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

Noise Stress Abrogates Structure-Specific Endonucleases within the Mammalian Inner Ear

Nucleotide excision repair (NER) is a multistep biochemical process that maintains the integrity of the genome. Unlike other mechanisms that maintain genomic integrity, NER is distinguished by two irreversible nucleolytic events that are executed by the xeroderma pigmentosum group G (XPG) and xeroderma pigmentosum group F (XPF) structure-specific endonucleases. Beyond nucleolysis, XPG and XPF regulate the overall efficiency of NER through various protein-protein interactions. The current experiments evaluated whether an environmental stressor could negatively affect the expression of Xpg (Ercc5: excision repair cross-complementing 5) or Xpf (Ercc4: excision repair cross-complementing 4) in the mammalian cochlea. Ubiquitous background noise was used as an environmental stressor. Gene expression levels for Xpg and Xpf were quantified from the cochlear neurosensory epithelium after noise exposure. Further, nonlinear cochlear signal processing was investigated as a functional consequence of changes in endonuclease expression levels. Exposure to stressful background noise abrogated the expression of both Xpg and Xpf, and these effects were associated with pathological nonlinear signal processing from receptor cells within the mammalian inner ear. Given that exposure to environmental sounds (noise, music, etc.) is ubiquitous in daily life, sound-induced limitations to structure-specific endonucleases might represent an overlooked genomic threat.

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.

Listening Habits to Music during COVID-19 Pandemic: Is There a Risk to Hearing?

BACKGROUND

 The coronavirus disease 2019 (COVID-19) pandemic introduced a unique situation by consigning people to their homes, with free time for music listening, joined with increased anxiety and stress levels. The question arises whether listening habits to music have changed during the pandemic. Such a change in listening habits might pose a greater potential risk to hearing than in routine days.

PURPOSE

 To evaluate listening habits to music using earphones during the COVID-19 pandemic and assess if any change occurred in these habits compared with routine days before the pandemic.

RESEARCH DESIGN

 Self-reported listening habits were collected using a purpose-built questionnaire submitted online.

STUDY SAMPLE

 In total, the questionnaire was distributed among 242 young adults aged 18 to 30 years (mean: 24.3 ± 2.8). A total of 192 participants, regular listeners to music using earphones, provided information concerning their listening habits.

DATA COLLECTION AND ANALYSIS

 Collected listening habits included: listening levels, duration, and frequency of listening during the pandemic compared with routine days. Symptoms and circumstances that occurred following music listening were reported as well. We compared statistically listening habits of participants that stayed home during the pandemic versus those that kept their office routine. In addition, we performed statistical analysis on hearing symptoms following unsafe versus safe music listeners.

RESULTS

 Most reported listening durations were 2 to 4 days (28.5%) and 7 days a week (29.7%), for at least 30 minutes, at high to very high listening levels, and volume control settings at 75 to 100%. Almost 50% of the participants reported a change in their listening habits during the pandemic, mainly a more frequent and longer listening duration. Overall, 29.1% of the participants were at potential risk of hearing loss due to unsafe listening habits.

CONCLUSION

 The change in listening habits during the COVID-19 pandemic underscores the need to monitor listening habits and raise awareness of the one cause for hearing loss that can be prevented.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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.

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.

Objective Measurement of Listening Device Use and Its Relation to Hearing Acuity

Objectives

To examine whether adolescents exceed recommended noise exposure limits when using personal listening devices (PLDs) and to investigate the relationship between objectively measured PLD use and hearing thresholds

Study Design

Cross-sectional study.

Setting

This study was embedded within an ongoing prospective birth cohort study in Rotterdam, the Netherlands. Data were collected from May 2017 to September 2019.

Methods

A smartphone application was developed to measure daily noise exposure from PLDs. Listening habits were monitored among 314 adolescents with a mean age of 13 years 7 months (SD, 5 months), of whom 51.6% were male. Hearing acuity was measured by pure tone audiometry, and tympanometry was performed in both ears.

Results

Within the study group, 2.2% adolescents exceeded the recommended daily noise dose (85 dBA as an 8-hour time-weighted average) among all days when the application was active and 9.9% when among only the listening days. No significant correlation was found between the daily noise dose from PLDs and pure tone thresholds.

