Estimated prevalence of noise-induced hearing threshold shifts among children 6 to 19 years of age: the Third National Health and Nutrition Examination Survey, 1988-1994, United States

Accelerometer-Determined Physical Activity and Mortality in a National Prospective Cohort Study: Considerations by Hearing Sensitivity

BACKGROUND

Previous work demonstrates that hearing impairment and physical inactivity are associated with premature all-cause mortality. The purpose of this study was to discern whether increased physical activity among those with hearing impairment can produce survival benefits.

METHOD

Data from the 2003-2006 National Health and Nutrition Examination Survey were used, with follow-up through 2011. Physical activity was objectively measured over 7 days via accelerometry. Hearing sensitivity was objectively measured using a modified Hughson Westlake procedure.

RESULTS

Among the 1,482 participants, 152 died during the follow-up period (10.26%, unweighted); the unweighted median follow-up period was 89 months (interquartile range = 74-98 months). For those with normal hearing and after adjustments, for every 60-min increase in physical activity, adults had a 19% (HR [Hazard Ratio] = 0.81; 95% confidence interval [CI] [0.48-1.35]; p = .40) reduced risk of all-cause mortality; however, this association was not statistically significant. In a similar manner, physical activity was not associated with all-cause mortality among those with mild hearing loss (HR = 0.76; 95% CI [0.51-1.13]; p = .17). However, after adjustments, and for every 60-min increase in physical activity for those with moderate or greater hearing loss, there was a 20% (HR = 0.20; 95% CI [0.67-0.95]; p = .01) reduced risk of all-cause mortality.

CONCLUSION

Physical activity may help to prolong survival among those with greater hearing impairment.

Loudness and acoustic parameters of popular children's toys

OBJECTIVE

This project was conducted to evaluate the loudness and acoustic parameters of toys designed for children. In addition, we investigated whether occluding the toys' speaker with tape would result in a significant loudness reduction; thereby potentially reducing the risk of noise induced hearing loss.

METHODS

Twenty-six toys were selected after an initial screening at two national retailers. Noise amplitudes at 0.25, 0.5, 1, 2, 4, and 8kHz were measured using a digital sound level meter at a distance of 0 and 30cm. The toys' speakers were then occluded using adhesive tape and the same acoustic parameters were re-measured.

RESULTS

Mean maximum noise amplitude of the toys at 0cm and 30cm was 104dBA (range, 97-125dBA) and 76dBA (range, 67-86dBA), respectively. Mean maximum noise amplitude after occlusion at 0cm and 30cm distances was 88dBA (range, 73-110dBA) and 66dBA (range, 55-82dBA), respectively, with a p-value <0.001.

CONCLUSIONS

Proper use of the loudest toys at a distant of 30cm between the speaker and the child's ear will likely not pose a risk of noise-induced hearing loss. However, since most toys are used at closer distances, use of adhesive tape is recommended as an effective modification to decrease the risk of hearing loss.

Synaptopathy in the noise-exposed and aging cochlea: Primary neural degeneration in acquired sensorineural hearing loss

The classic view of sensorineural hearing loss (SNHL) is that the "primary" targets are hair cells, and that cochlear-nerve loss is "secondary" to hair cell degeneration. Our recent work in mouse and guinea pig has challenged that view. In noise-induced hearing loss, exposures causing only reversible threshold shifts (and no hair cell loss) nevertheless cause permanent loss of >50% of cochlear-nerve/hair-cell synapses. Similarly, in age-related hearing loss, degeneration of cochlear synapses precedes both hair cell loss and threshold elevation. This primary neural degeneration has remained hidden for three reasons: 1) the spiral ganglion cells, the cochlear neural elements commonly assessed in studies of SNHL, survive for years despite loss of synaptic connection with hair cells, 2) the synaptic terminals of cochlear nerve fibers are unmyelinated and difficult to see in the light microscope, and 3) the degeneration is selective for cochlear-nerve fibers with high thresholds. Although not required for threshold detection in quiet (e.g. threshold audiometry or auditory brainstem response threshold), these high-threshold fibers are critical for hearing in noisy environments. Our research suggests that 1) primary neural degeneration is an important contributor to the perceptual handicap in SNHL, and 2) in cases where the hair cells survive, neurotrophin therapies can elicit neurite outgrowth from spiral ganglion neurons and re-establishment of their peripheral synapses. This article is part of a Special Issue entitled .

Hearing in young adults. Part II: The effects of recreational noise exposure

Great concern arises from recreational noise exposure, which might lead to noise-induced hearing loss in young adults. The objective of the current study was to evaluate the effects of recreational noise exposure on hearing function in young adults. A questionnaire concerning recreational noise exposures and an audiological test battery were completed by 163 subjects (aged 18-30 years). Based on the duration of exposure and self-estimated loudness of various leisure-time activities, the weekly and lifetime equivalent noise exposure were calculated. Subjects were categorized in groups with low, intermediate, and high recreational noise exposure based on these values. Hearing was evaluated using audiometry, transient-evoked otoacoustic emissions (TEOAEs), and distortion-product otoacoustic emissions (DPOAEs). Mean differences in hearing between groups with low, intermediate, and high recreational noise exposure were evaluated using one-way analysis of variance (ANOVA). There were no significant differences in hearing thresholds, TEOAE amplitudes, and DPOAE amplitudes between groups with low, intermediate, or high recreational noise exposure. Nevertheless, one-third of our subjects exceeded the weekly equivalent noise exposure for all activities of 75 dBA. Further, the highest equivalent sound pressure levels (SPLs) were calculated for the activities visiting nightclubs or pubs, attending concerts or festivals, and playing in a band or orchestra. Moreover, temporary tinnitus after recreational noise exposure was found in 86% of our subjects. There were no significant differences in hearing between groups with low, intermediate, and high recreational noise exposure. Nevertheless, a long-term assessment of young adults’ hearing in relation to recreational noise exposure is needed.

The Efficacy of Routine Screening for High-Frequency Hearing Loss in Adults and Children

PURPOSE

This study was conducted to investigate the efficacy of routine screening for high-frequency hearing loss (HFHL) including 3000, 6000, and 8000 Hz frequencies with conventional test frequencies (1000, 2000, and 4000 Hz) in adults and children in a university outreach program.

