Thomas Steffens

The prevalence of audiometric notches in adolescents in Germany: The Ohrkan-study

Although there is concern about increasing hearing loss in adolescents caused by leisure noise exposure, prevalence data are scarce. In an US study, about 16-17% of adolescents were affected by audiometric notches. To estimate the prevalence of audiometric notches in adolescents in Germany, baseline data of the cohort study Ohrkan, recruitment during the school years 2009/2010 and 2010/2011 were analyzed. All students in grade 9 visiting any school in the city of Regensburg were eligible for participation. Data was collected via standardized questionnaires from students and their parents. In addition, students were asked to visit the University Clinics of Regensburg for ear examination including a tympanogram and the determination of hearing thresholds in air conduction audiometry. The prevalence of audiometric notches was determined in students with normal tympanogram in both ears and complete audiometry data. Audiometric notches were defined according to criteria used to analyse US data. Overall, 2149 students (1158 girls, 991 boys mainly aged 15-16 years) of the 3846 eligible adolescents (56%) participated. Among the 1843 adolescents with complete audiometry and tympanometry data, the prevalence of audiometric notches was 2.4% (95% confidence interval 1.7-3.1%). We could not confirm the high prevalence of audiometric notches as reported in National Health and Nutrition Examination Surveys for adolescents in the US. Differences in prevalence might be at least partly due to methodical differences in audiometry. Even if empirical evidence is presently ambiguous, it is reasonable to educate young people about the potential risks of high leisure noise exposure.

Total leisure noise exposure and its association with hearing loss among adolescents

Abstract Objective: To investigate total leisure noise exposure among adolescents and to assess its association with hearing. Design: Based on self-reported time spent on 19 leisure activities and associated mean sound pressure levels reported in the literature, total leisure noise exposure was evaluated and compared to noise at work limits (> 85 dB(A) = hazardous) in a cross-sectional survey. Tympanometry and pure-tone audiometry was performed in sound isolated rooms. Study sample: The study sample consists of 2143 pupils attending grade nine in any school in a German city 2009–2011 (mean age: 15.4 years; range: 13–19 years). Audiometric data were available for 1837 (85.8%) pupils (53.9% girls). Results: 41.9% of the 2143 adolescents who had provided self-reported data on leisure activities associated with noise exposure were estimated to be hazardously exposed to leisure time noise. The interaction of gender with total leisure time noise exposure was not significant. No association between leisure time noise exposure and audiometric notches could be detected. Conclusion: While hearing loss seems seldom in this age group, a high proportion of adolescents aged 15–16 years are exposed to noise levels during leisure time bearing long-term risks of hearing loss.

Usage of personal music players in adolescents and its association with noise-induced hearing loss: A cross-sectional analysis of Ohrkan cohort study data

Abstract Objective: To describe personal music player (PMP) usage among adolescents, sociodemographic determinants and association with audiometric notches. Design: Audiometric evaluation to assess hearing status, and standardized questionnaires to evaluate PMP listening behaviors, leisure noise exposures and self-reported hearing loss symptoms. Sociodemographic information was collected using a parent questionnaire. Noise exposure by PMP usage equivalent for a 40u2009h week was estimated based on self-reported volume and duration of use. Study sample: A total of 2143 students (54% females) attending 9th grade in Regensburg, Germany, during 2009 to 2011. Results: Overall, 85% of the students reported using PMPs. Exposure level exceeded 80u2009dB(A) in approximately one third, and 85u2009dB(A) in one quarter, of those who used PMP. An audiometric notch was found in 2.3% of participants, but was not significantly associated with higher PMP exposure. Conclusions: PMP exposure above the occupational limits of 80 and 85u2009dB(A) set by the Directive 2003/10/EC may be a risk factor for developing noise-induced hearing loss. Educational measures to ameliorate high risk behaviors in PMP usage are needed, particularly for socially disadvantaged groups.

Average optimal DPOAE primary tone levels in normal-hearing adults

Abstract Objective: Despite great progress towards optimizing DPOAE primary tone characteristics, factors such as stimulus and intra-subject emission variability have not been addressed. The purpose of this study was to identify optimal primary tone level relationships when these sources of variability were acknowledged, and to identify any influences of test frequency. Design: Following coupler-based measurements assessing primary tone level stability, two experiments were conducted. In experiment 1, DPOAE test-retest reliability without probe replacement was measured for f2 =u20091–6u2009kHz with L1u2009=u2009L2u2009= 65u2009dB SPL. In experiment 2, optimal L1-L2 relationships were identified for f2 =u20091–6u2009kHz. For 20u2009≤u2009L2u2009≤u200975u2009dB SPL, L1 was varied 15u2009dB SPL above and below the recommendation of L1 =u20090.4u2009L2u2009+u200939 [dB SPL]. Study sample: Eleven normal-hearing adults participated in experiment 1. Thirty normal-hearing adults participated in experiment 2. Results: Stimulus variability did not exceed 0.1u2009dB SPL. DPOAE reliability testing revealed an across-frequency mean standard error of measurement of 0.52u2009dB SPL. The average optimal L1-L2 relationship was described by L1 =u20090.49u2009L2u2009+u200941 [dB SPL]. A significant effect of frequency was identified for 6u2009kHz. Conclusion: Including relevant sources of variability improves internal validity of a primary tone level optimization formula.

