Adolescents and MP3 players: too many risks, too few precautions

Risky listening behaviour to music via headphones and its determinants - 7.5 years OHRKAN cohort study

OBJECTIVE

To examine risky leisure noise exposure from listening to music via headphones and to identify potential determinants with special focus on portable listening devices (PLDs) among adolescents over a period of 7.5-years.

DESIGN

Data were collected by questionnaires at four equidistant time points (O1-O4). Music exposure via headphones was calculated based on self-reported volume setting and listening duration. Exceeding 85 dB(A) equivalent for a 40-hour working week was defined as risky noise exposure. Determinants of risky headphone and PLD exposure were investigated using generalised estimating equations and accounting for missing data by multiple imputation.

STUDY SAMPLE

Closed cohort of 2148 students attending 9th grade of any secondary school type in Regensburg (Germany), during 2009 to 2011.

RESULTS

Risky noise exposure from headphone usage was almost twice as high in wave O1 and O2 (at age 15 or 18) compared with 20-23-year-olds in O3 and O4. Risky exposure to headphones and PLDs were associated with younger age, low and medium education, single-parent household and smoking, whereas good self-rated hearing showed a protective effect. Additionally, not being born in Germany was associated with risky PLD exposure.

CONCLUSION

Before harmful behaviours become entrenched, starting preventive efforts at a young age is essential.

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.

Identifying Health-Related Conditions Associated with Tinnitus in Young Adults

OBJECTIVE

The present study investigated the epidemic of tinnitus in college-aged young adults. Our first objective was to identify health conditions associated with tinnitus in young adults. The second objective was to evaluate the predictive utility of some known risk factors.

STUDY DESIGN

A cross-sectional design was used to investigate the prevalence and risk factors for tinnitus.

SETTING

A questionnaire was distributed, reaching out to a large college-aged population. A total of 2258 young adults aged 18-30 years were recruited from April 2021 to February 2022.

INTERVENTIONS

A questionnaire was administered to investigate the epidemiology of tinnitus in a population of college-aged young adults.

RESULTS

About 17.7% of young adults reported bothersome tinnitus perception lasting for ≥5 min in the last 12 months. The prevalence of chronic tinnitus (bothersome tinnitus for ≥1 year) and acute tinnitus (bothersome tinnitus for <1 year) was 10.6% and 7.1%, respectively. About 19% of the study sample reported at least one health condition. Individuals reporting head injury, hypertension, heart disease, scarlet fever, and malaria showed significantly higher odds of reporting chronic tinnitus. Meningitis and self-reported hearing loss showed significant associations with bothersome tinnitus. The prevalence of chronic tinnitus was significantly higher in males reporting high noise exposure, a positive history of reoccurring ear infections, European ethnic background, and a positive health history. Risk modeling showed that noise exposure was the most important risk factor for chronic tinnitus, followed by sex, reoccurring ear infections, and a history of any health condition. A positive history of COVID-19 and self-reported severity showed no association with tinnitus. Individuals reporting reoccurring ear infections showed a significantly higher prevalence of COVID-19.

CONCLUSIONS

While young adults with health conditions are at a higher risk of reporting tinnitus, the predictive utility of a positive health history remains relatively low, possibly due to weak associations between health conditions and tinnitus. Noise, male sex, reoccurring ear infections, European ethnicity, and a positive health history revealed higher odds of reporting chronic tinnitus than their counterparts. These risk factors collectively explained about 16% variability in chronic tinnitus, which highlights the need for identifying other risk factors for chronic tinnitus in young adults.

The association of sociodemographic factors and risk behavior with unsafe use of personal listening devices in adolescents

Many young people are potentially at risk of noise-induced hearing loss due to unsafe use of personal listening devices. The aim of this cross-sectional study was to examine the association of sociodemographic factors and risk behavior with unsafe use of personal listening devices in adolescents to identify a target group for prevention. A smartphone application was developed to objectively measure music listening habits among 314 adolescents with a mean age of 13 years and 7 months (SD ±5 months). Listening habits were characterized as safe or unsafe based on the weekly noise dose. Data on sociodemographic factors and traditional health risk behaviors were obtained by questionnaires. Within the study group, 10.5% of the participants exceeded the 50%, and 4.8% the 100% recommended weekly noise dose. Adolescents with a lower socioeconomic status were more likely to engage in unsafe listening habits as compared to adolescents with a higher socioeconomic status. Additionally, risk behavior was associated with higher odds of having unsafe listening habits as compared to no risk behavior. Age, sex and educational levels were not significantly associated with unsafe listening habits. The findings of the present study indicate that interventions to promote safe listening habits should target adolescents with a lower socioeconomic status and higher risk behavior. Future research is needed to investigate how these adolescents can be motivated to adopt safe listening habits.

