Evaluation of early hearing damage in personal listening device users using extended high-frequency audiometry and otoacoustic emissions

Extended High-Frequency Audiometry Using the Wireless Automated Hearing Test System Compared to Manual Audiometry in Children and Adolescents

OBJECTIVES

Valid wireless automated Békésy-like audiometry (ABA) outside a sound booth that includes extended high frequencies (EHF) would increase access to monitoring programs for individuals at risk for hearing loss, particularly those at risk for ototoxicity. The purpose of the study was to compare thresholds obtained with (1) manual audiometry using an Interacoustics Equinox and modified Hughson-Westlake 5 dB threshold technique to automated audiometry using the Wireless Automated Hearing Test System (WAHTS) and a Békésy-like 2 dB threshold technique inside a sound booth, and (2) ABA measured in the sound booth to ABA measured outside the sound booth.

DESIGN

Cross-sectional study including 28 typically developing children and adolescents (mean = 14.5 years; range = 10 to 18 years). Audiometric thresholds were measured from 0.25 to 16 kHz with manual audiometry inside the sound booth and with ABA measured both inside and outside the sound booth in counterbalanced order.

RESULTS

ABA thresholds measured inside the sound booth were overall about 5 dB better compared with manual thresholds in the conventional frequencies (0.25 to 8 kHz). In the EHFs (10 to 16 kHz), a larger threshold difference was observed, where ABA thresholds were overall about 14 dB better compared with manual thresholds. The majority of ABA thresholds measured outside the sound booth were within ±10 dB of ABA thresholds measured inside the sound booth (conventional: 86%; EHF: 80%). However, only 69% of ABA thresholds measured inside the sound booth were within ±10 dB of manual thresholds in the conventional frequencies and only 32% of ABA thresholds measured inside the sound booth were within ±10 dB of manual thresholds in the EHFs.

CONCLUSIONS

These results indicate that WAHTS ABA results in better thresholds in conventional frequencies than manual audiometry in children and adolescents, consistent with previous studies in adults. Hearing thresholds for the EHF were better when measured with WAHTS ABA compared with manual audiometry, likely due to different transducer-related calibration values that are not age-adjusted. Additional studies of WAHTS automated Békésy-like EHF thresholds that include healthy pediatric participants are needed to establish age-appropriate normative thresholds for clinical application in monitoring programs for noise-induced hearing loss and/or ototoxicity.

Association of Occupational Noise Exposure and Extended High-Frequency Hearing Loss in Young Workers With Normal Hearing

OBJECTIVES

Studies on the relationship between occupational noise exposure and extended high-frequency (EHF) hearing loss are limited. This study investigated the relationship between occupational noise exposure and EHF hearing loss in workers exposed to noise as measured by sound pressure level, exposure duration, and kurtosis to help provide a basis for early detection and prevention of hearing loss in noise-exposed workers.

DESIGN

A cross-sectional survey was conducted among 602 participants with 472 noise-exposed workers and 130 non-noise-exposed controls. General demographic characteristics, noise exposure data, and hearing thresholds at conventional frequencies (0.25 to 8 kHz) and EHF (9 to 16 kHz) were collected and analyzed. Linear mixed-effects model analyses between hearing thresholds of EHF and noise exposure indicators including the 8-h equivalent continuous A-weighted sound pressure level ( LAeq,8h ), cumulative noise exposure (CNE), and kurtosis-adjusted CNE (CNE-K) were conducted.

RESULTS

Among the 602 participants included in the analysis, 472 individuals (78.4%) were occupationally exposed to noise exposures ≥75 dBA. Significant differences ( p < 0.05) were observed in sex, exposure duration, LAeq,8h , CNE, and CNE-K between the noise-exposed group and the nonexposed group. The mean hearing thresholds for all tested extended high frequencies ranging from 9 to 16 kHz were significantly higher in the noise-exposed group than in the nonexposed group ( p < 0.05). The mean hearing thresholds of subjects in different groups of LAeq,8h exposures were generally stable with little variance in the conventional frequencies (0.25 to 8 kHz) but differed in the EHF range. Moreover, EHF hearing loss appeared to be most prominent in the subjects exposed to noise with 80 dBA < LAeq,8h ≤ 85 dBA. After the combination of the sound pressure level, exposure duration, and kurtosis by using the noise exposure indicators CNE and CNE-K, the subjects at the different noise exposures showed significant differences in hearing thresholds at EHF ( p < 0.05). Linear mixed-effected model analyses showed that the CNE-K was the best to indicate noise-induced hearing loss among the three noise exposure indicators at EHF.

CONCLUSIONS

The results indicate that the EHF hearing threshold testing is more sensitive to identifying early occupational noise-induced hearing loss than conventional audiometry. The CNE-K, an indicator combining noise energy, exposure duration, and kurtosis, is a more comprehensive and effective method for assessing the risk of EHF hearing loss due to occupational noise exposure.

The Role of a Smartphone Application in Monitoring the Risk of Hearing Loss Associated with Personal Listening Devices in Young Adults

Background Exposure to loud music has been reported to affect high-frequency hearing thresholds in adults. This study aimed to use a mobile application to assess the risk of hearing loss associated with personal listening devices (PLDs) in young adults. Methods A cross-sectional study was conducted on 99 healthy iPhone Operating System (iOS) smartphone users aged 17 to 31 years. Based on their weekly, monthly, 6-month, and annual listening data from the "Health" application, participants were classified into at-risk or non-risk groups. Six individuals in the at-risk group underwent audiological assessments. The Speech, Spatial, and Qualities of Hearing Scale (SSQ) was given to all participants. SSQ scores were compared between groups using the Mann-Whitney U test. The correlation between average PLD sound levels and SSQ scores was analyzed using the Spearman's test. Results The weekly, monthly, 6-month, and annual listening data showed that 16, 14, 12, and 12 participants were at risk, respectively. All six participants who underwent audiological assessment exhibited normal hearing thresholds. However, a pattern of decline at high frequencies was noted. A significant difference was found between the groups in terms of overall SSQ score (z = -2.74, P = 0.00), speech perception score (z = -3.25, P = 0.00), and hearing quality score (z = -2.01, P = 0.04) based on the 6-month and annual listening data. A weak positive correlation was found between the SSQ scores across all subscales and monthly sound-level data. Exposure duration was negatively correlated with speech perception (r = -0.32, P < 0.05), spatial perception (r = -0.26, P < 0.05), and overall score (r = -0.29, P < 0.05) in weekly data, as well as with hearing quality (r = -0.21; P < 0.05) and overall score (r = -0.21, P < 0.05) in annual data. Conclusions The immediate effects of loud music exposure were absent; however, prolonged exposure resulted in reduced speech perception and hearing-quality levels. Data from the iOS "Health" application indicated that some individuals were at risk of hearing loss, suggesting the need to modify their listening habits to prevent long-term decline in hearing function.

