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A Critical Review of Current Practices and Outcomes in Recreational Noise-Induced Hearing Loss Studies

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A Critical Review of Current Practices and Outcomes in Recreational Noise-Induced Hearing Loss Studies A Critical Review of Current Practices and Outcomes In Recreational Noise-Induced Hearing Loss Studies KAMAKSHI GOPAL UNIVERSITY OF NORTH TEXAS DENTON, TEXAS, USA Outline • Introduction • Overview of current practices • Summary of study outcomes • Need for a universal protocol Introduction • The objective of this presentation is to summarize the methods adopted and results obtained by various investigators in the area of recreational noise- induced hearing loss. The purpose is to provide an opportunity to recognize the commonalities and inconsistencies among these studies. • During this discussion, noise-induced hearing loss from recreational or environmental noise in non-occupational situations will be referred to as recreational noise-induced hearing loss (RNHIL). • Under this the following settings/contexts were considered appropriate: bars, nightclubs, pubs, concerts, discos, sports arenas, noisy sports, hobbies, personal audio systems, theaters, urban transportation systems, etc. Current perspectives • A review of literature indicates that for more than 40 years studies have attempted to identify and quantify the effects of recreational noise exposure on hearing and auditory-related symptoms. • Comparison of results across research studies has been a challenge because of varied samples, methods and protocols. • Individual susceptibility to noise is a major factor (Biassoni and Serra et al. 2005), and must be recognized as we discuss variability between studies and samples. • However, even with varied methods, it must be acknowledged that the data obtained thus far supports the risk posed by recreational noise on the human auditory system. • Most studies point to the fact that excessive exposure to loud recreational noise does impact hearing ability, and can lead to other auditory-related symptoms such as tinnitus, difficulty understanding speech and hyperacusis. Sample studies that reported Temporary or Persistent Tinnitus and Temporary or Permanent Threshold Shifts Temporary Hearing Permanent Hearing Category Author(s) Temporary Tinnitus Persistent Tinnitus Threshold Shift (TTS) Threshold Shift (PTS) Concerts/Bars/ Recreational Bogoch et al. (2005) 26 to 50% 76 to 100% 76 to 100% 26 to 50% Studies Jokitulppo et al. (2005) 51 to 75% 0 to 25% Muhr & Rosenhall (2010) 0 to 25% 0 to 25% 0 to 25% Percent of Participant Results or Reports of target symptom in Derebery et al. (2012) 0 to 25% 51 to 75% article Gilles et al. (2012) 76 to 100% 0 to 25% 51 to 75% Gilles et al. (2013) 51 to 75% 0 to 25% 26 to 50% 0 to 25% Tung & Chao (2013) 0 to 25% 26 to 50% Degeest et al. (2014) 51 to 75% 0 to 25% 51 to 75% Balanay & Kearney (2015) 0 to 25% 0 to 25% 76 to 100% Gan et al. (2016) 26 to 50% Degeest et al. (2017) 51 to 75% PAS Studies Williams (2005) 0 to 25% 0 to 25% 0 to 25% Bulbul et al. (2009) Group 1 - 26 to 50% Group 1 - 26 to 50% Group 2 - 26 to 50% Group 2 - 0 to 25% Group 3 - 0 to 25% Group 3 - 26 to 50% Fontana Zocoli et al. (2009) 51 to 75% McNeill et al. (2010) 26 to 50% Figueiredo et al. (2011) MP3 Users: 26 to 50% Non-users: 0 to 25% Danhauer et al. (2012) 76 to 100% 0 to 25% Oghu et al. (2012) 0 to 25% Sulaiman et al. (2014) 26 to 50% Keppler et al. (2015) 76 to 100% 26 to 50% Silvestre et al. (2015) 0 to 25% Sulaiman et al. (2015) PAS users: 0 to 25% PAS users: 0 to 25% Le Prell (2011) Sporting Event Studies Swanepoel et al. (2010) 51 to 75% Adams et al. (2016) TTS >10 dB: 26 to 50% TTS >15 dB: 0 to 25% Review • For today’s discussion, research findings from 74 studies (from online databases) under the general topic of ‘RNIHL’ will be deliberated within the contexts of concerts/bars, personal listening devices (iPods, MP3 players) and sporting events. These studies were numbered 1 thru 74 The next set of slides will summarize information from various studies under the topics of: • Inclusion criteria – context/subjects • Testing methods • Test environment • Key findings from audiometric tests and questionnaires Inclusion criteria 1. For inclusion in this literature review, studies that addressed exposure to recreational noise and its effects on the auditory system in the context of (a) bars/concerts/clubs, (b) personal audio systems (PAS), or (c) sports arenas were included. 2. Cross-sectional as well as longitudinal studies were included. 