Evaluation of -Induced Hearing Loss in Young People Using a Web-Based Survey Technique

Jeannie H. Chung, MD*; Catherine M. Des Roches, PhD‡; John Meunier, MS§; and Roland D. Eavey, MD*

ABSTRACT. Objective. Many adolescents and young based study, Niskar et al1 estimated that 12.5% of adults consciously expose themselves to loud for children aged 6 to 19 years have noise-induced entertainment. We hypothesized that these individuals threshold shifts. In 1985, Lees et al2 reported that 40% might not be aware that exposure to loud music could of students aged 16 to 25 years had audiometric result in hearing loss. Furthermore, we wished to assess evidence of NIHL, and in 1996, Blair et al3 reported the feasibility of a web-based survey to collect health information from this group. that 1% of all school-aged children have some degree 4,5 Methods. A 28-question survey was designed to tar- of NIHL. Studies from the United Kingdom, get adolescents and young adults. The survey contained France,6 Sweden,7 and China8 have also reported questions about views toward general health issues, in- evidence of NIHL in children and young adults. cluding hearing loss, and was presented to random visi- NIHL in children and young adults has been tors at the MTV web site. linked to recreational noise and leisure activities. In Results. In 3 days, 9693 web surveys were completed. 1985, Axelsson and Jerson9 evaluated noisy toys as Hearing loss was defined on a Likert scale as “a very big possible sources of NIHL in children. They found problem” by 8% of respondents compared with other health issues: sexually transmitted diseases, 50%; alco- that squeaky toys could produce levels of 78 hol/drug use, 47%; depression, 44%; smoking, 45%; nu- to 108 dBA at a distance of only 10 cm, whereas trition and weight issues, 31%; and acne, 18%. Notably, firecrackers produced sound levels of 125 to 156 dBA most respondents had experienced or hearing at a distance of 3 m. Other leisure activities involving impairment attending (61%) and clubs (43%). woodworking, recreational vehicles, and power tools Only 14% of respondents had used ; however, may produce Ͼ85 dBA.10 Classrooms also many could be motivated to try ear protection if they harbor potentially dangerous levels of noise. One were aware of the potential for permanent hearing loss study measured sound levels in band and industrial (66%) or were advised by a medical professional (59%). 11 Conclusions. A majority of young adults have expe- technology classrooms at 80 to 110 dB. Further- rienced tinnitus and hearing impairment after exposure more, adolescents who lived on farms had greater to loud music. Fortunately, many of these individuals prevalence of hearing loss compared with their peers could be motivated to wear ear protection. This novel from their exposure to sound levels Ͼ95 dBA.12 web-based survey technique rapidly generated a large In today’s society, adolescents and young adults database and is a feasible method to obtain health data consciously expose themselves to loud music, often from this group. Pediatrics 2005;115:861–867; noise-in- for hours at a time. Loud music from concerts, clubs, duced hearing loss. and personal audio systems pose a potentially dan- gerous source of recreational noise. Sound levels at ABBREVIATION. NIHL, noise-induced hearing loss. rock concerts have been recorded at 120 dB to 140 dB, and the sound levels in bars can reach Ͼ95 dB on a weekend night.4,13 Lee et al14 found that transient oise-induced hearing loss (NIHL) is a signif- threshold shifts Ͼ10 db could be seen after listening icant social and public health problem. Much to for 3 hours at normally used output of the efforts to reduce NIHL have concen- N levels. Despite evidence of hazardous noise exposure trated on reducing risks from occupational noise ex- posure in adults. However, several studies have re- among adolescents and young adults, no safety stan- ported an increasing trend of NIHL in children and dards or guidelines exist for nonoccupational noise adolescents. In the first large, national, population- exposure. Although short periods of exposure to amplified sound may be experienced without permanent hear- From the *Department of Otolaryngology, Pediatric Otolaryngology Ser- ing loss, the damage from chronic exposure to these vice, Massachusetts Eye and Ear Infirmary, and Department of Otology and sound levels is cumulative so that a slight hearing Laryngology, Harvard Medical School, Boston, Massachusetts; ‡Center for loss in childhood can eventually become a substan- Survey Research, Harvard School of Public Health, Boston, Massachusetts; and §Cogent Research, Cambridge, Massachusetts. tial one in adulthood. The prevention of such hearing Accepted for publication Jul 27, 2004. loss begins with education with hearing conserva- doi:10.1542/peds.2004-0173 tion programs ideally targeting children and young No conflict of interest declared. adults. Reprint requests to (R.D.E.) Massachusetts Eye and Ear Infirmary, 243 In 2002, Folmer et al15 performed a comprehensive Charles St, Boston, MA 02114. E-mail: roland࿝[email protected] PEDIATRICS (ISSN 0031 4005). Copyright © 2005 by the American Acad- review of hearing conservation education programs emy of Pediatrics. for children. They reviewed 29 organizations with