Conclusions

The majority of adolescents exhibited listening habits that could be considered safe. As noise-induced hearing loss develops slowly over time, it could be that the effects of PLD use on hearing are not evident yet in this young population with a relatively short duration of PLD use.

Loud Music and Leisure Noise Is a Common Cause of Chronic Hearing Loss, Tinnitus and Hyperacusis

High sound levels capable of permanently damaging the ear are experienced not only in factories and war zones but in concert halls, nightclubs, sports stadiums, and many other leisure environments. This review summarizes evidence that loud music and other forms of "leisure noise" are common causes of noise-induced hearing loss, tinnitus, and hyperacusis, even if audiometric thresholds initially remain within clinically normal limits. Given the huge global burden of preventable noise-induced hearing loss, noise limits should be adopted in a much broader range of settings, and education to promote hearing conservation should be a higher public health priority.

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

Background

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

Methods

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

Results

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

Conclusions

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

Graphical abstract

Supplementary Information

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

Personal Listening Device Use Habits, Listening Belief, and Perceived Change in Hearing Among Adolescents

PURPOSE

This study aimed to identify personal listening device (PLD) usage habits, listening belief, and perceived change in hearing, and to investigate how the variables related to perceived change in hearing among adolescents.

METHODS

The participants were 183 middle school students and 233 high school students from Ulsan. Data were collected by self-reported questionnaires from August 1, 2019, to October 22, 2019, and analyzed with descriptive statistics, χ² test, Mann-Whitney U test, and hierarchical multiple logistic regression.

RESULTS

Most students started to use PLDs from elementary school, and mean preferred listening level was 70.13 dB. Mean perceived susceptibility to music-induced hearing loss (MIHL) and perceived barriers to prevent MIHL were 5.18 and 3.40, respectively. Perceived change in hearing was reported on 14.2% of middle school students and 32.2% of high school students, and as the average score of perceived barriers to prevent MIHL increases by one point, the odds of decrease in hearing increase by 2.05 times (p < .001) and 1.35 times (p < .05), respectively.

CONCLUSION

Considering that most adolescents are exposed to PLD in elementary schools and about a quarter experienced a decrease in hearing after PLD use, educational programs on hearing conservation are required to start as early as in schools. Particularly, knowledge and skills to overcome barriers to prevent MIHL should be emphasized in educational programs.

Use of Personal Listening Devices and Knowledge/Attitude for Greater Hearing Conservation in College Students: Data Analysis and Regression Model Based on 1009 Respondents

Given the concern regarding increased hearing loss in young people who use personal listening devices (PLDs), the present study analyzes the experience of PLDs among college students to identify their knowledge of and attitude toward hearing conservation. It also explains their relationship between knowledge of hearing loss and attitude-related hearing conservation as a questionnaire response using a regression model. A total of 1009 Korean college students responded to an online questionnaire. As a survey tool, the Personal Listening Device and Hearing Questionnaire was adapted as a Korean version with 78 modified items under 9 categories. Using principal component analysis, specific factors were extracted, and their relationships and paths were confirmed using multiple regression analysis. The results of the knowledge category of the questionnaire indicate that most respondents knew how to maintain healthy hearing and understood the signs of hearing loss. Regardless, many college students habitually use PLDs at high levels in noisy environments; they do not recognize how to prevent hearing loss. Even though they continue their current use pattern for PLDs, they also had a positive attitude toward receiving more information about hearing conservation. According to the regression model, the students' self-reported hearing deficits were due to the volume rather than the frequent use. Interestingly, knowledge about hearing loss may encourage students to develop a positive attitude toward reasonable restriction of PLD use. When PLD users have detailed knowledge about the hearing loss provided by professionals, we believe that most will avoid serious hearing problems and its risks and maintain a judicious attitude toward their own conservation.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

PRACTICE IMPLICATIONS

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

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

LEVEL OF EVIDENCE

NA Laryngoscope, 130:541-545, 2020.

