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

Prevention of noise-induced hearing loss in children - evidence-informed recommendations for safe listening at events

OBJECTIVE

Children's events are often perceived as excessively loud, with risks of noise-induced hearing loss and other adverse effects. In many countries, including Hungary, specific regulations for recreational noise levels are absent. This research aims to establish a scientific basis for safety categories and noise level limits to protect children's hearing.

DESIGN

Noise levels were measured at events, and otoacoustic emissions were assessed to determine auditory impacts. Children and parents also completed loudness perception surveys.

STUDY SAMPLE

Thirteen events were analysed with 25 noise-level measurement points. We included children aged 3-12 years, conducted 38 otoacoustic emission tests on both ears before and after the event, and collected 51 completed questionnaires.

RESULTS

Only seven measurement points were in the "safe" category, 40% were "risky", and 32% were "dangerous". While safe events did not alter inner ear function, it was reduced in several cases after risky events. High noise intensities were uncomfortable for 80% of the children.

CONCLUSIONS

Children's events often exceed safe noise levels, underscoring the critical need for sound monitoring and control. We recommend implementing guidelines, public education, and warnings to prevent hearing loss, with proposed regulations and age-related safety recommendations, presenting sound intensity categories with letters A to F.

Effect of pre-school sound exposure on children's hearing function: results from preparatory studies assessing hearing function by distortion product otoacoustic emissions

OBJECTIVE

This study investigated the potential impact of sound exposure in preschools on children's hearing function by measuring distortion product otoacoustic emissions (DPOAE) over time.

DESIGN

A longitudinal repeated-measures approach was employed to evaluate how DPOAE amplitudes varied with sound exposure and pre-school attendance duration, analysed using general estimation equation (GEE) modelling.

STUDY SAMPLE

The sample included 62 children aged three to six years attending preschools. Sound exposure levels and DPOAE amplitudes were measured during time being indoor.

RESULTS

Average indoor sound levels (time indoors (Ti)) were 81 dB LAeqTi, with highest noise events reaching 112 dB LAFmax. A total of 31 measurements (52%) exceeded 80 dB LAeqTi. GEE analysis showed a significant decrease in DPOAE amplitudes at 6 and 8 kHz in the right ear in relation to sound exposure levels, suggesting a sound level-dependent effect. Time spent in pre-school revealed a decrease in DPOAE amplitudes at 3 and 4 kHz in the right ear over the day and week, indicating cumulative effects of sound exposure.

CONCLUSIONS

The findings suggest that pre-school sound exposure may adversely affect children's hearing, particularly at higher frequencies and over time. Further research is needed to validate these results and explore long-term implications of early-age noise exposure.

Investigation of Factors Associated with Noise-Induced Hearing Loss and Mental Health Analysis in Children: A Retrospective Study

OBJECTIVE

To understand the related factors and mental health status of children with noise-induced hearing loss (NIHL) and provide a reliable reference for the prevention and control of children's hearing health.

METHODS

This study was a retrospective study. Sixty-nine children diagnosed with NIHL attending First Affiliated Hospital of Bengbu Medical College from December 2021 to December 2023 were included, and general characteristics, audiological assessment, self-questionnaire on factors associated with hearing loss, and Strengths and Difficulties Questionnaire (SDQ) were collected to analyze the relevant factors of NIHL in children and their mental health status.

RESULTS

The 69 NIHL patients included in the study were 50.73% male; the mean age of the patients used was 13.61 ± 2.00 years. Overall, 30.43% of the patients met the "notch" criteria, 59.42% met the high-frequency hearing loss criteria, and 10.14% met both criteria. The major correlation factor for hearing loss was dominated by prolonged use of headphones (82.60%), followed by practicing musical instruments without hearing protection (10.14%), and the majority of the patients showed minor hearing loss (91.30%). The total SDQ score of the included patients was 16.12 ± 1.89, which was borderline. The emotional symptoms score was 6.42 ± 0.76, which was also borderline. The scores of conduct problems, hyperactive behavior, peer interaction problems, and pro-social behaviors were at normal levels.

CONCLUSION

For children with NIHL, long-term use of headphones was the main associated factor, characterized by high-frequency hearing loss and minor hearing loss. At the same time, the children showed mental health problems that mainly included emotional symptoms.

Protecting our future: environmental hazards and children's health in the face of environmental threats: a comprehensive overview

Children face the excitement of a changing world but also encounter environmental threats to their health that were neither known nor suspected several decades ago. Children are at particular risk of exposure to pollutants that are widely dispersed in the air, water, and food. Children and adolescents are exposed to chemical, physical, and biological risks at home, in school, and elsewhere. Actions are needed to reduce these risks for children exposed to a series of environmental hazards. Exposure to a number of persistent environmental pollutants including air pollutants, endocrine disruptors, noise, electromagnetic waves (EMWs), tobacco and other noxious substances, heavy metals, and microplastics, is linked to damage to the nervous and immune systems and affects reproductive function and development. Exposure to environmental hazards is responsible for several acute and chronic diseases that have replaced infectious diseases as the principal cause of illnesses and death during childhood. Children are disproportionately exposed to environmental toxicities. Children drink more water, eat more food, and breathe more frequently than adults. As a result, children have a substantially heavier exposure to toxins present in water, food, or air than adults. In addition, their hand-to-mouth behaviors and the fact that they live and play close to the ground make them more vulnerable than adults. Children undergo rapid growth and development processes that are easily disrupted. These systems are very delicate and cannot adequately repair thetional development in children's environmental health was the Declaration of the Environment Leaders of the Eight on Children's Environmental Health by the Group of Eight. In 2002, the World Health Organization launched an initiative to improve children's environmental protection effort. Here, we review major environmental pollutants and related hazards among children and adolescents.

A Pilot Dashboard System to Track Cumulative Exposure to Sound Levels during Music Instruction: A Technical Report

BACKGROUND

 Music-induced hearing loss (MIHL) is a critical public health issue. During music instruction, students and teachers are at risk of developing hearing loss due to exposure to loud and unsafe sound levels that can exceed 100 dBA. Prevention of MIHL in music students must be a desired action of all music educators.

PURPOSE

 To promote deliberate changes in music instruction and encourage more moderate sound creation and exposure during music education, it is essential to equip the instructors with live dynamic tools to monitor the overall sound intensities during music instruction. Equally important data to convey to the instructors are information regarding the intensity and duration of sounds at specific frequency regions in the music they are generating. Unfortunately, there are no feasible techniques to track cumulative live music exposures at various frequencies nor are there any guidelines for safe music exposure.

RESEARCH DESIGN

 We created a visually appealing, user-friendly dashboard prototype system to display the accumulated time and intensity of sound exposure during live classes/rehearsals categorized into three frequency ranges. These visuals can be easily understood at a glance allowing musicians and instructors to make informed decisions about how to play music safely.

EXPERIMENTAL APPROACH AND RESULTS

 The dashboard included a collection of circular dial graphs that displayed in real time the accumulated sound exposure in the instructor's selected frequency range and showed the percentage of the maximum daily sound exposure based on the National Institute for Occupational Safety and Health Standards (NIOSH, 1998). Although NIOSH standards are not widely applied for music exposure, we propose that these standards can be used to provide initial guidelines to develop critical levels of music exposure. Additionally, the dashboard included a color-coded equalizer that displayed the instantaneous frequency distribution of sounds to indicate if sound levels at specific frequencies were too high even for short-term exposure.

CONCLUSION

 Less expensive than existing technology and more convenient to use, this dashboard will enable music instructors to make informed decisions on how to best adapt their teaching approaches to protect the hearing health of their students.