Compensating for missing data in the OHRKAN cohort study examining total leisure noise exposure among adolescents

OBJECTIVE

Investigating determinants of total leisure noise (TLN) exposure among adolescents over 7.5 years and compensating for missing data due to loss to follow-up.

DESIGN

In the OHRKAN cohort study, data were collected by questionnaires at four waves. TLN was calculated from self-reported duration spent participating in 18 leisure activities. High exposure was defined as exceeding 85 dB(A) of equivalent continuous average sound pressure level (SPL) during a 40-h week. Multiple imputation (MI) and generalised estimating equations (GEE) were used to analyse odds ratios (OR) of determinants of TLN exposure and compared to complete-case analysis.

STUDY SAMPLE

Closed cohort of 2148 students enrolled in grade 9 of any school in Regensburg (Germany), recruited from 2009 to 2011.

RESULTS

Up to 74% of adolescents had risky TLN exposure, depending on wave. The most significant sources were discotheques, portable listening devices (PLD) and stereo systems. Higher TLN exposure was associated with time point, education, single-parent households and gender. MI under MAR assumption changed results only slightly compared to complete-case analysis.

CONCLUSIONS

Prevalence of risky TLN is high during adolescence. MI reinforced trends detected in former results of OHRKAN. Preventive measures should consider the main drivers of noise exposure including changes by age and high risks groups.

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.

Hearing loss and hearing needs in an adult homeless population: a prospective cross-sectional study

BACKGROUND

Given that hearing loss is associated with increased social isolation, reduced earning potential and neurocognitive disease, findings of uncorrected hearing loss in the homeless population have important policy implications. We sought to estimate the prevalence of hearing impairment in an adult homeless population.

METHODS

We recruited adult (age ≥ 18 yr) homeless people across 10 homeless shelters in Toronto between April and June 2018 using a 2-stage sampling technique. Participants were interviewed by 1 interviewer using a modified survey that had been used in previous studies looking at other health needs in homeless populations. A comprehensive head and neck examination and audiometric evaluation were performed in each participant by an otolaryngologist and an audiologist. Descriptive statistics were estimated. Audiometric data were standardized directly for age and sex to facilitate direct comparisons with the general Canadian population.

RESULTS

Of the 132 people invited, 100 (75.8%) agreed to participate. The median age was 46 (interquartile range [IQR] 37-58) years. The median duration of homelessness was 24 (IQR 6-72) months. Although most participants (78) had some form of extended health care benefits through social assistance, only 22/78 (28%) were aware that hearing tests and hearing aids were covered through these programs. After direct standardization for age and sex, the proportions of participants with a speech-frequency and high-frequency hearing loss were 39.5% (95% confidence interval [CI] 30.4%-49.3%) and 51.9% (95% CI 42.2%-61.4%), respectively. Nineteen participants were hearing aid candidates, only 1 of whom owned functional hearing aids. Rates of speech-frequency hearing loss (39.5%, 95% CI 30.4%-49.3% v. 19.2%, 95% CI 16.9%-21.7%) and high-frequency hearing loss (51.9%, 95% CI 42.2%-61.4% v. 35.5%, 95% CI 33.1%-37.7%) were substantially higher than in the general Canadian population.

INTERPRETATION

Our results suggest that homeless adults have a high prevalence of hearing impairment, even when living within a system of universal health insurance; awareness of health care benefits through social assistance programs was poor. Results from this study may prompt initiatives surrounding homeless outreach and health screening.

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

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

Evaluation of dichotic listening performance in normal-hearing, noise-exposed young females

Recent animal studies have shown that intense noise exposures that produce robust temporary threshold shift (TTS) can inflict irreversible damage to the synaptic connections between the inner hair cells and auditory neurons. It was hypothesized that noise-induced cochlear synaptopathy may cause impaired acoustic encoding in the central auditory nervous system leading to impaired speech perception, particularly in challenging listening situations. The aim of the study was to evaluate the influence of high noise exposure background (NEB) on dichotic listening performance, speech-in-noise performance, and auditory brainstem responses (ABR) measured in young females with normal audiograms. The central hypothesis was that individuals with high NEB would exhibit reduced ABR wave I amplitude and subsequently would exhibit poorer performance on speech-in-noise and dichotic listening. In a sample of 32 females (14 with high NEB and 18 with low NEB) aged 18-35 years, the study compared behavioral hearing thresholds (from 250 to 16000 Hz), distortion-product otoacoustic emissions (DPOAEs, 1000-16000 Hz), click-evoked ABR, QuickSIN signal-to-noise ratio (SNR) loss and dichotic digit test (DDT). The results showed no clear association between NEB, and hearing thresholds, DPOAEs, click-evoked ABR measures, and QuickSIN SNR loss. Individuals with high NEB revealed significantly lower DDT scores and evidence of reduced right ear advantage compared to individuals with low NEB. The poorer performance in DDT and the ear asymmetry in DDT scores with normal ABR findings suggest that high NEB might alter the hemispheric organization of speech-sound processing and cognitive control. The clinical significance of the present findings is discussed.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

LEVEL OF EVIDENCE

NA Laryngoscope, 130:541-545, 2020.