No Reliable Association Between Recreational Noise Exposure and Threshold Sensitivity, Distortion Product Otoacoustic Emission Amplitude, or Word-in-Noise Performance in a College Student Population

OBJECTIVES

The purpose of this study was to evaluate the relationship between recreational sound exposure and potentially undiagnosed or subclinical hearing loss by assessing sound exposure history, threshold sensitivity, distortion product otoacoustic emission (DPOAE) amplitudes, and performance on the words-in-noise (WIN) test.

DESIGN

Survey data were collected from 74 adult participants (14 male and 60 female), 18 to 27 years of age, recruited via advertisements posted throughout the University of Florida campus. Of these participants, 70 completed both the survey and the additional functional test battery, and their preferred listening level was measured in a laboratory setting.

RESULTS

There were statistically significant relationships between hearing thresholds and DPOAE amplitude. In contrast, performance on the WIN was not reliably related to threshold sensitivity within this cohort with largely normal hearing. The two most common exposures included bars or dance clubs, followed by music player use. There were no statistically significant relationships between individual or composite measures of recreational sound exposure, including preferred listening level, years of music player use, number of reported sound exposures, previous impulse noise exposure, or previous noise-induced change in hearing, and functional measures including threshold, DPOAE amplitude, and WIN measures. Some subjects were highly consistent in listening level preferences, while others were more variable from song to song.

CONCLUSIONS

No reliable relationships between common recreational sound exposure or previous noise-induced changes in hearing were found during analysis of threshold sensitivity, DPOAE amplitude, or WIN performance in this cohort. However, the study sample was predominantly female and Caucasian, which limits generalizability of the results.

Impact of listening to music while wearing a ski helmet on sound source localization

OBJECTIVES

In recreational skiing and snowboarding, listening to music may be associated with an increased injury risk due to impaired sound localization. Thus, we evaluated effects of listening to music at different sound levels on sound source localization while wearing a ski helmet.

DESIGN

within-subjects design.

METHOD

Sound source localization of 20 participants (50% females; age: 23.8±2.4years) was assessed in an anechoic chamber under six conditions: (1) head bare, (2) wearing a ski helmet, (3) wearing a ski helmet and insert ear phones, and (4-6) the latter and listening to music at 3 different sound levels of 45, 55, and 65dB sound pressure level (SPL), respectively.

RESULTS

One-way repeated measures ANOVA show that the percentage of correct sound localization was significantly affected by various conditions: F (5, 95)=138.2, p<.001 (ƞ²=0.88). Compared to the situation "head bare" with a correct score of 88%, increasing music sound levels of 45, 55 and 65dB SPL significantly decreased the ability to correctly localize the sound source to 54%, 45% and 37% correct scores, respectively. Also, angular errors [F (5, 95)=31.0, p<.001, ƞ²=0.62] and front rear confusion [F (2.8, 53.4)=57.9, p<.001, ƞ²=0.75] were significantly affected by wearing a ski helmet and listening to music simultaneously.

CONCLUSIONS

Listening to music while wearing a ski helmet impacts negatively on sound source localization. The extent of worsening strongly depends on the sound level.

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.

Sound pressure levels generated at risk volume steps of portable listening devices: types of smartphone and genres of music

Background

The present study estimated the sound pressure levels of various music genres at the volume steps that contemporary smartphones deliver, because these levels put the listener at potential risk for hearing loss.

Methods

Using six different smartphones (Galaxy S6, Galaxy Note 3, iPhone 5S, iPhone 6, LG G2, and LG G3), the sound pressure levels for three genres of K-pop music (dance-pop, hip-hop, and pop-ballad) and a Billboard pop chart of assorted genres were measured through an earbud for the first risk volume that was at the risk sign proposed by the smartphones, as well as consecutive higher volumes using a sound level meter and artificial mastoid.

Results

The first risk volume step of the Galaxy S6 and the LG G2, among the six smartphones, had the significantly lowest (84.1 dBA) and highest output levels (92.4 dBA), respectively. As the volume step increased, so did the sound pressure levels. The iPhone 6 was loudest (113.1 dBA) at the maximum volume step. Of the music genres, dance-pop showed the highest output level (91.1 dBA) for all smartphones. Within the frequency range of 20~ 20,000 Hz, the sound pressure level peaked at 2000 Hz for all the smartphones.

