Usage of personal music players in adolescents and its association with noise-induced hearing loss: A cross-sectional analysis of Ohrkan cohort study data

V. N. Auditory Spatial Perception as a Function of Recreational Noise Exposure in Gen-Z Adults with Normal Hearing

The study aimed to evaluate auditory spatial perception in individuals with and without recreational noise exposure using Virtual Acoustic Space Identification. A standard group comparison design using purposive sampling was conducted on 60 normal-hearing participants aged 18-30. They were divided into experimental and control groups based on their scores on the recreational hearing habits questionnaire (CHAR). The experimental group was exposed to recreational noise for at least 4 h per day, while the control group had no noise exposure. The procedure involved the administration of Virtual Acoustic Space Identification (VASI) at 65 dB SPL. Spatial perception was measured at eight spatial percepts within the head. Based on the confusion matrix, accuracy scores, reaction time at each virtual location, and the overall VASI score were calculated. The results indicate a significant difference in Front errors and Front-as-back errors in the two groups; people with recreational noise exposure had more errors in these spatial percepts. This indicates the differential impact of recreational noise on auditory spatial perception. The differences observed in the test can be attributed to the complexity of the auditory spatial perception task, the stimulus and the better sensitivity of the VASI in detecting spatial deficits. Recreational noise exposure affects spatial auditory perception, emphasizing the importance of mitigating recreational noise-related risks for auditory spatial skills.

'Cultural Insights into Adults' Hearing Awareness and Personal Listening Device Habits: A Survey Study

Objective

The aim of this study was to investigate adults' habits regarding personal listening devices (PLDs), associated factors such as tinnitus and hearing threshold shift, and their knowledge of safety measures, including the use of hearing protectors in noisy environments.

Design

A cross-sectional survey was designed and distributed online.

Study Sample

Participants between the ages of 18 and 40 years were invited to complete the survey. The online survey was filled out by 274 individuals with an average age of 24.2 years (SD= 5.1 years). Based on age, the participants were grouped into young adults (18-23 years old, 151 participants) and adults (24-40 years old, 123 participants). The estimation of noise exposure was calculated based on self-reported responses of PLD use. Two categories emerged from this calculation: the participants with exposure lower than 80 dB were in the low exposure category (N: 196, 62.9 dB), while the participants with exposure higher than 80 dB were in the high exposure category (N: 78, 89.9 dB).

Results

Based on the age categories, most of the questionnaire answers were similar between the young adults and the adults, revealing similar habits in using their PLDs. However, the investigation based on exposure revealed differences, as the participants with high exposure levels were more likely to have hobbies that involved noise, and they were less likely to obtain hearing evaluations. Among the participants, 30% used their devices at the maximum volume level and on a daily basis. 33.5% reported experiencing worsening in hearing, 2.4% reported persistent tinnitus, 94.1% knew that hearing protectors were available but only 20.7% reported using hearing protectors.

Conclusion

The study concludes that adults are at risk of hearing loss due to unsafe listening habits. A discrepancy between knowledge and practice is apparent and needs to be addressed in young adults by increasing awareness of hearing loss, hearing protection and annual hearing evaluation.

Risk analysis of noise-induced hearing loss of workers in the automobile manufacturing industries based on back-propagation neural network model: a cross-sectional study in Han Chinese population

OBJECTIVES

This study aims to predict the risk of noise-induced hearing loss (NIHL) through a back-propagation neural network (BPNN) model. It provides an early, simple and accurate prediction method for NIHL.

DESIGN

Population based, a cross sectional study.

SETTING

Han, China.

PARTICIPANTS

This study selected 3266 Han male workers from three automobile manufacturing industries.

PRIMARY OUTCOME MEASURES

Information including personal life habits, occupational health test information and occupational exposure history were collected and predictive factors of NIHL were screened from these workers. BPNN and logistic regression models were constructed using these predictors.

RESULTS

The input variables of BPNN model were 20, 16 and 21 important factors screened by univariate, stepwise and lasso-logistic regression. When the BPNN model was applied to the test set, it was found to have a sensitivity (TPR) of 83.33%, a specificity (TNR) of 85.92%, an accuracy (ACC) of 85.51%, a positive predictive value (PPV) of 52.85%, a negative predictive value of 96.46% and area under the receiver operating curve (AUC) is: 0.926 (95% CI: 0.891 to 0.961), which demonstrated the better overall properties than univariate-logistic regression modelling (AUC: 0.715) (95% CI: 0.652 to 0.777). The BPNN model has better predictive performance against NIHL than the stepwise-logistic and lasso-logistic regression model in terms of TPR, TNR, ACC, PPV and NPV (p<0.05); the area under the receiver operating characteristics curve of NIHL is also higher than that of the stepwise and lasso-logistic regression model (p<0.05). It was a relatively important factor in NIHL to find cumulative noise exposure, auditory system symptoms, age, listening to music or watching video with headphones, exposure to high temperature and noise exposure time in the trained BPNN model.