METHOD

Screening outcomes were examined in 2 cohorts of adults (Cohort 1, N = 315, M = 66.2 years; Cohort 2, N = 67, M = 68.3 years) and children (Cohort 1, N = 177, M = 6.5 years; Cohort 2, N = 57, M = 6.9 years) with a high-frequency screen protocol (1000-8000 Hz at 25 dB HL for adults and 20 dB HL for children) using supra-aural headphones. A rescreen was conducted in Cohort 2 with a modified protocol using insert earphones and monitored ambient noise levels.

RESULTS

Average total test time significantly increased (p < .0001) and nearly doubled with inclusion of 3000-, 6000-, and 8000-Hz frequencies, adding approximately 1 min. Rescreen referral rates decreased by approximately 2%-16% at 1000-8000 Hz (approximately 13%-16% at 6000 and 8000 Hz) using the modified protocol in adults and children, supporting false-positive responses using supra-aural headphones.

CONCLUSION

Screening for HFHL should include insert earphones in order to prevent potential errors, particularly at 6000 and 8000 Hz.

Spatial learning and memory deficits in young adult mice exposed to a brief intense noise at postnatal age

Noise pollution is a major hazardous factor to human health and is likely harmful for vulnerable groups such as pre-term infants under life-support system in an intensive care unit. Previous studies have suggested that noise exposure impairs children's learning ability and cognitive performance and cognitive functions in animal models in which the effect is mainly attributed to the oxidant stress of noise on the cognitive brain. The potential role of noise induced hearing loss (NIHL), rather than the oxidant stress, has also been indicated by a depression of neurogenesis in the hippocampus long after a brief noise exposure, which produces only a tentative oxidant stress. It is not clear if noise exposure and NIHL during early development exerts a long term impact on cognitive function and neurogenesis towards adulthood. In the present study, a brief noise exposure at high sound level was performed in neonatal C57BL/6J mice (15 days after birth) to produce a significant amount of permanent hearing loss as proved 2 months after the noise. At this age, the noise-exposed animals showed deteriorated spatial learning and memory abilities and a reduction of hippocampal neurogenesis as compared with the control. The averaged hearing threshold was found to be strongly correlated with the scores for spatial learning and memory. We consider the effects observed are largely due to the loss of hearing sensitivity, rather than the oxidant stress, due to the long interval between noise exposure and the observations.

Occupational safety threats among dental personnel and related risk factors

Occupational diseases are primarily considered to be important health problems for individuals with occupations in heavy industry fields. Although dentists work in very clean and elegant offices, they are frequently exposed to various chemicals and high-intensity, sound-producing instruments, such as compressors and aerators. In our study, we aimed to investigate the risk for occupational hearing loss of dental personnel, by performing pure-tone audiometry in 40 dentists and comparing the results with those of healthy individuals. We also sampled the nasal mucosa to investigate the effects of occupational chemicals on the nasal mucosa of the dentists. The pure-tone audiometric thresholds at 5 different frequencies (1000, 2000, 4000, 6000, and 8000 Hz) and working time were evaluated as potential risk factors. The pure-tone audiometric results (as decibels) at each frequency and the median values for each side (right and left ears) were significantly higher for dentists than for the control group (P < 0.05). The pure-tone audiometric results did not significantly differ between the women and men in the study group (P > 0.05). The findings in the nasal mucosa (goblet cell hyperplasia, neutrophil/eosinophil/basophil distribution, metaplasia, dysplasia, premalignant or malignant cells) were similar in the study and control groups (P > 0.05). In conclusion, our study indicated that high-intensity, sound-producing equipment is an important occupational threat for dentists, whereas chemical agents have minimal hazardous effects.

Feasibility of a bilateral 4000-6000 Hz notch as a phenotype for genetic association analysis

OBJECTIVE

Noise-induced hearing loss (NIHL) is a worldwide health problem and a growing concern among young people. Although some people appear to be more susceptible to NIHL, genetic association studies lack a specific phenotype. We tested the feasibility of a bilateral 4000-6000 Hz audiometric notch as a phenotype for identifying genetic contributions to hearing loss in young adults.

DESIGN

A case-control-control study was conducted to examine selected SNPs in 52 genes previously associated with hearing loss and/or expressed in the cochlea. A notch was defined as a minimum of a 15-dB drop at 4000-6000 Hz from the previous best threshold with a 5-dB 'recovery' at 8000 Hz.

STUDY SAMPLE

Participants were 252 individuals of European descent taken from a population of 640 young adults who are students of classical music. Participants were grouped as No-notch (NN), Unilateral Notch (UN), or Bilateral Notch (BN).

RESULTS

The strongest evidence of a genetic association with the 4000-6000 Hz notch was a nonsynonymous SNP variant in the ESRR- gene (rs61742642:C> T, P386S). Carriers of the minor allele accounted for 26% of all bilateral losses.

CONCLUSION

This study indicates that the 4000-6000 Hz bilateral notch is a feasible phenotype for identifying genetic susceptibility to hearing loss.

The music listening preferences and habits of youths in Singapore and its relation to leisure noise-induced hearing loss

INTRODUCTION

Noise-induced hearing loss (NIHL) is a preventable condition, and much has been done to protect workers from it. However, thus far, little attention has been given to leisure NIHL. The purpose of this study is to determine the possible music listening preferences and habits among young people in Singapore that may put them at risk of developing leisure NIHL.

METHODS

In our study, the proportion of participants exposed to > 85 dBA for eight hours a day (time-weighted average) was calculated by taking into account the daily number of hours spent listening to music and by determining the average sound pressure level at which music was listened to.

RESULTS

A total of 1,928 students were recruited from Temasek Polytechnic, Singapore. Of which, 16.4% of participants listened to portable music players with a time-weighted average of > 85 dBA for 8 hours. On average, we found that male students were more likely to listen to music at louder volumes than female students (p < 0.001). We also found that the Malay students in our study listened to louder music than the Chinese students (p < 0.001).

CONCLUSION

We found that up to one in six young persons in Singapore is at risk of developing leisure NIHL from music delivered via earphones. As additional risks due to exposure to leisure noise from other sources was not taken into account, the extent of the problem of leisure NIHL may be even greater. There is a compelling need for an effective leisure noise prevention program among young people in Singapore.