Downloaded from www.aappublications.org/news by guestPEDIATRICS on October 1, Vol.2021 115 No. 4 April 2005 861 Fig 1. Survey created by researchers at the Massachusetts Eye and Ear Infirmary, the Harvard School of Public Health, and Cogent Research, Inc.

curricula in place to produce and disseminate hear- on Deafness and Other Communication Disorders). ing conservation materials suitable for children. Wise Ears is one of the most comprehensive curricula Some of the organizations and programs reviewed available for children and includes lesson plans for included Crank It Down! (National Hearing Conser- teachers, videos, and interactive programs on their vation Association), Stop That Noise! (League for the web site. In their review, Folmer et al15 found that Hard of Hearing), and Wise Ears (National Institute the various hearing conservation programs had ef-

862 EVALUATION OF NOISE-INDUCEDDownloaded from www.aappublications.org/news HEARING LOSS IN YOUNG by guest on PEOPLE October 1, 2021 fective program materials and resources but that dis- patients feel about the use of hearing protection? semination of these materials to the schools was in- Which interventions might influence preventive be- adequate. havior? These are some of the questions that we Although concerned professionals can implement wished to address. The objectives of this report were audiometric screenings and promote education to evaluate awareness of NIHL among young adults, about NIHL in schools, influence for behavior mod- to examine perceptions of hearing protection, and to ifications may be achieved perhaps more effectively identify factors that might influence behavior in a if we could understand the perceptions about hear- positive way. In addition, we wished to determine ing and NIHL. What do adolescents and young the utility of a web-based survey technique to gather adults know about hearing loss? How do young health information from this group.