CONCLUSIONS

The BPNN model was a valuable tool in dealing with the occupational risk prediction problem of NIHL. It can be used to predict the risk of an individual NIHL.

Associations Between Recreational Noise Exposure and Hearing Function in Adolescents and Young Adults: A Systematic Review

PURPOSE

There is an increasing concern regarding hazardous recreational noise exposure among adolescents and young adults. Daily exposure to loud sound levels over a long period of time can increase the risk of noise-induced hearing loss. The full extent of the impact of recreational noise on hearing is not yet fully understood. The purpose of this review was to synthesize research that investigated hearing function in relation to recreational noise exposure in adolescents and young adults.

METHOD

A systematic literature search of five databases covering the years 2000-2023 was performed. The articles included investigated audiological measurements of hearing function in relation to recreational noise exposure.

RESULTS

Four hundred sixty records were identified, of which 20 met the inclusion criteria and were included in the results. This review showed that although some recreational noise activities can be potentially harmful, there is an unclear relationship between exposure and outcome. Some findings indicated hearing threshold shifts or reduced otoacoustic emission amplitudes after recreational noise exposure, but most changes were short term and in the extended high-frequency range.

CONCLUSIONS

There seemed to be inconsistencies regarding the utilization of methods of measuring exposure and outcome between studies. This might be one reason for the differing results in studies on the reported impact on hearing function from recreational noise exposure. To draw more certain conclusions about long-term effects, there is a need for longitudinal research that utilizes sound level measurements to assess low and high degrees of recreational noise exposure in relation to hearing function.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25114193.

Global, Regional, and National Burdens of Hearing Loss for Children and Adolescents from 1990 to 2019: A Trend Analysis

This study presents a comprehensive analysis of global, regional, and national trends in the burden of hearing loss (HL) among children and adolescents from 1990 to 2019, using data from the Global Burden of Disease study. Over this period, there was a general decline in HL prevalence and years lived with disability (YLDs) globally, with average annual percentage changes (AAPCs) of -0.03% (95% uncertainty interval [UI], -0.04% to -0.01%; p = 0.001) and -0.23% (95% UI, -0.25% to -0.20%; p < 0.001). Males exhibited higher rates of HL prevalence and YLDs than females. Mild and moderate HL were the most common categories across all age groups, but the highest proportion of YLDs was associated with profound HL [22.23% (95% UI, 8.63%-57.53%)]. Among females aged 15-19 years, the prevalence and YLD rates for moderate HL rose, with AAPCs of 0.14% (95% UI, 0.06%-0.22%; p = 0.001) and 0.13% (95% UI, 0.08%-0.18%; p < 0.001). This increase is primarily attributed to age-related and other HL (such as environmental, lifestyle factors, and occupational noise exposure) and otitis media, highlighting the need for targeted research and interventions for this demographic. Southeast Asia and Western Sub-Saharan Africa bore the heaviest HL burden, while High-income North America showed lower HL prevalence and YLD rates but a slight increasing trend in recent years, with AAPCs of 0.13% (95% UI, 0.1%-0.16%; p < 0.001) and 0.08% (95% UI, 0.04% to 0.12%; p < 0.001). Additionally, the analysis revealed a significant negative correlation between sociodemographic index (SDI) and both HL prevalence (r = -0.74; p < 0.001) and YLD (r = -0.76; p < 0.001) rates. However, the changes in HL trends were not significantly correlated with SDI, suggesting that factors beyond economic development, such as policies and cultural practices, also affect HL. Despite the overall optimistic trend, this study emphasizes the continued need to focus on specific high-risk groups and regions to further reduce the HL burden and enhance the quality of life for affected children and adolescents.

The validity of using a self-report single question as a means to detect hearing loss in an adolescent population

OBJECTIVE

The overall objective in the study was to compare self-reported hearing based on a single question ("how good would you currently rate your hearing?") to measure hearing loss determined by audiometry in a cohort of adolescents. Prevalence of audiometrically measured hearing loss and frequencies of self-reported poor hearing as well as factors that have an impact on self-reported hearing were examined.

DESIGN

Baseline and 5-year follow-up data of the Ohrkan study were used. Participants filled in a questionnaire and underwent audiometric measurements.

STUDY SAMPLE

Data from 979 adolescents were analysed. Participants were 54.7% female and aged between 13 and 18 years at baseline and 17-21 years at 5-yr follow-up.

