Evaluation of Noise-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 music 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 sound 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 tinnitus or hearing at a distance of 3 m. Other leisure activities involving impairment attending concerts (61%) and clubs (43%). woodworking, recreational vehicles, and power tools Only 14% of respondents had used earplugs; however, may produce sounds 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 headphones 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).