Conclusions

The results showed that the sound pressure levels of either the first volume step or the maximum volume step were not the same for the different smartphone models and genres of music, which means that the risk volume sign and its output levels should be unified across the devices for their users. In addition, the risk volume steps proposed by the latest smartphone models are high enough to cause noise-induced hearing loss if their users habitually listen to music at those levels.

Attitudes, Risk Behavior, and Noise Exposure among Young Adults with Hearing Problems: Identifying a Typology

This study explored attitudes toward leisure noise, use of hearing protection, and perceived susceptibility to leisure-noise damage in young adults with hearing problems. Twelve participants aged between 18 and 35 years took part in a semistructured interview. Data were analyzed using framework analysis. The results showed that a positive attitude to noise, a passion for loud music, a lack of knowledge of the consequences of noise damage, and perceived low risk of hearing problems were associated with people not using earplugs. The aesthetics, comfort, perceived effects on music quality and attitude of others were all barriers to earplug use. Of those who had used earplugs, previous hearing-related symptoms and concern about future hearing damage were the main motivators for use. Four types of people were identified to describe the variation in attitudes and behaviors: those who had no change in behavior or concern about damage; those who were concerned and used earplugs; those who were concerned and avoided loud venues; and those who were concerned about communication difficulties only. Considering the wide variability, it may be more effective to shift attention from trying to change individual attitudes and behaviors to considering systemic changes to protect hearing, through ensuring the music industry and relevant authorities take greater responsibility.

WHO Environmental Noise Guidelines for the European Region: A Systematic Review on Environmental Noise and Permanent Hearing Loss and Tinnitus

Background: Hearing loss is defined as worsening of hearing acuity and is usually expressed as an increase in the hearing threshold. Tinnitus, defined as "ringing in the ear", is a common and often disturbing accompaniment of hearing loss. Hearing loss and environmental exposures to noise are increasingly recognized health problems. Objectives: The objective was to assess whether the exposure-response relationship can be established between exposures to non-occupational noise and permanent hearing outcomes such as permanent hearing loss and tinnitus. Methods: Information sources: Computer searches of all accessible medical and other databases (PubMed, Web of Science, Scopus) were performed and complemented with manual searches. The search was not limited to a particular time span, except for the effects of personal listening devices (PLDs). The latter was limited to the years 2008-June 2015, since previous knowledge was summarized by SCENIHR descriptive systematic review published in 2008. Study eligibility criteria: The inclusion criteria were as follows: the exposure to noise was measured in sound pressure levels (SPLs) and expressed in individual equivalent decibel values (L_EX,8h), the studies included both exposed and reference groups, the outcome was a permanent health effect, i.e., permanent hearing loss assessed with pure-tone audiometry and/or permanent tinnitus assessed with a questionnaire. The eligibility criteria were evaluated by two independent reviewers. Study appraisal and synthesis methods: The risk of bias was assessed for all of the papers using a template for assessment of quality and the risk of bias. The GRADE (grading of recommendations assessment, development, and evaluation) approach was used to assess the overall quality of evidence. Meta-analysis was not possible due to methodological heterogeneity of included studies and the inadequacy of data. Results: Out of 220 references identified, five studies fulfilled the inclusion criteria. All of them were related to the use of PLDs and comprised in total of 1551 teenagers and young adults. Three studies used hearing loss as the outcome and three tinnitus. There was a positive correlation between noise level and hearing loss either at standard or extended high frequencies in all three of the studies on hearing loss. In one study, there was also a positive correlation between the duration of PLD use and hearing loss. There was no association between prolonged listening to loud music through PLDs and tinnitus or the results were contradictory. All of the evidence was of low quality. Limitations: The studies are cross-sectional. No study provides odds ratios of hearing loss by the level of exposure to noise. Conclusions: While using very strict inclusion criteria, there is low quality GRADE evidence that prolonged listening to loud music through PLDs increases the risk of hearing loss and results in worsening standard frequency audiometric thresholds. However, specific threshold analyses focused on stratifying risk according to clearly defined levels of exposure are missing. Future studies are needed to provide actionable guidance for PLDs users. No studies fulfilling the inclusion criteria related to other isolated or combined exposures to environmental noise were identified.

