|Year : 2020 | Volume
| Issue : 2 | Page : 107-114
Community awareness of noise-induced hearing loss from portable listening devices and possible preventive measures
Farid Alzhrani1, Saad Al-Saleh1, Shayma Asrar2, Ahmed Al-Dhafeeri1, Bashaer Al-Baqami3, Mona Al-Harbi3, Amani Al-Harbi4, Mai Al-Masoud4, Tahera Islam5
1 Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
2 Department of Pediatrics, Prince Sultan Military Hospital, Riyadh, Saudi Arabia
3 Department of Pediatrics, National Guard Hospital, Riyadh, Saudi Arabia
4 Al-Maarefa Medical College, Riyadh, Saudi Arabia
5 College of Medicine and Research Center, King Saud University, Riyadh, Saudi Arabia
|Date of Submission||09-Jul-2019|
|Date of Decision||02-Oct-2019|
|Date of Acceptance||18-Oct-2019|
|Date of Web Publication||02-Apr-2020|
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University, PO Box 245, Riyadh 11411
Source of Support: None, Conflict of Interest: None
Introduction: Although there is some degree of awareness among adults concerning noise-induced hearing loss (NIHL), they may not perceive themselves to be at risk and may, therefore, find it unnecessary to change their listening habits. The current study investigated the beliefs, attitudes, and practices regarding NIHL in the community. Materials and Methods: A cross-sectional, community-based survey was conducted on 739 respondents from different regions (north, south, west, east, and central) of Saudi Arabia. An electronic Arabic questionnaire (Survey Monkey Arabic questionnaire) was distributed through social media (Facebook, WhatsApp group, and Twitter) for 3 months starting from May 2017. A total of forty questions were designed in order to investigate the participants' beliefs and knowledge about NIHL within the community. Results: Approximately 25% of the study participants reported mild-to-severe hearing problems, especially among male participants. A significantly higher prevalence of hearing problems was noted in listeners who were accustomed to using a volume level of more than 80%. The risk factors for NIHL included the number of sessions per day that the participant was exposed to a noise source and the degree to which the volume of the TV or the radio was increased along with the duration of exposure per session. Approximately 75% of the study participants preferred to decrease the volume of their personal audio devices as a means of protection against NIHL. Conclusion: This study identified that there is a significant prevalence of hearing impairment in the Saudi community. In general, majority of the respondents are aware of the risk factors concerning NIHL. In spite of that, the practice of population showed unhealthy listening habits. The positive attitude of the participants toward changing their lifestyle indicates that there is a need for NIHL awareness campaigns to further educate the community.
Keywords: Attitudes, audio devices, awareness, hearing, knowledge, noise, volume
|How to cite this article:|
Alzhrani F, Al-Saleh S, Asrar S, Al-Dhafeeri A, Al-Baqami B, Al-Harbi M, Al-Harbi A, Al-Masoud M, Islam T. Community awareness of noise-induced hearing loss from portable listening devices and possible preventive measures. J Nat Sci Med 2020;3:107-14
|How to cite this URL:|
Alzhrani F, Al-Saleh S, Asrar S, Al-Dhafeeri A, Al-Baqami B, Al-Harbi M, Al-Harbi A, Al-Masoud M, Islam T. Community awareness of noise-induced hearing loss from portable listening devices and possible preventive measures. J Nat Sci Med [serial online] 2020 [cited 2023 Jan 30];3:107-14. Available from: https://www.jnsmonline.org/text.asp?2020/3/2/107/272327
| Introduction|| |
One of the most common forms of acquired hearing impairment is noise-induced hearing loss (NIHL). NIHL is attributed to exposure to high volumes of sound for long durations of time. In the last decade, changes in lifestyle have led to people being more and more exposed to damaging noise sources. Moreover, people seem to be disregarding the detrimental effects of excess exposure to noise on their health, such as NIHL. Two of the most important sources of loud noise encountered during routine life include occupational and recreational exposure to noise sources. The latter source is usually encountered during leisure activities and in various other social settings where exposure to loud music takes place. These sources include the use of personal audio devices (PADs) such as MP3 players, mobiles, and headphones in addition to car sound systems, aerobic music, and attendance at music concerts and nightclubs. Over the last few years, there has been a decrease in exposure to occupational noise; however, exposure to leisure-associated noise has increased threefold.