Cost of care for subjective tinnitus in relation to patient satisfaction

OBJECTIVE

A consistent management algorithm for subjective tinnitus remains to be elucidated. Chronic tinnitus yields approximately US$2110 in annual health care costs per patient. However, it is unclear whether spending more in the management of tinnitus equates with greater patient satisfaction. Thus, the aim of this study is to correlate patient satisfaction with patient demographics, provider recommendations, and total health care-related expenditures.

STUDY DESIGN

A retrospective chart review and a patient satisfaction questionnaire.

SETTING

All data were collected from a large Midwestern hospital.

SUBJECTS AND METHODS

Patients were included who presented to the tinnitus clinic during the year 2011 and were between the ages of 18 and 89 years. They were excluded with diagnoses of Ménière's disease, pulsatile tinnitus, acoustic neuromas, or autoimmune inner ear diseases. The retrospective data and satisfaction surveys were entered by 3 of the authors. Responses were based on Likert scales.

RESULTS

Of the 692 patients included, 230 completed and returned the satisfaction questionnaire (33.2% response rate), yielding an overall mean of $662.60 charges. The frequency of intervention recommendations per patients ranged from 0 to 13, with a median of 4. Spearman's correlations did not result in significant correlations between patient satisfaction and number of clinic visits (P=.499) or associated charges (P=.453).

CONCLUSION

Given that the variability among provider recommendations, the high overall mean of tinnitus-related charges, and patient satisfaction was not related to costs, further research is needed examining patient preference in the treatment of tinnitus.

Protection from noise-induced hearing loss with Src inhibitors

Noise-induced hearing loss is a major cause of acquired hearing loss around the world and pharmacological approaches to protecting the ear from noise are under investigation. Noise results in a combination of mechanical and metabolic damage pathways in the cochlea. The Src family of protein tyrosine kinases could be active in both pathways and Src inhibitors have successfully prevented noise-induced cochlear damage and hearing loss in animal models. The long-term goal is to optimize delivery methods into the cochlea to reduce invasiveness and limit side-effects before human clinical testing can be considered. At their current early stage of research investigation, Src inhibitors represent an exciting class of compounds for inclusion in a multifaceted pharmacological approach to protecting the ear from noise.

Auditory risk estimates for youth target shooting

OBJECTIVE

To characterize the impulse noise exposure and auditory risk for youth recreational firearm users engaged in outdoor target shooting events. The youth shooting positions are typically standing or sitting at a table, which places the firearm closer to the ground or reflective surface when compared to adult shooters.

DESIGN

Acoustic characteristics were examined and the auditory risk estimates were evaluated using contemporary damage-risk criteria for unprotected adult listeners and the 120-dB peak limit suggested by the World Health Organization (1999) for children.

STUDY SAMPLE

Impulses were generated by 26 firearm/ammunition configurations representing rifles, shotguns, and pistols used by youth. Measurements were obtained relative to a youth shooter's left ear.

RESULTS

All firearms generated peak levels that exceeded the 120 dB peak limit suggested by the WHO for children. In general, shooting from the seated position over a tabletop increases the peak levels, LAeq8 and reduces the unprotected maximum permissible exposures (MPEs) for both rifles and pistols. Pistols pose the greatest auditory risk when fired over a tabletop.

CONCLUSION

Youth should utilize smaller caliber weapons, preferably from the standing position, and always wear hearing protection whenever engaging in shooting activities to reduce the risk for auditory damage.

Current office-based hearing screening questions fail to identify adolescents at risk for hearing loss

OBJECTIVE

There is a rising prevalence of hearing loss among adolescents in the United States. Current paediatric preventive care recommendations by the Bright Futures guidelines and the American Academy of Pediatrics suggest that clinicians should ask adolescents ten hearing screening questions to identify those who are at high risk of hearing loss for further objective hearing testing. We assessed the utility of these subjective risk assessment questions to distinguish those adolescents with objectively documented hearing loss.

SETTING

A single public high school in Pennsylvania.

METHODS

We compared results from a prospective study evaluating objective hearing assessments with the use of the ten Bright Futures hearing screening questions plus additional adolescent-specific questions to predict adolescent hearing loss.

RESULTS

In relation to the questions used in this study, adolescents who were referred following objective hearing screens were more likely to report "trouble following the conversation when two or more people are talking at the same time" and a "past experience of slight hearing loss". Referrals from sound treated booth testing were more likely to report "trouble hearing over the phone" and have a diagnosis or history of hearing loss.

CONCLUSIONS

Most Bright Futures questions were not associated with adolescent hearing loss. An objective adolescent hearing screen should be considered in the recommended schedule of preventive care, instead of the current risk-based subjective assessment.

Association between accelerometer-assessed physical activity and objectively measured hearing sensitivity among U.S. adults with diabetes

PURPOSE

The purpose of this study was to examine the association between objectively measured physical activity and hearing sensitivity among a nationally representative sample of U.S. adults with diabetes.

METHOD

Data from the 2003-2006 National Health and Nutrition Examination Survey were used. One hundred eighty-four U.S. adults with diabetes wore an ActiGraph 7164 accelerometer and had their hearing function objectively assessed. A negative binomial logistic regression was used to examine the association between moderate-to-vigorous physical activity (MVPA) and hearing sensitivity. RESULTS were adjusted for age, gender, race/ethnicity, education, body mass index, comorbidity index, marital status, cotinine, homocysteine, high-density lipoprotein cholesterol, glycohemoglobin (HbA1c), C-reactive protein, microalbuminuria, noise exposure, and vision impairment.

RESULTS

Compared to those with hearing within normal limits, results showed that participants with mild hearing loss and moderate or greater hearing loss, respectively, engaged in 93% fewer minutes of MVPA (incident rate ratio = 0.07; 95% CI [0.01, 0.60]) and 94% fewer minutes of MVPA (incident rate ratio = 0.06; 95% CI [0.01, 0.54]).

CONCLUSION

Adults with diabetes who have greater hearing impairment are less physically active. Future research is needed to determine the direction of causality.

Personally Modifiable Risk Factors Associated with Pediatric Hearing Loss: A Systematic Review

BACKGROUND

Pediatric hearing loss is an increasingly recognized problem with significant implications. Increasing our quantitative understanding of potentially modifiable environmental risk factors for hearing loss may form the foundation for prevention and screening programs.