Which Environmental Pollutants Are Toxic to Our Ears?-Evidence of the Ototoxicity of Common Substances

Ototoxicity refers to the adverse effects of substances on auditory or vestibular functions. This study examines the evidence of ototoxicity's association with exposure to common environmental pollutants, as documented in toxicological profiles by the Agency for Toxic Substances and Disease Registry. Our aim was to evaluate whether the evidence supports modifying the charting of ototoxic effects in the summary tables of these toxicological profiles and providing a guide for scientists to access these data. Health outcomes of interest included hearing loss, vestibular effects, cochlear lesions, tonal alterations, cellular damage, and ototoxicity-related outcomes (neurological, nephrotoxic, hepatic, and developmental effects). We obtained ototoxicity information for 62 substances. Hearing-related effects were reported, along with neurological effects. Overall, 26 profiles reported strong evidence of ototoxicity, including 13 substances previously designated as ototoxic by other health and safety agencies. Commonly studied outcomes included hearing loss, damage to ear anatomy, and auditory dysfunction. Vestibular dysfunction and tinnitus are rarely studied. Our findings highlight the lack of conclusive evidence of ototoxic properties for many substances, especially for pesticides and herbicides. This review supports charting the evidence of ototoxicity separately in toxicological profiles' summary tables. Improving the communication of ototoxicity-related health effects might impact their recognition and prompt further research. A stronger evidence base could support improved prevention efforts in terms of serious health outcomes.

Hearing Health at School: analysis of knowledge, behaviors and attitudes of Southern-Brazilian children and adolescents on noise

PURPOSE

to analyze the knowledge, behaviors, and attitudes of students on noise.

METHODS

We used an observational method study, in 32 Schools from Itajaí/Brazil, with a convenience sample, comprising 1,835 students, 45.7% females and 54.3% males, mean age of 11.53 ± 0.8 years, was conducted. The Portuguese version of Dangerous Decibels® questionnaire was applied. For the data analysis, descriptive and inferential statistics were used, significance level of 5%.

RESULTS

A large part of the sample part of the sample had harmful hearing habits; 62.6% reported knowledge on the subject, but only 25.4% answered the questions on the theme correctly; 58.9% reported that they did not know how to protect hearing if necessary. Regarding sex and age: males have more hazardous hearing habits (p < 0.001) and tinnitus complaint (p<0.001) and females have more knowledge (p < 0.001) and the intent to wear hearing protection (p<0.001), greater intention to wear hearing protection among younger students (10 and 11 years old) (p < 0.001), and the older ones (12 to 16 years old) get more exposed to noise (p < 0.001), and there are more tinnitus complaints (p < 0.05) among them.

CONCLUSION

A large part of the students in the study has hazardous noisy habits and scarce knowledge on the theme, with males and older subjects showing the worst attitudes and behaviors in face of the potential hearing risk caused by exposure to high noise levels.

Extended high-frequency hearing loss among Afro-Colombian adolescents from a rural area in Colombia: a cross-sectional study

OBJECTIVES

Research trends concerning hearing loss within teen rural populations are limited and current evidence suggests that extended high-frequency audiometry can be a sensitive tool to detect subclinical hearing loss. Moreover, current research emphasises the importance of representing different ethnic populations in science. This study aimed to determine the prevalence of acquired hearing loss through conventional pure-tone (0.25-8 kHz) and extended high frequency (EHF) (9-20 kHz) audiometry in Afro-Colombian adolescents from a rural area in Colombia.

DESIGN

Observational, cross-sectional study.

PARTICIPANTS

230 Afro-Colombian adolescents aged 13-17 years who attended high school in a rural population from Cartagena, Colombia.

INTERVENTIONS

Otoscopic examination, conventional (0.25-8 kHz) and EHF (9-20 kHz) audiometry tests were performed during February-March 2021. Sociodemographic and associated factor questionnaires were also applied to assess probable factors associated with EHF hearing loss.

MAIN OUTCOME MEASURES

Prevalence of acquired hearing loss using conventional and EHF audiometry, and factors associated with hearing loss.

RESULTS

Of 230 adolescents who met the eligibility criteria, 133 (57.82%) were female. The mean age was 15.22 years (SD: 1.62). The prevalence of hearing loss in at least one ear assessed with conventional audiometry was 21.30% and with EHF audiometry 14.78%. The main abnormal otoscopic findings included: neotympanum (1.30%), myringosclerosis (0.87%) and monomeric scars (0.43%). Factors associated with a higher probability of EHF hearing loss found through logistic regression were older age (prevalence ratio (PR): 1.45; 95% CI 1.16 to 1.80), attending the 'Picó' four or more times a month (PR: 6.63; 95% CI 2.16 to 20.30), attending bars more than three times a month (PR: 1.14; 95% CI 1.03 to 1.59) and self-reported hearing difficulties (PR: 1.24; 95% CI 1.22 to 4.05).

CONCLUSIONS

Our results suggest that acquired hearing loss is already widespread among this young rural population.

The perception of ultrasonic vocalizations by laboratory mice following intense noise exposures

Noise-induced hearing loss interacts with age, sex, and listening conditions to affect individuals' perception of ecologically relevant stimuli like speech. The present experiments assessed the impact of age and sex on vocalization detection by noise-exposed mice trained to detect a downsweep or complex ultrasonic vocalization in quiet or in the presence of a noise background. Daily thresholds before and following intense noise exposure were collected longitudinally and compared across several factors. All mice, regardless of age, sex, listening condition, or stimulus type showed their poorest behavioral sensitivity immediately after the noise exposure. There were varying degrees of recovery over time and across factors. Old-aged mice had greater threshold shifts and less recovery compared to middle-aged mice. Mice had larger threshold shifts and less recovery for downsweeps than for complex vocalizations. Female mice were more sensitive, had smaller post-noise shifts, and had better recovery than males. Thresholds in noise were higher and less variable than thresholds in quiet, but there were comparable shifts and recovery. In mice, as in humans, the perception of ecologically relevant stimuli suffers after an intense noise exposure, and results differ from simple tone detection findings.

Easy as 1-2-3: Development and Evaluation of a Simple yet Valid Audiogram-Classification System

Almost since the inception of the modern-day electroacoustic audiometer a century ago the results of pure-tone audiometry have been characterized by an audiogram. For almost as many years, clinicians and researchers have sought ways to distill the volume and complexity of information on the audiogram. Commonly used approaches have made use of pure-tone averages (PTAs) for various frequency ranges with the PTA for 500, 1000, 2000 and 4000 Hz (PTA4) being the most widely used for the categorization of hearing loss severity. Here, a three-digit triad is proposed as a single-number summary of not only the severity, but also the configuration and bilateral symmetry of the hearing loss. Each digit in the triad ranges from 0 to 9, increasing as the level of the pure-tone hearing threshold level (HTL) increases from a range of optimal hearing (< 10 dB Hearing Level; HL) to complete hearing loss (≥ 90 dB HL). Each digit also represents a different frequency region of the audiogram proceeding from left to right as: (Low, L) PTA for 500, 1000, and 2000 Hz; (Center, C) PTA for 3000, 4000 and 6000 Hz; and (High, H) HTL at 8000 Hz. This LCH Triad audiogram-classification system is evaluated using a large United States (U.S.) national dataset (N = 8,795) from adults 20 to 80 + years of age and two large clinical datasets totaling 8,254 adults covering a similar age range. Its ability to capture variations in hearing function was found to be superior to that of the widely used PTA4.

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.

Preventing Excessive Noise Exposure in Infants, Children, and Adolescents

Noise exposure is a major cause of hearing loss in adults. Yet, noise affects people of all ages, and noise-induced hearing loss is also a problem for young people. Sensorineural hearing loss caused by noise and other toxic exposures is usually irreversible. Environmental noise, such as traffic noise, can affect learning, physiologic parameters, and quality of life. Children and adolescents have unique vulnerabilities to noise. Children may be exposed beginning in NICUs and well-baby nurseries, at home, at school, in their neighborhoods, and in recreational settings. Personal listening devices are increasingly used, even by small children. Infants and young children cannot remove themselves from noisy situations and must rely on adults to do so, children may not recognize hazardous noise exposures, and teenagers generally do not understand the consequences of high exposure to music from personal listening devices or attending concerts and dances. Environmental noise exposure has disproportionate effects on underserved communities. In this report and the accompanying policy statement, common sources of noise and effects on hearing at different life stages are reviewed. Noise-abatement interventions in various settings are discussed. Because noise exposure often starts in infancy and its effects result mainly from cumulative exposure to loud noise over long periods of time, more attention is needed to its presence in everyday activities starting early in life. Listening to music and attending dances, concerts, and celebratory and other events are sources of joy, pleasure, and relaxation for many people. These situations, however, often result in potentially harmful noise exposures. Pediatricians can potentially lessen exposures, including promotion of safer listening, by raising awareness in parents, children, and teenagers. Noise exposure is underrecognized as a serious public health issue in the United States, with exposure limits enforceable only in workplaces and not for the general public, including children and adolescents. Greater awareness of noise hazards is needed at a societal level.

