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Personal Music Players Use and Other Noise Hazards Among Children 11 to 12 Years Old

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Personal Music Players Use and Other Noise Hazards Among Children 11 to 12 Years Old International Journal of Environmental Research and Public Health Article Personal Music Players Use and Other Noise Hazards among Children 11 to 12 Years Old Weronika Swierniak 1 , Elzbieta Gos 1, Piotr Henryk Skarzynski 1,2,3,*, Natalia Czajka 1 and Henryk Skarzynski 4 1 Department of Teleaudiology and Screening, World Hearing Center, Institute of Physiology and Pathology of Hearing, 10 Mochnackiego Street, 02-042 Warsaw, Poland; [email protected] (W.S.); [email protected] (E.G.); [email protected] (N.C.) 2 Heart Failure and Cardiac Rehabilitation Department, Faculty of Medicine, Medical University of Warsaw, 8 Kondratowicza Street, 03-242 Warsaw, Poland 3 Institute of Sensory Organs, 1 Mokra Street, 05-830 Nadarzyn/Kajetany, Poland 4 Department of Oto-Rhino-Laryngosurgery, World Hearing Center, Institute of Physiology and Pathology of Hearing, 10 Mochnackiego Street, 02-042 Warsaw, Poland; [email protected] * Correspondence: [email protected]; Tel.: +48-22-3560366 Received: 21 August 2020; Accepted: 19 September 2020; Published: 22 September 2020 Abstract: Exposure to loud music—due to widespread personal music players (PMPs) and noisy leisure activities—are major risk factors for noise induced hearing loss (NIHL) in adolescents. However, there is little evidence of the impact of noise on the hearing of younger children. This study aimed to explore an association between PMP use and hearing, and to identify other sources of noise among children. The study sample consisted of 1032 children aged 11–12 years old. Hearing thresholds were determined from 0.5 to 8 kHz. PMP use and other noise exposures were evaluated using a survey. We found that 82% of the children had a PMP, and 78% were exposed to noise when playing computer games. An audiometric notch was documented in 1.3% of the children. Only 11.5% of the children ever used hearing protection while engaged in noisy activities. We found no convincing evidence of an association between PMP use and hearing thresholds, although our results suggest that tinnitus may be an early sign of NIHL in young children. The study shows a need to provide children, their parents, and educators with knowledge of how to take care of hearing, including how to avoid and minimize noise exposure. Keywords: noise; noise induced hearing loss; personal music players; children 1. Introduction Noise exposure is a common component of life which negatively affects human health. There are many studies that have described the effects of environmental noise and its association with health problems such as annoyance [1,2], sleep disturbance [3], hypertension and ischemic heart disease [4,5], and learning impairment in children [6,7]. Some people are exposed to constant but lower noise, not high enough to have a direct effect, but inducing various health problems [8,9]. Noise exposure is particularly detrimental to hearing. Noise-induced hearing loss (NIHL) can result from both a single sudden noise (acoustic trauma) or from long-term steady noise [10]. It can injure the eardrum or middle-ear ossicles, damage hair cells in the cochlea [11–13], and affect the auditory nerve and its myelin sheath [14]. NIHL is typically revealed by a notch in the audiogram at 4 kHz [15], which can spread to nearby frequencies at 3 and 6 kHz but with some hearing recovery at 8 kHz [16,17]. A genetic susceptibility to NIHL is being investigated [13,18], but most researchers focus their attention on environmental factors. For adults, occupational noise is the main consideration [19], Int. J. Environ. Res. Public Health 2020, 17, 6934; doi:10.3390/ijerph17186934 www.mdpi.com/journal/ijerph Int. J. Environ. Res. Public Health 2020, 17, 6934 2 of 10 but for children the impact of noisy leisure activities and use of personal music players (PMPs) is the primary aspect [20]. Many studies have shown that the prevalence of NIHL is considerable among young people. Data from a large-scale American study (1988–1994) indicated that 15.9% of children aged 12 to 19 years had hearing deficits attributable to noise exposure [21]. More recent data (2005–2006) from young Americans were quite similar, the rate being 16.8% [22]. In the Netherlands it has been found that 14.2% of a large cohort showed that children aged 9 to 11 years had hearing impairment possibly correlated with NIHL [23]. In Poland, 11.5% of 643 youths aged 13 to 18 years showed a notched hearing loss at 4 or 6 kHz, and it was significantly higher in those with heavy exposure to loud music (16.3%) compared to those with mild exposure (10.7%) [24]. Many children, adolescents, and young adults engage in noisy recreational activities (e.g., attending concerts, matches, discos, playing with noisy toys, and