss affects not just hearing, but also understanding and it may cause tinnitus. Suppressors are effective because they reduce the sound at the source, and those benefits are additive with ear-level protection. As you know, they don’t silence gunshots. What they do is that they reduce the damage from “definite damage” to “tolerable trauma”. And they’re really, as such, a preventive health measure.
So, just a quick review of how we hear. Sound energy is mechanical energy. Hearing is an electrical signal. So, that translation has to happen, and it happens in the ear. The sound waves come in the ear canal, hit the eardrum. The eardrum vibrates, makes the hammer, the anvil, and the stirrup vibrate, and that makes the fluid in the inner ear set up fluid waves. And when that fluid moves, it shifts the membranes in the inner ear and causes the hearing receptors to fire, and they’re really the transducers: they send an electrical signal along the hearing nerve to the brain.
And if we zoom in a little bit, that little blue membrane is the membrane that shifts with the fluid waves, and the tips of those little hearing receptors, or inner hair cells, are what send the hearing electrical impulses to the brain. There’s also an outgoing pathway that’s regulatory, that helps control some of the higher-level functions of hearing, and we’ll talk about that in a little bit.
Now because sound is a mechanical energy, if it’s powerful enough, it can damage the hearing in two ways. Well, really three. If it’s severe enough, it can cause a severe concussion or a shock wave that immediately damages those hearing receptors. Less intense energy causes a lesser degree of damage, but those hearing cells, hearing receptors, gradually deteriorate and die. And you can see the difference between a nice, healthy population of those hearing receptors and what they look like when they’re damaged. And if we zoom out on a larger level, you can see nice, orderly structure, normal population, normal organization. And then, as the structures are damaged from noise, the structure is broken, the structure breaks down, and you have damage, but also lots of areas where the hearing receptors are actually missing.
Now the third way is if it’s loud enough, it can actually bypass the ear, including your ear protection, and go through what’s called bone conduction, and the sound goes directly through the vibrations of the skull and can damage the ear that way. So at a milder level of injury, you get what’s called temporary threshold shift. And if you’ve been to the range for a long period of time, or maybe a front row of an AC/DC concert when you were young and foolish, you would have that sense walking out of muffled sound, ringing, roaring, you may even have pain. And those are hearing receptors that are injured but not destroyed. It’s essentially a mild inner ear concussion.
But noise-induced hearing loss is a more severe level, similar symptoms but more severe. And the hearing receptors and the regulatory system also are permanently damaged. And there is no recovery from that. And you may actually have progression. So if you look at that graph, with temporary threshold shift, immediately afterwards, your hearing is at its worst and gradually recovers.
With the permanent damage, the hearing loss may initially be mild, but then gradually worsens.
So if you go to your audiologist or your ear doctor, they may do an audiogram and you get a graph that looks like this. Noise-induced hearing loss, for reasons that have to do with the structure of the inner ear, the damage is most severe and the ear is most susceptible at 4,000 cycles per second or 4,000 hertz. And then with more severe injury and more duration of injury, that loss not only moves down, causing a loss of hearing acuity, but it also spreads to a wider range of frequencies.
So what happens? Because it is the higher frequencies that are affected, the consonants live there. So they are the areas of speech that are most likely affected. So you start losing your T’s,your S’s, your F’s, and what happens is your ability to tell words apart that sound similar begins to deteriorate. You also lose the ability to hear softer speech. You may have trouble hearing in background noise because those higher level functions like filtering start to deteriorate and you have difficulty picking out a specific speaker. And you may also get sensitivity to loud sounds.
Now having said that, if you go home to your significant other and say that your selective hearing loss is because you have been to the range and not because you are not listening or not paying attention, you are on your own on that one.
So, tinnitus. Tinnitus actually is complicated, but I think an easy way to think about it is because that regulatory mechanism and the supporting cells are more susceptible to noise induced damage than the hearing receptors themselves, you can get areas where the hearing receptors are functional, but the regulatory mechanism is not. And the hearing receptors will start spontaneously firing. You basically get a spontaneous electrical discharge in the ear even though there is not really a sound. And that information goes along the hearing nerve to the brain. They are just doing what they are supposed to do. And so there is nothing physically dangerous or harmful about it, but it can be at best annoying, and at worst, psychologically very disturbing. But again, that is just another function, another aspect of noise induced hearing loss.