A lack of knowledge concerning the risk factors associated with NIHL contributes to hazardous health effects that the general public does not usually perceive. A study in the USA found that a third of college students may be at high risk for NIHL due to the chronic use of PADs.
A nationwide survey conducted in the USA in 2013 showed that the prevalence of NIHL in the American society is 3.4%. Moreover, research indicates that compared to 20 years ago, the prevalence of NIHL has increased significantly. However, literature linking NIHL to social activities has revealed some rather inconsistent findings. While some studies have reported an increase in health problems due to social noise,,, other studies could not detect such an association.,, A risk assessment of NIHL caused by social noise exposure was found to be confounded by exposure to occupational noise. In noisy social environments, higher sound levels exist and people are exposed to loud noise sources for longer periods of time. Both of these factors are known to aggravate the risk of hearing loss. Changes in lifestyle as well as the use of modern gadgets including PADs have contributed to an increased risk of NIHL. Enhancing healthy listening habits depends on encouraging individuals, especially adolescents and young adults to monitor and modify their behavior as required, especially with regard to the use of PADs. Further investigations are required with regard to young adult behavior and their beliefs about their susceptibility to hearing loss from causes that are within human control. Although modernization and better education has contributed to the development of our nation, we hypothesize that the general public in Saudi Arabia are largely unaware of the ensuing health hazards that result from an overexposure to sound. Knowledge and attitude toward NIHL is poorly studied in Saudi Arabia and the Middle East in general. A study among Saudi adults in Albaha region suggests gaps in community knowledge regarding the causes and protective measures against NIHL. Majority (78%) of the participants believed that doctors can cure hearing loss – a belief that might make the Saudi population less interested in preventive measures and more susceptible to the development of NIHL. The result of a recent study conducted on university students in Jordan, discovered inadequate knowledge and poor listening practice about NIHL in this group. Owing to the current paucity of literature that exists in relation to the Saudi population's knowledge and awareness of NIHL, this study was deemed to be essential in terms of national progress. Therefore, the purpose of the current study was to investigate Saudi beliefs, attitudes, and practices regarding NIHL as well as the true extent of the risk of hearing loss in the community.
| Materials and Methods|| |
This study is a descriptive, cross-sectional study approved by the institutional review board of a university hospital. A total of 739 patients were randomly selected from different administrative regions in Saudi Arabia (north, south, west, east, and central regions). We included only Saudi participants who were ≥18 years old and who consented to participate before initiation of the study. Partially filled questionnaire entries were excluded from the study. The patient data were kept strictly confidential, and all participants knew that their participation in the study would bear no ill consequences. The data were collected using an anonymous online survey instrument (Survey Monkey Arabic questionnaire). The link was distributed through social media (Facebook, WhatsApp groups, and Twitter) for 3 months, starting from May 2017. A descriptive questionnaire was designed by the research team and later reviewed and validated by four otolaryngology consultants. The 40-item questionnaire was divided into six sections as follows: questions 1–5 investigated demographic information, questions 6–10 inquired about general medical history, questions 11–15 explored the usage of audible devices as well as attitudes toward NIHL and its risk factors, questions 16–20 investigated the signs and symptoms of hearing problems, questions 21–28 explored societal beliefs and knowledge regarding NIHL, questions 29–31 explored which methods were favored by participants in relation to receiving information about hearing problems, and questions 32–39 identified practices and attitudes related to the prevention of NIHL. The last question explored whether participants were receiving any helpful information from the questionnaire. The questionnaire took 2.30–3 min to fill.