Downloaded from www.aappublications.org/news by guest on October 1, 2021 ARTICLES 863 METHODS loss a “very big problem” or “somewhat of a big” A 28-question survey was created by researchers at the Massa- problem when they had previous education on hear- chusetts Eye and Ear Infirmary, the Harvard School of Public ing loss (41% vs 29%; P Ͻ .05). Health, and Cogent Research, Inc (Fig 1). The survey was designed The majority of respondents had attended a con- to target adolescents and young adults and contained initial ques- tions about views toward several general health issues, including cert, club, or party with loud music in the last 6 hearing loss. The survey further directed 16 questions at specific months (Table 3), and 61% and 43% reported expe- hearing issues such as the use of hearing protection, factors that riencing tinnitus or temporary hearing impairment, might increase use of hearing preservation, and personal exposure respectively, while attending loud music venues. to loud recreational music. The survey also collected demographic Only 14% of respondents reported wearing ear pro- data such as age and occupational and socioeconomic status (Ta- ble 1). The survey format included multiple choice, multichoto- tection in places where loud music was being played, mous, and open-ended questions designed to be completed easily. but 39% reported that suggestions had been made to The survey contained 4 questions with multiple subquestions that wear earplugs; suggestion to wear earplugs was required the respondents to prioritize the significance of answers made to 29% of all respondents Ͻ15 years, to 38% of about a health issue on a Likert scale such as “a very big problem,” respondents 15 to 18 years, to 35% of respondents 19 “somewhat of a problem,” “not too much of a problem,” or “not Ͼ a problem at all.” to 21 years, and to 44% of respondents 21 years. The survey was administered anonymously as a random Parents (55%) were the most likely group to have pop-up survey to every 30th visitor to the MTV.com web site for recommended the use of earplugs. Physicians had 3 consecutive days. The MTV web site was chosen because of the recommended the use of hearing protection to 22% large congruence of visitors (Ͼ400 000 visits per day) with the project requirements. MTV is accepted as a leading authority in of respondents. Before this survey, only 16% of re- music and is specifically geared toward 15- to 34-year-olds. In 3 spondents had heard, read, or seen anything publicly days, 49 800 visitors received the pop-up survey and 9693 surveys related to the issue of hearing loss, with 9% receiving were completed (19% cooperation rate). Of the surveys that were education at school. not completed (81%), the number of participants who withdrew from the survey versus the number of incomplete surveys was not Only 20% of respondents reported the personal recorded. Respondents between the ages of 13 and 65 years were intention to use earplugs at a future or club included in the study. Those who were between the ages of 35 and with loud music. However, this number increased 65 years constituted Ͻ0.2% of the study respondents. The result- (Table 4) when the respondents were made aware of ing study population consisted of 3310 (35%) male and 6148 (65%) the potential for permanent hearing loss (66%) or female respondents, with an average age of 19.2 years. The re- sponses to each question are reported in percentages. Informed were encouraged by a medical professional (59%). consent was not obtained given the inherent, voluntary nature of The respondents also would be inclined to wear completing an anonymous web-based survey. hearing protection if they knew that earplugs protect hearing without decreasing enjoyment (57%). When RESULTS asked by open-ended question about the perceptions Hearing loss was defined as “a very big problem” of peers who wear earplugs in a social situation with by 8% of respondents compared with the following: loud noise, 41% responded negatively and 59% were sexually transmitted diseases, 50%; alcohol/drug positive or equivocal. As to the availability, 68% of use, 47%; depression, 44%; smoking, 45%; nutrition respondents knew that ear plugs could be purchased and weight issues, 31%; and acne, 18%. Female re- in a drug store. spondents were statistically more likely to consider drug and alcohol use, sexual issues, nutrition and DISCUSSION weight-loss issues, and depression as a “very big The results of this study indicate the low priority problem” compared with male respondents (Table of hearing loss relative to other health issues. Ironi- 2). A respondent was more likely to consider hearing cally, a 61% majority of respondents have experi- enced hearing loss and tinnitus at rock concerts. The health issues that are considered to be of concern for TABLE 1. Demographic Data our group, such as alcohol and drug use, smoking, Respondents, % sexually transmitted diseases, and depression, are Female gender 65 consistent with results drawn from an original sur- Age vey on Americans’ views toward children’s health Mean age 19 y Ͻ issues designed by the Harvard School of Public 15 16 16 15–18 41 Health Survey Research Center. Unlike such issues 19–21 19 as alcohol and drug use, which may have immediate Ͼ21* 23 life-threatening consequences, hearing loss does not Education level pose a concern for youths as the detrimental effects In high school 40 may not manifest for years. Furthermore, they are High school graduate or higher 60 Employment status unable to appreciate fully the significant impact that Student 63 hearing loss may have on future quality of life. Employed part-time, full-time, 37 Given the low priority to hearing loss, the infre- homemaker, other quent use of hearing protection is not unexpected. Family income in 2001 Above average 34 Expecting individuals to modify behavior requires a Internet use/wk significant amount of education at many levels in 0–3 h 23 society. A small number of respondents (16%) re- 4 h or more 77 ported any exposure to or education about issues * Respondents between the ages of 35 and 65 constitute Ͻ0.2% of surrounding hearing health; significantly, this group the study sample. was more likely to consider hearing loss an impor-

