Personal Listening Devices Research Articles

Influence of Hearing Risk Information on the Motivation and Modification of Personal Listening Device Use.

The purpose of this study was (a) to investigate the behaviors, knowledge, and motivators associated with personal listening device (PLD) use and (b) to determine the influence of different types of hearing health risk education information (text with or without visual images) on motivation to modify PLD listening use behaviors in young adults. College-age students (N = 523) completed a paper-and-pencil survey tapping their behaviors, knowledge, and motivation regarding listening to music or media at high volume using PLDs. Participants rated their motivation to listen to PLDs at lower volume levels following each of three information sets: text only, behind-the-ear hearing aid image with text, and inner ear hair cell damage image with text. Acoustically pleasing and emotional motives were the most frequently cited (38%-45%) reasons for listening to music or media using a PLD at high volume levels. The behind-the-ear hearing aid image with text information was significantly (p < .0001) more motivating to participants than text alone or the inner ear hair cell damage image with text. Evocative imagery using hearing aids may be an effective approach in hearing protective health campaigns for motivating safer listening practices with PLDs in young adults.

Comparison of Post Exposure Effect of Music through Personal Listening Device (PLD) on Hearing in Young Adults

Comparison of Post Exposure Effect of Music through Personal Listening Device (PLD) on Hearing in Young Adults

Preferred listening levels of mobile phone programs when considering subway interior noise.

Today, people listen to music loud using personal listening devices. Although a majority of studies have reported that the high volume played on these listening devices produces a latent risk of hearing problems, there is a lack of studies on “double noise exposures” such as environmental noise plus recreational noise. The present study measures the preferred listening levels of a mobile phone program with subway interior noise for 74 normal-hearing participants in five age groups (ranging from 20s to 60s). The speakers presented the subway interior noise at 73.45 dB, while each subject listened to three application programs [Digital Multimedia Broadcasting (DMB), music, game] for 30 min using a tablet personal computer with an earphone. The participants’ earphone volume levels were analyzed using a sound level meter and a 2cc coupler. Overall, the results showed that those in their 20s listened to the three programs significantly louder with DMB set at significantly higher volume levels than for the other programs. Higher volume levels were needed for middle frequency compared to the lower and higher frequencies. We concluded that any potential risk of noise-induced hearing loss for mobile phone users should be communicated when users listen regularly, although the volume level was not high enough that the users felt uncomfortable. When considering individual listening habits on mobile phones, further study to predict total accumulated environmental noise is still needed.

Personal listening habits and the potential for hearing loss of Canadian university students

Rationale: Personal and external factors, such as earphone type and music preference, can influence music volume adjustment beyond safe levels. The present study attempted to identify which factors are most influential on volume adjustment. Method: A cross-sectional survey of university students (n = 75) who use personal listening devices (PLD) was performed. Additionally, each participant's PLD music volume was measured through their earphones. Results: On average, participants listened to music at safe (&lt;85 dB) but high levels (79.8 dB) for generally less than four hours per day. Nearly 60% of respondents used earbuds and half preferred “noisy” music genres such as hip-hop and rock/folk. The vast majority of respondents indicated listening to music while travelling by bus for the purpose of blocking out environmental noise or out of boredom. About 75% of the participants were categorized as “pro-noise”. Most students claimed to respond to changing noise environments by adjusting music volume, but few enabled PLD built-in volume controls. Impact: This study determined that earphone type, listening environment, music genre, and listening duration were influential on an participants’ adjustment of music volume. Further research is needed to assess earphone quality and to clearly elucidate more complex associations between external or personal factors and volume adjustment.

Hearing Risk among Young Personal Listening Device Users: Effects at High-Frequency and Extended High-Frequency Audiogram Thresholds.

The usage of personal listening devices (PLDs) is associated with risks of hearing loss. The aim of this study is to evaluate the effects of music exposure from these devices on high-frequency hearing thresholds of PLD users. A total of 282 young adults were questioned regarding their listening habits and symptoms associated with PLD listening. Their audiogram thresholds were determined at high (3-8 kHz) frequencies and extended high frequencies (EHFs, 9-16 kHz). The preferred listening volumes of PLD users were used to compute their overall 8-h equivalent music exposure levels (LAeq8h). Approximately 80% of the subjects were regular PLD users. Of these, 20.1% had LAeq8h of ≥75 dBA, while 4.4% of them had LAeq8h of ≥85 dBA, which carries a high risk of hearing damage. Compared with those exposed to LAeq8h of <75 dBA, subjects who had LAeq8h of ≥75 dBA reported a significantly higher incidence of tinnitus and difficulty in hearing others immediately after using PLDs. PLD users who were exposed to LAeq8h of ≥75 dBA and had been using their devices for ≥4 years also showed significantly higher mean audiogram thresholds compared with non-users at most EHFs tested. In addition, the thresholds of PLD users at EHFs showed a weak but significant positive correlation with their LAeq8h. The present findings suggest that excessive exposure to music among PLD users may lead to initial effects on their hearing at very high frequencies.

