Academic medical organizations have traditionally resisted the decades-long loosening of American gun-control laws. Since at least the 1980s, they have been uniformly hostile to the very idea of gun ownership. They take this position despite the fact that this freedom is enshrined in our history and in the U.S. Constitution. By doing so, they have strayed from their mission of treating people.
In view of this history, it is encouraging and perhaps even surprising that the national specialty society of ear, nose and throat surgeons—the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS)—has adopted an official position statement endorsing firearm suppressors (silencers) for hearing preservation.
The position statement was authored by seven subject-matter experts, all of whom are board-certified ear, nose and throat surgeons. Four of these people are also fellowship-trained neurotologists, sub-specialists who operate only on the ear and the base of the skull. And one of them is a former president of the prestigious American Otological Society—a group that is three years older than the National Rifle Association. The position statement on suppressors was vetted by two AAO-HNS committees before being submitted to the Academy’s board of directors, who gave final approval to the position statement last November.
The AAO-HNS position statement grew out of a 2017 publication of Doctors for Responsible Gun Ownership that described the pathology of noise-induced hearing loss resulting from gunshot-impulse noise exposure. It describes the damage done to the delicate so-called hair cells of the inner ear hearing organ (cochlea). This white paper called for making firearm suppressors readily available to the public. In the seven years since that report, suppressors have only grown in popularity among American shooters. This has occurred despite the fact that some in the federal government and some state government officials have discouraged or banned their use.
Another society of hearing professionals, the Academy of Doctors of Audiology, issued its own official statement with a May 1, 2023, letter to two congressional sponsors of the Hearing Protection Act (HPA). The HPA would remove the federal barriers to suppressor ownership and use. In supporting the passage of the HPA, the audiologists note: “The use of conventional hearing protection (earplugs, earmuffs) is essential for preventing NIHL [noise-induced hearing loss] in firearm users. However, conventional hearing protection alone does not always offer adequate protection from noise exposure. Firearm noise suppressors can be an effective supplement to traditional hearing protection.”
When they perform the precise hearing test called an audiogram, an audiologist sees every patient with hearing loss from gunshot noise the ENT doctor sees. A typical audiogram of a long-time shooter will show the “4k notch,” a drop in hearing in the high frequencies at and adjacent to 4,000 Hertz. The consonant sounds of speech, such as the letter “t” and “p” and “s” and “f,” are in this area of the frequency range. Hearing words with those sounds mixed up is often the first effect of noise-induced hearing loss. With more noise exposure, the problem gets worse. If the noise exposure is repeated and long-standing, the final result is devastating hearing loss in almost all the frequencies.
Over a career, an ear specialist typically sees many patients with permanent inner-ear hearing loss from firearm-muzzle blast noise, whether from occupational exposure, hunting or target shooting. There is no treatment for such hearing loss other than hearing aids. Research cited in the AAO-HNS position statement shows that a firearm suppressor reduces the ear-splitting impulse noise of a gunshot by as much as 30 decibels (dB). To be clear, that’s not enough by itself to come close to eliminating the loud noise. But when a suppressor is used with ear-level hearing protection, such as ear muffs or plugs, the noise can be reduced to safe levels.
Firearms produce a very loud sound signature over a time interval of a few milliseconds, called impulse noise. One of the articles cited in support of the AAO-HNS position statement is a research paper written by one of the statement’s authors, Matthew Branch, MD, published in the AAO-HNS’s own academic journal, Otolaryngology-Head and Neck Surgery. Dr. Branch used a sound meter and microphone combination calibrated with Military-Standard 1474D placement protocol. Unsuppressed handgun rounds (9 mm and .45 ACP) and rifle rounds (.223 and .308) were fired, producing sound levels between 155 and 170 dB. When the same-caliber rounds were fired through suppressed guns, Dr. Branch found a reduction in sound levels at the shooter’s ear of around 30 dB, depending on the caliber fired. According to the Occupational Safety and Health Administration, 140 dB is the safe threshold of impulse-noise exposure, so it’s clear that suppressed firearms bring the level of most firearms in common use down close to the limit of safe noise exposure.
Ear muffs and plugs typically are advertised as reducing sound levels by 30 dB. But for several reasons, often including faulty positioning by the shooter, they generally provide less protection. Still, it’s clearly beneficial to provide further protection than what the suppressor can achieve by simply adding ear muffs and ear plugs, when possible, for maximum protection. Remember, once hearing is lost from loud noise exposure, there’s no getting it back.
Further complicating the picture is the fact that damaging noise can enter the inner ear through a route other than the ear canal. Sound is normally conducted into the inner ear through the ear canal via the ear drum and three tiny bones, the malleus, incus and stapes. It is this sound transmitted through this route that ear muffs and plugs can reduce before it damages the inner ear. But gun shots are strong enough that the vibrations are also conducted directly through the bone of the skull into the inner ear, bypassing the ear canal and ear drum.