The effect of screen time on hearing and balance in 6-16 aged children

BACKGROUND

The increase in screen time and the decrease in physical- activity cause balance problems as well as many systemic handicaps.

AIMS/OBJECTIVES

This study aimed to determine the effect of screen time on balance and the effect of headphone usage time on hearing.

METHOD

Thirty-four individuals aged 6-16 years who applied to our clinic with complaints of dizziness and/or balance disorder were included in the study. Participants were divided into 2 groups according to their screen time: Group 1 (4-8 h/day) and Group2(>8 h/day). The other two groups are grouped according to headphone usage time as Group A (2-4 h/day) and Group B (>4hours/day). Pure-tone audiometry, extended high frequency-audiometry, Videonystagmography (VNG) and Computerized Dynamic Posturography (CDP) tests and Pediatric Berg Balance Scale and Visual Analogue Scale were applied to all individuals. CDP scores and pure tone hearing thresholds between groups were compared.

RESULTS

A significant difference was observed between Group 1 and Group 2 according to the CDP test (visual, vestibular and composite scores), and according to the VAS-dizziness and PBS (p ≤ .05). Pure tone average and pure tone thresholds at high frequencies were compared between Group A and Group B according to headphone usage time. Pure tone thresholds of Group B were worse at high frequencies than Group A (p ≤ .05).

CONCLUSIONS

It has been observed that prolonged screen time may cause balance impairment in children and prolonged use of headphones may affect high-frequency hearing thresholds.

Attitudes to noise in young adults and associated factors: adaptation of the youth attitude to noise scale into Spanish using item response theory analysis

OBJECTIVE

This study aimed to identify the attitudes to noise in young adults and the possible effects of gender, age, and a positive history of auditory symptoms related to recreational noise exposure on the attitudes to noise in this population.

DESIGN

The Youth Attitude to Noise (YANS) and the hearing symptom description (HSD) scales were adapted into Spanish to be used with young adults. The validity was determined using factor analyses and Item Response Theory (IRT) models. Linear regression models were used to determine whether the YANS scores were associated with gender, age, and auditory symptoms.

STUDY SAMPLE

Both instruments were given to a sample of 728 Chilean young adults. Data obtained from this sample was used to determine the YANS and HSD scales' validity and to assess the effects of gender, age, and auditory symptoms on attitudes.

RESULTS

Our results showed that the YANS and HSD scales had adequate validity and reliability. Differences in the items' capacity to discriminate attitudes to noise were noted using the IRT model. Auditory symptoms were significantly associated with the YANS scores.

CONCLUSIONS

The attitudes to noise in Chilean young adults are influenced by self-perception of auditory symptoms, age, and gender.

The Role of Metabolic Syndrome Components in Sensorineural Hearing Loss in Adolescents: A Case-Control Study

Introduction  Metabolic syndrome (MetS) and its associated components were reported as a possible cause of inner ear dysfunction. However, research about the influence of cardiovascular risk factors on hearing thresholds are conducted mainly in adult patients. Objective  The aim of the present study was to investigate auditory function in adolescents with MetS compared with healthy controls. Methods  One hundred adolescents with metabolic syndrome and 200 sex- and age-matched controls were recruited from a university pediatric endocrine clinic from May 2018 to July 2020. Hearing loss was defined as hearing level ≥ 15 dB at speech frequency (SFHL) or high frequency (HFHL) in one or both ears. A multivariable conditional logistic regression analysis examined the correlation between MetS components and several important demographic characteristics, and hearing loss. Results  A total of 165 (55.0%) boys and 135 (45.0%) girls participated in this study. The rates of SFHL and HFHL in adolescents with MetS were 32.0% and 51.0%, respectively. Those values for controls were 5.0% and 15.5%, respectively. The regression analysis showed high triglycerides as a significant predictor for SFHL (odds ratio 10.87; 95% confidence interval: 1.98, 59.74). Neither predictor of interest was significant for HFHL. Conclusion  Hypertriglyceridemia may be an important factor in the pathogenesis of SFHL. However, the strength of the association was not significant with a wide confidence interval. Also, we were unable to find an association between predictors and HFHL with the current sample size. Larger and prospective studies are recommended.

Audiological benefit, quality of life, and factors associated with functional gain in elderly hearing aid users in a developing country between 2017 and 2020: a pre-post-study

BACKGROUND

Sensorineural hearing loss (SNHL) is the most common auditory deficit in older adults and may lead to quality-of-life deterioration. However, few studies have been performed in low/middle-income countries, particularly in Latin America. This study aimed to assess the audiological benefit, quality of life, and factors associated with functional gain in elderly hearing aid users in the Fundación Santa Fe de Bogotá and UNIMEQ-ORL, two otology referral centers in Colombia.

DESIGN

Pre-post study that included hearing aid users at the otology consult of the Fundación Santa Fe de Bogotá and UNIMEQ-ORL between June 2017 and December 2020. Glasgow Benefit Inventory (GBI) and Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaires were applied. Audiometric (0,5 kHz to 4 kHz) and speech audiometry results were collected.

RESULTS

A total of 75 participants (132 ears) were included. The mean age was 70.73 years (SD: 12.66). The median hearing aid use in years was 0.71 (IQR: 0.64-0.90). Mean change in speech audiometry was - 26.53dB (95%CI: -28.09, -24.97; p < 0.001), in functional gain was - 21.75dB (-23.81, -19.68; p < 0.001). The mean changes in the APHAB domains were Ease of Communication: -37.85 (95%CI: -43.01; -32.7), Background Noise: -3.51 (-6.06; -0.95), and Aversiveness of Sounds: -6.9 (-2.04; 11.77). The GBI assessment of quality of life showed improvement in 100% of the population after the use of hearing aids. The number of years of hearing aids use was associated with functional gain.

CONCLUSION

The number of years of hearing aids use may impact on the functional gain in these populations. A significant clinical benefit was found in terms of quality of life, communication, and reverberation related to the use of hearing aids. Access to hearing aids should be granted, and public health strategies are needed to grant the access to hearing rehabilitation in these populations.

TRIAL REGISTRATION

Fundación Santa Fe de Bogotá (Protocol Number: CCEI-12666-2020).

Early-life stress affects Mongolian gerbil interactions with conspecific vocalizations in a sex-specific manner

During development, early-life stress (ELS) impairs cognition, learning, and emotional regulation, in part by disrupting neural circuitry in regions underlying these higher-order functions. In addition, our recent work indicates that ELS also alters simple sensory perception: ELS impaired auditory perception and neural encoding of short gaps in sounds, which are essential for vocal communication. The combination of higher-order and basic sensory disruption suggests that ELS is likely to affect both the perception and interpretation of communication signals. We tested this hypothesis by measuring behavioral responses to conspecific vocalizations (those emitted by other gerbils) in ELS and untreated Mongolian gerbils. Because stress effects often differ by sex, we separately examined females and males. To induce ELS, pups were intermittently maternally separated and restrained from post-natal days (P) 9-24, a time window when the auditory cortex is most sensitive to external disruption. We measured the approach responses of juvenile (P31-32) gerbils to two types of conspecific vocalizations: an alarm call, which is emitted to alert other gerbils of a potential threat, and the prosocial contact call, which is emitted near familiar gerbils, especially after separation. Control males, Control females, and ELS females approached a speaker emitting pre-recorded alarm calls, while ELS males avoided this source, suggesting that ELS affects the response to alarm calls in male gerbils. During playback of the pre-recorded contact call, Control females and ELS males avoided the sound source, while Control males neither approached nor avoided, and ELS females approached the sound. These differences cannot be accounted for by changes in locomotion or baseline arousal. However, ELS gerbils slept more during playback, suggesting that ELS may reduce arousal during vocalization playback. Further, male gerbils made more errors than females on a measure of working memory, but the sex difference of cognition in this context may stem from novelty aversion rather than impaired memory. These data indicate that ELS influences behavioral responses to ethologically relevant communication sounds in a sex-specific manner, and are among the first to demonstrate an altered response to auditory stimuli following ELS. Such changes may arise from differences in auditory perception, cognition, or a combination of factors, and suggest that ELS may affect auditory communication in human adolescents.