Gender Factors that Affect Health and Hearing Acuity in Personal Listening Device Users and Non-Users

Gender Factors that Affect Health and Hearing Acuity in Personal Listening Device Users and Non-Users Background: Research has revealed that differences in hearing levels exist among males and females due to physiological differences between genders. However, few studies have explored gender differences involving the link between hearing levels and frequency of exposure to noise, hearing protection, duration and intensity level of personal listening device (PLD) use, and fitness factors across the lifespan. Methods: Data were analyzed from 115 males and females (ages 18 to 84) recruited from Oxford, Ohio. Participants were separated into two groups: PLD-users and PLD non-users, depending on their usage. Both groups completed audiometric and health-related fitness testing. Results: Males were more likely to listen to music at potentially harmful levels (85 dBA) in silence (p= 0.002). Although the majority of participants listened at “safe” levels, males were more likely to listen at louder and potentially dangerous levels in silence than females. Waist-to-hip ratio was positively correlated with hearing levels in both genders. Only 23% of participants reported using hearing protection: half female, half male. Participants who used PLDs for a greater number of years had better traditional frequency hearing thresholds than non-PLD users. Conclusion: A majority of those who have been using PLDs for a greater number of years are younger adults whose hearing acuity has not yet been greatly affected by degenerative effects of aging. Medical advancements and improved fitness levels may protect the younger generations’ hearing acuity as they age. Gender differences related to hearing loss can provide valuable information about risk factors for developing hearing loss throughout aging.

Changes of Acoustic Reflex Thresholds and Speech-In-Noise Perception Using Personal Listening Device Under Subway Interior Noise

Although it is well-known that environmental noise can lead to hearing loss in individuals, the true extent of subway noise effects in the general population remains poorly understood. The purpose of the present study is to see changes of acoustic reflex thresholds and speech perception scores when passengers listen to music presented from their personal listening device in the subway. Forty subjects with normal hearing participated being divided into two groups, experimental and control groups. As a baseline, all subjects were measured by acoustic reflex thresholds in five test frequencies and Korean speech perception in noise (KSPIN) test at 0 and -5 dB SNR. In the experiment, the control group read newspaper or magazine in the subway noise, whereas the experimental group listened to music presented from their smartphone under the subway noise through speakers at 73.45 dBA for 60 min. After completing the experiment, two groups also conducted both acoustic reflex thresholds and KSPIN tests in the same condition as the baseline. The results showed that there was a significant difference of correct percent in speech-in-noise test between experimental and control groups and of that between two signal-to-noise ratios, which means the double noise exposure of 60 min might cause some degradation of speech perception when noise increases compared to only subway noise condition that was not statistically significant difference. We concluded that a risk of some degraded speech perception ability would be expected when passengers have a habit of listening to music in the subway noisy situation for a long duration.

College students’ personal listening device usage and knowledge

Objective: To determine the usage and knowledge of safe limits on personal listening devices (PLD) among college students. Design: First, information on health history was collected. Second, microphone in real ear techniques determined eardrum to free-field correction factors. Third, hearing levels were evaluated and information gathered about knowledge of safe listening behaviors. Study sample: 180 college students participated in a one-hour session using their PLDs and earphones set to their personal preference. Results: Virtually all participants reported knowledge of hearing loss risk due to PLD use and accurately recognized their own PLD listening levels (p = .01) as either within or exceeding safe sound limits. Forty-four subjects listened at greater than 80-dBA free-field equivalent levels. Only 7% of these participants were aware of these hazardous levels and 15% of participants’ exposure surpassed free-field equivalent levels normalized to eight hours. Conclusions: Despite reported knowledge of hearing loss risk due to PLD use in virtually all college students, 1 in 4 were found to listen to their PLDs at free-field equivalent levels greater than 80-dBA, with 94% unaware of their potential risk. Further research is needed to provide accurate PLD listening information and evaluate the possibility of long term PLD intensities that surpass recommended safety levels on hearing loss in adults over time.

Ear Raid

Ear Raid

Music listening behavior, health, hearing and otoacoustic emission levels.