864 EVALUATION OF NOISE-INDUCEDDownloaded from www.aappublications.org/news HEARING LOSS IN YOUNG by guest on PEOPLE October 1, 2021 TABLE 2. Relative Priority of Health Concerns Considered a “Very Big Problem” Health Concern Considered a Gender, %† Age, %‡ “Very Big Problem,” %* Ͻ15 Years 15–18 Years 19–21 Years Ͼ21 Years Hearing loss 8 Male: 10 9 8 8 9 Female: 8 Sexually transmitted diseases 50 Male: 47 44 50 57 54 Female: 54 Alcohol/drug use 47 Male: 40 40 48 44 52 Female: 51 Depression 44 Male: 37 40 45 50 42 Female: 59 Smoking 45 Male: 39 37 43 46 44 Female: 45 Nutrition and weight issues 31 Male: 23 23 26 37 41 Female: 36 Acne 18 Male: 14 19 23 14 9 Female: 18 * Percentage of the total number of respondents. † Percentage of all male or all female respondents. ‡ Percentage of respondents within a corresponding age group.

TABLE 3. Number of Attendances at Concerts or Clubs in the dents had never worn protective earplugs; posttest Past 6 Months results showed that 15% to 20% more students No. of Attendances Respondents, % would wear them. These classic public health tech- Concert niques of information and persuasion seem highly 034promising regarding hearing preservation at enter- 1–9 60 tainment venues and are certainly easier to imple- 10ϩ 6 ment than the legislation-intensive techniques of re- Club striction and/or prohibition. 034 1–9 44 Parents were the group most likely to recommend 10–19 10 the use of hearing protection. However, other groups 20ϩ 13 should also play an allied role in convincing children and adolescents to protect hearing as individuals in this age group may typically engage in rebellious tant health concern. Experts advocate that educa- behavior against parental authority. Our respon- tional programs must begin early in life and have dents reported that social influences such as peers suggested well-child physician visits and annual (39%), public role models (46%), and television (24%) school examinations throughout elementary and could also influence behavior to use hearing protec- high school as possible opportunities.1,13,17,18 tion. The substantial positive behavioral response (59%) This study attests to the accessibility and feasibility to a “doctor or nurse telling you that you should of a web-based survey as shown by the overwhelm- wear ear plugs” indicates that we in the medical ing response to the survey. The World Wide Web has community have failed to communicate an effective emerged as a powerful tool in which to collect data message but that we still do have a significant op- and allows unprecedented access to the population. portunity to have an impact on hearing behaviors. Although the Internet and the use of the web is not Importantly, only 9% of respondents reported receiv- yet as ubiquitous as the conventional telephone sur- ing any education about hearing in school, another vey technique, Internet survey methodology is in- opportunity for change. Several studies have shown creasing.20 Most of the respondents (77%) spend 4 or the positive impact of hearing conservation pro- more hours per week on the Internet. In fact, a study grams on behavior modification of school-aged chil- by the Kaiser Family Foundation revealed that teens dren and young adults.11,18,19 A survey by Lass et spend a considerable amount of web time visiting al18 examined high school students’ knowledge health sites.21 The study report GenerationRX.com about hearing health. They found deficiencies in the was a national, random, telephone survey of 1209 students’ knowledge about normal hearing mecha- young people aged 15 to 24 years. The GenerationRx. nism and hearing loss and about the effect on hear- com survey reported that 75% of teens and young ing of overexposure to noise. Although only 14% of adults who have used the Internet most often have the study groups have worn hearing protection, the searched for health information compared with play- subjects report a positive influence to wear hearing ing games (72%), downloading music (72%), shop- protection if educated about the potential for perma- ping (50%), or checking sports scores (46%). Of those nent hearing loss (66%) and if known that hearing who have accessed health information online, the protection would not decrease enjoyment (57%). A majority (55%) have done so only a few times a year, study by Lewis19 also exemplifies the power of edu- but 39% do so at least once a month. The survey also cation. He evaluated 1529 students at 5 Ohio high found that 39% of respondents have changed their schools before and after a hearing conservation-edu- personal behavior because of the health information cation program. Pretesting showed that 87% of stu- that they obtained on-line.21 As a significant portion