Prevalence of Hearing Loss in US Children and Adolescents: Findings From NHANES 1988-2010

Importance

There have been concerns about increasing levels of hearing impairment in children and adolescents, especially in relation to noise exposure, because even mild levels of hearing loss can affect educational outcomes.

Objective

To further characterize changes in prevalence of hearing loss and noise exposures in the US pediatric population over time.

Design, Setting, and Participants

This is a retrospective analysis of demographic and audiometric data from the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994), NHANES 2005-2006, NHANES 2007-2008, and NHANES 2009-2010. The NHANES are nationally representative survey data sets collected and managed by the US National Center for Health Statistics, and this study includes a total of 7036 survey participants ages 12 to 19 years with available audiometric measurements.

Exposures

Hearing-related behaviors and risk factors such as history of ear infections, noise exposures, firearm use, and hearing protection use.

Main Outcomes and Measures

Level of hearing loss measured by pure-tone audiometry, as well as high-frequency and low-frequency hearing loss and noise-induced threshold shifts.

Results

Overall, data from 7036 survey participants ages 12 to 19 years with available audiometric measurements were analyzed. The prevalence of hearing loss increased from NHANES III to NHANES 2007-2008 (17.0% to 22.5% for >15 dB hearing loss; absolute difference, 5.5%; 95% CI, 6.1%-10.3%) but decreased in the NHANES 2009-2010 to 15.2% (absolute difference, 7.2%; 95% CI, 2.0%-12.4%) with no significant overall secular trend identified. There was an overall rise in exposure to loud noise or music through headphones 24 hours prior to audiometric testing from NHANES III to NHANES 2009-2010. However, noise exposure, either prolonged or recent, was not consistently associated with an increased risk of hearing loss across all surveys. The most recent survey cycle showed that nonwhite race/ethnicity and low socioeconomic status are independent risk factors for hearing loss.

Conclusions and Relevance

This analysis did not identify significant changes in prevalence of hearing loss in US youth ages 12 to 19 years over this time period despite increases in reported noise exposures. No consistent associations were shown between noise exposure and hearing loss, though there was an association between racial/ethnic minority status and low socioeconomic status and increased risk of hearing loss. Ongoing monitoring of hearing loss in this population is necessary to elucidate long-term trends and identify targets for intervention.

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.

Hearing thresholds, tinnitus, and headphone listening habits in nine-year-old children

Objective: Investigate hearing function and headphone listening habits in nine-year-old Swedish children. Design: A cross-sectional study was conducted and included otoscopy, tympanometry, pure-tone audiometry, and spontaneous otoacoustic emissions (SOAE). A questionnaire was used to evaluate headphone listening habits, tinnitus, and hyperacusis. Study sample: A total of 415 children aged nine years. Results: The prevalence of a hearing threshold ≥20 dB HL at one or several frequencies was 53%, and the hearing thresholds at 6 and 8 kHz were higher than those at the low and mid frequencies. SOAEs were observed in 35% of the children, and the prevalence of tinnitus was 5.3%. No significant relationship between SOAE and tinnitus was found. Pure-tone audiometry showed poorer hearing thresholds in children with tinnitus and in children who regularly listened with headphones. Conclusion: The present study of hearing, listening habits, and tinnitus in nine-year old children is, to our knowledge, the largest study so far. The main findings were that hearing thresholds in the right ear were poorer in children who used headphones than in children not using them, which could be interpreted as headphone listening may have negative consequences to children’s hearing. Children with tinnitus showed poorer hearing thresholds compared to children without tinnitus.

ICBEN review of research on the biological effects of noise 2011-2014

The mandate of the International Commission on Biological Effects of Noise (ICBEN) is to promote a high level of scientific research concerning all aspects of noise-induced effects on human beings and animals. In this review, ICBEN team chairs and co-chairs summarize relevant findings, publications, developments, and policies related to the biological effects of noise, with a focus on the period 2011-2014 and for the following topics: Noise-induced hearing loss; nonauditory effects of noise; effects of noise on performance and behavior; effects of noise on sleep; community response to noise; and interactions with other agents and contextual factors. Occupational settings and transport have been identified as the most prominent sources of noise that affect health. These reviews demonstrate that noise is a prevalent and often underestimated threat for both auditory and nonauditory health and that strategies for the prevention of noise and its associated negative health consequences are needed to promote public health.