RESULTS

The single question on self-reported hearing ability achieved a sensitivity of 41.9% and a positive predictive value of 7.1% at baseline. For the 5-yr follow-up, sensitivity was 40.0%, positive predictive value was 13.9%. Factors influencing self-reported poor hearing were gender, tinnitus, "muffled" ears after exposure to loud noise (e.g. after a concert) and low-frequency hearing loss.

CONCLUSIONS

The single question about hearing ability used in the Ohrkan study is not sufficient to replace audiometry to detect hearing loss as defined in the study in adolescents.

Leisure noise exposure and hearing outcomes among Canadians aged 6 to 79 years

OBJECTIVE

To examine the association between individual and cumulative leisure noise exposure in addition to acceptable yearly exposure (AYE) and hearing outcomes among a nationally representative sample of Canadians.

DESIGN

Audiometry, distortion-product otoacoustic emissions (DPOAEs) and in-person questionnaires were used to evaluate hearing and leisure noise exposure across age, sex, and household income/education level. High-risk cumulative leisure noise exposure was defined as 85 dBA or greater for 40 h or more per week, with AYE calculations also based on this occupational limit.

STUDY SAMPLE

A randomised sample of 10,460 respondents, aged 6-79, completed questionnaires and hearing evaluations between 2012 and 2015.

RESULTS

Among 50-79 year olds, high-risk cumulative leisure noise was associated with increased odds of a notch while high exposure to farming/construction equipment noise was associated with hearing loss, notches and absent DPOAEs. No associations with hearing loss were found however, non-significant tendencies observed included higher mean hearing thresholds, notches and hearing loss odds.

CONCLUSION

Educational outreach and monitoring of hearing among young and middle-aged populations exposed to hazardous leisure noise would be beneficial.

Prevalence and global estimates of unsafe listening practices in adolescents and young adults: a systematic review and meta-analysis

INTRODUCTION

This study aimed to determine the prevalence of unsafe listening practices from exposure to personal listening devices (PLDs) and loud entertainment venues in individuals aged 12-34 years, and to estimate the number of young people who could be at risk of hearing loss from unsafe listening worldwide.

METHODS

We conducted a systematic review and meta-analysis to estimate the prevalence of unsafe listening practices from PLDs and loud entertainment venues. We searched three databases for peer-reviewed articles published between 2000 and 2021 that reported unsafe listening practices in individuals aged 12-34 years. Pooled prevalence estimates (95% CI) of exposed populations were calculated using random effects models or ascertained from the systematic review. The number of young people who could be at risk of hearing loss worldwide was estimated from the estimated global population aged 12-34 years, and best estimates of exposure to unsafe listening ascertained from this review.

RESULTS

Thirty-three studies (corresponding to data from 35 records and 19 046 individuals) were included; 17 and 18 records focused on PLD use and loud entertainment venues, respectively. The pooled prevalence estimate of exposure to unsafe listening from PLDs was 23.81% (95% CI 18.99% to 29.42%). There was limited certainty (p>0.50) in our pooled prevalence estimate for loud entertainment venues. Thus, we fitted a model as a function of intensity thresholds and exposure duration to identify the prevalence estimate as 48.20%. The global estimated number of young people who could be at risk of hearing loss from exposure to unsafe listening practices ranged from 0.67 to 1.35 billion.

CONCLUSIONS

Unsafe listening practices are highly prevalent worldwide and may place over 1 billion young people at risk of hearing loss. There is an urgent need to prioritise policy focused on safe listening. The World Health Organization provides comprehensive materials to aid in policy development and implementation.

Threshold Equalizing Noise Test Reveals Suprathreshold Loss of Hearing Function, Even in the "Normal" Audiogram Range

Objectives:

The threshold equalizing noise (TEN(HL)) is a clinically administered test to detect cochlear “dead regions” (i.e., regions of loss of inner hair cell [IHC] connectivity), using a “pass/fail” criterion based on the degree of elevation of a masked threshold in a tone-detection task. With sensorineural hearing loss, some elevation of the masked threshold is commonly observed but usually insufficient to create a “fail” diagnosis. The experiment reported here investigated whether the gray area between pass and fail contained information that correlated with factors such as age or cumulative high-level noise exposure (>100 dBA sound pressure levels), possibly indicative of damage to cochlear structures other than the more commonly implicated outer hair cells.

Design:

One hundred and twelve participants (71 female) who underwent audiometric screening for a sensorineural hearing loss, classified as either normal or mild, were recruited. Their age range was 32 to 74 years. They were administered the TEN test at four frequencies, 0.75, 1, 3, and 4 kHz, and at two sensation levels, 12 and 24 dB above their pure-tone absolute threshold at each frequency. The test frequencies were chosen to lie either distinctly away from, or within, the 2 to 6 kHz region where noise-induced hearing loss is first clinically observed as a notch in the audiogram. Cumulative noise exposure was assessed by the Noise Exposure Structured Interview (NESI). Elements of the NESI also permitted participant stratification by music experience.