MRI noise and auditory health: Can one hundred scans be linked to hearing loss? The case of the Courtois NeuroMod project

Magnetic resonance imaging (MRI) is one of the most commonly used tools in neuroscience. However, it implies exposure to high noise levels. Exposure to noise can lead to temporary or permanent hearing loss, especially when the exposure is long and/or repeated. Little is known about the hearing risks for people undergoing several MRI examinations, especially in the context of longitudinal studies. The goal of this study was to assess the potential impact of repeated exposure to MRI noise on hearing in research participants undergoing dozens of MRI scans. This investigation was made possible thanks to an unprecedented intensive MRI research data collection effort (the Courtois NeuroMod project) where participants have been scanned weekly (up to twice a week), with the use of hearing protection, since 2018. Their hearing was tested periodically, over a period of 1.5 years. First, baseline pure-tone thresholds and distortion product otoacoustic emission (DPOAE) amplitudes were acquired before the beginning of this study. Hearing tests were then scheduled immediately before/immediately after a scan and with a delay of two to seven days after a scan. Pure-tone thresholds and DPOAE amplitudes showed no scanner noise impact right after the scan session when compared to the values acquired right before the scan session. Pure-tone thresholds and DPOAE amplitudes acquired in the delayed condition and compared to the baseline showed similar results. These results suggest an absence of impact from MRI noise exposure. Overall, our results show that an intensive longitudinal MRI study like the Courtois NeuroMod project likely does not cause hearing damage to participants when they properly utilize adequate hearing protection.

Is Noise Exposure Associated With Impaired Extended High Frequency Hearing Despite a Normal Audiogram? A Systematic Review and Meta-Analysis

Understanding the initial signature of noise-induced auditory damage remains a significant priority. Animal models suggest the cochlear base is particularly vulnerable to noise, raising the possibility that early-stage noise exposure could be linked to basal cochlear dysfunction, even when thresholds at 0.25-8 kHz are normal. To investigate this in humans, we conducted a meta-analysis following a systematic review, examining the association between noise exposure and hearing in frequencies from 9 to 20 kHz as a marker for basal cochlear dysfunction. Systematic review and meta-analysis followed PRISMA guidelines and the PICOS framework. Studies on noise exposure and hearing in the 9 to 20 kHz region in adults with clinically normal audiograms were included by searching five electronic databases (e.g., PubMed). Cohorts from 30 studies, comprising approximately 2,500 participants, were systematically reviewed. Meta-analysis was conducted on 23 studies using a random-effects model for occupational and recreational noise exposure. Analysis showed a significant positive association between occupational noise and hearing thresholds, with medium effect sizes at 9 and 11.2 kHz and large effect sizes at 10, 12, 14, and 16 kHz. However, the association with recreational noise was less consistent, with significant effects only at 12, 12.5, and 16 kHz. Egger's test indicated some publication bias, specifically at 10 kHz. Findings suggest thresholds above 8 kHz may indicate early noise exposure effects, even when lower-frequency (≤8 kHz) thresholds remain normal. Longitudinal studies incorporating noise dosimetry are crucial to establish causality and further support the clinical utility of extended high-frequency testing.

Extended High-Frequency Thresholds: Associations With Demographic and Risk Factors, Cognitive Ability, and Hearing Outcomes in Middle-Aged and Older Adults

OBJECTIVES

This study had two objectives: to examine associations between extended high-frequency (EHF) thresholds, demographic factors (age, sex, race/ethnicity), risk factors (cardiovascular, smoking, noise exposure, occupation), and cognitive abilities; and to determine variance explained by EHF thresholds for speech perception in noise, self-rated workload/effort, and self-reported hearing difficulties.

DESIGN

This study was a retrospective analysis of a data set from the MUSC Longitudinal Cohort Study of Age-related Hearing Loss. Data from 347 middle-aged adults (45 to 64 years) and 694 older adults (≥ 65 years) were analyzed for this study. Speech perception was quantified using low-context Speech Perception In Noise (SPIN) sentences. Self-rated workload/effort was measured using the effort prompt from the National Aeronautics and Space Administration-Task Load Index. Self-reported hearing difficulty was assessed using the Hearing Handicap Inventory for the Elderly/Adults. The Wisconsin Card Sorting Task and the Stroop Neuropsychological Screening Test were used to assess selected cognitive abilities. Pure-tone averages representing conventional and EHF thresholds between 9 and 12 kHz (PTA (9 - 12 kHz) ) were utilized in simple linear regression analyses to examine relationships between thresholds and demographic and risk factors or in linear regression models to assess the contributions of PTA (9 - 12 kHz) to the variance among the three outcomes of interest. Further analyses were performed on a subset of individuals with thresholds ≤ 25 dB HL at all conventional frequencies to control for the influence of hearing loss on the association between PTA (9 - 12 kHz) and outcome measures.

RESULTS

PTA (9 - 12 kHz) was higher in males than females, and was higher in White participants than in racial Minority participants. Linear regression models showed the associations between cardiovascular risk factors and PTA (9 - 12 kHz) were not statistically significant. Older adults who reported a history of noise exposure had higher PTA (9 - 12 kHz) than those without a history, while associations between noise history and PTA (9 - 12 kHz) did not reach statistical significance for middle-aged participants. Linear models adjusting for age, sex, race and noise history showed that higher PTA (9 - 12 kHz) was associated with greater self-perceived hearing difficulty and poorer speech recognition scores in noise for both middle-aged and older participants. Workload/effort was significantly related to PTA (9 - 12 kHz) for middle-aged, but not older, participants, while cognitive task performance was correlated with PTA (9 - 12 kHz) only for older participants. In general, PTA (9 - 12 kHz) did not account for additional variance in outcome measures as compared to conventional pure-tone thresholds, with the exception of self-reported hearing difficulties in older participants. Linear models adjusting for age and accounting for subject-level correlations in the subset analyses revealed no association between PTA (9 - 12 kHz) and outcomes of interest.

