Epidemiology of the extent of recreational noise exposure and hearing protection use: cross-sectional survey in a nationally representative UK adult population sample

Risky leisure noise exposure during the transition to adulthood and the impact of major life events - results of the OHRKAN cohort study

OBJECTIVE

To investigate the influence of four major life events (leaving home, full-time employment, married/cohabiting, parenthood) and socio-demographic variables on risky total leisure noise (TLN) during transition to adulthood with a special focus on visiting discotheques and listening to portable listening devices (PLDs).

DESIGN

Longitudinal analysis of the OHRKAN cohort. Risky TLN covering 22 activities was defined as exceeding 85 dB(A) averaged over a 40-hour week. Potential determinants were analysed using Generalised Linear Mixed Models.

STUDY SAMPLE

A closed cohort of 2,148 students recruited in ninth grade at schools in Regensburg in 2009-2011 and surveyed five times over about 10 years. In waves 3 to 5, 1,608 individuals participated at least once.

RESULTS

The prevalence of risky TLN decreased from 72.5% (median age 20) to 38.5% (median age 26). A decrease was also observed for visiting discotheques while exposure to PLD use remained relatively constant. Marriage/cohabiting and parenthood significantly reduced the prevalence of risky TLN and discotheques visits while only marriage/cohabiting reduced the prevalence of risky PLD use.

CONCLUSIONS

Young adults are particularly at risk to leisure noise exposure. The later major life events occur, the longer they expose themselves to risky leisure noise. Therefore, prevention is of utmost importance.

Music to Define a Generation: Factors Associated With Hearing Protection Use at Music Venues

OBJECTIVES

Excessive noise levels in music venues can negatively impact long-term hearing health. We investigated the prevalence, characteristics, and factors associated with hearing protection use among music event attendees.

STUDY DESIGN

Cross-sectional cohort.

METHODS

Adult participants (2,352) from online music forums completed a questionnaire assessing attendance at music events, hearing protection (HP) usage, type, and frequency, along with history of hearing-related symptoms and medical history. Primary outcome was defined as HP use at music venues. Data were characterized using descriptive statistics, paired t tests, and Pearson's chi-squared tests. Multivariable regression analysis elicited factors associated with any and regular HP use.

RESULTS

Our 2,352 respondents were primarily male (61.3%) and on average 28.7 years old (SD = 7.0). Of the respondents, 60.6% reported using HP, and 33.2% reported regular use; high-fidelity earplugs were the most used HP type (57.5%). HP use was associated with significantly fewer reports of negative hearing-related symptoms. In a multivariable regression model, factors associated with less likelihood of HP use included being female (vs male, OR = 0.74, CI = [0.55-0.98]), less concern about effects on hearing (OR = 0.53, CI = [0.45-0.61]), and pop music event attendance (vs EDM, OR = 0.40, CI = [0.22-0.72]). Increased attendance frequency in the past year was associated with higher likelihood of regular HP use (OR = 1.07, CI = [1.04-1.09]). Decreased attendance duration was associated with decreased likelihood (OR = 0.09, CI = [0.03-0.33]).

CONCLUSION

HP use prevalence was high, while frequent use remained low. HP use was significantly associated with reduced hearing-related symptoms. Demographic factors, otologic symp-tomology, and attendance-related characteristics were associated with HP use. These findings may guide interventions to increase adoption at music venues.

LEVEL OF EVIDENCE

4.

Hearing Loss: Self-Reported Onset and Etiology Among Older Adults in the United States

This study investigated self-reported age of onset and etiology of hearing loss among older adults in the United States. Study cohort included older adult (≥70 years) survey respondents from the 2017 to 2020 National Health and Nutrition Examination Survey (n = 797). Overall, 51.1% [95% confidence interval [CI]: 46.1-56.1] of older adults self-reported hearing loss. Among older adults who reported hearing loss, the most reported age of onset was age 70 or older (41.7% [95% CI: 38.1%-45.3%]), followed by sequentially younger age brackets including ages 60 to 69 years (27.3% [95% CI: 23.6%-31.3%]) and ages 40 to 59 years (15.7% [95% CI: 12.9%-19.0%]). The most common etiology of hearing loss was aging (66.3% [95% CI: 60.8%-71.4%]) followed by loud long-term noise (30.3% [95% CI: 26.2%-34.9%]) and loud brief noise (13.8% [95% CI: 10.3%-18.4%]). Our study describes the most common age of onset and etiologies of hearing loss among a representative sample of United States older adults.