Downloaded from www.aappublications.org/news by guest on October 1, 2021 ARTICLES 865 TABLE 4. Factors That Are Likely to Influence the Use of Hearing Protection Respondents, % Finding out that limited exposure to very loud music can 66 permanently damage hearing A doctor or nurse telling you that you should wear ear plugs 59 Finding out that many musicians and performers wear 46 earplugs while performing Finding out that friends wear ear plugs 39 Learning about earplugs on television 24 of adolescents and young adults spend time “surfing CONCLUSION the net” for health information, health researchers This study shows that NIHL has a low level of and educators should extract the full potential of the awareness priority among adolescents and young World Wide Web as a powerful communication me- adults. Fortunately, many would be persuaded to dium. Examples of web sites that are dedicated to wear hearing protection with adequate education NIHL are www.hearinghealth.net (The National and counseling. Hearing conservation education Campaign for Hearing Health Online) and www. must be implemented on many fronts in society to hearnet.com (Hearing Education and Awareness for educate our youths about hearing health. The World Rockers). Wide Web is powerful medium to collect health data The World Wide Web has been used in survey from this group, and with additional experience, sur- research, and these studies have compared tradi- vey result interpretations hopefully will refine even tional, mailed questionnaires, personal interviews, further. and e-mail surveys for differences in response rates and response effects.22,23A recent study also assessed ACKNOWLEDGMENTS the feasibility of collecting health risk behavior data We sincerely thank Shari Redstone of National Amusements from undergraduate students using a web-based sur- and Viacom for wise and gracious guidance and enthusiastic vey.20 Undergraduate students were randomized to assistance. Sumner Redstone of Viacom and several individuals at MTV should be recognized for invaluable aid to this project: Mark receive a traditional paper survey in the mail or a Rosenthal, Stephen Friedman, Allison Reidy, Jeannette Prymas, web-based survey. There were no statistical differ- Ahna Biddle, Matthew Catapano, and Jeffrey Kaufman as well as ences for demographics, response rates, item com- the members of the MTV technical crew in Cancu´n. Kathy Peck pletion, and item completion errors. However, the from H.E.A.R. along with Gwendaline Mazarra and DJ Polywog study found that the web group participants were provided on-site experience and provided earplugs from Aero. Elizabeth Thorpe from the Deafness Research Foundation and more inclined to reveal potentially embarrassing or Peter Venner of Mack’s Ear Plugs generously provided advice and sensitive information than were participants in the ear protection plugs, respectively, for the Cancu´n audience. Dr mail survey group. Felipe Santos greatly assisted with the paper survey in Cancu´n.Dr Web-based surveys offer advantages and distinct Jose Ignatio Santos provided Mexican educational media oppor- design elements such as checkboxes, radiobuttons, tunities. Betty Treanor provided excellent manuscript preparation. pop-up questions, and text-entry boxes that limit REFERENCES data entry errors. Software now exists that allows 1. Niskar AS, Kieszak SM, Holmes AE, Esteban E, Rubin C, Brody DJ. raw data to be entered directly into a statistical da- Estimated prevalence of noise-induced hearing threshold shifts among tabase, which allows for immediate data analysis children 6 to 19 years of age: the Third National Health and Nutrition such as for this survey. Furthermore, the survey may Examination Survey, 1988–1994, United States. Pediatrics. 2001;108:40–43 be designed in such a manner that maximizes the 2. Lees REM, Roberts JH, Wald Z. Noise induced hearing loss and leisure activities of young people: a pilot study. Can J Public Health. 1985;76: question completion rate and decreases the comple- 171–173 tion time with such features as skip patterns. 3. Blair JC, Hardegree D, Benson PV. Necessity and effectiveness of a Traditional surveys pose numerous methodologi- hearing conservation program for elementary students. J Educ Audiol. cal problems and are costly and time-consuming. 1996;4:12–16 Furthermore, surveys that allow contact between the 4. Sadhra S, Jackson CA, Ryder T, Brown MJ. Noise exposure and hearing loss among student employees working in university entertainment respondent and the surveyor may lead to biased venues. Ann Occup Hyg. 2002;46:455–463 overreporting of socially desirable responses, espe- 5. West PD, Evans EF. Early detection of hearing damage in young listen- cially when sensitive information is being asked.20 ers resulting from exposure to amplified music. Br J Audiol. 1990;24: Self-administered, anonymous surveys are less likely 89–103 6. Meyer-Bisch C. Epidemiological evaluation of hearing damage related to overreport socially desirable responses, but re- to strongly amplified music (personal cassette players, discotheques, sponse rates and item completion rates may be low. rock concerts)—high-definition audiometric survey on 1364 subjects. Although this study had a large number of respon- Audiology. 1996;35:121–142 dents, there are several shortfalls in the study. First, 7. Costa OA, Axelsson A, Aniansson G. Hearing loss at age 7, 10 and by virtue that the survey was linked to the sole 13—an audiometric follow-up study. Scand Audiol Suppl. 1988;30:25–32 8. Morioka I, Luo WZ, Miyashita K, Takeda S, Wang YX, Li SC. Hearing MTV.com web site, respondents were not a random impairment among young Chinese in a rural area. Public Health. 1996; sample taken from the population. Second, the inher- 110:293–297 ent nature of a web survey excludes those without a 9. Axelsson A, Jerson T. Noisy toys: a possible source of sensorineural computer or access to the Internet. Third, the volun- hearing loss. Pediatrics. 1985;76:574–578 10. Dalton DS, Cruickshanks KJ, Wiley TL, Klein BE, Klein R, Tweed TS. tary nature of the respondents’ participation may Association of leisure-time noise exposure and hearing loss. Audiology. influence data by self-selection of those who are bi- 2001;40:1–9 ased in a certain opinion. 11. Lukes E, Johnson M. Hearing conservation: an industry-school partner-