Hazardous noise exposure from noisy toys may increase after purchase and removal from packaging: A call for advocacy

OBJECTIVE

Previous studies identified hazardous noise levels from packaged toys. Sound levels may increase when packaging is removed and therefore, complicate the ability to accurately assess noise levels before purchase. The goal of this study was to evaluate how packaging affects the decibel (dB) level of toys by: 1) Assessing dB level of toys with and without packaging. 2) Evaluating the percentage of packaged and unpackaged toys that exceed a safety limit of 85 dB.

METHODS

Thirty-five toys were selected from the 2009-2011 Sight and Hearing Association (SHA) based on availability for purchase. Toys' speakers were categorized as Exposed, Partially Exposed, or Covered, based on its packaging. The dB level of each toy was tested at 0 cm and 25 cm from the speaker using a handheld digital sound meter in a standard audiometric booth. T tests and ANOVA were performed to assess mean change in sound level before and after packaging removal.

RESULTS

Significant dB increases were noted after packaging was removed (mean change 11.9 dB at 0 cm; and 2.5 dB at 25 cm, p < 0.001). Sixty-four percentage of Covered toys (n = 14) had dB greater than 85 dB when packaged and this increased to 100% when unpackaged.

CONCLUSION

Many manufactured toys have hazardous sound levels. Caregivers and healthcare providers should be aware that toys tested in the store may actually be louder when brought home and removed from their packaging. Limits on and disclosure of dB level of toys should be considered nationally.

A preliminary study on time-compressed speech recognition in noise among teenage students who use personal listening devices

OBJECTIVE

To compare speech perception obtained with different time compression rates in teenagers that do or do not use personal listening devices (PLDs).

DESIGN

Teenagers in a high school were recruited to complete questionnaires reporting their recreational noise exposure using PLDs. The dose of individual recreational noise exposure was calculated. The individuals with the most and least doses of recreational noise were selected and grouped into PLD users and non-PLD users. Normal rate and time-compressed (60% and 70%) speech recognition in quiet and noisy conditions was measured.

STUDY SAMPLE

PLD user and non-PLD user group each included 20 participants.

RESULTS

ANOVA analysis showed that the effect of group, background, compression rate, and interactions between any two factors are significant. Post hoc analysis showed that the speech recognition scores with normal rate in quiet and noise and those obtained from time-compressed speech in the quiet condition were not significantly different between PLD users and non-PLD users. However, differences in the time-compressed speech recognition scores (60% and 70%) in noisy conditions between the two groups were statistically significant.

CONCLUSIONS

The fast-speed speech recognition in noise decreased significantly in PLD users compared with that in non-PLD users selected by extreme entertainment exposure.

Early Indication of Noise-Induced Hearing Loss in Young Adult Users of Personal Listening Devices

Objectives:

The recent integration of portable music players into cell phones has further increased the use of personal listening devices (PLD) among young adults, raising concerns about potentially hazardous effects on hearing.

Methods:

Assessment of young adults’ hearing ability and listening preferences by subjective and objective measurement. Young adult users of PLDs (n = 50; 30 females, 20 males; mean age = 24.1 ± 4.2 years; average PLD use = 6.1 ± 2.1 years) were included. Subjective assessment of listening preferences was performed via a questionnaire as well as objective assessment of preferred volume levels in different background noise environments and hearing tests.

Results:

Preferred volume levels were significantly correlated with hearing thresholds. Most participants exhibited safe listening behavior according to National Institute for Occupational Safety and Health criteria. We identified a substantial high-risk subgroup of PLD users (22% of participants, daily use ⩾2 h at ⩾91 dB) in which pure tone audiometry showed increased hearing thresholds at 4000 and 6000 Hz, potentially indicating an early manifestation of noise-induced hearing loss (NIHL).

Conclusions:

These findings suggest that preventive measures may be warranted to prevent a future increase of clinically relevant NIHL among heavy users of PLDs.