OBJECTIVE

To determine whether specific threshold exposure levels of personally modifiable risk factors for hearing loss have been defined, with the overarching goal of providing actionable guidance for the prevention of pediatric hearing loss.

DATA SOURCES

A systematic review was performed. Computerized searches of PubMed, EMBASE, and the Cochrane Library were completed and supplemented with manual searches.

REVIEW METHODS

Inclusion/exclusion criteria were designed to determine specific threshold values of personally modifiable risk factors on hearing loss in the pediatric population. Searches and data extraction were performed by independent reviewers.

RESULTS

There were 38 criterion-meeting studies, including a total of 50,651 subjects. Threshold noise exposures significantly associated with hearing loss in youth included: (1) more than 4 hours per week or more than 5 years of personal headphone usage, (2) more than 4 visits per month to a discotheque, and (3) working on a mechanized farm. Quantified tobacco levels of concern included any level of in utero smoke exposure as well as secondhand exposure sufficient to elevate serum cotinine.

CONCLUSIONS

Specific thresholds analyses are limited. Future studies would ideally focus on stratifying risk according to clearly defined levels of exposure, in order to provide actionable guidance for children and families.

Risky music listening, permanent tinnitus and depression, anxiety, thoughts about suicide and adverse general health

OBJECTIVE

To estimate the extent to which exposure to music through earphones or headphones with MP3 players or at discotheques and pop/rock concerts exceeded current occupational safety standards for noise exposure, to examine the extent to which temporary and permanent hearing-related symptoms were reported, and to examine whether the experience of permanent symptoms was associated with adverse perceived general and mental health, symptoms of depression, and thoughts about suicide.

METHODS

A total of 943 students in Dutch inner-city senior-secondary vocational schools completed questionnaires about their sociodemographics, music listening behaviors and health. Multiple logistic regression analyses were used to examine associations.

RESULTS

About 60% exceeded safety standards for occupational noise exposure; about one third as a result of listening to MP3 players. About 10% of the participants experienced permanent hearing-related symptoms. Temporary hearing symptoms that occurred after using an MP3 player or going to a discotheque or pop/rock concert were associated with exposure to high-volume music. However, compared to participants not experiencing permanent hearing-related symptoms, those experiencing permanent symptoms were less often exposed to high volume music. Furthermore, they reported at least two times more often symptoms of depression, thoughts about suicide and adverse self-assessed general and mental health.

CONCLUSIONS

Risky music-listening behaviors continue up to at least the age of 25 years. Permanent hearing-related symptoms are associated with people's health and wellbeing. Participants experiencing such symptoms appeared to have changed their behavior to be less risky. In order to induce behavior change before permanent and irreversible hearing-related symptoms occur, preventive measurements concerning hearing health are needed.

Insult-induced adaptive plasticity of the auditory system

The brain displays a remarkable capacity for both widespread and region-specific modifications in response to environmental challenges, with adaptive processes bringing about the reweighing of connections in neural networks putatively required for optimizing performance and behavior. As an avenue for investigation, studies centered around changes in the mammalian auditory system, extending from the brainstem to the cortex, have revealed a plethora of mechanisms that operate in the context of sensory disruption after insult, be it lesion-, noise trauma, drug-, or age-related. Of particular interest in recent work are those aspects of auditory processing which, after sensory disruption, change at multiple—if not all—levels of the auditory hierarchy. These include changes in excitatory, inhibitory and neuromodulatory networks, consistent with theories of homeostatic plasticity; functional alterations in gene expression and in protein levels; as well as broader network processing effects with cognitive and behavioral implications. Nevertheless, there abounds substantial debate regarding which of these processes may only be sequelae of the original insult, and which may, in fact, be maladaptively compelling further degradation of the organism's competence to cope with its disrupted sensory context. In this review, we aim to examine how the mammalian auditory system responds in the wake of particular insults, and to disambiguate how the changes that develop might underlie a correlated class of phantom disorders, including tinnitus and hyperacusis, which putatively are brought about through maladaptive neuroplastic disruptions to auditory networks governing the spatial and temporal processing of acoustic sensory information.

Pilot study of a high-frequency school-based hearing screen to detect adolescent hearing loss

OBJECTIVE

Like most of the United States, school-based hearing screening in Pennsylvania focuses on low-frequency, conductive hearing losses typical for young children, rather than the high-frequency, noise-induced hearing loss more prevalent among adolescents. The objective of this study was to compare the sensitivity and specificity of current school hearing screening in Pennsylvania with hearing screening including high frequencies, designed to detect adolescent hearing loss.

SETTING

A single public high school.

METHODS

In the Autumn of 2011 the high-frequency screen was delivered alongside the Pennsylvania school screen for students in the 11(th) grade. Screening referrals and a subset of passes returned for "gold standard" testing with audiology in a sound treated booth, in order to determine the sensitivity and specificity of the screening tests.

RESULTS

Of 282 participants, five (2%) were referred on the Pennsylvania school screen, and 85 (30%) were referred on the high-frequency screen. Of the 48 who returned for gold standard testing with audiology, hearing loss was diagnosed in 9/48 (19%). Sensitivity of the Pennsylvania and high-frequency screens were 13% (95% confidence interval [CI] 0-53%) and 100% (95% CI 66-100%) respectively. Specificity of the Pennsylvania and high-frequency screens were 97% (95% CI 87-100%) and 49% (95% CI 32-65%) respectively.

CONCLUSIONS

Current school hearing screens have low sensitivity for detection of adolescent hearing loss. Modifying school-based protocols may be warranted to best screen adolescents, and make optimal use of school nurse time and effort.

FVB/NJ mice demonstrate a youthful sensitivity to noise-induced hearing loss and provide a useful genetic model for the study of neural hearing loss

The hybrid mouse diversity panel (HMDP), a panel of 100 strains, has been employed in genome wide association studies (GWAS) to study complex traits in mice. Hearing is a complex trait and the CBA/CaJ mouse strain is a widely used model for age-related hearing loss (ARHI) and noise induced hearing loss (NIHL). The CBA/CaJ strain's youthful sensitivity to noise and limited age-related loss led us to attempt to identify additional strains segregating a similar phenotype for our panel. FVB/NJ is part of the HMDP and has been previously described as having a similar ARHI phenotype to CBA/CaJ. For these reasons, we have studied the FVB/NJ mouse for ARHI and NIHL phenotypes in hopes of incorporating its phenotype into HMDP studies. We demonstrate that FVB/NJ exhibits ARHI at an earlier age than CBA/CaJ and young FVB/NJ mice are vulnerable to NIHL up until 10 to 12 weeks. This suggests that FVB/NJ may be used as an additional genetic model for neural forms of progressive hearing loss and for the study of youthful sensitivity to noise.

