Abstract
Purpose
Noise exposure leads to high frequency hearing loss. Use of Personal Listening Devices may lead to decline in high frequency hearing sensitivity because of prolonged exposure to these devices at high volume. This study explores the changes in hearing thresholds by Extended High Frequency audiometry in users of personal listening devices.
Material and method
A descriptive, hospital based observational study was performed with total 100 subjects in age group of 15–30 years. Subjects were divided in two groups consisting of 30 subjects (Group A) with no history of Personal Listening Devices use and (Group B) having 70 subjects with history of use of Personal Listening Devices. Conventional pure tone audiometry with extended high frequency audiometry was performed in all the subjects.
Result
Significant differences in hearing thresholds of Personal Listening Device users were seen at high frequencies (3 kHz, 4 kHz and 6 kHz) and extended high frequencies (9 kHz, 10 kHz, 11 kHz, 13 kHz, 14 kHz, 15 kHz and 16 kHz) with p value < 0.05. Elevated hearing thresholds were observed in personal listening devices users which were directly proportional to volume and duration of usage.
Conclusion
In present study no significant changes were noted in hearing thresholds in PLD users before 5 years of PLD use. However, hearing thresholds were significantly increased at 3 kHz, 10 kHz, 13 kHz in PLD users having > 5 years usage at high volume. Thus, it can be reasonably concluded that extended high frequencies can be used for early detection of NIHL in PLD users.
1
Introduction
Hearing loss is the most common sensory deficit in humans today and second leading cause of ‘Years lived with Disability (YLD)’ . Noise induced hearing loss (NIHL) is the most frequently occurring preventable disability . NIHL is second most common acquired hearing loss followed by presbycusis . It is permanent and irreversible but preventable cause of hearing loss. The repeated exposure to loud sound for prolonged periods can lead to gradual NIHL which can be due to occupational/recreational noise exposure. Young adults frequently participate in noisy recreational activities and are exposed to loud sounds which can potentially lead NIHL . It has been observed that NIHL affects the higher frequencies first . Mechanism of NIHL is damage to outer and inner hair cells along with cochlear nerve ending .
The omnipresent Personal Listening Devices e.g. mobiles (smartphones), MP3 players, laptops, iPODs, tablets with earphones or headphones have made lives more comfortable, productive, pleasurable. However, excessive and addictive use of these devices is leading to harmful effects like headache, tinnitus, decreased concentration etc. . The sound output measured from PLDs exceed 100 dB at higher gain settings carrying a significant risk of hearing damage .
Most common method of assessment of hearing sensitivity is pure tone audiometry (PTA) at conventional audiometric frequencies from 125 Hz–8 kHz . Extended high frequency (EHF) audiometry includes frequencies from 9 k–20 kHz. It is a sensitive method for early detection of NIHL as noise affects higher frequencies first . The purpose of this study is to identify changes in hearing sensitivity in PLD users by EHF audiometry.
2
Material and methods
The study sample comprised of total 100 subjects of both gender. The population was divided into two groups. Group A (non PLD users) comprised of 30 subjects with no history of PLD use (patients presenting to OPD with complaints other than ear complaints). Group B (PLD users) comprised of participants with history of use of PLDs. Subjects were eligible for inclusion in the study if they were in age group 15–30 years, no prior hearing loss, no history of ear discharge/disease, tinnitus, hyperacusis, ototoxic drug intake. All the participants were having normal tympanic membrane on otoscopic examination and normal systemic examination. Participants had minimum 1 h/day use of PLDs for 1 year and no exposure to loud noise 2 days preceding the EHF audiometry. Subjects were excluded if they had current upper respiratory tract infection, evidence of middle ear dysfunction and any abnormality on otological examination.
History of PLD use with the duration of use, hours of use per day, type of PLD used and type of earphones and volume at which PLD was used taken. These were recorded in a Performa.
Pure tone audiometry and Extended High Frequency audiometry.
The pure tone audiometry (125 Hz to 8000 Hz) and extended high frequency audiometry (9000 Hz to 20,000 Hz) were performed in a sound proof room with minimal ambient noise with Labat Audiolab Audiometer (Labat Srl, Italy) using Modified Hughson – Westlake Procedure. Sennheiser HDA 300 earphones (Sennheiser, Germany) were used for measuring air conduction thresholds. The bone conduction was done with bone conductor Radio Ear B71 (Radioear, USA) in frequencies 250 Hz to 4000 Hz.
The qualitative variables are expressed as frequencies or percentages and compared between the two groups using the Chi – square test. The quantitative variables are expressed as mean ± SD and compared using Unpaired T – test. A p-value < 0.05 is considered statistically significant. IBM SPSS version 15.0 was used for statistical analysis.