Association of Polygenic Risk Scores for Hearing Difficulty in Older Adults With Hearing Loss in Mid-Childhood and Midlife: A Population-Based Cross-sectional Study Within the Longitudinal Study of Australian Children

Importance

Although more than 200 genes have been associated with monogenic congenital hearing loss, the polygenic contribution to hearing decline across the life course remains largely unknown.

Objective

To examine the association of polygenic risk scores (PRSs) for self-reported hearing difficulty among adults (40-69 years) with measured hearing and speech reception abilities in mid-childhood and early midlife.

Design, Setting, and Participants

This was a population-based cross-sectional study nested within the Longitudinal Study of Australian Children that included 1608 children and 1642 adults. Pure tone audiometry, speech reception threshold against noise, and genetic data were evaluated. Linear and logistic regressions of PRSs were conducted for hearing outcomes. Study analysis was performed from March 1 to 31, 2022.

Main Outcomes and Measures

Genotypes were generated from saliva or blood using global single-nucleotide polymorphisms array and PRSs derived from published genome-wide association studies of self-reported hearing difficulty (PRS1) and hearing aid use (PRS2). Hearing outcomes were continuous using the high Fletcher index (mean hearing threshold, 1, 2, and 4 kHz) and speech reception threshold (SRT); and dichotomized for bilateral hearing loss of more than 15 dB HL and abnormal SRT.

Results

Included in the study were 1608 children (mean [SD] age, 11.5 [0.5] years; 812 [50.5%] male children; 1365 [84.9%] European and 243[15.1%] non-European) and 1642 adults (mean [SD] age, 43.7 [5.1] years; 1442 [87.8%] female adults; 1430 [87.1%] European and 212 [12.9%] non-European individuals). In adults, both PRS1 and PRS2 were associated with hearing thresholds. For each SD increment in PRS1 and PRS2, hearing thresholds were 0.4 (95% CI, 0-0.8) decibel hearing level (dB HL) and 0.9 (95% CI, 0.5-1.2) dB HL higher on the high Fletcher index, respectively. Each SD increment in PRS increased the odds of adult hearing loss of more than 15 dB HL by 10% to 30% (OR for PRS1, 1.1; 95% CI, 1.0-1.3; OR for PRS2, 1.3; 95% CI, 1.1-1.5). Similar but attenuated patterns were noted in children (OR for PRS1, 1.1; 95% CI, 0.8-1.2; OR for PRS2, 1.2; 95% CI, 1.0-1.5). Both PRSs showed minimal evidence of associations with speech reception thresholds or abnormal SRT in children or adults.

Conclusions and Relevance

This population-based cross-sectional study of PRSs for self-reported hearing difficulty among adults found an association with hearing ability in mid-childhood. This adds to the evidence that age-related hearing loss begins as early as the first decade of life and that polygenic inheritance may play a role together with other environmental risk factors.

Diagnosing Noise-Induced Hearing Loss Sustained During Military Service Using Deep Neural Networks

The diagnosis of noise-induced hearing loss (NIHL) is based on three requirements: a history of exposure to noise with the potential to cause hearing loss; the absence of known causes of hearing loss other than noise exposure; and the presence of certain features in the audiogram. All current methods for diagnosing NIHL have involved examination of the typical features of the audiograms of noise-exposed individuals and the formulation of quantitative rules for the identification of those features. This article describes an alternative approach based on the use of multilayer perceptrons (MLPs). The approach was applied to databases containing the ages and audiograms of individuals claiming compensation for NIHL sustained during military service (M-NIHL), who were assumed mostly to have M-NIHL, and control databases with no known exposure to intense sounds. The MLPs were trained so as to classify individuals as belonging to the exposed or control group based on their audiograms and ages, thereby automatically identifying the features of the audiogram that provide optimal classification. Two databases (noise exposed and nonexposed) were used for training and validation of the MLPs and two independent databases were used for evaluation and further analyses. The best-performing MLP was one trained to identify whether or not an individual had M-NIHL based on age and the audiogram for both ears. This achieved a sensitivity of 0.986 and a specificity of 0.902, giving an overall accuracy markedly higher than for previous methods.

Task force Guideline of Brazilian Society of Otology ‒ hearing loss in children - Part I ‒ Evaluation

OBJECTIVES

To provide an overview of the main evidence-based recommendations for the diagnosis of hearing loss in children and adolescents aged 0 to 18 years.

METHODS

Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on childhood hearing loss were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions.

RESULTS

The evaluation and diagnosis of hearing loss: universal newborn hearing screening, laboratory testing, congenital infections (especially cytomegalovirus), genetic testing and main syndromes, radiologic imaging studies, vestibular assessment of children with hearing loss, auditory neuropathy spectrum disorder, autism spectrum disorder, and noise-induced hearing loss.

CONCLUSIONS

Every child with suspected hearing loss has the right to diagnosis and appropriate treatment if necessary. This task force considers 5 essential rights: (1) Otolaryngologist consultation; (2) Speech assessment and therapy; (3) Diagnostic tests; (4) Treatment; (5) Ophthalmologist consultation.

Establishing Healthy Lifestyle Choices Early: How to Counsel Children and Their Parents

Promoting childhood and adolescent health and long-term well-being requires an emphasis on preventative care and anticipatory guidance. In this review, the authors will focus on pertinent ear, nose, and throat preventative health in children, providing clinicians with relevant and succinct information to counsel children and their parents on the following essential subjects: foreign body aspiration and ingestion, upper respiratory infection prevention, noise exposure risks, aural hygiene, risks of primary and secondhand smoke exposure, and sleep hygiene.

The audiogram: Detection of pure-tone stimuli in ototoxicity monitoring and assessments of investigational medicines for the inner ear

Pure-tone thresholds have long served as a gold standard for evaluating hearing sensitivity and documenting hearing changes related to medical treatments, toxic or otherwise hazardous exposures, ear disease, genetic disorders involving the ear, and deficits that develop during aging. Although the use of pure-tone audiometry is basic and standard, interpretation of thresholds obtained at multiple frequencies in both ears over multiple visits can be complex. Significant additional complexity is introduced when audiometric tests are performed within ototoxicity monitoring programs to determine if hearing loss occurs as an adverse reaction to an investigational medication and during the design and conduct of clinical trials for new otoprotective agents for noise and drug-induced hearing loss. Clinical trials using gene therapy or stem cell therapy approaches are emerging as well with audiometric outcome selection further complicated by safety issues associated with biological therapies. This review addresses factors that must be considered, including test-retest variability, significant threshold change definitions, use of ototoxicity grading scales, interpretation of early warning signals, measurement of notching in noise-induced hearing loss, and application of age-based normative data to interpretation of pure-tone thresholds. Specific guidance for clinical trial protocols that will assure rigorous methodological approaches and interpretable audiometric data are provided.

Encouraging Hearing Loss Prevention in Music Listeners Using Personalized Technology: Questionnaire Study

Background

Noise-induced hearing loss (NIHL) affects millions of people despite being almost completely preventable. For recreational music listening through personal listening equipment (such as earbuds), it seems that listeners do not yet have a way to accurately assess their risk of developing hearing loss and prevent it accordingly.

Objective

The aim of this study is to analyze the perceived utility of a hypothetical device that encourages NIHL prevention based on listeners’ exposure to noise and to determine the most effective methods of such encouragement. Here, we describe 3 different potential NIHL risk notification method types, as follows: auditory, external visual, and visual.

Methods

An open, web-based survey was created on Google Forms, and the link was posted to Amazon’s Mechanical Turk as well as music-related Reddit communities. The survey was designed to gauge each respondent’s self-assessed NIHL awareness, willingness to lower their audio if reminded, and NIHL risk notification type preference. The likelihood of a specific notification type to encourage NIHL prevention among its users was based on the average of each user’s responses to 2 survey questions. Data collection started on July 13, 2020, and ended on July 17, 2020.