Headphone listening habits, hearing thresholds and listening levels in Swedish adolescents with severe to profound HL and adolescents with normal hearing

OBJECTIVE

Research has minimally focussed on the music listening habits and preferred sound volumes among adolescents with severe to profound congenital HL. Listening to music played at loud sound volumes and for a long duration of time could imply risks of worsening the HL. Therefore, it is important to investigate the listening habits in adolescents with HL. The aim of the present study was to describe the use of personal music devices, subjective estimated sound levels, measured sound levels, listening habits, and hearing symptoms in adolescents with severe to profound hearing loss compared with adolescents with normal hearing.

DESIGN

The study was conducted in two steps. First, a questionnaire was given to students with or without hearing loss. In step two, hearing and sound level measurements were made in a subsample from both groups.

STUDY SAMPLE

The study sample were based on 112 seventeen-year-old students with severe to profound hearing loss and 279 adolescents with normal hearing. Hearing thresholds and listening levels was measured on two subsamples based on 29 adolescents with severe to profound hearing loss and 50 adolescents from the group with normal hearing.

RESULTS

The results showed that adolescents with severe to profound hearing loss listened to significantly louder sound levels for longer periods. For both groups, those listening at louder sound levels had poorer hearing thresholds. This finding is especially alarming for subjects with hearing loss. Among those listening above 85 dB per occasion, the sound level ranged between 85.8 dB up to 109 dB for those with hearing loss, whereas the sound level ranged between 85.5 dB and 100 dB for those with normal hearing.

CONCLUSIONS

Adolescents with congenital hearing loss used portable music devices in the same manner as adolescents with normal hearing. However, adolescents with hearing loss listened to louder sound volumes most likely to compensate for their hearing loss, which significantly increases the risk of further damage to their hearing. From a hearing rehabilitation perspective it could be concluded that aspect of music listening habits should be focussed in order to prevent noise induced hearing loss among individuals with congenital hearing loss.

Discriminación auditiva en entornos de ruido, en personas que usan auriculares de forma habitual || Perception of phonemes in noise environments, in people who usually use headphones

La finalidad de este trabajo era conocer cómo la utilización diaria y prolongada de auriculares, así como el ruido de fondo, afectan a la comprensión del habla. Existe evidencia en la literatura de que el uso habitual de auriculares puede traducirse en una pérdida de audición en la frecuencia de 3000 Hz, y también son conocidas las dificultades de comprensión que surgen cuando hay un elevado nivel de ruido ambiental. Por ello, en esta investigación se quiso contar con una muestra de personas que prácticamente no han sido objeto de estudio pero que por su ocupación llevan cierto tiempo bajo los efectos de ambos factores. Así, se contó con la colaboración como grupo experimental de 24 teleoperadoras y de otras 20 personas no relacionadas con la profesión como grupo control equivalente. Para la tarea de evaluación se empleó una versión reducida y en español del Speech Perception in Noise Test. La tarea consistía en repetir la última palabra de una serie de frases pregrabadas con distintos sonidos de fondo, en las que había distintos fonemas y diferente predictibilidad de las palabras. Los resultados obtenidos mostraron que la utilización habitual de auriculares tiene un efecto negativo sobre la percepción auditiva de ciertas frecuencias y que el ruido de call center afecta negativamente a la compresión del habla, incluso más que el de tráfico. Estos hallazgos son de aplicación tanto en lo laboral como en lo educativo y prueban la importancia de sensibilizar a la población sobre el uso adecuado de auriculares.

Listening to music with personal listening devices: monitoring the noise dose using a smartphone application

OBJECTIVES

To monitor listening habits to personal listening devices (PLDs) using a smartphone application and to compare actual listening habits to self-report data.

DESIGN

Two stages: self-report listening habits questionnaire, and real-time monitoring of listening habits through a smartphone application.

STUDY SAMPLE

Overall 117 participants aged 18-34 years (mean 25.5 years) completed the questionnaire, and of them, 40 participants (mean age: 25.2 years) were monitored for listening habits during two weeks.

RESULTS

Questionnaire main findings indicated that most of the participants reported listening for 4-7 days a week, for at least 30 min at high listening levels with volume control settings at 75-100%. Monitored data showed that actual listening days per week were 1.5-6.5 d, with mean continuous time of 1.56 h, and mean volume control setting of 7.39 (on a scale of 1-15). Eight participants (22%) were found to exceed the 100% noise dose at least once during the monitoring period. One participant (2.7%) exceeded the weekly 100% daily noise dose. Correlations between actual measurements and self-report data were low to moderate.

CONCLUSIONS

Results confirmed the feasibility of monitoring listening habits by a smartphone application, and underscore the need for such a tool to enable safe listening behaviour.

