Personal audio systems (PAS) are a major source of harmful noise doses, especially for children, teenagers, and young adults, who typically listen many hours daily at volumes exceeding the globally recommended public health limit of 70 dBA LEQ24h. PAS users increase listening volume to overcome high ambient noise. Research shows that (1) PAS use among people aged 9 + is associated with permanent, progressive hearing health disabilities including tinnitus, hyperacusis, speech communication impairments, and noise-induced hearing loss (NIHL); i(2) auditory health risk is highest for personal listening 1 + hours daily at over 50% volume with 5 + years of exposure; (3) clinical measures demonstrate noise-induced neural or retrocochlear auditory processing disorders precede sensory or cochlear impairments; and (4) children are highest risk because auditory system maturation is incomplete and normal hearing health is vital for learning, socialization, and vocational potential. Acquired hearing loss is associated with increased risk of accidents, communication difficulties, social isolation, and health impairments, including dementia in later life. Public health hearing conservation policies are needed to prevent an imminent NIHL epidemic in younger generations, including PAS noise emission standards and public education on the dangers of PAS use and about safer listening behaviors.