2
Material and methods
The study sample comprised of total 100 subjects of both gender. The population was divided into two groups. Group A (non PLD users) comprised of 30 subjects with no history of PLD use (patients presenting to OPD with complaints other than ear complaints). Group B (PLD users) comprised of participants with history of use of PLDs. Subjects were eligible for inclusion in the study if they were in age group 15–30 years, no prior hearing loss, no history of ear discharge/disease, tinnitus, hyperacusis, ototoxic drug intake. All the participants were having normal tympanic membrane on otoscopic examination and normal systemic examination. Participants had minimum 1 h/day use of PLDs for 1 year and no exposure to loud noise 2 days preceding the EHF audiometry. Subjects were excluded if they had current upper respiratory tract infection, evidence of middle ear dysfunction and any abnormality on otological examination.
History of PLD use with the duration of use, hours of use per day, type of PLD used and type of earphones and volume at which PLD was used taken. These were recorded in a Performa.
Pure tone audiometry and Extended High Frequency audiometry.
The pure tone audiometry (125 Hz to 8000 Hz) and extended high frequency audiometry (9000 Hz to 20,000 Hz) were performed in a sound proof room with minimal ambient noise with Labat Audiolab Audiometer (Labat Srl, Italy) using Modified Hughson – Westlake Procedure. Sennheiser HDA 300 earphones (Sennheiser, Germany) were used for measuring air conduction thresholds. The bone conduction was done with bone conductor Radio Ear B71 (Radioear, USA) in frequencies 250 Hz to 4000 Hz.
The qualitative variables are expressed as frequencies or percentages and compared between the two groups using the Chi – square test. The quantitative variables are expressed as mean ± SD and compared using Unpaired T – test. A p-value < 0.05 is considered statistically significant. IBM SPSS version 15.0 was used for statistical analysis.
3
Results
Demographic profile of subjects along with the PLD characteristics and pattern of use has been summarised in Table 1 . Mobile phones coupled with insert type earphones was most common type of PLD used.
| Demographic profile | ||
|---|---|---|
| Non PLD users | PLD users | |
| Number of subjects | 30 | 70 |
| Sex (M:F) | 10:20 | 22:48 |
| Age (years) | 22.3 ± 3.18 | 23.7 ± 2.35 |
| Type of PLD | Smartphones (75.35%) Samsung (37.15%), iPhone (20%), Nokia (18.2%) Laptops (24.65%) | |
| Duration of PLD (years) | 1–3 years- 23 (35.7%) 3–5 years- 31(44.2%) > 5 years- 14 (20%) | |
| Duration of PLD (hours/day) | 1 h/day- 22 (31.4%) 1–3 h/day-40 (57.1%) > 3 h/day- 8 (11.4%) | |
| Volume of PLD (self reported) | High (110–120 dB SPL) 20 (28.5%) Medium (90–110 dB SPL) 8(40%) Low (70–90 dB SPL)-23(32.5%) | |
| Activities during which PLD was used | Travelling (68.5%) Reading (21.4%) Leisure time (10.1%) | |
On comparison between the mean hearing thresholds of PLD and non PLD group at conventional PTA (125–8000 Hz) and EHF (9 kHz–20 kHz), statistically significant differences were found in PLD group with p value < 0.05 at 3000 Hz, 4000 Hz, 6000 Hz, 9 kHz, 10 kHz, 11 kHz, 13 kHz, 14 kHz, 15 kHz, 16 kHz ( Table 2 , Figs. 1 & 2 ).
| Frequencies (kHz) | Non PLD users | PLD Users | p value | ||
|---|---|---|---|---|---|
| Mean (dB HL) | SD (±) | Mean (dB HL) | SD (±) | ||
| 0.125 | 0.17 | 6.64 | − 0.29 | 6.23 | 0.332 |
| 0.25 | 7.25 | 6.41 | 5.61 | 6.28 | 0.047 |
| 500 | 1.58 | 5.45 | 15.43 | 5.95 | 0.432 |
| 750 | 19.58 | 6.53 | 19.75 | 5.95 | 0.430 |
| 1 | 19.42 | 6.64 | 18.93 | 6.08 | 0.307 |
| 1.5 | 16.92 | 6.52 | 16.07 | 7.36 | 0.221 |
| 2 | 16.42 | 5.45 | 16.21 | 8.33 | 0.431 |
| 3 | 18.67 | 6.03 | 21.75 | 8.22 | 0.005 ⁎ |
| 4 | 15.08 | 6.61 | 18.07 | 9.03 | 0.011 ⁎ |
| 6 | 19.00 | 6.09 | 21.5 | 10.08 | 0.038 ⁎ |
| 8 | 11.42 | 8.08 | 13.5 | 9.46 | 0.069 |
| 9 | 31.00 | 10.57 | 34.11 | 11.08 | 0.033 ⁎ |
| 10 | 26.00 | 9.10 | 28.93 | 10.26 | 0.029 ⁎ |
| 11 | 24.17 | 9.53 | 27.61 | 11.67 | 0.023 ⁎ |
| 12 | 30.75 | 11.45 | 32.93 | 13.00 | 0.131 |
| 13 | 37.25 | 11.91 | 41.32 | 14.77 | 0.030 ⁎ |
| 14 | 48.75 | 16.59 | 55.44 | 16.51 | 0.005 ⁎ |
| 15 | 60.17 | 19.63 | 67.09 | 18.31 | 0.009 ⁎ |
| 16 | 73.95 | 18.19 | 79.65 | 17.74 | 0.024 ⁎ |
| 17 | 86.00 | 14.70 | 88.01 | 14.64 | 0.209 |
| 18 | 100.10 | 12.06 | 98.3 | 12.61 | 0.225 |
| 20 | 102.89 | 5.53 | 104.44 | 4.67 | 0.085 |
On comparing duration of PLD use, statistically significant changes in hearing thresholds were observed in those using PLDs for > 5 years in extended high frequencies (10 kHz and 13 kHz) ( Table 3 ). Likewise, the hearing thresholds were significantly elevated in those listening to PLDs at high volume settings as compared to normal group and low volume users. ( Table 4 , Fig. 3 ).
