Toward a better understanding of nonoccupational sound exposures and associated health impacts: Methods of the Apple Hearing Study

Estimating Earphone Level and Dose Using Real-Ear Measures and Ecological Momentary Assessment

PURPOSE

Prior work estimating sound exposure dose from earphone use has typically measured earphone use time with retrospective questionnaires or device-based tracking, both of which have limitations. This research note presents an exploratory analysis of sound exposure dose from earphone use among college-aged adults using real-ear measures to estimate exposure level and ecological momentary assessment (EMA) to estimate use time.

METHOD

Earphone levels were measured at the ear drum of 53 college students using their own devices, earphones, and preferred music and speech stimuli at their normal listening volume. Participants completed 1 week of EMA, where they reported on their minutes of earphone use every 2 hr. Based on the EMAs and their measured earphone levels, sound exposure doses from earphone use were calculated.

RESULTS

Compliance on EMA was 73%, comparable to most studies using this method in audiology research. Earphone levels were lower than those reported by most prior literature. The average listening level across music and speech, with A-weighting and diffuse-field corrections, was 60 dBA. Earphone use time was also lower than most prior work. Most participants had doses under 1%.

CONCLUSIONS

Using EMA to track earphone use is a potentially simple way to facilitate measurements of sound exposure from earphone use without relying on retrospective questionnaires or limiting the sample to specific devices, earphones, or apps. Evidence was also found for potentially lower sound levels and sound exposure doses from earphone use among college-aged adults than previously reported.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.28205072.

Evaluating the Accuracy of Android Applications in Monitoring Environmental Noise Levels

Objective This study aimed to evaluate the accuracy of Android applications (apps) in measuring environmental noise levels, focusing on their potential use for occupational health assessments. Methods The top 10, highly rated, free Android apps were tested on a Samsung Galaxy A54 Smartphone (Samsung Group, Samsung Town, Seoul, South Korea) using pure tones at 100 Hz, 2000 Hz, and 4000 Hz, across four noise levels (25 dB, 40 dB, and 85 dB). Measurements were compared with a calibrated Precision Gold N09AQ environment meter (Maplin Electronics Ltd, Wath-Upon-Dearne, United Kingdom) in a controlled room. Data were analyzed using linear regression to determine R2 values for each app. Results The control meter showed the highest accuracy (R2 = 0.99). SPL Meter dB and sound Meter (KTW apps, Petaling Jaya, Selangor, Malaysia) and Sound Meter (Pony AI Inc.,Guangzhou, Guangdong, China) had the best performance (R2 = 0.98). Accuracy declined at higher noise levels, with Sound Meter (ABC Apps) showing the least accuracy (R2 = 0.85). User ratings did not correlate consistently with app performance. Conclusion Android apps offer potential as affordable noise measurement tools, with some apps demonstrating high accuracy at lower decibels. However, limitations such as reduced accuracy at higher decibels and lack of A-weighting for regulatory compliance hinder their use in professional settings. Further development and real-world testing are needed.

Digital Transformation in Cardiology - Mobile Health

The World Health Organization recognizes digital health as a key driver for sustainable health systems. Digital health is broad concept that refers to the use of digital technologies to improve health and healthcare. Mobile health is part of digital health and refers to the use of mobile devices such as smartphones, tablets, and wearable gadgets to deliver health-related services. By proactively utilizing personal health records from mHealth, in conjunction with electronic health records, advanced medical practices can be achieved. This integration facilitates app-based patient education and encouragement, lifestyle modification, and efficient sharing of medical information between hospitals. Beyond emergency care, information sharing enables patients to visit multiple healthcare facilities without redundant tests or unnecessary referrals, reducing the burden on both patients and healthcare providers.

Understanding activity and physiology at scale: The Apple Heart & Movement Study

Physical activity or structured exercise is beneficial in a wide range of circumstances. Nevertheless, individual-level data on differential responses to various types of activity are not yet sufficient in scale, duration or level of annotation to understand the mechanisms of discrete outcomes nor to support personalized recommendations. The Apple Heart & Movement Study was designed to passively collect the dense physiologic data accessible on Apple Watch and iPhone from a large real-world cohort distributed across the US in order to address these knowledge gaps.

'Cultural Insights into Adults' Hearing Awareness and Personal Listening Device Habits: A Survey Study

Objective

The aim of this study was to investigate adults' habits regarding personal listening devices (PLDs), associated factors such as tinnitus and hearing threshold shift, and their knowledge of safety measures, including the use of hearing protectors in noisy environments.

Design

A cross-sectional survey was designed and distributed online.

Study Sample

Participants between the ages of 18 and 40 years were invited to complete the survey. The online survey was filled out by 274 individuals with an average age of 24.2 years (SD= 5.1 years). Based on age, the participants were grouped into young adults (18-23 years old, 151 participants) and adults (24-40 years old, 123 participants). The estimation of noise exposure was calculated based on self-reported responses of PLD use. Two categories emerged from this calculation: the participants with exposure lower than 80 dB were in the low exposure category (N: 196, 62.9 dB), while the participants with exposure higher than 80 dB were in the high exposure category (N: 78, 89.9 dB).