The Effects of Earphone Use and Environmental Lead Exposure on Hearing Loss in the Korean Population: Data Analysis of the Korea National Health and Nutrition Examination Survey (KNHANES), 2010-2013

BACKGROUND

Although previous studies have reported that frequent earphone use and lead exposure are risk factors for hearing loss, most of these studies were limited to small populations or animal experiments. Several studies that presented the joint effect of combined exposure of noise and heavy metal on hearing loss were also mainly conducted on occupational workers exposed to high concentration.

OBJECTIVES

We investigated both the individual and joint effects of earphone use and environmental lead exposure on hearing loss in the Korean general population.

METHODS

We analyzed data from 7,596 Koreans provided by the Korea National Health and Nutrition Examination Survey (KNHANES) during the period 2010-2013. The pure-tone average (PTA) of hearing thresholds at 2, 3, and 4 kHz frequencies was computed, and hearing loss was defined as a PTA ≥ 25 dB in one or both ears.

RESULTS

A dose-response relationship in hearing loss with earphone use time and blood lead level is observed after adjustment for confounding factors. With a 1-hour increase in earphone use time and 1 μg/dL increase in blood lead concentration, the odds of hearing loss increased by 1.19 and 1.43 times, respectively. For hearing loss, the additive and multiplicative effect of earphone use and blood lead level were not statistically significant.

CONCLUSIONS

Earphone use and environmental lead exposure have an individual effect on hearing loss in the general population. However, the estimated joint effect of earphone use and lead exposure was not statistically significant.

Influence of Hearing Risk Information on the Motivation and Modification of Personal Listening Device Use

PURPOSE

The purpose of this study was (a) to investigate the behaviors, knowledge, and motivators associated with personal listening device (PLD) use and (b) to determine the influence of different types of hearing health risk education information (text with or without visual images) on motivation to modify PLD listening use behaviors in young adults.

METHOD

College-age students (N = 523) completed a paper-and-pencil survey tapping their behaviors, knowledge, and motivation regarding listening to music or media at high volume using PLDs. Participants rated their motivation to listen to PLDs at lower volume levels following each of three information sets: text only, behind-the-ear hearing aid image with text, and inner ear hair cell damage image with text.

RESULTS

Acoustically pleasing and emotional motives were the most frequently cited (38%-45%) reasons for listening to music or media using a PLD at high volume levels. The behind-the-ear hearing aid image with text information was significantly (p < .0001) more motivating to participants than text alone or the inner ear hair cell damage image with text.

CONCLUSIONS

Evocative imagery using hearing aids may be an effective approach in hearing protective health campaigns for motivating safer listening practices with PLDs in young adults.

Age and gender differences in children and adolescents' attitudes toward noise

OBJECTIVE

Most school-aged children experience exposure to hazardous sound levels via high-risk noise activities (e.g. loud music/concerts, firearms). Little information exists regarding factors influencing pediatric engagement in these activities and use of hearing protection devices. This study explores effects of age, gender, and attitudes toward noise on participation in acoustic risk-taking behaviors and hearing conservation practices in children and adolescents.

DESIGN

Cross-sectional.

STUDY SAMPLE

Children and adolescents (10-19 years) with normal hearing.

RESULTS

Most children and adolescents (86.5%) participate in at least one potentially high-risk noise behavior. The most frequently cited activities include sporting events, concerts, and playing a musical instrument. Use of hearing protection devices varies by activity, with consistent wear while using firearms but inconsistent application during all other activities. Gender, but not age, influences acoustic risk-taking behaviors: Boys engage in significantly more high-risk noise activities than girls. Participants expressed a neutral attitude toward noise that persisted across age and gender, but a trend shifting toward a pro-noise attitude emerges in later adolescence.

CONCLUSIONS

The proliferation of acoustic risk-taking behaviors and lack of hearing conservation practices in children and adolescents requires attention at an early age to prevent future noise-induced hearing loss and subsequent quality of life effects.

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

PURPOSE

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

METHOD

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

RESULTS

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

CONCLUSION

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

The socioeconomic impact of hearing loss in U.S. adults

OBJECTIVE

To evaluate the associations between hearing loss and educational attainment, income, and unemployment/underemployment in U.S. adults.

STUDY DESIGN

National cross-sectional survey.

SETTING

Ambulatory examination centers.

PATIENTS

Adults aged 20 to 69 years who participated in the 1999 to 2002 cycles of the NHANES (National Health and Nutrition Examination Survey) audiometric evaluation and income questionnaire (N = 3,379).

