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Diners are getting an earful as well as a mouthful.

Noisy restaurants have become so common that medical experts are taking note.

“There definitely are many places I go where I can’t hear a thing. I can’t understand a person sitting across from me, just because the restaurant environment is too loud,” said Dr. Angela Shoup, an audiologist and director of communicative and vistibular disorders at the University of Texas Southwestern Medical Center.

A research journal that few diners see–Audiology Today–recently ran a story with this headline: “I’ll Have a Side Order of Earplugs, Please.”

The authors, two audiologists at the University of California at San Francisco, measured sound levels at several restaurants in the San Francisco area. They were disturbed by some findings. While diners may be merely annoyed, the study warned that restaurant workers could need “hearing-conservation programs.”

Leigh Montgomery and her fiance, Etienne Pelletier, were at Pappadeaux Seafood Kitchen in Dallas for lunch recently. Sometimes, “I don’t like coming here because it’s so loud,” Montgomery said. “People are screaming, and the music is blaring.”

The restaurant’s general manager, Greg Suetzer, said he and his employees have no trouble hearing each other over the background music and chattering customers. “It’s never that loud when you can hear another individual.”

Noise “has not been an issue” for the Texas Restaurant Association, said Michael Lyttle, a spokesman for the trade group. “There is going to be some noise inherent with the restaurant experience,” he said. “If you happen to be eating at a popular restaurant, there are going to be a lot of excited people talking at moderate volume.” And he knows of no problems where restaurant employees were concerned by noise or injured by it.

One problem at restaurants is that noise can beget more noise, said Dr. Jerry Northern, editor of Audiology Today and a past president of the American Academy of Audiology.

“When you’re in a noisy place, when you speak there is a reflex that makes your voice get louder. You can’t control that very well, so if you go to anything where there’s noise in the background, your voice automatically gets louder,” Northern said. “So take a person who goes into a noisy background, and they have to shout louder, and that adds to the overall din.”

A certain amount of noise can be necessary in the restaurant business, he said. “The restaurant owner is trying to find the correct balance of enough activity in a restaurant to create a nice ambience. They like the atmosphere of that. But that’s a hard thing to control, and it’s easy for them to go overboard with it.”

One of the nation’s biggest restaurant companies agrees.

Dallas-based Brinker International has had to tweak the noise levels at some of its properties in the past. Romano’s Macaroni Grill, for instance, was just too loud. Hard floors, high ceilings and a kitchen that opened onto the dining area created a clamor. Starting several years ago, Brinker added new materials to the ceiling for softer sound. The same technique is now commonly used at Brinker chains, including Chili’s.

“We’re not oblivious to noise, especially from the customers’ standpoint,” said company spokesman Tim Smith. “The level of concern on our part and the customer complaint level has gone down dramatically” with the changes, he said.

No company employee has ever filed a noise-related complaint, he said.

Phil Romano, who came up with the idea for Macaroni Grill, has spent much of his adult life creating restaurants. And he’s a defender of noise–to a point–saying loudness can create an atmosphere that people like.

While critics say noise can cut intimacy in dining, Romano sees the opposite. “People want some privacy. They want to go to a restaurant and tell a dirty joke or have an argument, and if there’s enough noise, you can do that. Same with the kids, if you need to scold them. If another table gets rowdy, that’s OK. There’s enough noise to cover it.”

Still, “the noise can’t be too great to interfere with the conversation at your table,” Mr. Romano said.

Nick & Sam’s, one of the restaurants Romano is involved in, was just too loud when it opened last year. “I was having a hard time talking with a table and listening to people. I’m getting older and a little hard of hearing. We brought the sound down by about 20 percent” by using some decorative ceiling tiles.

Those with hearing difficulties can have a particularly hard time in loud restaurants, said Lisa Tate, one of the audiologists who wrote the article in Audiology Today

“Background noise is a more extreme problem for people with hearing loss,” she said. “It’s more difficult for people with hearing aids — or people with hearing loss who don’t want hearing aids — to focus on the speech they want to focus on and ignore the background noise.”

The research for the article was really “a mini-study,” including five restaurants at peak hours, she said. “We would not call it conclusive.” The high-decibel rush hours don’t last a full shift for employees, so “there is not that much of a concern about the actual workers. If restaurant workers can take a break and rest their ears during their shift breaks and get to a quieter spot, that could help a lot.”

Shoup said she has never met a patient injured by restaurant noise. “A diner isn’t in that loud environment that long.” She does counsel patients with hearing problems to select restaurants carefully, so they’ll be better able to understand conversation. Good signs are carpeting, drapes and fabric on the walls, she said.