Results:

Across all frequencies and testing levels, a strong positive correlation was observed between elevation of TEN threshold and absolute threshold. These correlations were little-changed even after noise exposure and music experience were factored out. The correlations were observed even within the range of “normal” hearing (absolute thresholds ≤15 dB HL).

Conclusions:

Using a clinical test, sensorineural hearing deficits were observable even within the range of clinically “normal” hearing. Results from the TEN test residing between “pass” and “fail” are dominated by processes not related to IHCs. The TEN test for IHC-related function should therefore only be considered for its originally designed function, to generate a binary decision, either pass or fail.

Hearing loss symptoms and leisure noise exposure in university students in Barranquilla, Colombia

PURPOSE

The aim of this study was to investigate the total weekly exposure to leisure noise among university students and to assess its association with self-reported symptoms of hypoacusis.

METHODS

This is a cross-sectional survey. An online questionnaire based on the "Noise Exposure Questionnaire", plus 11 questions regarding hearing loss were sent to 730 randomly selected students. Participants self-reported time spent on different leisure noise activities and their subjective evaluation of the loudness of these activities, converted into equivalent noise levels, were used to estimate weekly noise exposure levels that were compared to occupational noise limits (> 85 dBA = hazardous). Inference statistics was applied to relate hearing symptoms and "likely or having some degree of hearing loss" with hazardous weekly leisure noise exposure levels.

RESULTS

Ninety-three percent of the participants reported at least one hypoacusis symptom. The most frequent sound-related ear symptom was tinnitus (72%). Fifty-five percent of the individuals presented weekly exposure to noise >85 dBA. Symptoms of hearing loss were more prevalent in those exposed to weekly noise levels >85 dBA.

CONCLUSION

This study suggests that there may be hearing loss caused by exposure to high levels of leisure noise in a large part of the study population. Health promotion of hearing conservation should be emphasized at university level. Objective repeated measurement of hearing acuity should be part of integral health services for the youth population.

Evaluation of Ergonomics-Related Disorders in Online Education Using Fuzzy AHP

The aim of the presented work is to analyze the ergonomics-related disorders in online education using the fuzzy AHP approach. A group dialogue with online education academicians, online education students, biotechnologists, and sedentary computer users has been performed to spot ergonomics-related disorders in online education. Totally eight ergonomics-related disorders in online education have been identified, and the weight of each disorder has been computed with triangle-shaped fuzzy numbers in pairwise comparison. Furthermore, the ergonomics-related disorders in online education are kept in four major categories such as afflictive disorders, specific disorders, psychosocial disorders, and chronic disorders. These four categories of ergonomics-related disorders in online education are evaluated and compared using fuzzy analytical hierarchical process methodology to get ranked in terms of priorities. The results may be instrumental for taking appropriate corrective actions to prevent ergonomics-related disorders.

Online, Asynchronous Hearing Education and Research Project for Ethnically Diverse Adolescents via Interprofessional Collaboration and Electronic Service-Learning During the COVID-19 Pandemic: A Pilot Study on the Needs and Challenges

Purpose This study discusses the creation of an online, asynchronous presentation to educate adolescents about prevention of noise-induced hearing loss (NIHL) through interprofessional collaborations and electronic service-learning (eSL) during the COVID-19 pandemic. Method The Hearing Education and Research (HEAR) presentation, which included activities and videos to educate a group of ethnically diverse adolescents (n = 100) on NIHL, was created by 11 doctor of audiology (AuD) students through online collaborations toward course-related eSL requirements. Adolescents responded to a baseline survey to assess hearing health-related behaviors prior to reviewing the presentation. A postprogram survey was administered 1 week after the presentation to assess change in knowledge and attitudes toward NIHL prevention. Online collaborations with schoolteachers helped with project implementation. Postreflection papers written by AuD students regarding the eSL activities were analyzed. Lastly, suggestions from a focus group of educators were included that highlight the role of interprofessional collaborations to enhance school-based hearing conservation opportunities. Results The HEAR presentation resulted in changes in knowledge about NIHL among the adolescents. Postreflection papers by the AuD students indicated that the eSL activity served as a high-impact pedagogical assignment, especially during the academic challenges of the pandemic. Feedback from a focus group of schoolteachers helped outline ideas for future implementation of sustainable hearing conservation programs in school settings. Conclusion The pilot data collected in this study serve as a proof of concept for future hearing conservation projects in school-based settings via interprofessional collaborations and by engaging university students via eSL.