New Paradigm of Music Listening: Hearing Protection Perceptions and Treatment Decision-Making Among Music Venue Attendees

OBJECTIVE

Investigate the prevalence of hearing protection (HP) use and behavioral motivations and barriers among adults attending music venues.

STUDY DESIGN

Cross-sectional online survey study.

SETTING

Noise exposure levels at popular social music venues often exceed national guidelines.

METHODS

Surveys were distributed on online music communities. Respondents (n = 2352) were asked about demographics, HP use at music venues, knowledge about noise exposure impact, and perceptions of HP use. Data were characterized through descriptive statistics. Multivariable regression analysis explored differences in knowledge and perception between HP users and nonusers.

RESULTS

In this cohort (mean age 29 ± 7 years, 61% male), HP users were significantly more aware of the impact of music venues on hearing (P < .01), believed their hearing ability had decreased after attending music venues (P < 0.01), and believed HP could protect from hearing loss (P < .01) than non-HP users. HP nonusers most frequently cited never considering HP (14.45%) and apathy about it affecting music quality (12.71%). Common sources of HP information were recommended by a friend/peer. Multivariable regression analysis accounting for demographics, medical history, and attendance characteristics found belief that HP use at music venues could protect from hearing loss (β = 0.64, 95% confidence interval [CI] = [0.49-0.78]) and HP use (β = 1.73, 95% CI = [1.47-1.98]) were significantly associated with increased subjective enjoyment while wearing HP.

CONCLUSION

HP users and nonusers have significantly different perceptions of HP use and its impact. Our findings have implications for understanding motivations and barriers related to HP use and developing strategies to promote HP use at music venues.

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.

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.

Noise-Related Hearing Disorder Among Vector Control Workers in Kuala Lumpur

Introduction Noise-related hearing disorder (NRHD) is the second most common sensorineural hearing loss, right after age-related hearing loss (presbycusis). It is the highest reported occupational disease and a major compensable occupational hazard in Malaysia. With the increase in dengue cases, the need for vector control workers to control the spread of dengue at the expense of being exposed to noisy fogging machines is critical. Methods This was a cross-sectional study of vector control workers conducted by a local authority in Kuala Lumpur. Participants were categorised as either vector control workers who were directly involved in fogging activities or those who were not. A self-administered questionnaire was used to collect sociodemographic, medical and occupational information. NRHD was confirmed by an audiogram test. Results This study found a high prevalence of NRHD among vector control workers exposed to fogging activity (occupational noise hazards), with 51.4% of them experiencing this condition. The predictors of NRHD include fogging status adjusted odds ratio (aOR) 1.94 (95% CI: 1.19 - 3.17), sex 18.28 (95% CI: 2.33 - 143.16) and age 2.03 (95% CI: 1.27 - 3.25). Conclusion The findings of this study imply that vector control workers are at risk of NRHD. The predictors of NRHD are fogging status, sex and age. These findings emphasise the major impact of occupational noise hazards on NRHD and emphasise the importance of addressing this issue to preserve employees' health; especially among male and older employees with chronic noise exposure.

Shedding Light on SARS-CoV-2, COVID-19, COVID-19 Vaccination, and Auditory Symptoms: Causality or Spurious Conjunction?