This study examined the relationship between hearing levels, otoacoustic emission levels and listening habits related to the use of personal listening devices (PLDs) in adults with varying health-related fitness. Duration of PLD use was estimated and volume level was directly measured. Biomarkers of health-related fitness were co-factored into the analyses. 115 subjects ages 18–84 participated in this study. Subjects were divided into two sub-groups; PLD users and non-PLD users. Both groups completed audiological and health-related fitness tests. Due to the mismatch in the mean age of the PLD user versus the non-PLD user groups, age-adjusted statistics were performed to determine factors that contributed to hearing levels. Age was the most significant predictor of hearing levels across listening and health-related fitness variables. PLD user status did not impact hearing measures, yet PLD users who listened less than 8 hours per week with intensities of less than 80 dBA were found to have better hearing. Other variables found to be associated with hearing levels included: years listening to PLD, number of noise environments and use of ear protection. Finally, a healthy waist-to-hip ratio was a significant predictor of better hearing, while body mass index approached, but did not reach statistical significance.

Evaluation of early hearing damage in personal listening device users using extended high-frequency audiometry and otoacoustic emissions

Although sound exposure from personal listening devices (PLDs) could potentially lead to noise-induced hearing loss (NIHL), the actual hearing risk associated with the use of these devices is still unclear. In this study, early hearing effects related to PLD usage were evaluated in 35 young adult PLD users (listening for >1 h/day, at >50% of the maximum volume setting of their devices) and their age- and sex-matched controls using a combination of conventional and extended high-frequency audiometry as well as transient-evoked otoacoustic emission (TEOAE) and distortion product of otoacoustic emission (DPOAE) measurements. The mean listening duration of the PLD users was 2.7 ± 1.0 h/day while their estimated average listening volume was 81.3 ± 9.0 dBA (free-field corrected). Typical signs of NIHL were not detected in the audiogram of PLD users and their audiometric thresholds at most of the conventional test frequencies (0.25-8 kHz) were comparable with those obtained from controls. However, compared with the controls, mean hearing thresholds of PLD users at many of the extended high-frequencies (9-16 kHz) were significantly higher. In addition, TEOAE and DPOAE amplitudes in users were reduced compared with controls. The deterioration of extended high-frequency thresholds and the decrease in DPOAE amplitudes were more evident in the users' right ears. These results indicate the presence of an early stage of hearing damage in the PLD user group. Preventive steps should be taken as the initial hearing damage in these users could eventually progress into permanent NIHL after many years of PLD use.

Low body mass index and jaw movement are protective of hearing in users of personal listening devices

Sound pressure level delivered through personal listening devices (PLDs) and reaching the ear drum might be affected by body size and jaw movements. This study aimed to investigate whether jaw movement and/or smaller body mass index (BMI) resulted in decrease of sound pressure level within the ear canals of PLD users via an earbud earphone. Case series. Forty-five normal-hearing subjects (16 males; mean age, 23.3 years) participated in this study. A probe-microphone system was used to measure sound pressure level in the external ear canal with music delivered from a media player via an earbud earphone. Test materials consisted of two 20-second excerpts from a heavy metal music piece. Subjects were instructed to adjust the volume of the media player to conform to three conditions for sound pressure measurement: comfortable, loud, and maximum. Measurements were then repeated while subjects mimicked chewing action under the same listening conditions. Sound pressure levels were significantly lower when measured with jaw movement than without jaw movement (P < .05). Sound pressure levels monitored with/without jaw movement were generally lower in subjects with a BMI<23 than those with a BMI ≥ 23 (P < .05). Jaw movement and low BMI (<23) reduced the overall sound level of PLDs at the ear canal. Sound pressure levels detected in the external ear canal of our subjects using earbud earphones were significantly lower under conditions of jaw movement/BMI <23. Our research invites further studies on a larger group of PLD users to correlate these variables with hearing threshold shifts over time.