Variability of state school-based hearing screening protocols in the United States

The prevalence of hearing loss has increased among United States children. As schools commonly perform hearing screens, we sought to contrast current United States school-based hearing screening protocols. State department of health and education websites were reviewed to assess school hearing screening protocols for the fifty states and the District of Columbia. Individuals listed on these websites were contacted as necessary to confirm and/or acquire relevant data. School-based hearing screening is currently required in 34/51 (67 %) states. Of these 34 states, 28 (82 %) mandate grades for screening, but only 20 (59 %) require screening beyond 6th grade. Pure tone audiometry is the most common screening method (33/34 [97 %]). A majority of states screen at 1, 2 and 4 kHz usually at 20 or 25 dB hearing level. Six states recommend or require testing at 6 or 8 kHz, which is necessary to detect high-frequency hearing loss. The results indicate that United States school-based hearing screens vary significantly. They focus on low frequencies with few testing adolescents for whom high-frequency hearing loss has increased. Disparities in hearing loss detection are likely, particularly considering the evolution of hazardous noise exposures and rising prevalence of hearing loss.

Multi-criteria anomaly detection in urban noise sensor networks

The growing concern of citizens about the quality of their living environment and the emergence of low-cost microphones and data acquisition systems triggered the deployment of numerous noise monitoring networks spread over large geographical areas. Due to the local character of noise pollution in an urban environment, a dense measurement network is needed in order to accurately assess the spatial and temporal variations. The use of consumer grade microphones in this context appears to be very cost-efficient compared to the use of measurement microphones. However, the lower reliability of these sensing units requires a strong quality control of the measured data. To automatically validate sensor (microphone) data, prior to their use in further processing, a multi-criteria measurement quality assessment model for detecting anomalies such as microphone breakdowns, drifts and critical outliers was developed. Each of the criteria results in a quality score between 0 and 1. An ordered weighted average (OWA) operator combines these individual scores into a global quality score. The model is validated on datasets acquired from a real-world, extensive noise monitoring network consisting of more than 50 microphones. Over a period of more than a year, the proposed approach successfully detected several microphone faults and anomalies.

Assessment of Noise Exposure to Children: Considerations for the National Children's Study

Evidence has been accruing to indicate that young children are vulnerable to noise in their physical environment. A literature review identified that, in addition to hearing loss, noise exposure is associated with negative birth outcomes, reduced cognitive function, inability to concentrate, increased psychosocial activation, nervousness, feeling of helplessness, and increased blood pressure in children. While increasing attention has been given to the health effects of noise in children, research about noise exposure is sparse and often the measure of exposure is simply proximity to a noise source. The U.S. National Children's Study (NCS) provides a unique opportunity to investigate noise exposures to pregnant women and children using a number of assessment modalities at different life stages. Measurement of noise levels in homes and other environments, personal dosimetry measurements made over a period of days, and questionnaires addressing sources of noise in the environment, annoyance to noise, perceived noise level, use of head phones and ear buds, noisy activity exposures, and occupational exposures, are planned for evaluation within the NCS Vanguard pilot study. We describe the NCS planned approach to addressing noise exposure assessment in study visits over a child's lifetime.

The risk of hearing loss in a population with a high prevalence of chronic suppurative otitis media

BACKGROUND

Chronic suppurative otitis media (CSOM) affects 65-330 million people in the developing part of the world and develops in early childhood. Knowledge of the long-term effects on hearing is scarce. Hearing loss (HL) can cause reduced ability to communicate, impair language development and academic skills.

OBJECTIVE

To estimate the prevalence of HL in a population with a high-risk of CSOM and to identify the risk of permanent hearing loss from CSOM.

METHODS

Ten and 15 years follow-up of two Greenlandic population-based children cohorts. Participants underwent otologic examination and audiometric evaluation. HL was defined using both the American Speech-Language-Hearing Association's (ASHA) and the World Health Organizations's (WHO) definition. Risk factors for HL were analyzed, using binomial logistic regression analysis.

RESULTS

A total of 438 individuals aged 11-24 years participated. Using the ASHA definition of HL the prevalence was 50% (95% CI 45.3-54.7). Using the WHO definition of HL the prevalence was 2.5% (95% CI 1.1-3.98). CSOM was the main cause of HL. Co-existing CSOM (OR 16.7, 95% CI 8.29-33.65), spontaneous healing from CSOM (OR 3.75, 95% CI 1.62-8.67), and male gender (OR 2.2, 95% CI 1.28-3.78) were associated with HL. Ninety-one percent of children with CSOM developed a permanent hearing loss >15dBHL.

CONCLUSION

CSOM was strongly associated with permanent hearing loss. CSOM was the main reason for HL in this population. The WHO definition of hearing loss is likely to underestimate the burden of hearing loss among children and adolescents in developing countries with a high prevalence of CSOM.

Association between accelerometer-assessed sedentary behavior and objectively-measured hearing sensitivity in older US adults

OBJECTIVE

To examine the association between sedentary behavior and hearing sensitivity among a nationally representative sample of older US adults.

METHODS

Data from the 2003-2006 NHANES study was used, with 682 older adults (≥ 55 years) included in the study. Participants wore an ActiGraph 7164 accelerometer to measure sedentary behavior and hearing sensitivity was objectively measured in a sound-isolating room.

RESULTS

After adjustments, and comparisons to those with moderate or greater hearing loss, participants 65 years and older with hearing within normal limits (coefficient=-0.07; 95% CI: -0.12 to -0.01) engaged in less sedentary behavior; participants with mild hearing loss (coefficient=0.02; 95% CI: -0.01-0.07) did not differ in sedentary behavior than those with moderate or greater hearing loss. Sedentary behavior was not associated with hearing among those 55 and older.

CONCLUSIONS

Adults 65 and older with hearing in normal limits engage in less sedentary behavior than their counterparts with moderate or greater hearing loss. Evaluation and implementation of strategies to limit sedentary behaviors among older adults with greater hearing impairment, in particular, are needed.