INTERVENTION(S)

Pure-tone audiometry, with hearing loss defined by World Health Organization criteria of bilateral pure-tone average of more than 25 dB (0.5, 1, 2, 4 kHz).

MAIN OUTCOME MEASURE(S)

Low educational attainment, defined as not completing high school; low income, defined as family income less than $20,000 per year; and unemployment or underemployment, defined as not having a job or working less than 35 hours per week.

RESULTS

Individuals with hearing loss had 3.21 times higher odds of low educational attainment (95% confidence interval [95% CI], 2.20-4.68) compared with normal-hearing individuals. Controlling for education, age, sex, and race, individuals with hearing loss had 1.58 times higher odds of low income (95% CI, 1.16-2.15) and 1.98 times higher odds of being unemployed or underemployed (95% CI, 1.38-2.85) compared with normal-hearing individuals.

CONCLUSION

Hearing loss is associated with low educational attainment in U.S. adults. Even after controlling for education and important demographic factors, hearing loss is independently associated with economic hardship, including both low income and unemployment/underemployment. The societal impact of hearing loss is profound in this nationally representative study and should be further evaluated with longitudinal cohorts. Received institutional review board approval (National Center for Health Statistics Institutional Review Board Protocol no. 98-12).

Exposure to classroom sound pressure level among dance teachers in Porto Alegre (RS)

Introduction: Dance teachers are exposed to high sound intensities.

Aim: To verify the sound intensity of music used by dance teachers during classes.

Method: This was a transversal and prospective study. Dance teachers were evaluated with a sociodemographic questionnaire, and sound intensity level measurements were taken at the beginning, middle, and end of dance classes.

Results: The sample comprised 35 teachers (average age, 31.8 years). The duration of their career as dance teachers was 1–37 years; they worked daily for approximately 1–10 h. Among the classes followed, there were 15 (42.85%) classical ballet classes, 4 (11.42%) tap dancing lessons, 5 (14.28%) jazz dance classes, 2 (5.71) Arab dance lessons, 6 (17.14%) street dance classes, and 3 (8.57%) ballroom dancing lessons. The average values observed at the beginning, middle, and end of the classes were 80.91 dB (A), 83.22 dB (A), and 85.19 dB (A), respectively. The music played in the street dance classes exposed teachers to the highest sound intensity.

Conclusion: The average level of sound intensity of the dance classes in this study was either below or equal to the limit considered harmful for hearing health. Analysis of different class types showed that the sound densities of street, ballroom, and tap dance classes were above the recommended limits.

Cigarette smoking causes hearing impairment among Bangladeshi population

Lifestyle including smoking, noise exposure with MP3 player and drinking alcohol are considered as risk factors for affecting hearing synergistically. However, little is known about the association of cigarette smoking with hearing impairment among subjects who carry a lifestyle without using MP3 player and drinking alcohol. We showed here the influence of smoking on hearing among Bangladeshi subjects who maintain a lifestyle devoid of using MP3 player and drinking alcohol. A total of 184 subjects (smokers: 90; non-smokers: 94) were included considering their duration and frequency of smoking for conducting this study. The mean hearing thresholds of non-smoker subjects at 1, 4, 8 and 12 kHz frequencies were 5.63 ± 2.10, 8.56±5.75, 21.06 ± 11.06, 40.79 ± 20.36 decibel (dB), respectively and that of the smokers were 7 ± 3.8, 13.27 ± 8.4, 30.66 ± 12.50 and 56.88 ± 21.58 dB, respectively. The hearing thresholds of the smokers at 4, 8 and 12 kHz frequencies were significantly (p<0.05) higher than those of the non-smokers, while no significant differences were observed at 1 kHz frequency. We also observed no significant difference in auditory thresholds among smoker subgroups based on smoking frequency. In contrast, subjects smoked for longer duration (>5 years) showed higher level of auditory threshold (62.16 ± 19.87 dB) at 12 kHz frequency compared with that (41.52 ± 19.21 dB) of the subjects smoked for 1-5 years and the difference in auditory thresholds was statistically significant (p<0.0002). In this study, the Brinkman Index (BI) of smokers was from 6 to 440 and the adjusted odds ratio showed a positive correlation between hearing loss and smoking when adjusted for age and body mass index (BMI). In addition, age, but not BMI, also played positive role on hearing impairment at all frequencies. Thus, these findings suggested that cigarette smoking affects hearing level at all the frequencies tested but most significantly at extra higher frequencies.

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

OBJECTIVE

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

SETTING

A single public high school in Pennsylvania.