Data were collected from all the questionnaires that were filled completely and accurately. Data were presented as percentages and frequencies. The Chi-square test was used to identify significant differences in the distribution of participants' answers with regard to the questions. P < 0.05 was considered statistically significant. Data were analyzed using the IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. (IBM Corp., Armonk, NY).
| Results|| |
A total of 739 individuals were surveyed [females: 57.1%; <50 years old: 89%; minimum educational level attained = graduate level: >78%; [Table 1], thereby resulting in an overall response rate of 75%. Most of the participants were nonsmokers (82.1%). Their past medical history revealed that 6.8%, 6.9%, and 3.2% of participants had the preexisting condition of diabetes mellitus, hypertension, and heart diseases, respectively. While the majority of the participants did not display any signs of hearing problems; mild (20–40 dB), moderate (40–60 dB), and severe (60–90 dB) impairment was found in approximately 20.2%, 3.7%, and 0.5% of the participants, respectively [Figure 1]. Moreover, a family history of hearing problems was reported by about 15% of the study participants [Table 1].
|Table 1: Distribution of demographic variables among the study participants|
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The risk factors for NIHL included occupational noise (16.9%), a preference for using earphones (45.3%), and a high frequency of sessions, 6 to ≥10 (24.2%), where the participant was exposed to a loud noise source corresponding to the following parameters: >3 h per se ssion (16.4%) and a level of volume in the range of 80%–100% (28.7%) [Table 2]. More than half of the study participants engaged in 1–5 sessions per week where they would listen to a noise source for < 1 h/day. A substantial number of participants also experienced ringing in the ears (34.9%), whereas others reported that people sometimes complained that they talked too loudly (33.8%). Other participants reported the need to increase the volume of the TV or radio sometimes (56.8%). Incidentally, this report has revealed that while only 42.2% needed 1 h to adapt to the degree of loudness emitted by the noise source, a considerable number of participants (28.8%) required anywhere between 5 and 15 h [Table 3].
|Table 2: Distribution of risk factors related to noise-induced hearing loss within the Saudi community|
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|Table 3: Distribution of signs and symptoms related to noise-induced hearing loss among the Saudi community|
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An assessment of participant beliefs concerning the risk factors of NIHL revealed interesting results. However, a majority of the participants were aware that high volume levels could cause hearing problems (89.3%) and that living in a noisy environment could also negatively affect hearing (87.1%). They also recognized that a preexisting hearing impairment could get worse by continued exposure to loud noise (69.4%) [Table 4]. Moreover, about 51% of the study participants believed that daily conversation becoming harder to follow was a sign of hearing impairment. Similarly, 31.4% of the study participants considered ringing sensations in the ear as a sign. Interestingly, a majority (64%) of the participants thought that hearing problems induced by noise are preventable, and roughly half of them assumed that they had enough information about the dangers of loud noises on their hearing ability. However, a substantial number of study participants did not even know the minimum time (42% of the participants) or the minimum volume (25.2% of the participants) that could negatively impact hearing ability [Table 4].
|Table 4: Distribution of beliefs and knowledge about noise-induced hearing loss in the Saudi community|
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The practices and attitudes related to NIHL indicate that a large number of the study participants (74.6%) preferred to decrease the volume of various audio devices as a protective measure, and a substantial number (49%) recommended that the factory should put voice-limiting features on devices [Table 5]. Moreover, a vast majority of the study participants (95%) recommended installing a warning feature in their audio device in order to limit the volume, whereas 43.2% preferred using a program to limit sound output. Nearly 31.8% of the study participants said that their preferred method of receiving educational messages pertaining to NIHL was via mobile short message service (SMS) texts.
|Table 5: Distribution of practices and attitudes toward noise-induced hearing loss in the Saudi community|
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In contrast to this, 21.7% of the participants stated that they would prefer to receive educational messages in the form of E-mails [Table 5].