Epidemiology of noise-induced tinnitus and the attitudes and beliefs towards noise and hearing protection in adolescents

Background and objectives

Previous research showed an increase of noise-induced symptoms in adolescents. Permanent tinnitus as a consequence of loud music exposure is usually considered as noise-induced damage. The objective was to perform an epidemiological study in order to obtain prevalence data of permanent noise-induced tinnitus as well as temporary tinnitus following noise exposure in a young population. In addition the attitudes and beliefs towards noise and hearing protection were evaluated in order to explain the use/non-use of hearing protection in a young population.

Methods

A questionnaire was completed by 3892 high school students (mean age: 16.64 years old, SD: 1.29 years). The prevalence of temporary and permanent tinnitus was assessed. In addition the ‘Youth Attitudes to Noise Scale’ and the ‘Beliefs About Hearing Protection and Hearing Loss’ were used in order to assess the attitudes and beliefs towards noise and hearing protection respectively.

Results

The prevalence of temporary noise-induced tinnitus and permanent tinnitus in high school students was respectively 74.9% and 18.3%. An increasing prevalence of temporary tinnitus with age was present. Most students had a ‘neutral attitude’ towards loud music and the use of hearing protection was minimal (4.7%). The limited use of hearing protection is explained by a logistic regression analysis showing the relations between certain parameters and the use of hearing protection.

Conclusions

Despite the very high prevalence of tinnitus in such a young population, the rate of hearing protection use and the knowledge about the risks of loud music is extremely low. Future preventive campaigns should focus more on tinnitus as a warning signal for noise-induced damage and emphasize that also temporary symptoms can result in permanent noise-induced damage.

Assessment of knowledge of harmful effects and exposure to recreational music in college students of delhi: a cross sectional exploratory study

Exposure to loud sounds results in a mild to profound degree of temporary or permanent hearing loss. Though occupational noise exposure remains the most commonly identified cause of noise-induced hearing loss, potentially hazardous noise can be encountered during recreational activities. Unfortunately not much attention is being given to the increasing trend of prolonged exposure to noisy environment, in the younger generation of Indians. The purpose of our study was to know the knowledge of college students about the harmful effects of loud music, prevailing practices with regard to exposure to recreational music and the subjective effects that this exposure is causing if any. Cross Sectional survey of College Students (n = 940), from randomly selected colleges of Delhi University. Majority of students listened to music using music-enabled phones; earphones were preferred and 56.6 % participants listened to music on a loud volume. Effects experienced due to loud sound were headache (58 %), inability to concentrate (48 %), and ringing sensation in the ear (41.8 %). Only 2.7 % respondents used ear protection device in loud volume settings. Twenty-three percent respondents complained of transient decreased hearing and other effects after exposure to loud music. 83.8 % knew that loud sound has harmful effect on hearing but still only 2.7 % used protection device. The survey indicates that we need to generate more such epidemiological data and follow up studies on the high risk group; so as to be able to convincingly sensitize the Indian young generation to take care of their hearing and the policy makers to have more information and education campaigns for this preventable cause of deafness.

Accelerometer-assessed physical activity and objectively determined dual sensory impairment in US adults

OBJECTIVE

To examine the association between hearing and vision impairment (with the focus on dual sensory impairment) and accelerometer-assessed physical activity (PA) in a national sample of US adults because limited research has examined this association.

PATIENTS AND METHODS

Data from the cross-sectional 2003-2006 National Health and Nutrition Examination Survey were used. The data were evaluated between May 28, 2012, and March 27, 2013. To assess moderate- to vigorous-intensity PA, participants wore an accelerometer for at least 4 days. Hearing and visual acuity were objectively measured in the mobile examination center. After exclusions, 1445 participants provided complete data on the study variables. A negative binomial regression was used to examine the association between PA and dual sensory impairment.

RESULTS

After adjusting for age, sex, race/ethnicity, education, body mass index, comorbidity index, cotinine level, C-reactive protein level, number of valid days of accelerometry, and accelerometer wear time, there was evidence of joint effects of vision and hearing on PA (incident rate ratio, 0.45; 95% CI, 0.29-0.68), indicating that participants experiencing both vision and hearing loss participated in less PA than would be expected based on their individual effects.

CONCLUSION

Adults with dual sensory impairment may be at increased risk for decreased PA. Possible strategies include, but are not limited to, teaching the patient how to make modifications to their indoor and outdoor environments, encouraging patients to engage in balance and resistance training, and advocating changes to public and private institutions to address common concerns.

Estimation of permanent noise-induced hearing loss in an urban setting

The potential burden of noise-induced permanent threshold shift (NIPTS) in U.S. urban settings is not well-characterized. We used ANSI S3.44-1996 to estimate NIPTS for a sample of 4585 individuals from New York City (NYC) and performed a forward stepwise logistic regression analysis to identify predictors of NIPTS >10 dB. The average individual is projected to develop a small NIPTS when averaged across 1000-4000 Hz for 1- to 20-year durations. For some individuals, NIPTS is expected to be substantial (>25 dB). At 4000 Hz, a greater number of individuals are at risk of NIPTS from MP3 players and stereos, but risk for the greatest NIPTS is for those with high occupational and episodic nonoccupational (e.g., power tool use) exposures. Employment sector and time spent listening to MP3 players and stereos and participating in episodic nonoccupational activities associated with excessive noise levels increased the odds of NIPTS >10 dB at 4000 Hz for 20-year durations. Our results indicate that the risk of NIPTS may be substantial for NYC and perhaps other urban settings. Noise exposures from "noisy" occupational and episodic nonoccupational activities and MP3 players and stereos are important risk factors and should be a priority for public health interventions.

Hearing Conservation Program for Marching Band Members: A Risk for Noise-Induced Hearing Loss?

Purpose

To examine the risk for noise-induced hearing loss (NIHL) in university marching band members and to provide an overview of a hearing conservation program for a marching band.

Method

Sound levels during band rehearsals were recorded and audiometric hearing thresholds and transient otoacoustic emission were measured over a 3-year period. Musician's earplugs and information about hearing loss were provided to the students. The hearing thresholds of other college students were tested as a partial control.

