If you're spending hours with your headphones blasting attack sounds, theme songs, and your friend's weird battle cries into your ears, you might be at risk of permanent hearing damage.

Sound is a major part of the video game experience for many, but we don't know much about what gaming does to our hearing. Studies into this are few and far between, but a team of researchers has rounded them up to see what we know so far.

Their systematic review identified 14 unique papers, which together involved over 50,000 people from nine different countries, all with a focus on the relationship between hearing loss and/or tinnitus and video games.

The research spans a variety of gaming circumstances, including home computers and consoles, mobile games, gaming centers, and eSports.

It's not just about turning the volume down. Both loudness and exposure time factor into the impact noise can have on your ears. As sound intensity increases, the safe exposure time drops drastically. So a three hour gaming session with the volume cranked can cause far more permanent damage than a 15-minute stint at the same level.

Adults can safely endure sound levels of about 80dB for 40 hours a week, according to the World Health Organization. But at 90dB, the volume of a person shouting, that time limit drops to four hours a week before risking hearing loss. Our ears can only handle sounds of 95dB (sound of a motorcycle's engine) for an hour and 15 minutes.

So, it's a bit concerning that the average headphone volume in four shooting games was 88.5 to 91.2dB, according to one of the studies in the review.

Another paper found that impulse sounds – short, loud bursts of noise that might signal a shot or a crash – can peak at 119dB.

One study found over 10 million Americans may be exposed to 'loud' or 'very loud' sound levels from video games, and another reported that gaming use increased the odds of self-reported hearing loss severity.

Three papers with a focus on gaming centers reported sound levels of between 80 and 90dB, and two found these environments increased the odds of severe tinnitus and high-frequency sound hearing loss.

It's worth noting that in two of the three studies on gaming centers, the main sources of noise were arcade gaming systems. Those studies were published in 1992 and 1983, which, as the authors point out, limits their comparability to modern gaming – although arcades are still immensely popular among certain groups.

One paper on mobile gaming found the average sound level was 43.2dB, suggesting this form of gaming is less of a concern, at least for our ears.

"Gamers who are listening at high-intensity sound levels and for long periods of time may be at risk of permanent sound-induced hearing loss and/or tinnitus," the authors write.

Although the evidence so far is pretty limited, the research available so far ultimately points to gaming as a likely source of unsafe listening.

It appears that the volume levels some people (or venues) have their game sounds set to, combined with the amount of time many gamers play for, is generally enough to be doing some damage.

Aside from the general issues that come with hearing damage, these findings could have particular consequences for professional gamers, whose performance is as high-stakes as that of more traditional professional competitors, and who spend far more time gaming than your average person. Video gaming success is enormously dependent on reaction time, team communication, and instruction comprehension, all of which can often rely on hearing.

"The findings suggest that there may be a need to prioritize interventions, such as initiatives focused on education and awareness of the potential risks of gaming, that can help promote safe listening among gamers," the authors write.

This research was published in BMJ Public Health.