Subgroup analyses pertaining to the identification of independent variables indicated that increased age was associated with a higher number of hearing problems; however, this association was not statistically significant (P = 0.059). Although the highest prevalence of hearing problems was in the north of the country (38.5%), comparing the rate of hearing problems reported from the different regions did not reveal any statistically significant (P = 0.355) difference. A significantly higher percentage of males reported hearing problems than females (30.6% vs. 20.4%; P = 0.001) [Table 6]. The risk factors associated with NIHL included working/living in a noisy environment (P = 0.000), ≥10 sessions/day where the individual is exposed to a source of loud noise (P = 0.035), increased volume levels emanating from a TV or radio (P = 0.000), and >5 h of/being exposed to a noise source (P = 0.001) [Table 7]. In addition to the information gathered above, certain participants reported that there were instances when people surrounding them could hear the noise from their PADs (P = 0.000). Perhaps, not surprisingly then, those individuals who were using higher volume levels (P = 0.005) had a statistically significantly higher prevalence of hearing problems than others [Table 7].
|Table 6: The associations between the reporting of hearing impairment and certain independent variables|
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|Table 7: The significant associations between the reporting of hearing impairment and certain risk factors|
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| Discussion|| |
“The negative consequences for health on account of loud social noise exposure are not immediately perceivable or considered to be serious in any way.” It seems that patients who report symptoms of hearing problems such as tinnitus, ringing in the ears, and noise sensitivity are more ready to adopt healthy protective listening habits., There is evidence of an increased awareness among young adults concerning the risk of NIHL. However, they may not perceive themselves to be personally at risk, and thus may find it unnecessary to change their listening habits.
A study conducted in Jordan showed that the majority (60.6%) of students were daily media device users with high-volume settings. In contrast to their report, only 13% of our study participants reported 6–9 times hearing session per week and 11% up to 10 times per week. Another notable difference is that only 44% of our participants were listening to volume more than 70%. This finding not necessarily imply better listening habit in Saudi participants because the Jordan study included only students with a mean age of 21.5 ± 2.18 years, whereas in the current study, only 20% represented the same age group. Nearly 40% of our participants reported tinnitus or ringing in the ear compared to 21% of the Jordanian students. Again, it should be noted that about 12% of the participants in the current study were above 50 years old, and the tinnitus might not represent only NIHL; rather, it might be due to other hearing problems.
In the present study, 24.8% of the participants reported a hearing impairment. These findings were much higher than the findings reported in a recent American study, where approximately 10% of college students reported a previous history of hearing impairment. In addition, a Malaysian study revealed an even lower prevalence of hearing loss than the Saudi individuals who took part in this study. The study showed that only 7.3% of the individuals reported a hearing impairment, whereas the vast majority of them demonstrated mild hearing loss, only.
In this study, approximately 16.9% of the study participants were exposed to either home-based or occupational noise. A higher percentage was found among college students in the USA though, where 29% of them reported working in a noisy environment.
In the current study, the majority of the participants (45.3%) preferred using earphones, similar result has been documented in Malaysia (2013), where they were used by 51% of the study participants. In the present study, approximately half of the participants listened to a noise source for < 1 h/session. On the contrary, higher mean listening time was documented in Malaysia in two different studies (1.2 ± 1.5 h  and 1.5–3.2 h ). Cultural and religious factors may have contributed to the shorter periods of usage of PADs in the Saudi community.
In the current study, 41% of the participants reported that sometimes the volume of their device was loud enough to be heard by the people around or near them. A slightly higher value (50%) was found among US students. In addition, 28.7% of our study participants used a volume level of 80%–100%, which is more than the levels unearthed in a (2012) study by Gilliver et al. where 20% of the participants reported that they listened to their devices at volume levels of 80% or more. However, it was lower than the results cited in a (2005) study by Williams (25%).
Rawool and Colligon-Wayne found that approximately 66% of the students in their study reported the sensation of ringing in their ears immediately after using PADS, whereas in the present study, only 34.9% has been reported. In addition, our study found that more than half of the participants who had been surveyed reported a difficulty in hearing to others, a result much higher than reported elsewhere.
In the present study, approximately 89% of the respondents believed that high volume levels could negatively affect their hearing. This is in agreement with an American study where roughly 10% of college students agreed with the statement “I believe that hearing loss does not occur as a result of listening to loud music.“ Different results were obtained in another study conducted among college students where only 42% of the participants felt that listening to music at high volumes could damage their hearing. In another qualitative study, adolescents who took part in a focus group discussion appeared to be generally aware of the overall risks of exposure to loud music, but they underestimated personal vulnerability.