A 10-year longitudinal study from the National Taiwan University Hospital showed that police officers using both ear plugs and muffs while engaging in regular target shooting experienced inner-ear hearing damage over a 10-year period. This suggests that conduction of loud noise directly into the inner ear via the bone of the skull can produce hearing loss, since it bypasses the protection afforded by plugs and muffs.
Because suppressors reduce the loud muzzle-blast noise at its source, they also reduce that portion of noise that would otherwise reach the inner ear by bone conduction. As a Centers for Disease Control and Prevention (CDC) research study put it: “The only potentially effective noise control method to reduce [shooters’] noise exposure from gunfire is through the use of noise suppressors that can be attached to the end of the gun barrel.”
Hiram Percy Maxim is credited with inventing the firearm suppressor and the automobile muffler in the early 1900s. The suppressor is a cylindrical accessory attached to the muzzle of a firearm by threaded connection, or it can be manufactured integrated into the muzzle. Inside the cylinder is a series of baffles and intervening spaces that deflect, cool and slow the hot gases’ exit from the barrel. The effect is to reduce the sound pressure level of the muzzle blast and its loudness as perceived by the ear.
The public-health value of suppressors to protect the hearing of hunters, firearm hobbyists and competitive shooters should be uncontroversial. Suppressors have been proven to help prevent an untreatable disability, and therefore are the very definition of a public-health tool. As it is, they are traditionally demonized on the basis of movie and television fantasies about shady gangsters and assassins. That’s one reason why the federal government still, after nearly a century, discourages their use with heavy taxes and piles of red tape.
To get permission to buy what should be a widely available consumer item, one must submit an application to the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) with fingerprints and passport photos, pay the $200 “transfer” tax and notify the local police chief or other licensing official. Once approved, the applicant enjoys the distinction of having her personal information entered into a national registry.
The National Firearms Act of 1934, the law requiring these hurdles, was passed at a time when organized crime was rampant. Still, according to a 2007 historical analysis in the Western Criminology Review by Paul A. Clark, the reasons for harsh penalties for “silencers” are obscure:
In 1934, the federal government began to regulate machine guns, sawed-off shotguns and silencers by placing a $200 tax on such weapons to discourage their sale (U.S. Congress, 1986b:219-220). The 1934 congressional debates provide no explanation about why silencers were licensed. Paulson (1996:10) opines that during the Great Depression, poaching game was thought to be a problem and silencers were licensed because of this concern.
Clark’s in-depth historical investigation of numerous state and federal criminal cases reveals decisions based on fear and bias, rather than tangible harm done to real persons. One California appeals court “… blithely declared that ‘A silencer is used only for killing other human beings’ (People v. Pen, 2004).” He notes that some judges, seeing the disproportionately harsh statutory penalties for a crime with no victim or any remote threat to society, have tried to soften sentences accordingly. In summary, Clark found no logical reason for the severity of punishments for suppressor possession and use. Further, he found the use of suppressors in crime to be rare.
Whatever the historical reasons for such burdensome regulations, 42 states now recognize the simple but precious value of suppressors. Many countries in Europe impose few if any regulations on purchasing, owning and using suppressors. The American Suppressor Association notes that since its inception in 2011, three states have legalized suppressor ownership, and nineteen have made them legal for hunting. But the holdouts are: California, Delaware, Hawaii, Illinois, Massachusetts, New Jersey, New York and Rhode Island plus the District of Columbia. Each of these states makes it a crime to attach a muffler to your gun to protect your hearing and the hearing of others.
The persistence of these restrictive laws is fueled by ignorance of how suppressors are used in real life. The myths perpetuated by bad guys in spy thriller movies have outlived their credibility. According to the National Shooting Sports Foundation, the number of suppressors registered in the U.S. increased from 1.3 million in 2017 to 2.66 million in May 2021 and shot up to 4.86 million and counting as of July 2024.
But those prohibitory laws soon may be in jeopardy, to the great benefit of America’s gun owners. Just as one state after another since the early 2000s has eliminated licensing requirements for carrying self-defense firearms, suppressors have now become just another useful firearm accessory in most of America. Monthly magazines for sport shooters and hunters now regularly feature splashy advertisements for suppressors, something never seen before the last decade or so.
With the new makeup of both houses of Congress, we are likely to see a revival of the dormant Hearing Protection Act (HPA). If the HPA is passed and suppressors are finally deregulated under federal law, that would leave only the few restrictive states and the District of Columbia claiming to protect the public from a largely imaginary threat of criminals with suppressor-equipped guns. As more people see through the myth, more states should be compelled to repeal their anti-public-health suppressor bans.
In the legislative hearings likely to come, as the HPA is newly debated, the AAO-HNS’s wise endorsement of suppressors will be powerful supporting evidence. This is truly a case where policymakers should follow the science.
Timothy Wheeler is a retired ear, nose and throat surgeon and the past director of Doctors for Responsible Gun Ownership.