866 EVALUATION OF NOISE-INDUCEDDownloaded from www.aappublications.org/news HEARING LOSS IN YOUNG by guest on PEOPLE October 1, 2021 ship. J Sch Nurs. 1999;15:22–25 [published erratum appears in J Sch Nurs. survey of high school students’ knowledge and awareness of hearing, 1999;15:42] hearing loss, and hearing health. Hear J. 1987;June:15–19 12. Broste SK, Hansen DA, Strand RL, Stueland DT. Hearing loss among 19. Lewis DA. A hearing conservation program for high-school-level stu- high school farm students. Am J Public Health. 1989;79:619–622 dents. Hear J. 1989;42:29–24 13. Gallagher G. Hot music, high noise, and hurt ears: are teens and young 20. Pealer LN, Weiler RM, Pigg RM Jr, Miller D, Dorman SM. The feasibility adults trading hearing ability for high volume? Hear J. 1989;42:7–11 of a web-based surveillance system to collect health risk behavior data 14. Lee PC, Senders CW, Gantz BJ, Otto SR. Transient sensorineural hearing from college students. Health Educ Behav. 2001;28:547–559 loss after overuse of portable headphone cassette radios. Otolaryngol 21. Kaiser Family Foundation, Generation Rx.com: How young people use Head Neck Surg. 1985;93:622–625 the Internet for health information. Menlo Park, CA: Kaiser Family 15. Folmer RL, Griest SE, Martin WH. Hearing conservation education Foundation. December 2001. Available at: www.kff.org/content/2002/ programs for children: a review. J Sch Health. 2002;72:51–57 20011211a/GenerationRx.pdf 16. Harvard School of Public Health, Cogent Research, Inc. Attitudes To- 22. Ryan JM, Corry JR, Attewell R, Smithson MJ. A comparison of an wards Children’s Health Care Issues Survey. Boston, MA: Harvard School electronic version of the SF-36 General Health Questionnaire to the of Public Health; 2002 standard paper version. Qual Life Res. 2002;11:19–26 17. Brookhouser PE, Worthington DW, Kelly WJ. Noise-induced hearing 23. Bliven BD, Kaufman SE, Spertus JA. Electronic collection of health- loss in children. Laryngoscope. 1992;102:645–655 related quality of life data: validity, time benefits, and patient prefer- 18. Lass NJ, Woodford CM, Lundeen C, Lundeen DJ, Everly-Myers D. A ence. Qual Life Res. 2001;10:15–22