CONCLUSIONS

EHF thresholds show age-, sex-, and race-related patterns of elevation that are similar to what is observed for conventional thresholds. The current results support the need for more research to determine the utility of adding EHF thresholds to routine audiometric assessment with middle-aged and older adults.

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

OBJECTIVES

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

STUDY DESIGN

Cross-sectional cohort.

METHODS

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

RESULTS

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

CONCLUSION

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

LEVEL OF EVIDENCE

4.

Exploring the Influence of Extended High-Frequency Hearing on Cochlear Functioning at Lower Frequencies

PURPOSE

Diminished basal cochlear function, as indicated by elevated hearing thresholds in the extended high frequencies (EHFs), has been associated with lower levels of click-evoked and distortion-product otoacoustic emissions measured at lower frequencies. However, stimulus-frequency otoacoustic emissions (SFOAEs) at low-probe levels are reflection-source emissions that do not share the same generation mechanism as distortion-source emissions. The primary objective of the present study was to examine the influence of hearing thresholds in the EHFs on SFOAEs measured at lower frequencies.

METHOD

SFOAEs were recorded from both ears in 45 individuals with normal hearing thresholds in the conventional audiometric frequencies (0.25-8 kHz). Hearing thresholds were also measured at EHFs (10, 12.5, and 16 kHz). SFOAE magnitudes and signal-to-noise ratios (SNRs) were averaged across 1, 2, and 4 kHz probe frequencies and also averaged for high-probe frequencies (2 and 4 kHz).

RESULTS

SFOAE magnitudes and SNRs were significantly higher for ears with better EHF hearing relative to poorer EHF hearing, categorized based on the median split. In addition, hearing in the EHFs significantly contributed to the variance in all SFOAE measures, except for the high-frequency SFOAE magnitudes model. However, hearing thresholds at the probe frequencies did not significantly contribute to the variance in SFOAEs.

CONCLUSIONS

The study findings suggest that alterations in the basal cochlea, as revealed by EHF hearing thresholds, could be associated with diminished cochlear functioning in relatively apical regions, shown by SFOAEs at lower frequencies, in individuals with normal audiograms. These findings underscore the significance of considering EHF thresholds in audiological evaluations, as alterations in these frequencies may reflect broader cochlear health status.

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

PURPOSE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

SUPPLEMENTAL MATERIAL

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

Risk-taking propensity as a risk factor for noise-induced hearing loss in the general population

OBJECTIVES

To examine general risk propensity in relation to perceptions of noise, risk behaviour, and hearing loss in the general population.

DESIGN

Participants completed an online survey using the Amazon Mechanical Turk crowdsourcing platform.

STUDY SAMPLE

The sample comprised 1274 adults from the United States.

RESULTS

Higher general risk propensity was associated with an increased likelihood to engage in noise-risk behaviours. Lower general risk propensity was associated with increased knowledge of noise risks and an increased perception of noise as risky. The frequency of self-reported exposures to hazardous noise resulted in estimated annual noise doses exceeding standard hazard limits in 40% of the surveyed population.

CONCLUSIONS

Results revealed limited knowledge of the risks and associated health consequences of noise exposure in the general population Results of this study suggest a high rate of self-exposure to hazardous noise by the general population. Those with higher general risk propensity are more likely to engage in risky noise behaviour. Risky noise behaviour is associated with age, gender, race, ethnicity, and general risk propensity. Intervention programs to modify risky noise behaviour in the general population should focus on both increasing knowledge and establishing accurate perceptions of risk.

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

Importance

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

Objective

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

Design, Setting, and Participants

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

Main Outcomes and Measures

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

Results

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

Conclusions and Relevance

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

Binaural temporal coding and the middle ear muscle reflex in audiometrically normal young adults

Noise exposure may damage the synapses that connect inner hair cells with auditory nerve fibers, before outer hair cells are lost. In humans, this cochlear synaptopathy (CS) is thought to decrease the fidelity of peripheral auditory temporal coding. In the current study, the primary hypothesis was that higher middle ear muscle reflex (MEMR) thresholds, as a proxy measure of CS, would be associated with smaller values of the binaural intelligibility level difference (BILD). The BILD, which is a measure of binaural temporal coding, is defined here as the difference in thresholds between the diotic and the antiphasic versions of the digits in noise (DIN) test. This DIN BILD may control for factors unrelated to binaural temporal coding such as linguistic, central auditory, and cognitive factors. Fifty-six audiometrically normal adults (34 females) aged 18 - 30 were tested. The test battery included standard pure tone audiometry, tympanometry, MEMR using a 2 kHz elicitor and 226 Hz and 1 kHz probes, the Noise Exposure Structured Interview, forward digit span test, extended high frequency (EHF) audiometry, and diotic and antiphasic DIN tests. The study protocol was pre-registered prior to data collection. MEMR thresholds did not predict the DIN BILD. Secondary analyses showed no association between MEMR thresholds and the individual diotic and antiphasic DIN thresholds. Greater lifetime noise exposure was non-significantly associated with higher MEMR thresholds, larger DIN BILD values, and lower (better) antiphasic DIN thresholds, but not with diotic DIN thresholds, nor with EHF thresholds. EHF thresholds were associated with neither MEMR thresholds nor any of the DIN outcomes, including the DIN BILD. Results provide no evidence that young, audiometrically normal people incur CS with impacts on binaural temporal processing.

The impact of screen exposure among school-aged children in South India during the COVID-19 pandemic: an online survey

Background

The impact of excessive screen time with personal listening devices (PLDs) on vision, hearing, balance, and overall health among adults has been reported in the literature. However, its impact on children is not well documented. A survey was undertaken to highlight the possible effects of screen time combined with transducers on vision, hearing, balance, and overall health complaints in children via parental proxy. This cross-sectional survey consisted of questions divided into four domains: vision, hearing, balance, and overall health. It was conducted online using social media to avail total maximum responses.

Results

A total of 136 responses were obtained from the parents of children studying from grade 1 to 8 through the survey conducted in south India. Increased negative impact on vision was observed in more than 50% of children. Similarly, the hearing and balance domain reported 16% ear pain, 4.4% tinnitus, 9.6% dizziness, 8.8% nausea, and 2.2% imbalance while walking. Likewise, the overall stress domain reported 26.5% general body discomfort, 37.5% neck pain and stiffness, 29.4% headaches, 43.4% lack of concentration, 39.7% overall changes in child’s health and 46.3% behavioral issues with various severity markings (slight to severe).