Results

Of the 116 respondents, 92 (79.3%) reported having prior awareness about NIHL; however, 60 (51.7%) described doing nothing to prevent it despite 96 (82.8%) feeling a moderate, high, or extreme risk of developing NIHL. Of those who already prevented NIHL, 96% (53.5/56) described using estimates to guide their prevention instead of using data. A Kruskal-Wallis test corrected for ties showed that despite the visual NIHL risk notification type being selected by the highest number of participants (84/116, 72.4%), the auditory type had a significantly higher (H1=6.848; P=.03) average percentage likelihood of encouraging NIHL prevention (62%, SD 24%) among the 40 respondents who chose it, with a median likelihood of 56% (95% CI 50%-75%). The visual type’s average likelihood was 50% (SD 28.1%), with a median of 50% (95% CI 37.5%-56.3%). Regardless of the NIHL risk notification type, 69% (80/116) of respondents were not opposed to using NIHL risk notifications and lowering their audio volume accordingly.

Conclusions

The hypothetical device detailed here was thought to be useful because most respondents (82.8%, 96/116) felt an extreme to moderate risk of developing NIHL and such a device could provide accurate data to those who currently use estimates to prevent NIHL, and most respondents were willing to act on NIHL risk notifications. The most effective NIHL risk notification type seemed to be the auditory type, but many aspects of this study need further research to determine which implementation method should reach the public.

Prevention of Noise-Induced Hearing Loss Using Investigational Medicines for the Inner Ear: Previous Trial Outcomes Should Inform Future Trial Design

Significance: Noise-induced hearing loss (NIHL) is an important public health issue resulting in decreased quality of life for affected individuals, and significant costs to employers and governmental agencies. Recent Advances: Advances in the mechanistic understanding of NIHL have prompted a growing number of proposed, in-progress, and completed clinical trials for possible protections against NIHL via antioxidants and other drug agents. Thirty-one clinical trials evaluating prevention of either temporary or permanent NIHL were identified and are reviewed. Critical Issues: This review revealed little consistency in the noise-exposed populations in which drugs are evaluated or the primary outcomes used to measure NIHL prevention. Changes in pure-tone thresholds were the most common primary outcomes; specific threshold metrics included both average hearing loss and incidence of significant hearing loss. Changes in otoacoustic emission (OAE) amplitude were relatively common secondary outcomes. Extended high-frequency (EHF) hearing and speech-in-noise perception are commonly adversely affected by noise exposure but are not consistently included in clinical trials assessing prevention of NIHL. Future Directions: Multiple criteria are available for monitoring NIHL, but the specific criterion to be used to define clinically significant otoprotection remains a topic of discussion. Audiogram-based primary outcome measures can be combined with secondary outcomes, including OAE amplitude, EHF hearing, speech-in-noise testing, tinnitus surveys, and patient-reported outcomes. Standardization of test protocols for the above primary and secondary outcomes, and associated reporting criterion for each, would facilitate clinical trial design and comparison of results across investigational drug agents. Antioxid. Redox Signal. 36, 1171-1202.

Auditory processing remains sensitive to environmental experience during adolescence in a rodent model

Elevated neural plasticity during development contributes to dramatic improvements in perceptual, motor, and cognitive skills. However, malleable neural circuits are vulnerable to environmental influences that may disrupt behavioral maturation. While these risks are well-established prior to sexual maturity (i.e., critical periods), the degree of neural vulnerability during adolescence remains uncertain. Here, we induce transient hearing loss (HL) spanning adolescence in gerbils, and ask whether behavioral and neural maturation are disrupted. We find that adolescent HL causes a significant perceptual deficit that can be attributed to degraded auditory cortex processing, as assessed with wireless single neuron recordings and within-session population-level analyses. Finally, auditory cortex brain slices from adolescent HL animals reveal synaptic deficits that are distinct from those typically observed after critical period deprivation. Taken together, these results show that diminished adolescent sensory experience can cause long-lasting behavioral deficits that originate, in part, from a dysfunctional cortical circuit.

Suprathreshold Auditory Measures for Detecting Early-Stage Noise-Induced Hearing Loss in Young Adults

BACKGROUND

Over 1 billion young adults are at risk for developing noise-induced hearing loss (NIHL) due to their habit of listening to music at loud levels. The gold standard for detecting NIHL is the audiometric notch around 3,000 to 6,000 Hz observed in pure tone audiogram. However, recent studies suggested that suprathreshold auditory measures might be more sensitive to detect early-stage NIHL in young adults.

PURPOSE

The present study compared suprathreshold measures in individuals with high and low noise exposure backgrounds (NEBs). We hypothesized that individuals with high NEB would exhibit reduced performance on suprathreshold measures than those with low NEB.

STUDY SAMPLE

An initial sample of 100 English-speaking healthy adults (18-35 years; females = 70) was obtained from five university classes. We identified 15 participants with the lowest NEB scores (10 females) and 15 participants with the highest NEB scores (10 females). We selected a sample of healthy young adults with no history of middle ear infection, and those in the low NEB group were selected with no history of impulse noise exposure.

DATA COLLECTION AND ANALYSIS

The study included conventional audiometry, extended high-frequency audiometry, middle ear muscle reflex (MEMR) thresholds, distortion-product otoacoustic emissions (DPOAEs), QuickSIN, and suprathreshold auditory brainstem response (ABR) measures. We used independent sample t-tests, correlation coefficients, and linear mixed model analysis to compare the audiometric measures between the NEB groups.

RESULTS

The prevalence of audiometric notch was low in the study sample, even for individuals with high NEB. We found that: (1) individuals with high NEB revealed significantly reduced QuickSIN performance than those with low NEB; (2) music exposure via earphone revealed a significant association with QuickSIN; (3) individuals with high NEB revealed significantly reduced DPOAEs and ABR wave I amplitude compared with individuals with low NEB; (4) MEMR and ABR latency measures showed a modest association with NEB; and (5) audiometric thresholds across the frequency range did not show statistically significant association with NEB.

CONCLUSION

Our results suggest that young adults with high NEB might exhibit impaired peripheral neural coding deficits leading to reduced speech-in-noise (SIN) performance despite clinically normal hearing thresholds. SIN measures might be more sensitive than audiometric notch for detecting early-stage NIHL in young adults.

The Relevance of Leisure Noise to Hearing Threshold Shifts: A Longitudinal Analysis Among Adolescents

PURPOSE

The aim of this study was to analyze the association of total leisure noise exposure and hearing threshold shifts over 5 years among adolescents enrolled in the Ohrkan cohort study.

METHOD

The Ohrkan cohort of 2,148 students aged 13-19 years was recruited from 2009 to 2011 and followed up 5 years later. Complete baseline and follow-up reports on exposure and outcome were available for 989 participants. Leisure noise exposure was assessed by questionnaires, and clinical audiometric examinations were performed. Two outcomes were defined: occurrence of the Niskar notch pattern and audiometry showing maximum hearing threshold values at 3, 4, and 6 kHz (both ears). Longitudinal analysis using generalized estimating equations was performed.

RESULTS

High total leisure noise exposure, defined as an energy equivalent of a 40-hr week of > 85 dBA, was estimated for 32.7% of students at baseline and 63.8% at follow-up. A noise notch was observed in 1.1% of adolescents at baseline and 3.3% at follow-up. At baseline, the maximum measured threshold shift was 55 dB, which increased to 85 dB at the follow-up. Longitudinal analysis did not reveal an association between leisure noise exposure and hearing thresholds. Hearing threshold shifts or noise notches were associated with sex, school type, and time point of measurement.

CONCLUSIONS

No relationship was found between leisure noise and hearing thresholds. Male adolescents and those attending secondary general schools, with graduation following completion of ninth or 10th grade, had a greater likelihood of developing hearing threshold shifts. Prevention programs should focus on these risk groups.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19233462.

Noise Exposure and Use of Hearing Protection Among Adolescents in Rural Areas

PURPOSE

Noise-induced hearing loss (NIHL) has been found in rural children, potentially due to occupational and recreational noise exposure without consistent use of hearing protection devices (HPDs). However, questions remain regarding the specifics of rural adolescents' noise exposure and use of hearing protection around different types of noise. As such, the purpose of the current study was to provide preliminary results on rural adolescents' noise exposure and use of hearing protection for gunfire, heavy machinery, power tools, all-terrain vehicles (ATVs), and music.

METHOD

A questionnaire was administered to 197 students (seventh to 12th grade) from rural schools in West Texas. Questions were related to noise exposure and use of HPDs for specific categories of noise. Testing was performed at the schools, with an investigator recording each student's responses.