3. Studies that used control groups (non-exposed participants), or those that compared pre-versus post-exposure data from the same set of subjects were included. Sampling and Subjects Sampling: Targeted approach was used most of the time (i.e., concert goers, PAS users), but questionnaires included volunteers. Number of subjects: A wide range was found, questionnaires had numbers in thousands, experimental as few as two. Subject age ranges: The subjects varied in age, ranging from pre-teens to older adults, but most were teenagers and young adults. Exposure: Varied settings for the non-PAS studies. Inclusion criteria: Some included only normal hearing subjects in their study, others did not specify. Criteria for shift Criteria for TTS: Any significant shift was accounted for in most studies, but some specified a minimum amount of shift, for example, 10 dB HL shift. Post-exposure testing timing: Usually within 15-30 min of post exposure. Follow-up after identifying TTS: Some reported testing subjects 16 hours after exposure, others waited 24 hrs. Intervention: Only a few studies compared findings with and without interventional strategies such as the use of earplugs and antioxidants. Methodology 1. Some studies relied on only self-reported questionnaires to capture awareness, and depth of knowledge among people regarding RNIHL. 2. Others obtained quantitative/experimental data in laboratory settings, clinical settings or venue settings using audiological equipment, dosimeter, etc. Some used combined approaches in their studies. 3. Most studies measured temporary changes in pure tone thresholds and/or Otoacoustic emissions, some looked at permanent changes. Test Battery Otoscopy: Almost all experimental studies reported performing otoscopy Audiological Tests: Most included air conduction pure tone audiometry – usually between 500 to 8000 Hz, some combined it with one or more of the following: (a) Extended high frequency audiometry (between 10 – 20 k Hz) (b) Otoacoustic emissions – most often DPOAE, some had TEOAE with or without DPOAEs (c) Immittance audiometry – tympanograms and reflex thresholds Concert/Bar Studies PAS Studies Sampling Volunteers (1,2,6,15,20, 25,32,29) Volunteers (35, 36,42,45,46,47,49,50,53,55,57,60, 61,64,68) Targeted (3,4,5,7,8, 9, 10,11,12, 17, 18, 22, 23, 24, 30,31) Targeted (34,39,40,41,43,44,50, 52,54,56,58, 59,62, 63,65, 69, 70) # subjects >8 (12,13,14,18,22,24,28,30) >10 (34,35,38,41,28,52,56,59,65,68) >100 (9, 10, 16,17,19,23,25,31,32) >100 (36, 39,42,43,44,45,49,51,54, 55,57,58, 60, 61, 62,63) >1000 (11,21) >1000 (40,50,53,64) >2000 (6,15, 20,27) >2000 (47) >5000 (29) Inclusion Normal hearing with or without tymps and ART Normal hearing with or without tymps and ART Criteria testing (2, 9, 10, 21) testing (38) PAS usage for at least a year at 50% volume (59) TTS Criteria Any shift (most studies) Any shift (most studies) 10 dB shift (4) 10 dB shift (none) Subjects Concert/Bar Studies PAS Studies Pre-teen (15) Teenager (2,9,10,16,18,20, 22,23) (43,44,47,50,52,53,54,62,64) Young adults (1,19,21,25, 28,30) (34,35,36,38, 39,40,45,46,49,55,57, 58,59, 60,61,63,65, 69, 70) Young & middle (3, 4,7,11,13,15,17) (51) age 16-59 yrs Young to elderly (8) (68) Middle age and (6) (51, 68) elderly 48-92 Military (11,17) (none) Recruits Concert/Bar Studies Exposure Rock and other concerts (1,3,4,18,28, 32) Music vs non-music noise exposure (2) Music majors (24,30,31) Rock concert – 4 types (8) Subgroups-disco/rock concert/PAS (5) Leisure activities (6,11,17,21,22,23) Exercise +/- loud music (7) Rec noise + PAS (16) Leisure activity and heart disease (29) Intervention Antioxidants with no alcohol (12) Earplugs (13) Concert/Bar Studies PAS Studies Otoscopy Most often reported Most often reported Questionnaires General 1, 4,5,6,8,9,10, 16,17,18,19,25 34,35,39,40,42,45,53,54,55,56,57, 60,61,62,63,64,65, 69, 70 Validated - 20*,27*,32* 43*,47*,60*,61*,50**,52***,49^,20^^,32^^ Other 9, 10, 22,23 59 75% Return Rate 8,11,13 Tympanometry 36,39,43,47, 50, 69, 70 Pure-tone Audiometry Standard Frequencies 1,2,3, 4,5,7, 9, 10,11,13,14,16,17,18, 21, 36, 38,39,43,44,59, 60,61,65,69,70 (.5, 1, 2, 3, 4, 6, and 8 kHz) 22,24,27,32 Air and bone 6 Extended High freq 10-20 kHz 9,10, 36,59,62,63, 65,69,70 OAEs DP (7,12,18,25, TEOAE (23,24,25) DPOAE (38,39,60,61,64) TEOAE (49,60,61) Dosimetry 3,4,9,10,12,13,14,18,24,28 56 Focus group interview 41,52 Real Ear/KEMAR 9,10 33,35,38,40 Youth Attitudes Towards Noise Scale (YANS)(*), National Health and Nutrition Examination Survey (NHANES)(**), and The Listening Habits questionnaire (***), Tinnitus Handicap Inventory (THI) (^), Beliefs about Hearing Protection and Hearing Loss (BAHPHL) (^^) Testing Concert/Bar Studies PAS Studies Environments Clinical sound-booth 2,3, 5, 7,11,17,21,24 36,43,44, 47,49, 50,60,61,62,63,65, 69, 70 Mobile vans with 12, 13,15,16,17,18,22 booth Quiet room in building 4,6,18,19, 21 Concert/Bar PAS Studies Studies Control Group 1,5, 12, 24, 25 36,39,59 Cross-Sectional 1, 2, 3, 4, 38,39,44,46,47,49,50,51,52,57,59,60,61,62, 11,23,24,25,27,29 63,64,65, 69, 70 Longitudinal 9 (4 yrs), 10, 22 (3 yrs) Dosimeter Findings >85dBA weekly exposure 11,12,13,18, 28 51, 53, 65 >100 dbA for 4.5 hrs 3, 9,13 >118 peak 13 Peak=140 dBA, > 2-4 daily 4 dose < OSHA/NIOSH (or other 14,28 limits in music practice) >OSHA/NIOSH 4,12,24,28,30,31 56, 66,69 Follow-up 4 36 Concert/Bar Studies PAS Studies PTS Findings Teenage boys had higher exposure levels and increased thresholds at 9 4&6k Hz in four years Moderate recreation activity led to less threshold shift (tough vs.
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