Conclusions

Longer periods of screen exposure have various negative impacts on vision, hearing, balance system, and overall health. These effects have to be managed for the health of our children.

Supplementary Information

The online version contains supplementary material available at 10.1186/s43163-023-00396-1.

Assessment of auditory function in hepatitis “C” patients managed by combination of sofosbuvir and daclatsavir

Background

To evaluate the effect of daclatasvir and sofosbuvir on auditory function in hepatitis C patients. Thirty hepatitis C virus (HCV) patients were included in this study with age ranged from 22 to 55 years. All patients underwent full audiological evaluation before beginning and after completion of their treatment with combination of daclatasvir and sofosbuvir.

Result

When the results of audiological data were compared before and after treatment, we found that; there were statistically significant differences in the pure tone audiometry (PTA) threshold and ART bilaterally mainly in the high frequency region. Transient evoked otoacoustic emission (TEOAE) reproducibility showed a statistically significant difference bilateral. However, there was no statistically significant difference in the Auditory Brainstem Response (ABR) findings.

Conclusion and recommendations

The combination therapy of daclatasvir and sofosbuvir used in patients with HCV led to deterioration in the hearing threshold in the basic audiological tests (PTA and immitancemetry). In addition, it had an adverse effect on the cochlear OHCs, with no affection on auditory nerve, brain stem functions or in sub-thalamic function, it seems that it had no effect, we cannot confirm. The study evaluate hearing at the end of treatment immediately. We recommend performing a routine monitoring of auditory functions in HCV patients treated with daclatasvir and sofosbuvir combination by specialist for early detection of auditory changes to avoid further damage to auditory system.

A Smartphone Application and Education Program for Hearing Health Promotion in High School Teenagers

OBJECTIVES

To assess knowledge retention after video-based hearing health education and measure headphone listening behavior change using a novel smartphone application.

METHODS

In this prospective longitudinal study, students participated in video-based hearing health education and hearing screening sessions. Hearing health knowledge was assessed in students and parents after 6 weeks. A novel smartphone application was created to measure daily noise exposure based on volume settings with headphone use and to display the National Institute for Occupational Safety and Health (NIOSH) noise doses with alerts for cumulative daily doses nearing the maximum.

RESULTS

Seventy-six teenage students and parents participated. Eighty three percent of participants identified as a racial or ethnic minority and 66% were of low-income socioeconomic status. Hearing health knowledge was retained in students 6 weeks after education and parents' knowledge improved from baseline. The smartphone app was installed on 12 student phones, and 25% of days monitored exhibited noise doses that exceeded the NIOSH maximum. App use for at least 10 days by nine students showed a significant reduction in average daily noise dose and time spent at the highest volume settings during the second-half of app use.

CONCLUSIONS

Video-based hearing health education with knowledge question reinforcement was associated with knowledge retention in students and improved parental attitudes and knowledge about hearing conservation. A smartphone app with a real-time display of headphone cumulative noise exposure dose identified at-risk students. The integration of hearing health education, hearing screening, and digital health tools has promised to promote positive behavior changes for long-term hearing conservation.

LEVEL OF EVIDENCE

4 Laryngoscope, 2022.

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

Objectives:

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

Design:

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

Results:

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

Conclusions:

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

The effect of age and hearing sensitivity at frequencies above 8 kHz on auditory stream segregation and speech perception

The effects of age and mild hearing loss over the extended high-frequency (EHF) range from 9000 to 16 000 Hz on speech perception and auditory stream segregation were assessed using four groups: (1) young with normal hearing threshold levels (HTLs) over both the conventional and EHF range; (2) older with audiograms matched to those for group 1; (3) young with normal HTLs over the conventional frequency range and elevated HTLs over the EHF range; (4) older with audiograms matched to those for group 3. For speech in quiet, speech recognition thresholds and speech identification scores did not differ significantly across groups. For monosyllables in noise, both greater age and hearing loss over the EHF range adversely affected performance, but the effect of age was much larger than the effect of hearing status. Stream segregation was assessed using a rapid sequence of vowel stimuli differing in fundamental frequency (F0). Larger differences in F0 were required for stream segregation for the two groups with impaired hearing in the EHF range, but there was no significant effect of age. It is argued that impaired hearing in the EHF range is associated with impaired auditory function at lower frequencies, despite normal audiometric thresholds at those frequencies.

Extended high-frequency audiometry in research and clinical practice

Audiometric testing in research and in clinical settings rarely considers frequencies above 8 kHz. However, the sensitivity of young healthy ears extends to 20 kHz, and there is increasing evidence that testing in the extended high-frequency (EHF) region, above 8 kHz, might provide valuable additional information. Basal (EHF) cochlear regions are especially sensitive to the effects of aging, disease, ototoxic drugs, and possibly noise exposure. Hence, EHF loss may be an early warning of damage, useful for diagnosis and for monitoring hearing health. In certain environments, speech perception may rely on EHF information, and there is evidence for an association between EHF loss and speech perception difficulties, although this may not be causal: EHF loss may instead be a marker for sub-clinical damage at lower frequencies. If there is a causal relation, then amplification in the EHF range may be beneficial if the technical difficulties can be overcome. EHF audiometry in the clinic presents with no particular difficulty, the biggest obstacle being lack of specialist equipment. Currently, EHF audiometry has limited but increasing clinical application. With the development of international guidelines and standards, it is likely that EHF testing will become widespread in future.

Detecting Noise-Induced Cochlear Synaptopathy by Auditory Brainstem Response in Tinnitus Patients With Normal Hearing Thresholds: A Meta-Analysis

Noise-induced cochlear synaptopathy (CS) is defined as a permanent loss of synapses in the auditory nerve pathway following noise exposure. Several studies using auditory brainstem response (ABR) have indicated the presence of CS and increased central gain in tinnitus patients with normal hearing thresholds (TNHT), but the results were inconsistent. This meta-analysis aimed to review the evidence of CS and its pathological changes in the central auditory system in TNHT. Published studies using ABR to study TNHT were reviewed. PubMed, EMBASE, and Scopus databases were selected to search for relevant literature. Studies (489) were retrieved, and 11 were included for meta-analysis. The results supported significantly reduced wave I amplitude in TNHT, whereas the alternations in wave V amplitude were inconsistent among the studies. Consistently increased V/I ratio indicated noise-induced central gain enhancement. The results indicated the evidence of noise-induced cochlear synaptopathy in tinnitus patients with normal hearing. However, inconsistent changes in wave V amplitude may be explained by that the failure of central gain that triggers the pathological neural changes in the central auditory system and/or that increased central gain may be necessary to generate tinnitus but not to maintain tinnitus.