There are reports of associations between SARS-CoV2, COVID-19, COVID-19 vaccines, and auditory symptoms (hearing difficulty, tinnitus). However, most studies have relied on self-report and lack baseline and/or non-COVID control groups. This makes it problematic to differentiate if symptoms are associated with SARS-CoV2, COVID-19, the vaccine, psychosocial factors or recall bias. In this study, we differentiate these by comparing hearing and tinnitus survey data collected pre- and during the pandemic. The survey conducted during the pandemic asked about the onset and change in three types of symptom. Type One—known association (loss of smell, memory/concentration issues, persistent fatigue), Type Two—indeterminate association (auditory symptoms), and Type Three—no established association with COVID-19 (toothache). We hypothesized that if auditory symptoms are directly associated with COVID-19, their onset and change would be similar to Type One symptoms, but if indirectly associated (reflecting psychosocial factors and/or recall bias) would be more similar to Type Three symptoms. Of the 6,881 individuals who responded, 6% reported confirmed COVID-19 (positive test), 11% probably had COVID-19, and 83% reported no COVID-19. Those with confirmed or probable COVID-19 more commonly reported new and/or worsened auditory symptoms than those not reporting COVID-19. However, this does not imply causality because: (1) new auditory symptoms coincided with COVID-19 illness among just 1/3 of those with confirmed or probable COVID-19, and another 1/3 said their symptoms started before the pandemic—despite reporting no symptoms in the pre-pandemic survey. (2) >60% of individuals who had COVID-19 said it had affected their Type 3 symptoms, despite a lack of evidence linking the two. (3) Those with confirmed COVID-19 reported more Type 1 symptoms, but reporting of Type 2 and Type 3 symptoms did not differ between those with confirmed COVID-19 and those without COVID-19, while those who probably had COVID-19 most commonly reported these symptom types. Despite more reports of auditory symptoms in confirmed or probable COVID-19, there is inconsistent reporting, recall bias, and possible nocebo effects. Studies that include appropriate control groups and use audiometric measures in addition to self-report to investigate change in auditory symptoms relative to pre-COVID-19 are urgently needed.

Self Reported Hearing Impairments and Associated Risk Factors Among Metal and Woodwork Workers in Gondar Town, North West Ethiopia

BACKGROUND

The global prevalence of occupational noise-induced hearing loss ranges between 16% and 24%. The wood and metalwork industries have recently expanded in Ethiopia. This study aims to determine the level of noise exposure and the prevalence of self-reported hearing impairments and associated risk factors among metal and woodworkers in Gondar town Ethiopia.

MATERIAL AND METHODS

An institutional-based cross-sectional study was conducted on 580 metal and woodwork workers from February10 to March 25/2020. The data were collected through an interviewer-led questioner and the noise level measurement. Multivariate Poisson regression models were used. P-values less than .05 and adjusted prevalence ratios with 95%CI were used to declare the presence and strength of an association respectively.

RESULT

The mean (SD) average noise exposure level in the wood and metalworking industries was 96.9 ± 3.5 dBA and 96.2 ± 4 dBA, respectively. The overall prevalence of self-reported hearing impairment was 20.7% [95%CI: (17.4-24)]. In an adjusted Poisson regression, listening to music with earphones for more than 2 hours per day (PR = 2.95, 95%CI: 1.32, 6.21) and listening to music at maximum volume (PR = 2.24, 95%CI: 1.05, 4.79) were associated with hearing impairments.

CONCLUSION

The majority of workers are exposed to noise levels that exceed OSHA's permissible exposure limit value. A hearing conservation program should be implemented to reduce noise exposure levels in the wood and metal work industries. Workers should be aware of the duration and volume of recreational noise exposure.

Identifying Targets for Interventions to Increase Earplug Use in Noisy Recreational Settings: A Qualitative Interview Study