Results

There were no significant differences in hearing thresholds between the two groups. During initial testing, more marching band members showed apparent high-frequency notches than control students. Follow-up hearing tests in a subsequent year for the marching band members showed that almost all notches disappeared. Persistent standard threshold shift (STS) across tests was not observed in the band members.

Conclusion

Band members showed no evidence of STS or persistent notched audiograms. Because accepted procedures for measuring hearing showed a lack of precision in reliably detecting early NIHL in marching band members, it is recommended that signs of NIHL be sought in repeated measurements compared to baseline audiograms rather than in a single measure (a single notch). A hearing conservation program for this population is still recommended because of lengthy rehearsal times with high sound-level exposure during rehearsals.

Systematic Assessment of Noise Amplitude Generated by Toys Intended for Young Children

Objective

To systematically evaluate the noise generated by toys targeted for children and to compare the results over the course of 4 consecutive holiday shopping seasons.

Study Design

Experimental study.

Setting

Academic medical center.

Subjects and Methods

During 2008-2011, more than 200 toys marketed for children older than 6 months were screened for loudness. The toys with sound output of more than 80 dBA at speaker level were retested in a soundproof audiometry booth. The generated sound amplitude of each toy was measured at speaker level and at 30 cm away from the speaker.

Results

Ninety different toys were analyzed. The mean (SD) noise amplitude was 100 (8) dBA (range, 80-121 dBA) at the speaker level and 80 (11) dBA (range, 60-109 dBA) at 30 cm away from the speaker. Eighty-eight (98%) had more than an 85-dBA noise amplitude at speaker level, whereas 19 (26%) had more than an 85-dBA noise amplitude at a 30-cm distance. Only the mean noise amplitude at 30 cm significantly declined during the studied period ( P < .001). There was no significant difference in mean noise amplitude of different toys specified for different age groups.

Conclusion

Our findings demonstrate the persistence of extremely loud toys marketed for very young children. Acoustic trauma from toys remains a potential risk factor for noise-induced hearing loss in this age group, warranting promotion of public awareness and regulatory considerations for manufacture and marketing of toys.

Effect of recreational noise exposure on hearing impairment among teenage students

Several studies have focused on the potential impact of children's hearing loss on learning and development. Recently, numerous teenage students have been found to be fond of listening to music on personal devices and participating in recreational music activities. The objective of this study was to investigate teenage students' hearing impairment, their experience with recreational noise exposure, and their self-reported hearing. The participants were 1878 first-year students at a university in Taiwan. The result of the pure tone audiometry test showed that 11.9% of the participants had one or two ears with a hearing threshold over 25 dB. Over the past year, approximately 80.9% of the participants had taken part in at least one loud-noise recreational activity, and 90.9% of the participants were in the habit of using earphones. Among the participants, 190 students with a high level of recreational noise exposure were assigned to the exposure group, and 191 students with a low level of recreational noise exposure constituted the control group. The exposure group had more hearing problems than the control group, but no significant difference existed between the two groups in the pure tone audiometry test (p=0.857). It is suggested that the schools should reinforce hearing health education and proactively provide intervention measures, such as hearing tests, evaluation of noise exposure, and hearing protection.

The prevention of noise induced hearing loss in children

Increasingly, our acoustic environment is filled with amplified sound sources (e.g., MP3 players, video game stations, and sports/entertainment venues). There is serious concern and also some controversy about the risks of acoustic trauma in children. This overview provides some basic information on the physiological mechanisms that lead to noise induced hearing loss, a survey of various studies that, on balance, indicates that there is cause for concern, and finally a discussion on measures that can help to prevent noise induced hearing loss in children. This paper is designed for public health and other healthcare professions (ENT, audiologists, family doctors, and pediatricians) who should understand the risks of noise induced hearing loss and its prevention.

"Epic Ear Defence"-A Game to Educate Children on the Risks of Noise-Related Hearing Loss

Hearing loss resulting from overexposure to entertainment-related sounds is a modern concern. "Epic Ear Defence" places the player in the three-dimensional environment of the ear canal and challenges the player to defend the ear from various noises, to delay the onset of noise-related hearing loss.

Promoting Hearing Loss Prevention in Audiology Practice

An audiologist should be the principal provider and advocate for all hearing loss prevention activities. Many audiologists equate hearing loss prevention with industrial audiology and occupational hearing conservation programs. However, an audiologist’s involvement in hearing loss prevention should not be confined to that one particular practice setting. In addition to supervising occupational programs, audiologists are uniquely qualified to raise awareness of hearing risks, organize public health campaigns, promote healthy hearing, implement intervention programs, and monitor outcomes. For example, clinical audiologists can show clients how to use inexpensive sound level meters, noise dosimeters, or phone apps to measure noise levels, and recommend appropriate hearing protection. Audiologists should identify community events that may involve hazardous exposures and propose strategies to minimize risks to hearing. Audiologists can help shape the knowledge, beliefs, motivations, attitudes, and behaviors of individuals toward self-protection. An audiologist has the education, tools, opportunity, and strategic position to facilitate or promote hearing loss surveillance and prevention services and activities. This article highlights real-world examples of the various roles and substantial contributions audiologists can make toward hearing loss prevention goals.

Noise-induced changes in cochlear compression in the rat as indexed by forward masking of the auditory brainstem response

The current study was undertaken to investigate changes in forward masking patterns using on-frequency and off-frequency maskers of 7 and 10 kHz probes in the Sprague-Dawley rat. Off-frequency forward masking growth functions have been shown in humans to be non-linear, while on-frequency functions behave linearly. The non-linear nature of the off-frequency functions is attributable to active processing from the outer hair cells, and was therefore expected to be sensitive to noise-induced cochlear damage. For the study, nine Sprague-Dawley rats' auditory brainstem responses (ABRs) were recorded with and without forward maskers. Forward masker-induced changes in latency and amplitude of the initial positive peak of the rats' auditory brainstem responses were assessed with both off-frequency and on-frequency maskers. The rats were then exposed to a noise designed to induce 20-40 dB of permanent threshold shift. Twenty-one days after the noise exposure, the forward masking growth functions were measured to assess noise-induced changes in the off-frequency and on-frequency forward masking patterns. Pre-exposure results showed compressive non-linear masking effects of the off-frequency conditions on both latency and amplitude of the auditory brainstem response. The noise rendered the off-frequency forward masking patterns more linear, consistent with human behavioral findings. On- and off-frequency forward masking growth functions were calculated, and they displayed patterns consistent with human behavioral functions, both prior to noise and after the noise exposure.