Construction and Evaluation of a High-Frequency Hearing Loss Screening Tool for Community Residents

Early screening and detection of individuals at high risk of high-frequency hearing loss and identification of risk factors are critical to reduce the prevalence at community level. However, unlike those for individuals facing occupational auditory hazards, a limited number of hearing loss screening models have been developed for community residents. Therefore, this study used lasso regression with 10-fold cross-validation for feature selection and model construction on 38 questionnaire-based variables of 4010 subjects and applied the model to training and testing cohorts to obtain a risk score. The model achieved an area under the curve (AUC) of 0.844 in the model validation stage and individuals’ risk scores were subsequently stratified into low-, medium-, and high-risk categories. A total of 92.79% (1094/1179) of subjects in the high-risk category were confirmed to have hearing loss by audiometry test, which was 3.7 times higher than that in the low-risk group (25.18%, 457/1815). Half of the key indicators were related to modifiable contexts, and they were identified as significantly associated with the incident hearing loss. These results demonstrated that the developed model would be feasible to identify residents at high risk of hearing loss via regular community-level health examinations and detecting individualized risk factors, and eventually provide precision interventions.

Analysis of the Actual One-Month Usage of Portable Listening Devices in College Students

Although contemporary researchers are concerned about overexposure of portable listening devices (PLD) for adolescents and young adults who often prefer listening to music at high levels for a long time, many of these studies have focused on either comparing sound pressure levels of various kinds of earphones or evaluating the recognition of noise-included hearing loss and listening habits through surveys. Further still, current criteria were developed for occupational noise-induced hearing loss, so there are only a few published guidelines for hearing insults due to recreational noise exposure. The present study, therefore, measures actual listening levels and PLD time in college students using a real-time measurement system and applying that gathered scientific data to the internationally recommended noise exposure standards. Thirty-four college students were asked to listen to music similar to their daily lifestyles for 4-weeks. After installing the application, the Google account that linked to the user's mobile phone was logged into the server communication. When a subject listened to music, the average and maximum listening levels and listening time could then be recognized as his or her Google account ID and stored in the database for analysis. User data was measured at 1-s intervals and delivered to the main server system every 5 s. The data were analyzed as LZeq for mean levels and LCpeak for maximum levels, and also for PLD use time. The mean of the preferred listening level was 68-70 dB SPL for 4 weeks with long enough break times. That is, the listening levels of college students were not high enough to induce instant hearing loss when they used PLD. However, there was a large individual difference in the listening levels and use times. When applied to three recommended noise exposure criteria, the number of exceeded subjects also differed from 0 to 56.72% depending on the criterion. We thus suggest that appropriate and standardized criteria for music-induced hearing loss might be proposed for recreational PLD users.

Low-sound-level auditory processing in noise-exposed adults

Early signs of noise-induced hearing damage are difficult to identify, as they are often confounded by factors such as age, audiometric thresholds, or even music experience. Much previous research has focused on deficits observed at high intensity levels. In contrast, the present study was designed to test the hypothesis that noise exposure causes a degradation in low-sound-level auditory processing in humans, as a consequence of dysfunction of the inner hair cell pathway. Frequency difference limens (FDLs) and amplitude modulation depth discrimination (MDD) were measured for five center frequencies (0.75, 1, 3, 4 and 6 kHz) at 15 and 25 dB sensation level (SL), as a function of noise exposure, age, audiometric hearing loss, and music experience. Forty participants, aged 33-75 years, with normal hearing up to 1 kHz and mild-to-moderate hearing loss above 2 kHz, were tested. Participants had varying degrees of self-reported noise exposure, and varied in music experience. FDL worsened as a function of age. Participants with music experience outperformed the non-experienced in both the FDL and MDD tasks. MDD thresholds were significantly better for high-noise-exposed, than for low-noise-exposed, participants at 25 dB SL, particularly at 6 kHz. No effects of age or hearing loss were observed in the MDD. It is possible that the association between MDD thresholds and noise exposure was not causal, but instead was mediated by other factors that were not measured in the study. The association is consistent, qualitatively, with a hypothesized loss of compression due to outer hair cell dysfunction.

Hearing and Exposure to Music in Adolescents From Four Schools of Córdoba, Argentina

Purposes The aims of this study are (a) to characterize the hearing of adolescents from four schools of Córdoba, Argentina, through the analysis of conventional and extended high-frequency audiometric thresholds and otoacoustic emissions (OAEs) and (b) to analyze the association between the mentioned hearing tests and exposure to music. Method It was a cross-sectional correlational descriptive study. Hearing thresholds (250-16000 Hz), transient evoked OAEs, and distortion product OAEs were evaluated in 225 adolescents (450 ears) aged 14 and 15 years. The ears were split into two groups: Group 1 had thresholds ≤ 21 dB HL in all frequencies, and Group 2 had thresholds > 21 dB HL in at least one. Exposure to music was evaluated through a questionnaire. Results Statistically significant differences were found in both ears between Groups 1 and 2. A notch at 3000-6000 Hz was noted in both groups. Group 2 showed a progressive threshold increase from 9000 Hz. Amplitude decrease, negative values, absent distortion product OAEs, and transient evoked OAEs were noted even in Group 1. A statistically significant association between Groups 1 and 2 and the presence/absence of OAEs was observed in most frequencies. Ears with moderate or high exposure to music had greater hearing thresholds compared to ears with low exposure at most frequencies; this was more evident in Group 1. Regarding exposure to music and OAEs, no significant differences were found between the exposure categories. Conclusions The findings highlight the value of implementing hearing conservation programs in Argentina, analyzing hearing tests correlated with questionnaires about recreational noise exposure in order to detect vulnerable ears early.

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.

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.

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

OBJECTIVE

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

DESIGN

Cross-sectional study.