Letters

Editor: While we welcome the attention to music-induced hearing loss provided by, “Hey, Teens, Listen Up!” (HJ 2012;64[4]:46; http://bit.ly/HeyTeens), this article includes exaggerations, factually incorrect statements, and the use of corporate advertising copy as fact in place of expert opinion. Our principal concerns are outlined below. The article cites a recent publication from the International Journal of Audiology, stating that the authors found that a quarter of the participants in the study “were at severe risk for hearing loss because of their personal listening devices.” (2012;51[4]:287.) What the authors actually stated in their conclusion was, “The results of the present study demonstrate the existence of a true risk to hearing encountered by more than 25% of the young teenagers, based upon questionnaires and physical measurements.” There is a substantial difference between “true risk” and “severe risk,” and we urge The Hearing Journal to be more careful in its choice of words. The article goes on to claim that the maximum output levels of MP3 players “can go up to 129 decibels” without giving a citation. The highest reported output level of which we are aware in peer-reviewed literature is 120 dBA, with a tight-fitting earphone. (J Acoust Soc Am 2008;123[6]:4227). While the difference between 120 and 129 dBA may seem small, a difference of 9 dBA is especially significant at these high levels. Even the value of 120 dBA is substantially higher than the levels typically measured in end-user studies, which rarely exceed 100 dBA. (J Am Acad Audiol 2011;22-[10]:663.) Of greater concern, however, is the use of inaccurate corporate advertising copy in place of real reporting. The description of the Aftershokz bone-conduction earphones included the statement, “Because the headphones do not use the eardrums to transmit sound, they allow users to listen to music without risk of eardrum damage.” MP3 player earphones are not capable of producing levels great enough to cause an eardrum perforation, so users would not be at risk of eardrum damage from any type of earphone. Rather, listeners are at risk of cochlear damage from overuse of any type of earphone. The fact that these earphones use bone-conduction transducers does not inherently make them any safer than any other earphone, as bone-conducted sound is transduced by the cochlea similarly to air-conducted sound. The statement about safety presented in the article is adapted from the Aftershokz website with a degree of exaggeration concerning the risk to eardrum damage and without review of the original or adaptation by The Hearing Journal's editorial advisory board. We would urge a more thorough vetting of marketing statements prior to their publication. Cory Portnuff, AuD, PhD Denver, CO Elliott Berger, MS Indianapolis, IN

SIG 8 Perspectives Vol. 12, No. 1, December 2011

SIG 8 Perspectives Vol. 12, No. 1, December 2011

Preferred listening levels of personal listening devices in young teenagers: Self reports and physical measurements

Objective: To assess the potential risk of hearing loss to young listeners, due to the use of personal listening devices (PLDs). Design: The study included two parts: (1) A self-report questionnaire on music listening habits, and (2) Physical measurements of preferred listening levels, in quiet and in everyday background noise. Study sample: Young teenagers aged 13 to 17 years. Part 1 included 289 participants with mean age of 14 years. Part 2 included 11 and 74 participants (2A and 2B) with a mean age of 15 years. Eleven listened to PLDs in quiet conditions (2A) and 74 in everyday background noise (2B). Results: Questionnaire main findings indicated that most of the participants reported high or very high volume settings and demonstrated low awareness towards loud music listening consequences. Physical measurements corrected for diffuse field indicated mean preferred listening levels of: 82 (SD = 9) dBA in quiet, and 89 (SD = 9) dBA in the presence of background noise. The potential risk to hearing of PLDs users was calculated using the 8 hour equivalent level. Conclusion: More than 25% of the participants in the noisy condition were found to be at risk according to occupational damage risk criteria NIOSH, 1998.

Survey of High School Students' Perceptions About Their iPod Use, Knowledge of Hearing Health, and Need for Education

High school students' knowledge about hearing health and their perceptions of how they use personal listening devices (PLDs) including iPods were surveyed to determine the need, content, and preferred format for educational outreach to them. This study was a descriptive convenience survey of students at a California high school. An 83-item questionnaire was administered in December 2009 to assess students' demographics, knowledge of hearing health, perceived iPod use, and risk activities. The response rate was 56%. Most of the students perceived that they used iPods safely. However, responses indicated that many of the respondents could be at risk of injury to themselves or others if they became unaware of their surroundings while listening to iPods. Some students were knowledgeable about hearing health and safe iPod use, but most needed information about hearing loss and hearing conservation. Most of the students needed education (e.g., via health classes or the Internet) about hearing health, the warning signs of hearing loss, and how to prevent hearing loss. Resources for educational audiologists are provided.

Targeting Hearing Health Messages for Users of Personal Listening Devices

To summarize the literature on patterns and risks of personal listening device (PLD) use, which is ubiquitous among teenagers and young adults. The review emphasizes risk awareness, health concerns of PLD users, inclination to take actions to prevent hearing loss from exposure to loud music, and specific instructional messages that are likely to motivate such preventive actions. We conducted a systematic, critical review of the English-language scholarly literature on the topic of PLDs and their potential effects on human hearing. We used popular database search engines to locate relevant professional journals, books, recent conference papers, and other reference sources. Adolescents and young adults appear to have somewhat different perspectives on risks to hearing posed by PLD use. Messages designed to suggest actions they might take in avoiding or reducing these risks, therefore, need to be targeted to achieve optimal outcomes. We offer specific recommendations regarding the framing and content of educational messages that are most likely to be effective in reducing the potentially harmful effects of loud music on hearing in these populations, and we note future research needs.