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

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

Low body mass index and jaw movement are protective of hearing in users of personal listening devices

OBJECTIVES/HYPOTHESIS

Sound pressure level delivered through personal listening devices (PLDs) and reaching the ear drum might be affected by body size and jaw movements. This study aimed to investigate whether jaw movement and/or smaller body mass index (BMI) resulted in decrease of sound pressure level within the ear canals of PLD users via an earbud earphone.

STUDY DESIGN

Case series.

METHODS

Forty-five normal-hearing subjects (16 males; mean age, 23.3 years) participated in this study. A probe-microphone system was used to measure sound pressure level in the external ear canal with music delivered from a media player via an earbud earphone. Test materials consisted of two 20-second excerpts from a heavy metal music piece. Subjects were instructed to adjust the volume of the media player to conform to three conditions for sound pressure measurement: comfortable, loud, and maximum. Measurements were then repeated while subjects mimicked chewing action under the same listening conditions.

RESULTS

Sound pressure levels were significantly lower when measured with jaw movement than without jaw movement (P < .05). Sound pressure levels monitored with/without jaw movement were generally lower in subjects with a BMI<23 than those with a BMI ≥ 23 (P < .05).

CONCLUSIONS

Jaw movement and low BMI (<23) reduced the overall sound level of PLDs at the ear canal. Sound pressure levels detected in the external ear canal of our subjects using earbud earphones were significantly lower under conditions of jaw movement/BMI <23. Our research invites further studies on a larger group of PLD users to correlate these variables with hearing threshold shifts over time.

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

Background and objectives

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

Methods

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

Results

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

Conclusions

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

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

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

Digital music exposure reliably induces temporary threshold shift in normal-hearing human subjects

OBJECTIVES

One of the challenges for evaluating new otoprotective agents for potential benefit in human populations is the availability of an established clinical paradigm with real-world relevance. These studies were explicitly designed to develop a real-world digital music exposure that reliably induces temporary threshold shift (TTS) in normal-hearing human subjects.

DESIGN

Thirty-three subjects participated in studies that measured effects of digital music player use on hearing. Subjects selected either rock or pop music, which was then presented at 93 to 95 (n = 10), 98 to 100 (n = 11), or 100 to 102 (n = 12) dBA in-ear exposure level for a period of 4 hr. Audiograms and distortion product otoacoustic emissions (DPOAEs) were measured before and after music exposure. Postmusic tests were initiated 15 min, 1 hr 15 min, 2 hr 15 min, and 3 hr 15 min after the exposure ended. Additional tests were conducted the following day and 1 week later.

RESULTS

Changes in thresholds after the lowest-level exposure were difficult to distinguish from test-retest variability; however, TTS was reliably detected after higher levels of sound exposure. Changes in audiometric thresholds had a "notch" configuration, with the largest changes observed at 4 kHz (mean = 6.3 ± 3.9 dB; range = 0-14 dB). Recovery was largely complete within the first 4 hr postexposure, and all subjects showed complete recovery of both thresholds and DPOAE measures when tested 1 week postexposure.

CONCLUSIONS

These data provide insight into the variability of TTS induced by music-player use in a healthy, normal-hearing, young adult population, with music playlist, level, and duration carefully controlled. These data confirm the likelihood of temporary changes in auditory function after digital music-player use. Such data are essential for the development of a human clinical trial protocol that provides a highly powered design for evaluating novel therapeutics in human clinical trials. Care must be taken to fully inform potential subjects in future TTS studies, including protective agent evaluations, that some noise exposures have resulted in neural degeneration in animal models, even when both audiometric thresholds and DPOAE levels returned to pre-exposure values.

Tinnitus evaluation in primary care

Tinnitus is a common, yet poorly understood problem. This symptom has many causes, both benign as well as serious. Patients can experience significant changes in quality-of-life related to symptom severity and duration. This article explores causes of tinnitus, evaluation in a primary care setting, and management strategies.

School daze: why are teachers and schools missing the boat on media?

Most American schools are 50 years behind in incorporating new technology into the classroom and using media wisely. Some experts estimate that 65% of today's grade-school students may end up doing jobs that have not even been invented yet. Abundant evidence now exists that children and teens learn preferentially from the media, yet the media are often frowned on as too distracting for students or too distant from the basic 3 Rs. American schools are failing in their fundamental responsibility to students. Educators need to learn how to use media and new technology wisely.

Children, adolescents, and the media: health effects

The media can be a powerful teacher of children and adolescents and have a profound impact on their health. The media are not the leading cause of any major health problem in the United States, but they do contribute to a variety of pediatric and adolescent health problems. Given that children and teens spend >7 hours a day with media, one would think that adult society would recognize its impact on young people's attitudes and behaviors. Too little has been done to protect children and adolescents from harmful media effects and to maximize the powerfully prosocial aspects of modern media.