Speech Recognition in Noise Using Binaural Diotic and Antiphasic Digits-in-Noise in Children: Maturation and Self-Test Validity

BACKGROUND

 Digits-in-noise (DIN) tests have become popular for hearing screening over the past 15 years. Several recent studies have highlighted the potential utility of DIN as a school-aged hearing test. However, age may influence test performance in children due to maturation. In addition, a new antiphasic stimulus paradigm has been introduced, allowing binaural intelligibility level difference (BILD) to be measured by using a combination of conventional diotic and antiphasic DIN.

PURPOSE

 This study determined age-specific normative data for diotic and antiphasic DIN, and a derived measure, BILD, in children. A secondary aim evaluated the validity of DIN as a smartphone self-test in a subgroup of young children.

RESEARCH DESIGN

 A cross-sectional, quantitative design was used. Participants with confirmed normal audiometric hearing were tested with a diotic and antiphasic DIN. During the test, arrangements of three spoken digits were presented in noise via headphones at varying signal-to-noise ratio (SNR). Researchers entered each three-digit spoken sequence repeated by the participant on a smartphone keypad.

STUDY SAMPLE

 Overall, 621 (428 male and 193 female) normal hearing children (bilateral pure tone threshold of ≤ 20 dB hearing level at 1, 2, and 4 kHz) ranging between the ages of 6 and 13 years were recruited. A subgroup of 7-year-olds (n = 30), complying with the same selection criteria, was selected to determine the validity of self-testing.

DATA COLLECTION AND ANALYSIS

 DIN testing was completed via headphones coupled to a smartphone. Diotic and antiphasic DIN speech recognition thresholds (SRTs) were analyzed and compared for each age group. BILD was calculated through subtraction of antiphasic from diotic SRTs. Multiple linear regressions were run to determine the effect of age on SRT and BILD. In addition, piecewise linear regressions were fit across different age groups. Wilcoxon signed-rank tests were used to determine differences between self- and facilitated tests.

RESULTS

 Age was a significant predictor, of both diotic and antiphasic DIN SRTs (p < 0.05). SRTs improved by 0.15 dB and 0.35 dB SNR per year for diotic and antiphasic SRTs, respectively. However, age effects were only significant up to 10 and 12 years for antiphasic and diotic SRTs, respectively. Age significantly (p < 0.001) predicted BILD, which increased by 0.18 dB per year. A small SRT advantage for facilitated over self-testing was seen but was not significant (p > 0.05).

CONCLUSIONS

 Increasing age was significantly associated with improved SRT and BILD using diotic and antiphasic DINs. DIN could be used as a smartphone self-test in young children from 7 years of age with appropriate quality control measures to avoid potential false positives.

Personal Music Players and Hearing Loss: The HUNT Cohort Study

It is unclear whether the current average use of personal music players (PMPs) including mobile phones has affected hearing in the general population. The association between the use of PMPs and hearing loss was assessed in a large population cross-sectional and follow-up study with the following distribution: cross-sectional (2018): n = 26,606, 56% women, mean age 54 years and 20-year follow-up (baseline 1998): n = 12,115, 57% women, mean age at baseline 43 years. Hearing threshold was determined as pure-tone average over the frequencies 3, 4, and 6 kHz. We used linear regression to assess relationships between hearing threshold and PMP use (yes), duration (1–2/2–6/>6 h per week), or sound volume (low/medium/high), with nonuse as reference. The PMP use increased from 8% in 1998 to 30% in 2018. Compared with nonusers, neither use nor duration was related to hearing threshold. As to sound volume, listening at low levels was associated with better thresholds (−2.5 dB [−4.1 to −0.8]), while listening at high levels was associated with worse thresholds (1.4 dB [0.1 to 2.8]). We adjusted for age, sex, baseline hearing threshold, education, noise exposure, ear infections, head injury, and daily smoking. The association with sound volume was nearly twice as strong when adjusting for hearing threshold at baseline. Accordingly, the possibility of reverse causality was reduced although not eliminated by the follow-up design. This large population study showed no association between normal PMP use and 20-year progression in hearing; however users listening to high levels increased their hearing threshold.

The Significance of Audiometric Notching in Individuals With a History of Noise Exposure: A Systematic Review

OBJECTIVES

The diagnosis of noise-induced hearing loss (NIHL) is reliant on the appraisal of audiometric data. A notch, dip or bulge, centered at the 4-kHz frequency is considered to be pathognomonic. However, guidelines applied to assist the diagnosis of NIHL often allow for a notch centered between the 3- and 6-kHz frequencies. The primary outcome of this review is to document the relationship between audiometric notching at particular frequencies and the populations in which they have been identified.

DESIGN

We included all population-based studies, cohort, cross-sectional, case-control, case-series, and case reports of adults and children, with exposure to noise and with a notch, dip or bulge. The review has been registered with Prospero (Registration: CRD42017079901) and prepared in line with the PRISMA guidelines.