listening to loud music). As documented by Henderson et al. [22], exposure to loud noise or listening to music over headphones is an upward trend among young people—which is not surprising, given the widespread use of PMPs, such as MP3 players, iPods, and mobile phones. In 2016, le Clercq et al. [20] undertook a systematic review and meta-analysis of music-induced hearing loss and its symptoms in young people, although most of the 33 articles concerned adolescents and young adults. It was concluded that most studies reported no significant association between exposure to loud music and pure-tone air thresholds, although some studies showed a higher prevalence of tinnitus and decreased otoacoustic emissions in participants more exposed to music. Significantly poorer hearing thresholds were documented for PMP users than for non-users, and le Clercq et al. [20] finally conclude that the accumulated data suggest an association between music exposure and hearing loss in children. Generally, there are few studies related to NIHL in younger children, and their conclusions are not strong [23,25,26]. There is no clear-cut evidence for association between recreational noise exposure and hearing loss in younger children. The aim of this study was to explore an association between personal music player use and hearing, and to identify other sources of noise among children. 2. Materials and Methods 2.1. Study Design Since November 2007, the Institute of Physiology and Pathology of Hearing, commissioned by Warsaw City Hall, has conducted hearing screening in primary schools in Warsaw. The goal of the program is to increase the detection of hearing disorders, improve early diagnosis, and give equal opportunities to children by reducing or eliminating the adverse consequences of hearing impairment [27,28]. The main objective of the hearing screening program is to assess the hearing of the studied population. For the purposes of the present article we retrospectively analyzed a portion of the data obtained in one year of the program to assess the noise hazard among sixth-grade children who were due to complete their primary education. Prior to testing, the children’s parents were informed of the testing procedure and were asked to give written consent for their children to participate in the hearing examinations. The study was conducted following the Declaration of Helsinki and was approved by the Research Ethics Committee (KB.IFPS:28/4/2018). 2.2. Audiometric Testing Screening pure tone audiometry was conducted in a quiet room allocated by the school headmaster. The examination was performed on the Platform for Sensory Organs Examination [27,29,30] connected to the “SZOK”® central database [31]. The system is based on a powerful central computer with multiple portable computers communicating with it via the Internet. Each portable device is equipped with software that allows it to perform pure-tone audiometry. The platform includes a response button Int. J. Environ. Res. Public Health 2020, 17, 6934 3 of 10 and is set up with Sennheiser HDA300 audiometric headphones which provide effective acoustic isolation from background noise. The platform is shown in Figure1. Int. J. Environ. Res. Public Health 2020, 17, x 3 of 11 FigureFigure 1. 1. PlatformPlatform for for Sensory Sensory Organs Organs Examination. Examination. ForFor each each ear ear separately, separately, air air conduction conduction thresholds thresholds at at conventional conventional octave octave frequencies frequencies from from 0.5 0.5 toto 8 8 kHz kHz were were determined determined with with the the same same paradigms paradigms as as in in a a previous previous study study [27,29,32] [27,29,32 ]as as well well as as at at half-octavehalf-octave frequencies frequencies of of 3 3 and and 6 6 kHz. kHz. Measurements Measurements at at 125 125 and and 250 250 Hz Hz were were omitted omitted as as being being less less usefuluseful and and vulnerable vulnerable to to noise noise disturbance disturbance [33]. [33]. Presence of a Notched Audiogram Presence of a Notched Audiogram Children were studied for the presence of a high-frequency notch. According to Niskar et al. [21], Children were studied for the presence of a high-frequency notch. According to Niskar et al. a notch was considered to be present when three conditions were met: (i) thresholds at 0.5 and 1 kHz [21], a notch was considered to be present when three conditions were met: (i) thresholds at 0.5 and were lower (better) than 15 dB; (ii) thresholds at 3, 4, or 6 kHz were 15 dB or higher (poorer) than the 1 kHz were lower (better) than 15 dB; (ii) thresholds at 3, 4, or 6 kHz were 15 dB or higher (poorer) poorest threshold at 0.5 or 1 kHz; and (iii) the threshold at 8 kHz was at least 10 dB lower (better) than than the poorest threshold at 0.5 or 1 kHz; and (iii) the threshold at 8 kHz was at least 10 dB lower the poorest threshold at 3, 4, or 6 kHz.
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