RESULTS

Approximately 18%-44% of adolescents reported exposure 12 or more times a year to gunfire, heavy machinery, power tools, and ATVs. Only 1%-18% of the adolescents reported never being exposed to such noise sources. Almost half of rural adolescents never used hearing protection around gunfire, and 77%-91% reported never wearing hearing protection when exposed to heavy machinery, power tools, and ATVs.

CONCLUSIONS

The current study revealed that rural adolescents are exposed to noise sources that could damage their hearing. However, the majority of rural adolescents do not consistently wear hearing protection. Additional research is now needed to extend these findings by assessing rural adolescents' duration of exposure to different noise sources, in addition to investigating prevention of NIHL in this population. Supplemental Material https://doi.org/10.23641/asha.17139335.

Guidelines for Diagnosing and Quantifying Noise-Induced Hearing Loss

This paper makes recommendations for the diagnosis and quantification of noise-induced hearing loss (NIHL) in a medico-legal context. A distinction is made between NIHL produced by: steady broadband noise, as occurs in some factories; more impulsive factory sounds, such as hammering; noise exposure during military service, which can involve very high peak sound levels; and exposure to very intense tones. It is argued that existing diagnostic methods, which were primarily developed to deal with NIHL produced by steady broadband noise, are not adequate for the diagnosis of NIHL produced by different types of exposures. Furthermore, some existing diagnostic methods are based on now-obsolete standards, and make unrealistic assumptions. Diagnostic methods are proposed for each of the types of noise exposure considered. It is recommended that quantification of NIHL for all types of exposures is based on comparison of the measured hearing threshold levels with the age-associated hearing levels (AAHLs) for a non-noise exposed population, as specified in ISO 7029 (2017), usually using the 50th percentile, but using another percentile if there are good reasons for doing so. When audiograms are available both soon after the end of military service and some time afterwards, the most recent audiogram should be used for diagnosis and quantification, since this reflects any effect of the noise exposure on the subsequent progression of hearing loss. It is recommended that the overall NIHL for each ear be quantified as the average NIHL across the frequencies 1, 2, and 4 kHz.

Modification of a Method for Diagnosing Noise-Induced Hearing Loss Sustained During Military Service

Moore (2020) proposed a method for diagnosing noise-induced hearing loss (NIHL) sustained during military service, based on an analysis of the shapes of the audiograms of military personnel. The method, denoted M-NIHL, was estimated to have high sensitivity but low-to-moderate specificity. Here, a revised version of the method, denoted rM-NIHL, was developed that gave a better balance between sensitivity and specificity. A database of 285 audiograms of military noise-exposed men was created by merging two previously used databases with a new database, randomly shuffling, and then splitting into two, one for development of the revised method and one for evaluation. Two comparable databases of audiograms of 185 non-exposed men were also created, again one for development and one for evaluation. Based on the evaluation databases, the rM-NIHL method has slightly lower sensitivity than the M-NIHL method, but the specificity is markedly higher. The two methods have similar overall diagnostic performance. If an individual is classified as having NIHL based on a positive diagnosis for either ear, the rM-NIHL method has a sensitivity of 0.98 and a specificity of 0.63. Based on a positive diagnosis for both ears, the rM-NIHL method has a sensitivity of 0.76 and a specificity of 0.95.

School-based hearing screening in Sweden - An evaluation of current practices

OBJECTIVES

Routines for school hearing screening vary between municipalities in Sweden, and no study has been carried out to investigate how this is conducted throughout the country. The aim of the present study was to determine the extent of school hearing screening, and how it is performed in all the municipalities in Sweden.

METHODS

An online survey was used to collect information on school hearing screening from municipalities in Sweden (N = 290). The survey included questions on the performance of hearing screening, including stimulus level and frequencies tested, the criteria for referral for further hearing evaluation, as well as the equipment and room used for testing, and who carried out the screening. Questions were also included on experience of, and attitudes towards hearing screening.

RESULTS

Answers were received from 225 municipalities (response rate 78%). Universal school hearing screening was performed in 202 municipalities, while in the other municipalities hearing screening was performed when a child was evaluated due to speech delay or learning difficulties. Many different protocols were used involving different stimulus levels, frequencies, and referral criteria. The most common was testing with pure tone audiometry with a lowest stimulus level of 20 dB HL at five frequencies, 500-6000 Hz. Hearing screening was usually performed in the preparation class (6 years of age), while in other municipalities it was performed in year 1 (7 years of age). Hearing screening was usually performed once in primary school, while some municipalities carried out screening once in primary school and once in high school. More rarely, hearing screening was conducted twice in primary school. In 25 % of the municipialities, newly arrived immigrant children were screened. Difficulties in performing hearing screening were reported, such as lack of soundproof rooms, lack of time and technical difficulties. There was an opinion among the participants that identifying students with hearing loss is important, as it affects their learning ability and communication skills. and they expressed a desire for national guidelines.

CONCLUSIONS

Hearing screening is performed in the vast majority of municipally run schools in Sweden. The way in which screening was performed varied regarding the stimulus level and frequencies used, as well as the criteria for referral to a specialist. The attitude towards hearing screening was positive among the participants. Hearing screening of newly immigrated children is important as their previous medical history is often unknown. There is a need for national guidelines on hearing screening of Swedish schoolchildren. Efforts must continue to ensure that the same level of healthcare regarding children's hearing is provided throughout the whole of Sweden.

Examination of hearing loss among school-aged children in Greenland

BACKGROUND

The highest prevalence of chronic suppurative otitis media is seen among children in Greenland. The purpose of this study was to investigate the prevalence of hearing loss among school children in Sisimiut, the second-largest city in Greenland.

MATERIAL AND METHOD

All 423 children from 5th to 10th grade from the two schools in Sisimiut and the nearby settlements were invited to participate. Participants filled out a questionnaire at home with their parents before ear-examination and audiometry. Risk factors for hearing loss and otitis media (OM) related otoscopy findings were analyzed by binomial logistic regression.

RESULTS

A total of 185 children between 9 and 15 years of age (median: 11 years, IQR: 10-13) were included; 60% (n = 111) were girls. Fifty-four children (29%) were found to have hearing impairment using a PTA of 15 dB for either low or high frequencies or both as threshold. When using 25 dB as threshold, the number of children with hearing impairment was 18 (10%). None of the children had hearing aids. Of 355 otoscopies available for evaluation, the majority were normal (n = 249, 70.1%). Perforation of the tympanic membrane was found in six ears (1.7%), of which all were unilateral. Other sequelae related to OM (i.e., circular atrophy and myringosclerosis) were found in 37 ears (10.4%). Children with OM-related otoscopy findings had significantly lower hearing tresholds compared to children without.

CONCLUSION

A high prevalence of untreated hearing loss was found among examined school children in Sisimiut. Children with otoscopy findings indicating prior OM had significantly lower hearing tresholds compared to children without.

Associations of Earphone Use with Tinnitus and Anxiety/Depression

Objective:

This study aimed to investigate the association of earphone use with audiologic and psychologic factors.

Materials and methods:

Korea National Health and Nutrition Examination Survey 2010–2012 data were collected for participants aged ≥12 years old with earphone use ≥1 hour/day. They were matched to a control group for age, sex, income, and education level. The relationship between earphone use and the hearing thresholds of pure-tone audiometry, tinnitus, and psychologic factors such as depression and anxiety, and other quality of life variables was analyzed using multiple logistic regression tests with complex sampling.

Results:

Among the participants, 22.9% (449/1955) of earphone users and 18.1% (355/1600) of control participants had tinnitus (P < 0.001). Earphone users showed 1.27-times higher odds for tinnitus (95% confidence interval [CI] = 1.09–1.50, P = 0.003). Moreover, 6.5% (128/1955) of earphone users and 5.0% (97/1600) of control participants had anxiety and depressive symptoms (P = 0.033). Earphone users showed 1.32-times higher odds for anxiety and depressive symptoms (95% CI = 1.14–1.52, P = 0.040). Nevertheless, the hearing thresholds were comparable between earphone users and control participants.

Conclusion:

Earphone use was associated with tinnitus and anxiety or depressive symptoms.

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.