RESULTS

We included 84 articles in the final systematic review. There were a total of 1,438,987 individuals, aged 7 to 80 years old. The studies were conducted in 26 different countries. Fourteen studies identified notching at 3 kHz, 63 studies identified notching at 4 kHz, and 47 studies identified notching at 6 kHz. The Newcastle-Ottawa risk assessment tool was performed on 82 of the studies emphasizing the high risk of bias in observational studies.

CONCLUSIONS

The overwhelming outcome of this systematic review demonstrates that the relationship between noise exposure and a 3- to 6-kHz audiometric notch is not straight-forward. A handful of articles have displayed a clear association between an individual's noise exposure and an audiometric notch. Unilateral notches, notches observed at 3 kHz and notches in the absence of continued high-intensity noise exposure must be scrutinized thoroughly. The ambiguous nature of NIHL directs its continued interest.

A smartphone application to objectively monitor music listening habits in adolescents : Personal listening device usage and the accuracy of self-reported listening habits

Background

Listening to music through personal listening devices (PLDs) has become more prevalent during last decades. The aim of this study was to evaluate music listening habits through PLDs in adolescents with a smartphone application, and to assess the accuracy of self-reported listening habits.

Methods

This study was embedded in the Generation R Study, a population-based prospective birth cohort in Rotterdam, the Netherlands. A smartphone application for Android operating systems was developed to objectively monitor music listening habits for a period of 35 days. A postal questionnaire was used to subjectively assess listening habits. The level of agreement between the objectively measured and self-reported listening habits were evaluated using weighted kappa coefficients. Data were collected from May 2017 to March 2019.

Results

A total of 311 adolescents aged 12 to 15 years were included, of whom 237 (76.2%) completed the postal questionnaire. The results of the smartphone application showed that the median listening frequency was 2.1 days a week (IQR 1.0–3.4), the median listening time 21.1 min a day (IQR 9.1–53.7), and the mean listening level 54.5% (SD 18.1%). There was a slight to fair agreement between the objectively measured, and self-reported listening habits according to the weighted kappa coefficients (k = 0.179 to 0.364).

Conclusions

The results of the current study suggest that self-reported measures of listening habits are not always accurate. We consider a smartphone application to monitor listening habits of added value in future research investigating the possible damaging effects of PLDs on hearing acuity.

Graphical abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s40463-020-00488-5.

Personal listening device usage among Canadians and audiometric outcomes among 6-29 year olds

OBJECTIVE

To describe personal listening device (PLD) usage and sociodemographic variables among a nationally representative sample of Canadians and examine audiometric outcomes among a subsample.

DESIGN

Audiometry and in-person questionnaires were used to evaluate hearing and PLD usage across age, sex, household income/education level. PLD exposure was quantified using a common occupational noise limit.

STUDY SAMPLE

A randomised sample of 10,460 respondents, aged 6-79, with audiometric analysis of a subsample (n = 4807), aged 6-29, tested between 2012 and 2015.

RESULTS

Loud PLD usage was reported by19.5% of Canadians. The highest prevalence was among teenagers (44.2%) and young adults (36.3%). Among children, 13.1% of users listened at loud volumes. High PLD usage (equivalent to or above 85 dBA, LEX 40) among 12-19 year olds was double that of 20-29 year olds: 10.2% versus 5.1%^E. Five years or more of loud PLD usage was associated with significantly higher mean hearing thresholds compared to less years. No association between loud or high PLD usage and mean thresholds were found.

CONCLUSION

The majority used PLDs safely, however a small proportion reported high risk usage which will impact hearing should this pattern persist over many years.

Personal Music Players Use and Other Noise Hazards among Children 11 to 12 Years Old

Exposure to loud music-due to widespread personal music players (PMPs) and noisy leisure activities-are major risk factors for noise induced hearing loss (NIHL) in adolescents. However, there is little evidence of the impact of noise on the hearing of younger children. This study aimed to explore an association between PMP use and hearing, and to identify other sources of noise among children. The study sample consisted of 1032 children aged 11-12 years old. Hearing thresholds were determined from 0.5 to 8 kHz. PMP use and other noise exposures were evaluated using a survey. We found that 82% of the children had a PMP, and 78% were exposed to noise when playing computer games. An audiometric notch was documented in 1.3% of the children. Only 11.5% of the children ever used hearing protection while engaged in noisy activities. We found no convincing evidence of an association between PMP use and hearing thresholds, although our results suggest that tinnitus may be an early sign of NIHL in young children. The study shows a need to provide children, their parents, and educators with knowledge of how to take care of hearing, including how to avoid and minimize noise exposure.