DEVICE ALLOWS DOCTORS TO PRACTICE DELIVERIES

“It does not look like anyone’s mother, and the baby it delivers has none of the emotional appeal of a newborn. But a life-like birth simulator developed at Johns Hopkins University may provide some important new information about problem deliveries in real mothers and infants. The birth simulator, which started out as a research project in engineering, has now been used to determine the best way to deliver a baby whose shoulders become stuck in the birth canal, a condition called shoulder dystocia....Theresearchers found that the Rubin’s maneuver produced less than half the force of the McRobert’s method, suggesting that it might be safer. The findings, being published . . . in American Journal of Obstetrics and Gynecology, still require further validation through additional research and clinical evaluation, so recommendations for a change in practice may not come for some time. But the evidence is mounting....‘There are commercially available birthing simulators,’ Dr. Edith D. Gurewitsch said in a telephone interview, ‘but really they’re just dolls. None have instrumentation like ours that actually tells you what kind of force you’re exerting on the head, neck, and nerves of the infant.’”

Bakalar N. New York Times. January 4, 2005

Noted by JFL, MD

Downloaded from www.aappublications.org/news by guest on October 1, 2021 ARTICLES 867 Evaluation of Noise-Induced Hearing Loss in Young People Using a Web-Based Survey Technique Jeannie H. Chung, Catherine M. Des Roches, John Meunier and Roland D. Eavey Pediatrics 2005;115;861 DOI: 10.1542/peds.2004-0173

Updated Information & including high resolution figures, can be found at: Services http://pediatrics.aappublications.org/content/115/4/861 References This article cites 20 articles, 2 of which you can access for free at: http://pediatrics.aappublications.org/content/115/4/861#BIBL Subspecialty Collections This article, along with others on similar topics, appears in the following collection(s): Dentistry/Oral Health http://www.aappublications.org/cgi/collection/dentistry:oral_health_s ub Ear, Nose & Throat Disorders http://www.aappublications.org/cgi/collection/ear_nose_-_throat_dis orders_sub Permissions & Licensing Information about reproducing this article in parts (figures, tables) or in its entirety can be found online at: http://www.aappublications.org/site/misc/Permissions.xhtml Reprints Information about ordering reprints can be found online: http://www.aappublications.org/site/misc/reprints.xhtml

Downloaded from www.aappublications.org/news by guest on October 1, 2021 Evaluation of Noise-Induced Hearing Loss in Young People Using a Web-Based Survey Technique Jeannie H. Chung, Catherine M. Des Roches, John Meunier and Roland D. Eavey Pediatrics 2005;115;861 DOI: 10.1542/peds.2004-0173

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Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. Pediatrics is owned, published, and trademarked by the American Academy of Pediatrics, 345 Park Avenue, Itasca, Illinois, 60143. Copyright © 2005 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 1073-0397.

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