Audiometric assessment of hearing loss sustained during military service

An analysis is presented of the audiograms, obtained using Telephonics TDH39 headphones (Huntington, NY), of 80 men claiming compensation for noise-induced hearing loss (NIHL) sustained during military service. A comparison with an independent database of audiograms collected using other headphones suggested that no adjustment was needed to the hearing threshold levels (HTLs) at 6 kHz to allow for the use of TDH39 headphones. The method of Moore [(2020). J. Acoust. Soc. Am. 148, 884-894] for diagnosing military noise-induced hearing loss (M-NIHL) gave a positive diagnosis for 92.5% of right ears and 97.5% of left ears. The mean HTLs were maximal and similar at 4, 6, and 8 kHz but with considerable individual variability. A comparison with age-expected HTLs showed that M-NIHL was typically greatest at 3, 4, 6, or 8 kHz but with considerable individual variability. M-NIHL values were positive from 0.5 to 8 kHz. The HTLs were significantly higher for the left than for the right ears, but the asymmetry varied across individuals and could usually be ascribed to specific features of the noise exposure. The asymmetry existed over the range from 0.5 to 8 kHz, supporting the idea that M-NIHL occurs over a wide frequency range. Tinnitus was reported by 76 of the 80 men.

Hearing Screening among First-Grade Children in Rural Areas and Small Towns in Małopolskie Voivodeship, Poland

Undiagnosed hearing deficits hamper a child’s ability to learn. Hearing screening in school aged children helps detect educationally significant hearing loss and prevents negative impacts on academic achievement. The main purpose of this study was to improve early detection and assess the incidence of hearing disorders in first-graders from rural areas and small towns in the Małopolskie Voivodeship of Poland. There were 5029 children aged 6–7 years. Hearing thresholds were measured over the frequency range 0.5–8 kHz. A result was considered positive (abnormal) if the hearing threshold was worse than 20 dB HL at one or more frequencies. The prevalence of hearing loss was estimated in terms of four-frequency hearing loss, high-frequency hearing loss, and low-frequency hearing loss. Parents filled in a brief audiological questionnaire. The analysis was performed using IBM SPSS Statistics, version 24. Of all the children, 20.5% returned a positive result and were referred for further audiological diagnoses. The estimated prevalence of hearing loss was 11.6%, made up of 6.5% with FFHL, 7.6% with HFHL, and 8.2% with LFHL. This study showed that large numbers of children in the district had hearing problems. Adoption of hearing screening in primary schools is recommended as a routine procedure within preventive pediatric health care.

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 4-year follow-up study of hearing acuity in a large population-based cohort of children and adolescents

OBJECTIVES

To describe the prevalence of hearing loss among 13 year old adolescents, and to examine the change in prevalence between ages 9 and 13 years.

METHODS

This study was embedded within Generation R, a population-based prospective cohort study from fetal life onwards in the Netherlands. Pure-tone thresholds were obtained at 0.5 to 8 kHz, and tympanometry was performed. Sensorineural hearing loss (SNHL) was defined as a low-frequency and/or high-frequency pure-tone average of more than 15 dB HL in one of both ears. Audiometric signs suggestive of noise-induced hearing loss (NIHL) included the presence of a notch and/or high-frequency hearing loss. The study was conducted from April 2012 to October 2015, and April 2016 to September 2019.

RESULTS

A total of 4572 adolescents with a mean age of 13 years and 7 months (SD, 5 months) were included, of whom 2334 (51.0%) were girls. Within the cohort, 6.4% (95% CI, 5.7%-7.2%) were estimated to have SNHL, and 12.4% (95% CI, 11.5%-13.4%) met the criteria of NIHL. In total, 3675 participants were included in the longitudinal analysis. The prevalence of SNHL decreased from 8.0% to 5.3% between ages 9 and 13 years (P < .001). The prevalence of NIHL increased from 9.8% to 11.7% (P = .004), due to an increase in number of participants with a notch.

CONCLUSIONS

The prevalence of SNHL significantly decreased by 2.7% (95% CI, 1.6%-3.9%) between ages 9 and 13 years, probably due to a change in alertness during assessment at the age of 13 years. Other possible explanations include the presence of selection bias or a decline in prevalence of conductive hearing loss. The number of participants with audiometric signs suggestive of NIHL increased by 1.9% (95% CI, 0.5%-3.3%).

LEVEL OF EVIDENCE

Level 3.

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.

Role of Subtitles in L2 Acquisition and Comprehension: A Pilot Study of Hearing-Impaired Students

The purpose of this study was to investigate whether subtitles can facilitate language processing in English as a second language (L2) and, if so, which subtitles would be more beneficial for hard-of-hearing students with Norwegian as their first language. In total, 14 advanced learners of L2 English were recruited and tested on English comprehension and target vocabulary items based on video material provided with subtitles in English or Norwegian in comparison to no subtitles (control condition). Subtitles aided comprehension of the plot, tested immediately after clip presentation, with an advantage for English subtitles over Norwegian subtitles and no subtitles. Furthermore, subtitles were found to enhance the performance of the participants with moderate hearing loss more than they did for mild hearing loss participants. The inclusion of English subtitles only marginally enhanced vocabulary understanding for both mild and moderate hearing loss students. The findings of this study can be transferred to classrooms and may supplement other methods of adjusting the academic environment, in order to meet the need of students with hearing loss.

The GoAudio Quantitative Mobile Audiology Test Enhances Access to Clinical Hearing Assessments

Purpose Hearing loss is a common impairment of the human senses with an estimated 48 million American adults reporting some trouble hearing; however, access to hearing health care is limited. Detection of hearing loss through a mobile, handheld tool can provide an important access point and potentially expedited access to the continuum of hearing health care. Here, we determined that GoAudio, a portable, automated hearing assessment tool, can be used to identify individuals who require additional hearing evaluation in a clinical workflow. Method This initial study included 24 adults, ages 18-65 years (M = 50, SD = 12), tested with GoAudio versus "gold-standard" clinical audiometry for eight frequencies to evaluate "real-world" applications. Participants utilized noise-canceling headphones combined with a tablet-based application for the GoAudio assessment. Results The primary study outcome measurements were the comparison of hearing thresholds (dB HL) from clinical audiometry and GoAudio. Results suggest that GoAudio is comparable to clinical audiometry for the identification of hearing loss at most frequencies (except 1 kHz for both ears and 2 kHz in the right ear). Upon stratifying data based on age, we identified that GoAudio is capable of identifying suspected age-related hearing loss or hearing thresholds greater than 30 dB HL at higher frequencies in both ears. Conclusion The study results support that GoAudio can be used effectively in clinical practice workflows as a reliable hearing assessment tool for the identification of hearing loss at the majority of frequencies outside a sound-treated booth and can detect characteristics of age-related hearing loss. Supplemental Material https://doi.org/10.23641/asha.13087682.

Prevalence of extended high-frequency hearing loss among adolescents from two rural areas in Colombia

OBJECTIVE

Worldwide research trends on the prevalence of hearing loss within young rural populations are scarce. Current evidence suggests extended high-frequency audiometry could be a sensitive predictor to detect subclinical hearing loss. This study aimed to determine the prevalence of hearing loss through conventional pure tone (0.25-8 kHz) and extended high-frequency (9-20 kHz) audiometry tests in a group of adolescents aged 13 to 19 years old from two rural areas of Colombia. A sociodemographic and associated factor for hearing loss questionnaire was applied.

DESIGN

Cross-sectional study.

STUDY SAMPLE

Three hundred sixty-six adolescents aged 13 to 19 years old from two rural municipalities in Colombia: Soracá, and Palmas del Socorro.

RESULTS

Hearing loss prevalence assessed through pure tone audiometry was 3.28% in right ears and 3.83% in left ears while through extended high-frequency audiometry was 14.21% and 13.11%, respectively. Associated factors found by the logistic regression were age (OR: 1.36; CI 95% 1.13-1.64) and obesity (OR: 3.74; CI 95% 1.07-13.11).

CONCLUSIONS

Using 15 dB as the normal hearing threshold parameter for audiometric frequencies, our results suggest that extended high-frequency hearing loss is already widespread among rural adolescents. This highlights the need for research on extended high-frequency audiometry in rural school-aged children.

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.