Consumer-Grade Headphones for Children: Limited Effectiveness of "Level Limiters" When Used With Portable or Home Media Players

Consumer-grade headphones for children are frequently packaged or marketed with labels claiming incorporation of an output-level-limiting function. Six pairs of headphones, sold separately from devices with audio interfaces, were selected either from online recommendations or from “best rated” with a large online retailer, the opinions being expressed in 2018 to early 2019. The acoustic outputs in response to an internationally standardized test signal were measured through the ears of a head-and-torso simulator and referenced to equivalent A-weighted diffuse-field sound pressure levels. The headphones were tested with a variety of music capable sources found in a domestic environment, such as a mobile phone, tablets, laptop computer, and a home “hi-fi” CD player. To maintain likely homogeneity of the audio interface, the computer-based platforms were manufactured by either Apple™ or certified Android devices. One of the two Bluetooth-linked headphones exhibited level limiting with low distortion (i.e., a compression ratio well in excess of unity). None of the devices wired directly to an audio output performed distortionless level limiting: “limiting” was implemented by a reduction of sensitivity or mechanical limitations, so could be called “soft limiting.” When driven by a laptop or CD player, some were still capable of producing output levels well in excess of “safe-listening” levels of 85 dB(A). Packaging labels were frequently ambiguous and imprecise.

Risk of noise-induced hearing loss due to recreational sound: Review and recommendations

This review was conducted to address three questions related to recreational sound exposure: (1) what criteria are used to determine noise exposure limits, (2) are there differences in the risk of hearing loss from occupational noise versus recreational sound, and (3) what is an appropriate exposure limit for recreational sound? For the first question, most standards specify an 8-h occupational noise exposure limit (L_EX) of 85 dBA. This limit assumes that some workers exposed at the limit will develop hearing loss. To eliminate the risk of hearing loss, a 24-h equivalent continuous level (L_EQ24h) limit of 70 dBA is appropriate. For the second question, there is some evidence that the effects of occupational noise on hearing may be worse than energetically equivalent recreational sound. Limits developed for noise are nevertheless applicable to recreational sound, and use of existing statistical models to predict hearing loss from recreational sound is appropriate, with the caveat that these models are limited to durations ≤40 years. For the third question, a recreational sound limit of 80 dBA L_EX, equivalent to a 75 dBA L_EQ24h, will virtually eliminate the risk of recreationally induced hearing loss in adults. Lower limits may be warranted for vulnerable or susceptible individuals.

Prevalence of loud leisure noise activities among a representative sample of Canadians aged 6-79 years

This population-based study estimates the prevalence of loud leisure noise exposure and hearing protection usage among Canadians, as well as the population potentially at-risk using an occupational limit of 85 dBA, LEX 40 h, which denotes a typical occupational noise limit for a 40 hour work week. A total of 10 460 participants, aged 6-79 years, completed a Canadian Health Measures Survey household questionnaire. Loud leisure noise was defined by vocal effort required while communicating at arm's length except for loud personal listening device (PLD) usage with earbuds/headphones, which included both volume setting and vocal effort. The most prevalent loud leisure noise activities were amplified music, car/home stereo listening, and power tools, with 40% reporting each source, followed by sporting/entertainment (25%), gasoline engines (23%), and loud PLD listening (19.5%). Loud leisure noise was more prevalent among 12-39 year olds and males. Hearing protection usage was uncommon, from 44.2% (firearms) to 20.3% (power tools) and below 3% during amplified music and sporting/entertainment events. Calculations using self-reported duration of loud leisure noise activities estimated that 6.6 × 10⁶ Canadians were in the high cumulative noise exposure category. A large proportion of Canadians would be expected to develop some degree of noise-induced hearing loss should this pattern persist over years.

Awareness, attitudes, and beliefs about music-induced hearing loss: Towards the development of a health communication strategy to promote safe listening

OBJECTIVE

Worldwide, 1.1 billion young people are at risk of developing hearing loss due to unsafe listening. The World Health Organization plans a global health campaign to promote behavior change. In an effort to develop effective evidence-based interventions, this study identifies modifiable factors that influence listening habits.

METHODS

Online survey among 1019 individuals aged 18-35. The questionnaire was based on theories of behavior change.

RESULTS

Individuals not contemplating change showed a lack of knowledge, tended not to feel particularly at risk, and did not see the benefits of preventive measures. Conversely, those considering a change perceived more barriers (e.g., lack of information on how to act,). Self-efficacy was shown to play an ambivalent role.

CONCLUSION

Four factors that can be influenced by a health communication intervention were identified: risk perception, perceived safe listening level due to a lack of symptoms, knowledge, and perceived benefits and barriers, in particular perceived loss of pleasure.