Are parents aware of their children's hearing complaints?

The accuracy of parents' impressions about their child's hearing status is variable and may not correspond to the child's complaints.

Aim

To investigate children's self-reported hearing symptoms and parents' impressions about it.

Methods

477 children (2^nd to 5^th grades of elementary schools) were interviewed and parents answered a survey at home. There were 393 matches between the children's interview and the parent's survey.

Results

29% of the children reported trouble in understanding what people said, 36.1% had history of 1-3 ear infections, 12.7% had four or more ear infections, 21.7% had continuous tinnitus (positive association with history of exposure to loud sounds, p = 0.0007), 3.8% had pulsatile tinnitus and 2.9% had auditory hallucinations. 28.5% of the children were annoyed by loud sounds (associated with tinnitus, p = 0.0142, and gender, p = 0.0029) 10.4% had had audiological tests, and the determinant factors were history of ear infections (p < 0.001) and parents' concern about their child's hearing (p = 0.043). Parents and their own child's responses were significantly different.

Conclusions

Children's auditory complaints were prevalent and relevant, but most of them had never had an audiological evaluation and most parents were not aware of their child's complaints. Sound intolerances and auditory hallucinations should be considered in clinical and audiological examinations.

Prevention of communication disorders--screening pre-school and school-age children for problems with hearing, vision and speech: European Consensus Statement

Background

Communication is an integral part of human behaviour. Communication disorders are associated mainly with impairment in hearing, vision, and/or speech, which influences the ability to receive, comprehend, produce, and express verbal, nonverbal, and graphic information. When unrecognized and unmanaged, these very often “invisible” conditions can have a significant detrimental effect on a child’s development, affecting educational, social, and psychological progress.

Material/Methods

A panel of experts discussed the screening of pre-school and school-age children for problems with hearing, vision, and speech during the 10^th Congress of the European Federation of Audiology Societies (EFAS), held in Warsaw, Poland, on 22 June, 2011.

Results

The European Consensus Statement on Hearing, Vision, and Speech Screening in Pre-School and School-Age Children was the result of the scientific discussions. It was endorsed by experts in audiology, otolaryngology, phoniatry, ophthalmology, and speech language pathology from throughout Europe^*. Key elements of the consensus, as described herein, are: 1) defining the role of screening programmes in the identification and treatment of communication disorders; 2) identifying the target population; 3) promoting general awareness about the consequences of communication disorders; 4) recognizing the need for a quality control system in screening programmes; 5) encouraging cooperation among European countries to provide a high level of public health services for the prevention, identification, and treatment of communication disorders.

Conclusions

The European Consensus Statement on Hearing, Vision, and Speech Screening in Pre-School and School-Age Children will encourage the appropriate authorities of the various countries involved to initiate screening for communication disorders in pre-school and school-age children.

Association Between Cardiorespiratory Fitness and Hearing Sensitivity

Purpose

As a follow-up to previous smaller scale studies, the purpose of the present study was to examine the link between cardiorespiratory fitness and hearing sensitivity using a nationally representative U.S. sample of adults.

Method

Data from the 1999–2004 National Health and Nutrition Examination Survey (NHANES; U.S. Centers for Disease Control and Prevention [CDC], 2011) were used in the analyses. After exclusions, the final sample included 1,082 NHANES participants ages 20–49 years. Maximum oxygen uptake (VO 2max ) was obtained from an established nonexercise prediction equation and through heart-rate extrapolation during a treadmill-based submaximal test. Audiometry data were objectively measured to obtain estimates of low (LPTA) and high (HPTA) pure-tone frequency average.

Results

VO 2max was not associated with hearing sensitivity when using the heart-rate extrapolation method but was significantly associated with hearing sensitivity (for women) when applying the nonexercise prediction equation for both LPTA and HPTA ( p < .01). Women with higher predicted cardiorespiratory fitness were 6% more likely than women with lower predicted cardio-respiratory fitness to have good hearing compared to worse hearing.

Conclusion

Cardiorespiratory fitness was associated with hearing sensitivity when using the nonexercise prediction equation to measure VO 2max . Further studies are needed to confirm these findings. Findings suggest a potentially auditory-protective effect of cardiorespiratory fitness.

Audiometric thresholds among a Canadian sample of 10 to 17 year old students

A total of 237 students, 10 to 17 years of age, from 14 schools underwent hearing evaluations. Otoscopic examination, tympanometry and air-conduction pure tone audiometry was conducted at low (0.5, 1, 2 kHz) and high (4 and 8 kHz) frequencies. In all schools, hearing thresholds were measured with headphones in a portable audiometric booth. Socio-demographic information from students and their parents were collected using questionnaires. Overall, the prevalence of any hearing loss greater than 15 dB was 22.3% for low or high frequency pure tone averages. Self-reported symptoms of hearing loss, such as tinnitus, difficulty following a conversation with background noise, and having to turn up the TV/radio more than in the past, were associated with audiometric thresholds, most notably at 4 kHz. These study findings are among the first to provide a detailed characterization of hearing status in a sample of youth in a Canadian demographic.

Noise-induced hearing threshold shift among US adults and implications for noise-induced hearing loss: National Health and Nutrition Examination Surveys

The objective of this study was to estimate the prevalence and evaluate the associated risk factors of the noise-induced hearing threshold shift (NITS) in the US adult population based on the National Health and Nutrition Examination Surveys (NHANES). The study population consisted of 5,418 individuals aged 20-69 years who had complete audiologic data from the NHANES database. Stringent criteria were used to define NITS. Prevalence of unilateral, bilateral, and total NITS and their association with several socio-demographic and hearing-related factors were evaluated. The prevalence of unilateral, bilateral, and total NITS was 9.4, 3.4 and 12.8%, respectively. Prevalence of bilateral NITS was higher in subjects with older age, male gender, white (non-Hispanic) and Hispanic ethnicities, education level less than or equal to high school diploma, married/living with partner status, Mexico as country of birth, service in armed forces, smoking history, diabetes, and different kinds of noise exposure. Odds of NITS were only higher in older people, males, and smokers. This study provides comprehensive information on the prevalence of NITS in the US adult population and its associated risk factors. More targeted interventions may be done for educational, preventative, and screening purposes.