STUDY SAMPLE

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

RESULTS

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

CONCLUSIONS

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

The Effects of Short-Term and Long-term Hearing Changes on Music Exposure: A Systematic Review and Meta-Analysis

The present study explores the scientific evidence on whether music exposure temporarily or permanently affects hearing sensitivity in young adults. Six electronic databases were searched using related keywords for the four categories of personal listening devices, listening habits, hearing outcomes, and age. The Hedges’ g and its 95% confidence intervals (CIs) were estimated. A Higgins I² was also used to check for heterogeneity. To test for publication bias, funnel plots were drawn using Egger’s regression. Based on the inclusion criteria, 16 studies were divided into two groups to identify short-term hearing changes (n = 7) and long-term hearing changes (n = 9). In the short term, there was no significant immediate change in the thresholds or amplitudes after the music exposure, although pure-tone thresholds (PTAs) and distortion product otoacoustic emissions (DPOAEs) did show the highest effect size (−0.344, CI −0.727 to 0.038) and (0.124, CI −0.047 to 0.296) at 4 kHz. On the other hand, for long-term hearing changes, the PTA provided the highest effect size at 6 kHz (−0.525, CI −0.897 to −0.154) and 8 kHz (–0.486, CI −0.819 to −0.152), while also implying that habitual and repeated personal listening device (PLD) usage can act on some significant hearing changes in audiological tests. We conclude that the use of a PLD produces a few temporary hearing changes at 4 kHz after its use but that the changes are then reversed. However, it is important to note heavy PLD users’ experience regarding permanent changes in their hearing thresholds at high frequencies, and the public should be educated on this issue.

Assessment of Safe Listening Intentional Behavior Toward Personal Listening Devices in Young Adults

Recreational noise-induced hearing loss (RNIHL) is a highly preventable disorder that is commonly seen in teenagers and young adults. Despite the documented negative effects of RNIHL, it is still challenging to persuade people to adopt safe listening behaviors. More research is needed to understand the underlying factors guiding listeners’ intentions to engage in safe listening habits. We used the Theory of Planned Behavior (TPB) to identify attitudes, social norms, and behavioral control in 92 young adults toward two intentional behaviors related to safe listening habits while listening to their personal listening devices: (1) lowering the intensity of loud music, and (2) shortening the listening duration of loud music. Using a Qualtrics survey, the major factors of the TPB model as they relate to the participants’ intention to engage in risk-controlling behavior were assessed. Behavioral intentions to turn the music down and listen for shorter durations were thought to be predicted by the TPB factors (attitudes, social norms, and perceived behavioral control). Linear regression findings indicated that the overall TPB models were significant. Positive attitudes toward turning the music down and shortening the durations were significantly associated with intentions to engage in non-risky behavior, more so for the former behavior.

Impact of usage of personal music systems on oto-acoustic emissions among medical students

Background:

Intact hearing is essential for medical students and physicians for communicating with patients and appreciating internal sounds with a stethoscope. With the increased use of (PMSs), they are exposed to high sound levels and are at a risk of developing hearing loss. The effect of long term personal music system (PMS) usage on auditory sensitivity has been well established. Our study has reported the immediate and short term effect of PMS usage on hearing especially among medical professionals.

Objective:

To assess the effect of short term PMS usage on distortion product otoacoustic emissions (DPOAE) among medical professionals.

Materials and Method:

34 medical students within the age range of 17–22 years who were regular users of PMS participated in the study. All participants had hearing thresholds <15 dBHL at audiometric octave frequencies. Baseline DPOAEs were measured in all participants after 18 h of non-usage of PMS. One week later DPOAEs were again measured after two hours of continuous listening to PMS. DPOAEs were measured within the frequency range of 2 to 12 kHz with a resolution of 12 points per octave. Output sound pressure level of the PMS of each participant was measured in HA-1 coupler and it was converted to free field SPL using the transformations of RECD and REUG.

Results:

Paired sample t test was used to investigate the main effect of short term music listening on DPOAE amplitudes. Analysis revealed no significant main effect of music listening on DPOAE amplitudes at the octave frequencies between 2 to 4 KHz (t₆₇ = −1.02, P = 0.31) and 4 to 8 KHz (t₆₇ = 0.24, P = 0.81). However, there was a small but statistically significant reduction in DPOAE amplitude (t₆₇ = 2.10, P = 0.04) in the frequency range of 9 to 12 kHz following short term usage of PMS. The mean output sound pressure level of the PMS was 98.29.

Conclusion:

Short term exposure to music affects the DPOAE amplitude at high frequencies and this serves as an early indicator for noise induced hearing loss (NIHL). Analysis of output sound pressure level suggests that the PMSs of the participants have the capability to induce hearing loss if the individual listened to it at the maximum volume setting. Hence, the medical professionals need to be cautious while using PMS.

Audiometric notch and extended high-frequency hearing threshold shift in relation to total leisure noise exposure: An exploratory analysis

BACKGROUND

Studies investigating leisure noise effect on extended high frequency hearing are insufficient and they have inconsistent results. The aim of this study was to investigate if extended high-frequency hearing threshold shift is related to audiometric notch, and if total leisure noise exposure is associated with extended high-frequency hearing threshold shift.

MATERIALS AND METHODS

A questionnaire of the Ohrkan cohort study was used to collect information on demographics and leisure time activities. Conventional and extended high-frequency audiometry was performed. We did logistic regression between extended high-frequency hearing threshold shift and audiometric notch as well as between total leisure noise exposure and extended high-frequency hearing threshold shift. Potential confounders (sex, school type, and firecrackers) were included.

RESULTS

Data from 278 participants (aged 18-23 years, 53.2% female) were analyzed. Associations between hearing threshold shift at 10, 11.2, 12.5, and 14 kHz with audiometric notch were observed with a higher prevalence of threshold shift at the four frequencies, compared to the notch. However, we found no associations between total leisure noise exposure and hearing threshold shift at any extended high frequency.

CONCLUSION

This exploratory analysis suggests that while extended high-frequency hearing threshold shifts are not related to total leisure noise exposure, they are strongly associated with audiometric notch. This leads us to further explore the hypothesis that extended high-frequency threshold shift might be indicative of the appearance of audiometric notch at a later time point, which can be investigated in the future follow-ups of the Ohrkan cohort.