Otoacoustic emissions before and after listening to music on a personal player

Background

The problem of the potential impact of personal music players on the auditory system remains an open question. The purpose of the present study was to investigate, by means of otoacoustic emissions (OAEs), whether listening to music on a personal player affected auditory function.

Material/Methods

A group of 20 normally hearing adults was exposed to music played on a personal player. Transient evoked OAEs (TEOAEs) and distortion product OAEs (DPOAEs), as well as pure tone audiometry (PTA) thresholds, were tested at 3 stages: before, immediately after, and the next day following 30 min of exposure to music at 86.6 dBA.

Results

We found no statistically significant changes in OAE parameters or PTA thresholds due to listening to the music.

Conclusions

These results suggest that exposure to music at levels similar to those used in our study does not disturb cochlear function in a way that can be detected by means of PTA, TEOAE, or DPOAE tests.

Extended high-frequency thresholds in college students: effects of music player use and other recreational noise

BACKGROUND

Human hearing is sensitive to sounds from as low as 20 Hz to as high as 20,000 Hz in normal ears. However, clinical tests of human hearing rarely include extended high-frequency (EHF) threshold assessments, at frequencies extending beyond 8000 Hz. EHF thresholds have been suggested for use monitoring the earliest effects of noise on the inner ear, although the clinical usefulness of EHF threshold testing is not well established for this purpose.

PURPOSE

The primary objective of this study was to determine if EHF thresholds in healthy, young adult college students vary as a function of recreational noise exposure.

RESEARCH DESIGN

A retrospective analysis of a laboratory database was conducted; all participants with both EHF threshold testing and noise history data were included. The potential for "preclinical" EHF deficits was assessed based on the measured thresholds, with the noise surveys used to estimate recreational noise exposure.

STUDY SAMPLE

EHF thresholds measured during participation in other ongoing studies were available from 87 participants (34 male and 53 female); all participants had hearing within normal clinical limits (≤25 HL) at conventional frequencies (0.25-8 kHz).

RESULTS

EHF thresholds closely matched standard reference thresholds [ANSI S3.6 (1996) Annex C]. There were statistically reliable threshold differences in participants who used music players, with 3-6 dB worse thresholds at the highest test frequencies (10-16 kHz) in participants who reported long-term use of music player devices (>5 yr), or higher listening levels during music player use.

CONCLUSIONS

It should be possible to detect small changes in high-frequency hearing for patients or participants who undergo repeated testing at periodic intervals. However, the increased population-level variability in thresholds at the highest frequencies will make it difficult to identify the presence of small but potentially important deficits in otherwise normal-hearing individuals who do not have previously established baseline data.

Analysis of Factors Affecting Output Levels and Frequencies of MP3 Players

Exposure to high levels of music that could lead to music induced hearing loss (MIHL) has been of recent interest especially for young adults, considering their excessive use of personal listening devices such as MP3 player. More attention should be drawn to MIHL for noting that early noise exposure leads to earlier onset of presbycusis. In search of appropriate and safe listening habits for young adults, this investigation was aimed to evaluate output levels and frequencies generated by the Samsung galaxy note MP3 player depending on two earphone types; ear-bud and over-the-ear earphones and three music genres; rock, hip-hop, ballade. A sound level meter was used to measure output level and frequency spectrum between 12.5 and 16000 Hz at all 1/3-octave bands. The following results can be summarized. 1) The earphone styles did not produce significant difference in output levels, but the music genres did. However, the results of music genres varied. 2) Neither earphone styles nor music genres produced significant difference in frequency response spectrum, except music genres at the volume settings we usually listen to. Additionally, volume levels should be lower than 50% for usual listening situation. Through this investigation, it was noted that the frequency range was substantial between 50 and 1000 Hz regardless of the styles of earphones and music genres, implying that we should be cautious of this frequency range when we listen to music. Researchers should give more attention to the effects of the mixture of output level and frequency spectrum, considering that the auditory system has frequency specificity from the periphery to the central to provide refined methods for protecting our ears from MIHL.