Determinants of the Audiometric Notch at 4000 and 6000 Hz in Young Adults

Background Noise-induced hearing loss (NIHL) is often characterized by the presence of an audiometric notch at 3000-6000 Hz in a behavioral audiogram. The audiometric notch is widely used to investigate NIHL in children and young adults. However, the determinants of the audiometric notch in young adults largely remain unknown.

Purpose The study aimed to investigate the determinants of the audiometric notch in young adults.

Research Design A cross-sectional design was adopted for the study.

Study Sample A sample of 124 adults (38 males and 86 females) aged 18-35 years with normal otoscopic and tympanometric findings was recruited.

Data Collection and Analysis Hearing thresholds and real-ear sound pressure levels (RESPLs) were obtained with calibrated ER-3A (Etymotic Research, Elk Grove Village, IL) andTDH-50P receivers (Telephonics, Farmingdale, NY). Distortion-product otoacoustic emissions (DPOAEs) were used to evaluate the cochlear function. The external auditory canal (EAC) length was measured using the acoustical method. Noise exposure background (NEB) was estimated using the Noise Exposure Questionnaire. The notched audiograms were identified using: Phillips, Coles, and Niskar criteria.

Results The prevalence of notched audiograms was substantially higher for TDH-50P supra-aural receivers than for ER-3A insert receivers. RESPLs at 6000 and 8000 Hz were the major predictors of notched audiograms for TDH-50P receivers. These predictors explained around 45% of the variance in the notched audiograms. The notched audiograms obtained with TDH-50P receivers showed no association with NEB. Individuals with notched audiograms measured using TDH-50P did not show convincing evidence of cochlear dysfunction as assessed by DPOAEs. Individuals with notched audiograms obtained with TDH-50P receivers revealed an average of shorter EAC and a poorer hearing threshold at 6000 Hz.

Conclusions The calibration error in the RESPLs at 6000 and 8000 Hz that are likely to be influenced by the shorter EAC was the major determinant of the notched audiograms when the supra-aural transducers were used to measure hearing thresholds. Therefore, the supra-aural receivers should not be used to estimate the prevalence of NIHL in children and young adults when the less restrictive notch identification criteria are used to identify NIHL. Real-ear calibration techniques that are least influenced by the standing waves in the EAC should be preferred when investigating the prevalence of and risk factors for NIHL in young adults.

Inflammation and hearing status in mid-childhood and mid-life: a population-based cross-sectional study

BACKGROUND

Lifelong inflammation - known to be associated with many non-communicable diseases - has not been thoroughly investigated in hearing. We aimed to determine if glycoprotein A (GlycA), a novel biomarker of chronic inflammation, is associated with hearing acuity in mid-childhood and mid-life.

METHODS

Population-based cross-sectional study within the Longitudinal Study of Australian Children with plasma GlycA and audiometry data (1169 children and 1316 parents). We calculated high Fletcher Index (mean threshold across 1, 2 and 4 kHz), defining hearing loss as threshold >15 decibel hearing level (dB HL) (better ear). Linear/logistic regression quantified associations of GlycA with hearing threshold/loss.

RESULTS

Mean [standard deviation (SD)] high Fletcher Indices (dB HL) were 8.0 (5.7) for children and 13.1 (6.9) for adults, with 8.7% and 26.1% respectively showing hearing loss. 1-SD rise in GlycA (children 0.13 mmol/L, adults 0.17 mmol/L) predicted higher hearing thresholds for the lower individual frequencies [1 kHz: children β 0.8, 95% confidence interval (CI) 0.3-1.3; adults β 0.8, 95% CI 0.2-1.4]. This same pattern was evident for the high Fletcher Index (children β 0.7, 95% CI 0.3-1.1; adults β 0.8, 95% CI 0.3-1.4). This translated into 1-SD rise in GlycA predicting adult hearing loss [odds ratio (OR) 1.2, 95% CI 1.0-1.5] with similar but attenuated patterns in children.

CONCLUSIONS

GlycA is associated with poorer hearing by mid-childhood. This potentially reframes hearing loss as a life-course condition with inflammatory antecedents common to other non-communicable diseases. Replication and mechanistic studies could inform causal inference and early prevention efforts.

Association between Smoking and Noise-Induced Hearing Loss: A Meta-Analysis of Observational Studies

The purpose of this study was to synthesize the results of previously published observational studies through meta-analysis to clarify the association between smoking and noise-induced hearing loss (NIHL). We searched several databases as of October 2019. Based on the results of heterogeneity analysis (Q statistic and I² statistic), a fixed effect model (for no heterogeneity; Q test P > 0.1 and I² ≤ 50%) or a random effects model (for heterogeneity) was used to calculate the pooled odds ratios (ORs). We explored the potential dose-response relationship between smoking and NIHL as well. In total, 27 studies involving 30,465 participants were included. Compared with non-smokers, the pooled OR of current smokers was 2.05 (95% Confidence interval (CI): 1.71–2.46), and of former smokers was 1.11 (95% CI: 1.05–1.18). We found a curve linear association between an increasing number of pack-years (packages/day × smoking years) and risk of NIHL. The dose-response meta-analysis suggested that when the number of pack-years was less than fifteen, the risk of NIHL was increasing, and the highest combined OR was 5.25 (95% CI: 2.30–11.96) for pack-years of fifteen. After fifteen pack-years, the pooled OR had a slow decline. Our study indicated that smoking is a risk factor for NIHL. Current smokers have a higher risk than former smokers, and there is a positive dose-response relationship between smoking and NIHL.

Prevalence, Awareness, and Factors Associated with Noise-induced Hearing Loss in Occupational Motorcyclists in Southwestern Nigeria

Background

There is generally a lack of awareness among professional motorcycle riders on the risk of noise-induced hearing loss; due to a variety of factors, they are exposed to by the nature of their job. This study, therefore, aimed to determine the prevalence, awareness, and factors associated with noise-induced hearing loss among motorcycle riders in Ido-Ekiti, Ekiti State, Nigeria.

Methodology

A cross-sectional descriptive study was conducted between February and March 2019 among 420 motorcycle riders in Ido-Ekiti, Ekiti State, Southwestern Nigeria. Data analyses were performed using the SPSS software version 20. P ≤ 0.05 was considered as statistically significant. Three hundred and sixty of the total of 420 consented for pure-tone audiometry which was done to assess their hearing thresholds.

Results

Majority of the respondents had at least a secondary level of education. About 14.5% of the total study population had hearing loss, among which 15% also reported an accompanying ear discharge. All of the respondents did not have any history of hearing loss before they started the occupation. More than half of the study population was aware of noise-induced hearing loss and was able to link it to their profession. None of the study participants used a hearing aid, but 17.9% reported using ear mufflers and 16.2% used earphones while riding.

Conclusion

Majority of our respondents had secondary school education and 14.5% of the total study population reported hearing loss, among which 15% also reported an accompanying ear discharge. Furthermore, more than half of the study population was aware of noise-induced hearing loss and was able to link it to their profession, whereas 50% agreed that their occupation placed them at risk of hearing loss.

Noise Exposure May Diminish the Musician Advantage for Perceiving Speech in Noise

OBJECTIVE

Although numerous studies have shown that musicians have better speech perception in noise (SPIN) compared to nonmusicians, other studies have not replicated the "musician advantage for SPIN." One factor that has not been adequately addressed in previous studies is how musicians' SPIN is affected by routine exposure to high levels of sound. We hypothesized that such exposure diminishes the musician advantage for SPIN.

DESIGN

Environmental sound levels were measured continuously for 1 week via body-worn noise dosimeters in 56 college students with diverse musical backgrounds and clinically normal pure-tone audiometric averages. SPIN was measured using the Quick Speech in Noise Test (QuickSIN). Multiple linear regression modeling was used to examine how music practice (years of playing a musical instrument) and routine noise exposure predict QuickSIN scores.

RESULTS

Noise exposure and music practice were both significant predictors of QuickSIN, but they had opposing influences, with more years of music practice predicting better QuickSIN scores and greater routine noise exposure predicting worse QuickSIN scores. Moreover, mediation analysis suggests that noise exposure suppresses the relationship between music practice and QuickSIN scores.

CONCLUSIONS

Our findings suggest a beneficial relationship between music practice and SPIN that is suppressed by noise exposure.