Risk Factors for Distortion Product Otoacoustic Emissions in Young Adults

Young adults with normal hearing may exhibit risk factors for hearing loss. The purpose of this study was to evaluate how self-reported personal music (PM) system volume use, preferred listening level, and self-reported alcohol use affects distortion product otoacoustic emissions (DPOAEs). Two-hundred, sixteen young adults, 161 women and 55 men, participated. Questionnaire data included the PM system and alcohol use. DPOAEs were obtained from 1–6 kHz and collapsed into 1/3rd octave bands and a probe microphone was used to determine preferred listening level. Alcohol was defined as drinks per month (DPM), categorized as No, Light (≤14), and Heavy (>14). Men who reported loud/very loud volume use had statistically significant lower DPOAEs at 1.5, 2, and 3 kHz than men who reported lower volume use. Light and Heavy DPM men had lower DPOAEs at 1.5, 2, and 3 kHz than no DPM men, but this was not statistically significant. There were no DPOAE differences for either variable in women and there was no association between preferred listening level and DPOAEs for women or men. Men who reported loud/very loud volume use and any DPM had poorer mid-frequency DPOAEs. There was not an association for volume use or DPM and DPOAEs in women.

The Association of Reactive Oxygen Species Levels on Noise Induced Hearing Loss of High Risk Workers in Dr. Soetomo General Hospital Surabaya, Indonesia

Excessive noise exposure could increase the production of reactive oxygen species in the cochlea, thus causing the risk of noise-induced hearing loss (NIHL). Noise is commonly found in the industrial sites. However, public places like hospital also can have noisy location which risk the workers of NIHL. To analyzed the correlation of reactive oxygen species and hearing impairment to employees at risk in the hospital. Participants were obtained by identifying the employees in hospital from 3813. They were examined for baseline characteristics, hearing loss and reactive oxygen species. Hearing loss was defined as audiometry and tympanometry level. The statistical test that used in this study is Chi square test (p < 0.05). The proportion of participant was 42.43 ± 10.72 years old in women (58.33%) and noise levels at Dr. Soetomo General Hospital was 98.15 ± 8.16 dB in range 85.39-112.90 dB. The prevalence of NIHL was 47.92% (audiometry) and 70.83% (otoacoustic emission). Reactive oxygen species estimated 5.55 ± 4.39 ng/ml. Statistical analysis of reactive oxygen species to audiometry (p = 0.993) and reactive oxygen species to otoacoustic emission (p = 0.647). Increased production of reactive oxygen species that cause hearing loss, but there was no correlation between reactive oxygen species and hearing loss in risk worker at the hospital.

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.

Assessment of auditory functions in chronic hepatitis C patients treated by sofosbuvir

OBJECTIVE

Evaluating the auditory function in patients with chronic hepatitis C treated with sofosbuvir and ribavirin.

METHODS

This study involved 80 patients with chronic hepatitis C who agreed to receive sofosbuvir and ribavirin. All participants were subjected to baseline otological and audiological assessment just before treatment. The audiological assessment included standard pure tone audiometry, extended high-frequency audiometry, immitancemetry and otoacoustic emissions (OAEs) (transient and distortion product). According to baseline hearing threshold measurements, the study population was divided into 2 groups. Group 1 included 42 patients with normal hearing sensitivity (250-8000 Hz), and Group 2 included 38 patients with sensorineural hearing loss. After 24 weeks of therapy, otological and audiological assessments were repeated and compared between the two groups and before and after therapy.

RESULTS

Post-treatment hearing threshold evaluation showed no significant difference from pretreatment evaluation at all tested frequencies. There was no statistically significant difference between pre and post-treatment otoacoustic emissions results.

CONCLUSION

Therapy with sofosbuvir and ribavirin in chronic hepatitis C has no noticeable effects on cochlear functions.

The hearing of rural workers exposed to noise and pesticides

In work environments, different physical and chemical agents that may pose a risk to workers‘ hearing health coexist. In this context, occupational hearing loss stands out. It has mostly been attributed to only noise exposure, although there are other agents, that is, pesticides that might contribute to occupational hearing loss. In this report, two cases will be presented that consider rural workers exposed to pesticides and intense noise generated by an adapted rudimentary vehicle. The noise measured in this vehicle was 88.3 dBA up to 93.4 dBA. Pure-tone audiometry, distortion product otoacoustic emissions, and high-frequency audiometry tests were performed. This report is unusual because of the short time of exposure to noise and pesticides and the hearing loss found, indicating a synergy between those agents.

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.

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

Context:

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

Aims:

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

Settings and Design:

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

Subjects and Methods:

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

Statistical Analysis Used:

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

Results:

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

Conclusions:

DPOAE signal strength alone cannot indicate preclinical NIHL in adolescents.

Cochlear function in students exposed to pesticides

Purpose

To estimate the degree of association between exposure to pesticides and the risk of alteration in cochlear function in students exposed to pesticides.

Methods

This study evaluated individuals aged 8 to 30, of both genders, residing in an area of heavy pesticide use in the town of Nova Friburgo, Rio de Janeiro State. Each study participant answered a questionnaire to assess their degree of pesticide exposure. To evaluate cochlear function, audiometry exams were performed, including transient evoked otoacoustic emissions (TEOAEs) and distortion product otoacoustic emissions (DPOAEs).

Results

The TEOAE responses were on average lower at higher frequencies, especially at 2.0 and 4.0 kHz, and lower at these frequencies among the most exposed individuals. A similar pattern was observed for DPOAE responses. The lowest response level in the DPOAE tests was observed at the frequency of 6 kHz in the group with the highest exposure score. The proportion of failures observed at more than one frequency in the TEOAE tests on the right ear was significantly higher in the highest exposure group when compared to the lowest exposure group. In the DPOAE test, the rate of failure was also greater in the group with highest exposure when compared to that of lowest exposure.

Conclusion

The results suggest that exposure to pesticides can significantly contribute to alterations in cochlear function in individuals with preserved audiometric thresholds.

Extended high frequency audiometry in users of personal listening devices

PURPOSE

Noise exposure leads to high frequency hearing loss. Use of Personal Listening Devices may lead to decline in high frequency hearing sensitivity because of prolonged exposure to these devices at high volume. This study explores the changes in hearing thresholds by Extended High Frequency audiometry in users of personal listening devices.

MATERIAL AND METHOD

A descriptive, hospital based observational study was performed with total 100 subjects in age group of 15-30years. Subjects were divided in two groups consisting of 30 subjects (Group A) with no history of Personal Listening Devices use and (Group B) having 70 subjects with history of use of Personal Listening Devices. Conventional pure tone audiometry with extended high frequency audiometry was performed in all the subjects.

RESULT

Significant differences in hearing thresholds of Personal Listening Device users were seen at high frequencies (3kHz, 4kHz and 6kHz) and extended high frequencies (9kHz, 10kHz, 11kHz, 13kHz, 14kHz, 15kHz and 16kHz) with p value <0.05. Elevated hearing thresholds were observed in personal listening devices users which were directly proportional to volume and duration of usage.