Results

Based on the age categories, most of the questionnaire answers were similar between the young adults and the adults, revealing similar habits in using their PLDs. However, the investigation based on exposure revealed differences, as the participants with high exposure levels were more likely to have hobbies that involved noise, and they were less likely to obtain hearing evaluations. Among the participants, 30% used their devices at the maximum volume level and on a daily basis. 33.5% reported experiencing worsening in hearing, 2.4% reported persistent tinnitus, 94.1% knew that hearing protectors were available but only 20.7% reported using hearing protectors.

Conclusion

The study concludes that adults are at risk of hearing loss due to unsafe listening habits. A discrepancy between knowledge and practice is apparent and needs to be addressed in young adults by increasing awareness of hearing loss, hearing protection and annual hearing evaluation.

Face the (unamplified) music: Key findings for musicians

Music is complex. There are risks to hearing health associated with playing due to excessive sound exposure. Face the Music is an on-going cross-sectional project to assess the risks to unamplified classical musicians. Key findings over the first fifteen years are presented based on the research undertaken with a leading conservatoire on more than 5000 classical music students. The work covers hearing health surveillance, education and awareness, sound exposure, and new technology. The future of the research programme is discussed along with opportunities in objective hearing health assessment and new acoustic solutions. A lot has changed in fifteen years, but the research was driven by a change in United Kingdom legislation. It is hoped that the research results can inform future regulation.

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.

Monitoring Occupational Noise Exposure in Firefighters Using the Apple Watch

Occupational noise exposure and hearing loss are prominent in the fire service. Firefighters are routinely exposed to hazardous levels of noise arising from the tools and equipment they use, from sirens and alarm tones to the emergency response vehicles they drive. The present study utilized the Apple Watch to continuously measure environmental noise levels for on-duty firefighters. Participants included 15 firefighters from the metropolitan South Florida area, and 25 adult non-firefighter control subjects. Firefighters were recruited from a variety of roles across two stations to ensure noise exposure profiles were appropriately representative of exposures in the fire service. All participants wore an Apple Watch for up to three separate 24 h shifts and completed a post-shift survey self-reporting on perceived exposures over the 24 h study period. Cumulative exposures were calculated for each shift and noise dose was calculated relative to the NIOSH recommended exposure limit of 85 dBA as an 8 h time-weighted average. The maximum dBA recorded on the Apple Watches was statistically significant between groups, with firefighters experiencing a median of 87.79 dBA and controls a median of 77.27 dBA. Estimated Exposure Time at 85 dBA (EET-85) values were significantly higher for firefighters when compared to controls: 3.97 h (range: 1.20-14.7 h) versus 0.42 h (range: 0.05-8.21 h). Only 2 of 16 firefighters reported the use of hearing protection devices during their shifts. Overall, our results highlight the utility of a commonly used personal device to quantify noise exposure in an occupationally at-risk group.

Noise-induced hearing disorders: Clinical and investigational tools

A series of articles discussing advanced diagnostics that can be used to assess noise injury and associated noise-induced hearing disorders (NIHD) was developed under the umbrella of the United States Department of Defense Hearing Center of Excellence Pharmaceutical Interventions for Hearing Loss working group. The overarching goals of the current series were to provide insight into (1) well-established and more recently developed metrics that are sensitive for detection of cochlear pathology or diagnosis of NIHD, and (2) the tools that are available for characterizing individual noise hazard as personal exposure will vary based on distance to the sound source and placement of hearing protection devices. In addition to discussing the utility of advanced diagnostics in patient care settings, the current articles discuss the selection of outcomes and end points that can be considered for use in clinical trials investigating hearing loss prevention and hearing rehabilitation.

The hunt for hidden hearing loss in humans: From preclinical studies to effective interventions

Many individuals experience hearing problems that are hidden under a normal audiogram. This not only impacts on individual sufferers, but also on clinicians who can offer little in the way of support. Animal studies using invasive methodologies have developed solid evidence for a range of pathologies underlying this hidden hearing loss (HHL), including cochlear synaptopathy, auditory nerve demyelination, elevated central gain, and neural mal-adaptation. Despite progress in pre-clinical models, evidence supporting the existence of HHL in humans remains inconclusive, and clinicians lack any non-invasive biomarkers sensitive to HHL, as well as a standardized protocol to manage hearing problems in the absence of elevated hearing thresholds. Here, we review animal models of HHL as well as the ongoing research for tools with which to diagnose and manage hearing difficulties associated with HHL. We also discuss new research opportunities facilitated by recent methodological tools that may overcome a series of barriers that have hampered meaningful progress in diagnosing and treating of HHL.

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

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