Risky music-listening behaviors and associated health-risk behaviors

OBJECTIVE

To examine, among adolescents and emerging adults attending inner-city lower education, associations between risky music-listening behaviors (from MP3 players and in discotheques and at pop concerts) and more traditional health-risk behaviors: substance use (cigarettes, alcohol, cannabis, and hard drugs) and unsafe sexual intercourse.

METHODS

A total of 944 students in Dutch inner-city senior-secondary vocational schools completed questionnaires about their music-listening and traditional health-risk behaviors. Multiple logistic regression analyses were used to examine associations between music-listening and traditional health-risk behaviors.

RESULTS

Risky MP3-player listeners used cannabis more often during the past 4 weeks. Students exposed to risky sound levels during discotheque and pop concert attendance used cannabis less often during the past 4 weeks, were more often binge drinkers, and reported inconsistent condom use during sexual intercourse.

CONCLUSIONS

The coexistence of risky music-listening behaviors with other health-risk behaviors provides evidence in support of the integration of risky music-listening behaviors within research on and programs aimed at reducing more traditional health-risk behaviors, such as substance abuse and unsafe sexual intercourse.

Characteristics of noise-canceling headphones to reduce the hearing hazard for MP3 users

Three pairs of headphones [standard iPod ear buds and two noise-canceling headphones (NCHs)] were chosen to investigate frequency characteristics of noise reduction, together with their attenuation effects on preferred listening levels (PLLs) in the presence of various types of background noise. Twenty-six subjects with normal hearing chose their PLLs in quiet, street noise, and subway noise using the three headphones and with the noise-canceling system on/off. Both sets of NCHs reduced noise levels at mid- and high-frequencies. Further noise reductions occurred in low frequencies with the noise canceling system switched on. In street noise, both NCHs had similar noise reduction effects. In subway noise, better noise reduction effects were found in the expensive NCH and with noise-canceling on. A two way repeated measures analysis of variance showed that both listening conditions and headphone styles were significant influencing factors on the PLLs. Subjects tended to increase their PLLs as the background noise level increased. Compared with ear buds, PLLs obtained from NCHs-on in the presence of background noise were reduced up to 4 dB. Therefore, proper selection and use of NCHs appears beneficial in reducing the risk of hearing damage caused by high music listening levels in the presence of background noise.

Preferred listening levels of personal listening devices in young teenagers: self reports and physical measurements

OBJECTIVE

To assess the potential risk of hearing loss to young listeners, due to the use of personal listening devices (PLDs).

DESIGN

The study included two parts: (1) A self-report questionnaire on music listening habits, and (2) Physical measurements of preferred listening levels, in quiet and in everyday background noise.

STUDY SAMPLE

Young teenagers aged 13 to 17 years. Part 1 included 289 participants with mean age of 14 years. Part 2 included 11 and 74 participants (2A and 2B) with a mean age of 15 years. Eleven listened to PLDs in quiet conditions (2A) and 74 in everyday background noise (2B).

RESULTS

Questionnaire main findings indicated that most of the participants reported high or very high volume settings and demonstrated low awareness towards loud music listening consequences. Physical measurements corrected for diffuse field indicated mean preferred listening levels of: 82 (SD = 9) dBA in quiet, and 89 (SD = 9) dBA in the presence of background noise. The potential risk to hearing of PLDs users was calculated using the 8 hour equivalent level.

CONCLUSION

More than 25% of the participants in the noisy condition were found to be at risk according to occupational damage risk criteria NIOSH, 1998.

Evidence of hearing loss in a 'normally-hearing' college-student population

We report pure-tone hearing threshold findings in 56 college students. All subjects reported normal hearing during telephone interviews, yet not all subjects had normal sensitivity as defined by well-accepted criteria. At one or more test frequencies (0.25-8 kHz), 7% of ears had thresholds ≥25 dB HL and 12% had thresholds ≥20 dB HL. The proportion of ears with abnormal findings decreased when three-frequency pure-tone-averages were used. Low-frequency PTA hearing loss was detected in 2.7% of ears and high-frequency PTA hearing loss was detected in 7.1% of ears; however, there was little evidence for 'notched' audiograms. There was a statistically reliable relationship in which personal music player use was correlated with decreased hearing status in male subjects. Routine screening and education regarding hearing loss risk factors are critical as college students do not always self-identify early changes in hearing. Large-scale systematic investigations of college students' hearing status appear to be warranted; the current sample size was not adequate to precisely measure potential contributions of different sound sources to the elevated thresholds measured in some subjects.