You guys have all seen graphs like this. Just one thing I want to mention is that loudness is measured in decibels, which is a log scale. So if we say a sound is 10 decibels louder or you have a 10 decibel change in noise induced hearing loss, that doesn’t mean it is 10%. A 10 decibel change is really 10 times the magnitude, 10 times the intensity. 20 decibels is 100, 30 decibels is 1000. So you look at the graph and the graph doesn’t look that bad, but it is really much more significant than that.
So gunshots, unsuppressed gunshots are really, really, really loud. Suppressed gunshots are just really loud. And Hollywood gunshots are just bullcrap. But what the suppressors do is to shift
that level down from an intensity that is going to cause immediate damage to a level that is more like a temporary threshold shift. Now with repeated exposure you can induce more severe damage, but it really lowers the risk. And that is why they are so important.
So as I said, they reduce the level from permanent damage to a temporary threshold shift. And I am preaching to the choir here, you know. They allow environmental and situational awareness. They protect against unexpected discharges. It mitigates amplified sound indoors at the range or God forbid in your house. And it reduces the risk of injury from repeated discharges. There is also the good neighbor effect with people that live near a range.
But from our perspective as ear docs, they are a preventive health tool. They prevent damage
to our sense of hearing. And because of that, we really felt like when it comes to the battle to get suppressors legalized, that preventive health piece was a very important piece of the fight.
And so, about a year ago, Tim Wheeler got a bunch of us together and we went to our academy, the American Academy of Otolaryngology, the medical specialty that is really charged with hearing healthcare. And we thought it was important to have a proactive statement from them that suppressors are critical for preventing hearing loss. It wasn’t a political statement, and it wasn’t tied to any particular piece of legislation. It was a preventive health statement from the doctors who know best about it.
But a really key piece of us getting that approved was that bolded statement from a CDC report.
Now, CDC is not known for its pro Second Amendment advocacy, but that was the truth and it was reality. And that was a very compelling piece of the puzzle for us to be able to get that through. And as I think some of you know, that got picked up by our friends on YouTube, our friends in the 2A Press, and is being utilized in litigation and legislation, so we were very gratified to see it used in the way in which we intended.
I have a little bit of time left. I just want to talk a little bit about DRGO. It’s been in the fight with you all since 1994 when Dr. Tim Wheeler started it. It was originally affiliated with the Claremont Institute, but then during the Obama administration, it found a home here at the Second Amendment Foundation. And they’ve had us under their umbrella and supported us ever since.
Our advocacy and our information is certainly not limited to hearing loss and suppressors. I strongly encourage you to go to our website. There’s a wealth of information, a wealth of resources there about a wide range of topics related to the Second Amendment and to health.
Our mission is really fighting the bias and the misinformation and the propaganda that we unfortunately see not just from the gun control lobby, but from many of our healthcare colleagues. I would also encourage you to follow us on X. Dr. Tim still runs our X account. He actually just put up one today. They’re timely, they’re informative, and they’re usually pretty entertaining.
Here are some QR codes linking to DRGO’s comprehensive white paper on suppressors, which is what gave rise to our advocacy statement that was put out in 2017. And then a link to that academy statement itself.
So if you have healthcare professionals in your family that are pro-2A people, please ask them to join. It’s a one-time fee. We’re just looking for support. And we are here for you. Talk to us here. Contact us on our website. Contact us on X. And thank you very much for the opportunity to speak to you.
Remember, protecting your hearing should not be a crime.
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— Hayes Wanamaker, MD practiced Otology/Neurotology for more than 30 years in Syracuse, NY, holding local, state and national leadership positions. He is an NRA instructor & range safety officer concerned with noise-induced hearing loss, situational awareness training and 2A legal issues.