| Frequency (kHz) | Non PLD users n = 60 ears MEAN (SD) | PLD users | |||||
|---|---|---|---|---|---|---|---|
| 1–3 years n = 74 ears | 3–5 years n = 22 ears | > 5 years n = 44 ears | |||||
| Mean (SD) (dB) | p value | Mean (SD) (dB) | p value | Mean (SD) (dB) | p value | ||
| 0.125 | 0.1 (6.6) | 0.2 (6.9) | 0.9 | 2.7 (3.3) | 0.23 | − 2.2 (5.4) | 0.1 |
| 0.25 | 7.2 (6.4) | 5.5 (6.9) | 0.3 | 8.8 (4.8) | 0.45 | 4.3 (5.3) | 0.08 |
| 0.5 | 15.5 (5.4) | 15.6 (5.9) | 0.9 | 18.1 (6) | 0.19 | 14 (5) | 0.3 |
| 0.75 | 19.5 (6.5) | 19.3 (6) | 0.9 | 22.7 (6.8) | 0.18 | 19.3 (5.2) | 0.8 |
| 1 | 19.4 (6.6) | 18.3 (6.4) | 0.4 | 20.2 (7.1) | 0.73 | 19.6 (4.8) | 0.8 |
| 1.5 | 16.9 (6.5) | 15.7 (7.9) | 0.5 | 19.0 (8.5) | 0.38 | 15.5 (5.3) | 0.4 |
| 2 | 16.4 (5.4) | 15.3 (8.7) | 0.5 | 19.5 (10.4) | 0.21 | 15.9 (5.8) | 0.7 |
| 3 | 18.6 (6.0) | 20.1 (7.9) | 0.4 | 20.6 (8.6) | 0.41 | 22.7 (6.8) | 0.02 ⁎ |
| 4 | 15 (6.6) | 16.9 (9.4) | 0.3 | 20 (8.1) | 0.05 | 19 (8.2) | 0.06 |
| 6 | 19 (6) | 20.1 (10.1) | 0.5 | 21 (6.2) | 0.32 | 22.5 (11.3) | 0.1 |
| 8 | 11.4 (8) | 12.7 (9.9) | 0.5 | 16.8 (8.2) | 0.06 | 13.2 (9) | 0.4 |
| 9 | 31 (10.5) | 34.6 (12.2) | 0.2 | 34.7 (10.6) | 0.31 | 32.8 (9.1) | 0.5 |
| 10 | 26 (9.1) | 26.9 (10.1) | 0.2 | 26.1 (8.2) | 0.96 | 31.7 (10.7) | 0.04 ⁎ |
| 11 | 24.1 (9.5) | 26.6 (10.6) | 0.3 | 26.1 (11.4) | 0.5 | 30.2 (13.7) | 0.05 |
| 12 | 30.7 (11.4) | 32.6 (12.5) | 0.5 | 31.1 (14.7) | 0.9 | 34.8 (13) | 0.2 |
| 13 | 37.2 (11.9) | 40.1 (14.8) | 0.3 | 42.7 (16) | 0.2 | 44.2 (13.8) | 0.048 ⁎ |
| 14 | 48.7 (16.5) | 53.6 (15.2) | 0.2 | 56.5 (15.4) | 0.18 | 58.2 (18.6) | 0.05 |
| 15 | 60.1 (19.6) | 65.5 (16.8) | 0.2 | 67 (19.3) | 0.32 | 68.9 (20.1) | 0.1 |
| 16 | 73.9 (18.1) | 80 (17.4) | 0.1 | 80 (19) | 0.35 | 79.1 (18.4) | 0.3 |
| 17 | 86 (14.7) | 88.9 (14) | 0.4 | 86.4 (18) | 0.9 | 86.5 (14.1) | 0.8 |
| 18 | 100.1 (12) | 99.1 (11) | 0.7 | 94.5 (20.7) | 0.2 | 98.7 (10.5) | 0.6 |
| 20 | 102.8 (5.5) | 103.2 (3.2) | 0.7 | 105.5 (3.6) | 0.15 | 105.9 (7.3) | 0.09 |
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