Music heard through headphones and earbuds can reach levels that damage hearing and cause tinnitus, a ringing or buzzing in the ears. But what about video games? Gamers often play at high-intensity sound levels for several hours at a time, and although billions of people worldwide play games on a computer, mobile device or gaming console, few studies have looked at the effect video games may have on hearing loss and the risk of tinnitus.

Gamers are often exposed to sound levels near or exceeding safe limits, according to an analysis of 14 studies with a total of almost 54,000 participants.

Impulse sounds, bursts of sound lasting less than one second with peak levels at least 15 decibels higher than background sounds, reached levels as high as 119 decibels during game play.

“Although the data included in this review is limited, they suggest that some gamers probably exceed permissible sound exposure limits, and thus engage in unsafe listening practices which increase their risk for permanent hearing loss and/or tinnitus,” members of the international team of researchers from the Medical University of South Carolina, the World Health Organization, and China and Australia wrote of the meta-analysis. Because video games are so popular, more public health efforts are needed to raise awareness about the risk of hearing loss.

Games' sound levels reported in the studies ranged between 43.2 decibels (dB) for mobile devices and 80 to 89 dB at gaming centers. The duration of a player's noise exposure depended on where the games were played — on a mobile device or a computer, or at gaming centers or personal computer rooms, which are popular in Asia.

One study included in the analysis noted that impulse sounds, bursts of sound lasting less than one second with peak levels at least 15 dB higher than background sounds, reached levels as high as 119 dB during game play. Safe exposure levels are about 100 dB for children and 130 to 140 dB for adults, making repeated exposure to these impulse sounds concerning.

The International Telecommunications Union, in collaboration with the World Health Organization, set a time-sound intensity tradeoff, or exchange rate. A permissible noise exposure level for adults of 80 dB for 40 hours per week with a 3dB exchange rate means that for every 3 dB increase in sound intensity, the permissible listening time is cut in half. At 83 dB sound intensity, for example, permissible exposure time becomes 20 hours per week. Most gamers reported playing for an average of three hours per week.

Four of the five studies that examined the association between gaming and self-reported hearing loss or tinnitus indicated that this association was significant. Gaming center use also increased young people’s risk of reporting an inability to hear high-frequency sounds.

One study calculated that more than 10 million people in the U.S. may be exposed to loud or very loud sound levels while playing video or computer games. Another large study found that gaming was associated with increasing severity of self-reported hearing loss. A study that measured the sound levels of five video games reported that daily levels of sound exposure from these games is close to the maximum for permissible levels.

Some of the studies included in the analysis date back to the 1990s, and only two published in the last 10 years objectively measured average sound levels from video games or at gaming centers. More research is needed to develop interventions to prevent hearing loss and tinnitus among gamers and policy initiatives to promote wearing hearing protection while playing video games.

The study is published in BMJ Public Health.