Earplugs can reduce the risk of hearing loss and tinnitus. However, earplug use during noisy recreational activities is uncommon, and methods for increasing uptake and regular use have had limited efficacy. The aim of the present study was to examine barriers and enablers of ever-performers (e.g., people who have used earplugs) and never-performers (e.g., people who have not used earplugs) to identify targets to inform the content of interventions to increase uptake and regular use of earplugs in recreational settings. The Capabilities, Opportunities, and Motivations model of Behaviour (COM-B) informed the outline for 20 semi-structured telephone interviews (ever-performers, N = 8, age range = 20-45 years; never-performers, N = 12; age range = 20-50 years). Thematic analysis was used to identify barriers and enablers to earplug use, which were mapped onto the Theoretical Domains Framework (TDF). Six key domains of the TDF were identified. Ever-performers described being more exposed to 'social influences' (e.g., facilitators such as friends/peers) and were more positive than never-performers concerning 'beliefs about consequences' (e.g., earplug protection outweighs any negative effects on listening/communication). Involvement of 'emotion' (e.g., fear of losing ability to listen to music) and 'reinforcement' tactics (e.g., creating habits/routines) were discussed by ever-performers, but were not mentioned by never-performers. Both groups reported lack of 'environmental context and resources' (e.g., prompts and cues), and their own 'memory, attention, and decision processes' (e.g., deciding when to use earplugs) as barriers to earplug use. The present research identifies the variables that would need to change in order to increase earplug uptake and use in recreational settings among ever-performers and never-performers. Further work is required to translate these findings into testable interventions by selecting appropriate intervention functions (e.g., modelling), policy categories (e.g., communication/marketing), behaviour change techniques (e.g., demonstration of behaviour), and mode of delivery (e.g., face-to-face).

Identifying Targets for Interventions to Increase Uptake and Use of Hearing Protection in Noisy Recreational Settings

Interventions to increase hearing protection behaviours within noisy recreational settings are limited by the lack of an underpinning evidence base. The aim of the present study was to identify targets for interventions in a population exposed to recreational noise, including those who had used hearing protection (ever-performers) versus those who had not (never-performers). A cross-sectional survey was administered to 185 UK adults who had been involved in noisy recreational activities. Participants had an average age of 36.79 years; the majority were women (68.1%), from a white ethnic background (87.6%), and with non-manual occupations (75.7%). Using Chi-square, MANOVA and ANOVA, we looked for differences in sociodemographic variables and variables from the capabilities, opportunities and motivations model of behaviour change (COM-B) between ever- and never-performers. Ever-performers were more likely to be younger (p < 0.050), men (p < 0.050), and in a manual occupation (p < 0.050) compared to never-performers. Although the two groups felt capable and reported similar opportunities to use hearing protection, never-performers lacked automatic motivation (p < 0.001) and reflective motivation (p < 0.001) compared to ever-performers. For the first time, the present study identifies potential groups at whom hearing protection interventions might be targeted and what those interventions may contain. Further work is required to develop interventions targeted at older people, women and those in non-manual occupations. Lack of motivation is a key concern, and further work that uses specific theoretical frameworks, such as the PRIME (Plans, Responses, Impulses, Motives, and Evaluations) theory of motivation, may shed light on the kinds of interventions that are needed to boost hearing protection use effectively.

What health policy makers need to know about mismatches between public perceptions of disease risk, prevalence and severity: a national survey

OBJECTIVES

The aim of this study was to assess people's perceptions of their personal risk, population prevalence and perceived severity in relation to three key health conditions (cancer, heart disease and hearing loss), gauge the size of any misperceptions, and identify correlates of such misperceptions.

DESIGN

This study was a cross-sectional survey.

STUDY SAMPLE

A total of 10,401 adults representative of the UK population were participated in the study.

RESULTS

Clear majorities of people incorrectly believe that they are at greater personal risk of cancer (>75%), that cancer is more prevalent in the population (>50%) and that cancer is more disabling (>65%), than either heart disease or hearing loss. In turn, people consistently regard their personal risk of hearing loss, the population prevalence of hearing loss and the severity of hearing loss as lower than either cancer or heart disease. Multiple regression analyses showed inconsistent patterns of relationships between people's beliefs, sociodemographic characteristics and their health behaviours.

CONCLUSIONS

Accuracy in beliefs about cancer, heart disease and hearing loss is low, and the relationships between these beliefs, their potential antecedents and consequences are complex. Policy makers should ensure close adherence to evidence or risk-making decisions that are costly both in financial terms and in terms of suboptimal population subjective well-being.