A study by Kumar et al. found that 30% of PAD users listened to music above a level that was considered safe (i.e., >80 dB for 8 h). Furthermore, Quintanilla-Dieck et al. found that about half of the participants in their study reported experiencing symptoms such as tinnitus or hearing loss after loud music exposure. Another study conducted in Australia showed that the mean perceived risk of exposure to high volumes faced by participants was 79%, which represents a level of around 85 dB. The study, taking into account their risk awareness of the participants of high level of volume, concluded that their assessment of risk associated with noise was realistic. In contrast to this finding, our study has revealed that the majority of participants have misperceptions regarding the level at which high sound volumes pose a danger to health. A large majority of our participants opt for reducing the volume as a preventive measure against NIHL. This is in agreement with the findings of a study by Shah et al. where the majority of the participants were concerned about hearing loss and were willing to listen at lower volume settings in order to protect their hearing.
A significantly higher percentage of males in our study reported hearing problems possibly due to exposure to sound at a higher level, frequency, and duration both in the workplace and in the outdoor environment. An increase in age was associated with an increase in the prevalence of hearing problems. The association between increased age and hearing problems has been well documented,, in relation to NIHL, although some studies attribute it to certain genetic factors., The preferred methods for receiving educational messages in the current study were via mobile SMS texts and the Internet. The present study findings are in agreement with those of a study by Quintanilla-Dieck et al. who reported that the provision of health-related information via electronic media in contrast to the dissemination of information by health-care providers is by far the most informative source of health information to the public.
Those participants who were accustomed to using a volume level of 80%–90% reported a significantly higher percentage of hearing problems (12.2%) than participants who generally used lower volume levels. Perhaps, somewhat predictably, however, the percentage of noise-induced hearing problems rose even higher (16.5%) in relation to those participants who used a volume level of 90%–100%. This is in agreement with a US study conducted by Rota-Donahue and Levey who found that people with a hearing impairment have had generally experienced longer and louder exposure to a noise source than people without a hearing impairment. In addition, a recent Malaysian study (2015) reported that the frequent listening to music using a PAD could affect hearing., Moreover, a meta-analysis conducted by Jiang et al. revealed that up to 58% of the participants in their study were exposed to more than the current recommended 100% noise dose on a daily basis.
A major limitation to this study was that the sample size was not calculated, and also the regional population distribution was not taken into account while collecting the data. On the other hand, the inclusion of a wide age range and participants with educational qualifications in this study helped to identify the subgroups who are more prone to NIHL. Moreover, the inclusion of participants from across four regions of the country helped to assess collectively the knowledge, practices, and general awareness of the Saudi community in relation to NIHL for the first time. The lack of a standardized questionnaire concerning the beliefs and attitudes related to NIHL could perhaps have limited the comparability/generalizability of the study findings. Further studies on larger population groups using a longitudinal approach with a control group will, hopefully, throw more light on the magnitude of NIHL in Saudi Arabia.
| Conclusion|| |
The current study has identified for the first time that there is a significant prevalence of hearing impairment in the Saudi community, especially among men. A majority of the participants were aware that such hearing problems were preventable, although many of them had no idea about the minimum time of exposure to a noise source or volume level leading to hearing impairment. In general, majority of the respondents are aware of the risk factors concerning NIHL; however, their practices showed unhealthy listening habits. The positive attitude shown by participants toward changing their lifestyle with respect to using PADs indicates a willingness to improve their knowledge about NIHL. Clearly, there is a need for more NIHL awareness campaigns in order to further educate the Saudi population. The data from our work will pave the way toward conducting a survey on a much larger scale with the intention of developing appropriate health communication strategies for the prevention of NIHL. In addition, we envisage that our data will help policymakers to consider providing education through diverse promotional programs via different media outlets. Hopefully, it will also provide the driving force behind various public health campaigns aimed at increasing the level of awareness of NIHL in the community.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]