PRACTICE IMPLICATIONS

The first aspects can be influenced through health communication interventions. Influencing the perceived loss of pleasure additionally requires an analysis of competing pressures. To support and not exceedingly burden the individual, we further suggest to address environmental aspects (e.g., policies).

Epidemiology and gender differences in pediatric recreational and firearms noise exposure in the USA

OBJECTIVE

We aim to identify contemporary noise exposures and hearing protection use among U.S. children in a large, population-based study.

METHODS

Cross-sectional analysis of the 2014 National Health Interview Series was performed. Results from in-person interviews of families with children under 18 years of age in all 50 states were queried. Potentially harmful exposures to loud sounds and patterns of hearing protection use in the last 12 months were analyzed after representative sample weights were applied.

RESULTS

Among 73.4 million children, 18.4% (9.1 ± 0.4 million) (boys: 23.2%, girls: 13.5%; P < 0.001) were exposed to firearms noise, and 28.2% (20.7 ± 0.6 million) (boys: 30.5%, girls: 25.8%; P < 0.001) to firecrackers and other explosive sounds. Exposure to recreational "very-loud" noise exposure was more common (7.9%; 5.8 ± 0.3 million), consisting of music players (46.5%), fireworks (44.8%), lawnmowers (42.6%), and firearms (32.5%). However, only 17.1% of boys and 15.6% of girls, totaling 16.4% of all children, always used hearing protection during noise exposures.

CONCLUSION

Children in the United States are commonly exposed to firearms and recreational loud noises. Hearing protection is infrequently used, and gender disparities in patterns of exposure and use of hearing protection are prevalent. Those children and families at risk should be identified via public health initiatives and appropriately counseled by healthcare providers.

LEVEL OF EVIDENCE

NA Laryngoscope, 130:541-545, 2020.

Is exposure to personal music players a confounder in adolescent mobile phone use and hearing health studies?

Objective

This study was performed to determine whether exposure to personal music players (PMPs) in the immediate morning prior to hearing testing confounds the association between mobile phone use and hearing thresholds of adolescents.

Design

In this cohort study of cognitive function in year 7 students (median age 13 years, range 11–14), information regarding the weekly use of mobile phones and the use of PMPs was assessed by a questionnaire. Pure-tone audiometry was used to establish hearing thresholds for all participants.

Results

Among a cohort of 317 adolescents (60.9% females), 130 were unexposed to PMP use while 33 were exposed to PMP use in the morning prior to hearing testing. No statistically significant difference in hearing threshold shifts was found between adolescents who were and were not exposed to PMP use prior to hearing testing. Likewise, the difference in the use of mobile phones according to the PMP use status was not statistically significant.

Conclusion

Exposure to PMPs prior to hearing testing did not introduce confounding in the present study of mobile phone use and hearing loss among adolescents.

Early indication of noise-induced hearing loss from PMP use in adolescents: A cross-sectional analysis

Context:

Distortion product otoacoustic emissions (DPOAEs) may indicate preclinical noise-induced hearing loss (NIHL) in adolescents from unsafe personal music player (PMP) use.

Aims:

The objective, therefore, was to observe preclinical signs of NIHL in 9^th grade adolescents with clinically normal hearing by comparing DPOAE signals between different levels of A-weighted equivalent PMP exposure.

Settings and Design:

Subjects were recruited from all secondary-level schools located in the city of Regensburg, Germany during two academic years 2009/2010 and 2010/2011.

Subjects and Methods:

A-weighted equivalent sound pressure levels (SPLs) for a 40-hour work week (L_Aeq,40h) were estimated from questionnaire responses on output and duration of PMP use of the previous week. Subjects were then categorized into four levels of exposure: <80, 80–85, >85 to <90, and ≥90 A-weighted Decibel [dB(A)]. DPOAE signals were collected by trained audiological staff, applying a standard optimized protocol, at the Department of Otorhinolaryngology of the University Hospital Regensburg.

Statistical Analysis Used:

Mean DPOAE signals were compared between levels by unpaired t test. Novel linear regression models adjusting for other leisure noise exposures and with outcome variables DPoutcome and 4 kilo Hertz (kHz) DPOAEs estimated effects between levels.

Results:

A total of 1468 subjects (56% female, mostly aged 15 or 16 years) were available for analysis. Comparison of DPOAE means by PMP exposure typically showed no greater than 1 dB difference between groups. In fact, comparisons between ≥90 dB(A) and <80 dB(A) presented the least differences in magnitude. Both DPoutcome and 4 kHz linear regression models presented a weak association with the 4-level PMP exposure variable. An expected dose-response to PMP exposure was not observed in any analyses.

Conclusions:

DPOAE signal strength alone cannot indicate preclinical NIHL in adolescents.