Previous exposure to musical auditory stimulation immediately influences the cardiac autonomic responses to the postural change maneuver in women

Background

Chronic exposure to musical auditory stimulation has been reported to improve cardiac autonomic regulation. However, it is not clear if music acutely influences it in response to autonomic tests. We evaluated the acute effects of music on heart rate variability (HRV) responses to the postural change maneuver (PCM) in women.

Method

We evaluated 12 healthy women between 18 and 28 years old and HRV was analyzed in the time (SDNN, RMSSD, NN50 and pNN50) and frequency (LF, HF and LF/HF ratio) domains. In the control protocol, the women remained at seated rest for 10 minutes and quickly stood up within three seconds and remained standing still for 15 minutes. In the music protocol, the women remained at seated rest for 10 minutes, were exposed to music for 10 minutes and quickly stood up within three seconds and remained standing still for 15 minutes. HRV was recorded at the following time: rest, music (music protocol) 0–5, 5–10 and 10–15 min during standing.

Results

In the control protocol the SDNN, RMSSD and pNN50 indexes were reduced at 10–15 minutes after the volunteers stood up, while the LF (nu) index was increased at the same moment compared to seated rest. In the protocol with music, the indexes were not different from control but the RMSSD, pNN50 and LF (nu) were different from the music period.

Conclusion

Musical auditory stimulation attenuates the cardiac autonomic responses to the PCM.

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.

Self-reported hearing difficulties, main income sources, and socio-economic status; a cross-sectional population-based study in Sweden

BACKGROUND

Hearing difficulties constitute the most common cause of disability globally. Yet, studies on people with hearing difficulties regarding socio-economic status (SES), work, long-term unemployment, sickness absence, and disability pension are scarce. The aim of the present study was to investigate the main income sources of men and women of working ages with and without self-reported hearing difficulties and associations with gender, age, SES, type of living area, and country of birth.

METHODS

A cross-sectional population-based study, using information on self-reported hearing difficulties and SES of 19 045 subjects aged 20-64 years participating in Statistics Sweden's annual Living Conditions Surveys in any of the years 2004 through 2008. The information was linked to a nationwide database containing data on demographics and income sources. Odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated, using binary logistic regression analysis.

RESULTS

Hearing difficulties increased with age and were more common in men (age-adjusted OR: 1.42 (95% CI: 1.30-1.56)) with an overall prevalence of 13.1% in men and 9.8% in women. Using working men as reference, the OR of having hearing difficulties was 1.23 (0.94-1.60) in men with unemployment benefits and 1.36 (1.13-1.65) in men with sickness benefits or disability pension, when adjusting for age and SES. The corresponding figures in women were 1.59 (1.17-2.16) and 1.73 (1.46-2.06). The OR of having sickness benefits or disability pension in subjects with hearing difficulties was 1.36 (1.12-1.64) in men and 1.70 (1.43-2.01) in women, when adjusting for age and SES and using men and women with no hearing difficulties as reference.

CONCLUSIONS

Hearing difficulties were more prevalent in men. After adjustment with age and SES as well as with type of living area and country of birth, a significant association with unemployment benefits was found only in women, and the associations with long-term sickness absence and disability pension tended to be stronger in women.

Quality and loudness judgments for music subjected to compression limiting

Dynamic-range compression (DRC) is used in the music industry to maximize loudness. The amount of compression applied to commercial recordings has increased over time due to a motivating perspective that louder music is always preferred. In contrast to this viewpoint, artists and consumers have argued that using large amounts of DRC negatively affects the quality of music. However, little research evidence has supported the claims of either position. The present study investigated how DRC affects the perceived loudness and sound quality of recorded music. Rock and classical music samples were peak-normalized and then processed using different amounts of DRC. Normal-hearing listeners rated the processed and unprocessed samples on overall loudness, dynamic range, pleasantness, and preference, using a scaled paired-comparison procedure in two conditions: un-equalized, in which the loudness of the music samples varied, and loudness-equalized, in which loudness differences were minimized. Results indicated that a small amount of compression was preferred in the un-equalized condition, but the highest levels of compression were generally detrimental to quality, whether loudness was equalized or varied. These findings are contrary to the "louder is better" mentality in the music industry and suggest that more conservative use of DRC may be preferred for commercial music.