Perceptions and practices regarding use of personal listening devices among medical students in coastal South India

Today's generation enjoys having music at their fingertips. This has led to an increase in the usage of personal listening devices (PLDs) over the past decade. There are significant concerns regarding harmful effects of PLD use. To find out the perception and practice of medical students regarding use of PLDs. Cross-sectional study was carried out in Mangalore, Coastal south India. Data were collected using a 31 item semi structured questionnaire that was distributed among 570 medical students, of which 485 completed questionnaire were received giving an overall response rate of 86.14%. The study was approved by the departmental review board. data were analyzed using SPSS Version 11.5, Chi-square test for association was used and P<0.05 was considered statistically significant. Of the total study participants, 83.1% of them used PLDs regularly, of whom 77.7% used it for more than 1 h a day. Overall, 18.0% of the study population was aware that prolonged use of PLDs could be harmful to their health. Majority of the study subjects (72.4%) felt that the safe duration of listening to PLDs is 3 to 5 h. Among the subjects using PLDs ≥ 1 h, 60.1% preferred ear phones and among those using PLDs <1 h, 44.1% preferred earphones. Overall, 12.4% experienced temporary hearing loss on usage of PLDs. The use of PLDs among the medical students is on the rise, and they should be made more aware of the harmful effects associated with its use.

High Frequency Hearing Sensitivity in Adolescent Females of a Lower Socioeconomic Status Over a Period of 24 Years (1985–2008)

To examine annually over a period of 24 years, the high frequency hearing sensitivity in different groups of urban female adolescents with a low socioeconomic status (SES) and residential foster care. Hearing screening (15 decibel [dB] hearing level ranging from 1,000 to 8,000 Hertz [Hz]) and threshold (>15 dB hearing level) records were obtained from 8,710 female adolescents (mean age, 15.8 years [range, 12-20 years]), predominantly Hispanic and African American from households with a low SES. Data related to the use of personal listening devices (PLDs), daily hours of usage, occurrence of tinnitus, and hearing thresholds between 1,000 and 8,000 Hz over an 8-year period (2001-2008) were obtained from the adolescents. High frequency hearing loss (HFHL) doubled over the 24-year period from 10.1% in 1985 to 19.2% in 2008. In comparison with the general adolescent population, this group of female adolescents presented with a higher percentage of bilateral mild or greater degrees of HFHL at two or more frequencies including 3,000, 4,000, and 6,000 Hz. Use of PLDs increased four-fold, from 18.3% (n = 68) in 2001 to 76.4% (n = 227) in 2008. Of the total number reporting tinnitus (n = 286), 99.7% (n = 285) also reported regular PLD use. A significant relationship was found between PLD use and reported tinnitus and HFHL irrespective of time of use of PLD. Increased incidence of HFHL, reported tinnitus, PLD use, and hours of daily use in at-risk female adolescents of a low SES was found. A frequency interval of 3,000-6,000 Hz should be included in hearing screening protocols to identify potentially disabling hearing loss. Hearing conservation strategies need to be developed and/or modified that target and reach at-risk children and adolescents.

Noise Exposure Estimates of Urban MP3 Player Users

To examine the sound level and duration of use of personal listening devices (PLDs) by 189 college students, ages 18-53 years, as they entered a New York City college campus, to determine whether noise exposure from PLDs was in excess of recommended exposure limits and what factors might influence exposure. Free-field equivalent sound levels from PLD headphones were measured on a mannequin with a calibrated sound level meter. Participants reported demographic information, whether they had just come off the subway, the type of PLD and earphones used, and duration per day and days per week they used their PLDs. Based on measured free-field equivalent sound levels from PLD headphones and the reported PLD use, per day 58.2% of participants exceeded 85 dB A-weighted 8-hr equivalent sound levels (L(Aeq)), and per week 51.9% exceeded 85 dB A-weighted 40-hr equivalent continuous sound levels (L(Awkn)). The majority of PLD users exceeded recommended sound exposure limits, suggesting that they were at increased risk for noise-induced hearing loss. Analyses of the demographics of these participants and mode of transportation to campus failed to indicate any particular gender differences in PLD use or in mode of transportation influencing sound exposure.