CONCLUSION

In present study no significant changes were noted in hearing thresholds in PLD users before 5years of PLD use. However, hearing thresholds were significantly increased at 3kHz, 10kHz, 13kHz in PLD users having >5years usage at high volume. Thus, it can be reasonably concluded that extended high frequencies can be used for early detection of NIHL in PLD users.

Decreased Speech-In-Noise Understanding in Young Adults with Tinnitus

OBJECTIVES

Young people are often exposed to high music levels which make them more at risk to develop noise-induced symptoms such as hearing loss, hyperacusis, and tinnitus of which the latter is the symptom perceived the most by young adults. Although, subclinical neural damage was demonstrated in animal experiments, the human correlate remains under debate. Controversy exists on the underlying condition of young adults with normal hearing thresholds and noise-induced tinnitus (NIT) due to leisure noise. The present study aimed to assess differences in audiological characteristics between noise-exposed adolescents with and without NIT.

METHODS

A group of 87 young adults with a history of recreational noise exposure was investigated by use of the following tests: otoscopy, impedance measurements, pure-tone audiometry including high-frequencies, transient and distortion product otoacoustic emissions, speech-in-noise testing with continuous and modulated noise (amplitude-modulated by 15 Hz), auditory brainstem responses (ABR) and questionnaires.Nineteen students reported NIT due to recreational noise exposure, and their measures were compared to the non-tinnitus subjects.

RESULTS

No significant differences between tinnitus and non-tinnitus subjects could be found for hearing thresholds, otoacoustic emissions, and ABR results.Tinnitus subjects had significantly worse speech reception in noise compared to non-tinnitus subjects for sentences embedded in steady-state noise (mean speech reception threshold (SRT) scores, respectively -5.77 and -6.90 dB SNR; p = 0.025) as well as for sentences embedded in 15 Hz AM-noise (mean SRT scores, respectively -13.04 and -15.17 dB SNR; p = 0.013). In both groups speech reception was significantly improved during AM-15 Hz noise compared to the steady-state noise condition (p < 0.001). However, the modulation masking release was not affected by the presence of NIT.

CONCLUSIONS

Young adults with and without NIT did not differ regarding audiometry, OAE, and ABR.However, tinnitus patients showed decreased speech-in-noise reception. The results are discussed in the light of previous findings suggestion NIT may occur in the absence of measurable peripheral damage as reflected in speech-in-noise deficits in tinnitus subjects.

Is there a relationship between premature hair greying and hearing impairment?

OBJECTIVE

There is evidence for a strong correlation between low bone mineral density and hearing loss. Furthermore, premature hair greying has been associated with low bone mineral density. Hence, this study aimed to investigate, for the first time, the relationship between premature hair greying and hearing impairment.

METHODS

Fifty patients with premature hair greying (20 women and 30 men), aged under 40 years (mean, 30.1 ± 4.9 years), who had onset of hair greying in their twenties, were recruited, along with 45 age- and sex-matched healthy control subjects (17 women and 28 men; mean age, 28.7 ± 5.1 years). Each participant was tested with low frequency audiometry at 0.125 to 2 kHz, high frequency audiometry at 4 to 8 kHz, and extended high frequency audiometry at 9 to 20 kHz.

RESULTS

Hearing thresholds were similar at all frequencies from 0.25 to 4 kHz (p > 0.05); however, significant hearing loss was observed at all frequencies from 8 to 20 kHz in the premature hair greying group compared with the control group (p < 0.05).

CONCLUSION

Patients with premature hair greying had hearing impairment at extended high frequencies. Premature hair greying may be an important risk factor for hearing loss.

Noise-induced hearing loss: a recreational noise perspective

PURPOSE OF REVIEW

This review will discuss the real-world risk factors involved in noise-induced hearing loss as a result of common and popular recreational activities prone to mid and high levels of noise exposure. Although there are currently no interventional measures available to reverse or mitigate preexisting hearing loss from noise, we discuss the vital importance of hearing loss prevention from noise exposure avoidance and reduction.

RECENT FINDINGS

Despite a seeming understanding of the effects of noise exposure from various recreational activities and devices, a large percentage of the general public who is at risk of such noise-induced hearing loss still chooses to refrain from using hearing protection instruments.

SUMMARY

While occupational exposures pose the greatest traditional risk to hearing conservation in selected workers, recreational risk factors for noise-induced hearing loss may be more insidious in overall effect given the indifferent attitude of much of the general public and particularly our youths toward hearing protection during recreational activities. Active counseling regarding the consequences of excessive noise exposure and the potential benefits to hearing from usage of hearing protection instruments is critical to providing best possible care in the hearing health professions.

Subjective and clinically assessed hearing loss; a cross-sectional register-based study on a swedish population aged 18 through 50 years

OBJECTIVES

Questionnaire studies suggest that hearing is declining among young adults. However, few studies have examined the reliability of hearing questionnaires among young adult subjects. This study examined the associations between pure tone audiometrically assessed (PTA) hearing loss and questionnaire responses in young to middle aged adults.

MATERIALS AND METHODS

A cross-sectional study using questionnaire and screening PTA (500 through 6000 Hz) data from 15322 Swedish subjects (62% women) aged 18 through 50 years. PTA hearing loss was defined as a hearing threshold above 20 dB in both ears at one or more frequencies. Data were analysed with chi-square tests, nonlinear regression, binary logistic regression, and the generalized estimating equation (GEE) approach.

RESULTS

The prevalence of PTA hearing loss was 6.0% in men and 2.9% in women (p < 0.001). Slight hearing impairment was reported by 18.5% of the men and 14.8% of the women (p < 0.001), whereas 0.5% of men and women reported very impaired hearing. Using multivariate GEE modelling, the odds ratio of PTA hearing loss was 30.4 (95% CI, 12.7-72.9) in men and 36.5 (17.2-77.3) in women reporting very impaired hearing. The corresponding figures in those reporting slightly impaired hearing were 7.06 (5.25-9.49) in men and 8.99 (6.38-12.7) in women. These values depended on the sound stimulus frequency (p = 0.001). The area under the ROC curve was 0.904 (0.892-0.915) in men and 0.886 (0.872-0.900) in women.

CONCLUSIONS

Subjective hearing impairment predicted clinically assessed hearing loss, suggesting that there is cause for concern as regards the future development of hearing in young to middle-aged people.