Audiometric notch and extended high-frequency hearing threshold shift in relation to total leisure noise exposure: An exploratory analysis

Background: Studies investigating leisure noise effect on extended high frequency hearing are insufficient and they have inconsistent results. The aim of this study was to investigate if extended high-frequency hearing threshold shift is related to audiometric notch, and if total leisure noise exposure is associated with extended high-frequency hearing threshold shift. Materials and Methods: A questionnaire of the Ohrkan cohort study was used to collect information on demographics and leisure time activities. Conventional and extended high-frequency audiometry was performed. We did logistic regression between extended high-frequency hearing threshold shift and audiometric notch as well as between total leisure noise exposure and extended high-frequency hearing threshold shift. Potential confounders (sex, school type, and firecrackers) were included. Results: Data from 278 participants (aged 18–23 years, 53.2% female) were analyzed. Associations between hearing threshold shift at 10, 11.2, 12.5, and 14u2009kHz with audiometric notch were observed with a higher prevalence of threshold shift at the four frequencies, compared to the notch. However, we found no associations between total leisure noise exposure and hearing threshold shift at any extended high frequency. Conclusion: This exploratory analysis suggests that while extended high-frequency hearing threshold shifts are not related to total leisure noise exposure, they are strongly associated with audiometric notch. This leads us to further explore the hypothesis that extended high-frequency threshold shift might be indicative of the appearance of audiometric notch at a later time point, which can be investigated in the future follow-ups of the Ohrkan cohort.

Early indication of noise-induced hearing loss from PMP use in adolescents: A cross-sectional analysis

Context: Distortion product otoacoustic emissions (DPOAEs) may indicate preclinical noise-induced hearing loss (NIHL) in adolescents from unsafe personal music player (PMP) use. Aims: The objective, therefore, was to observe preclinical signs of NIHL in 9th grade adolescents with clinically normal hearing by comparing DPOAE signals between different levels of A-weighted equivalent PMP exposure. Settings and Design: Subjects were recruited from all secondary-level schools located in the city of Regensburg, Germany during two academic years 2009/2010 and 2010/2011. Subjects and Methods: A-weighted equivalent sound pressure levels (SPLs) for a 40-hour work week (LAeq,40h) were estimated from questionnaire responses on output and duration of PMP use of the previous week. Subjects were then categorized into four levels of exposure: <80, 80–85, >85 to <90, and ≥90 A-weighted Decibel [dB(A)]. DPOAE signals were collected by trained audiological staff, applying a standard optimized protocol, at the Department of Otorhinolaryngology of the University Hospital Regensburg. Statistical Analysis Used: Mean DPOAE signals were compared between levels by unpaired t test. Novel linear regression models adjusting for other leisure noise exposures and with outcome variables DPoutcome and 4 kilo Hertz (kHz) DPOAEs estimated effects between levels. Results: A total of 1468 subjects (56% female, mostly aged 15 or 16 years) were available for analysis. Comparison of DPOAE means by PMP exposure typically showed no greater than 1u2009dB difference between groups. In fact, comparisons between ≥90 dB(A) and <80 dB(A) presented the least differences in magnitude. Both DPoutcome and 4u2009kHz linear regression models presented a weak association with the 4-level PMP exposure variable. An expected dose-response to PMP exposure was not observed in any analyses. Conclusions: DPOAE signal strength alone cannot indicate preclinical NIHL in adolescents.

Hörst du noch oder pfeift es schon?@@@Hearing loss in adolescents due to leisure noise: Hörschäden durch Freizeitlärm bei Jugendlichen und die Studie OHRKAN@@@The OHRKAN study

ZusammenfassungEine Zunahme an Hörverlusten bei Jugendlichen wird aufgrund hoher Freizeitlärmbelastungen befürchtet. Bei Übertragung der Schadensprinzipien aus dem Arbeitsschutz wird deutlich, dass Freizeitlärm, wie zum Beispiel häufiger Diskothekenbesuch, und häufiger lauter Musikkonsum über tragbare Abspielgeräte ein Gehörschadensrisiko bergen. Empirisch konnte dieses Risiko jedoch noch nicht eindeutig belegt werden. Es konnte bisher auch nicht gezeigt werden, dass die Prävalenz an lärmbedingten Hörverlusten unter Jugendlichen und jungen Erwachsenen überhaupt ansteigt. Mithilfe der prospektiven Kohortenstudie OHRKAN sollen daher sowohl Prävalenzen von Gehörschäden abgeschätzt als auch Risikofaktoren identifiziert werden. Derzeit werden an Regensburger Schulen 2240xa0Jugendliche der Jahrgangsstufexa09 rekrutiert. Bei den Jugendlichen werden Angaben zu Gehörschadensrisiken erfasst und zudem das Gehör untersucht (Tympanometrie, Audiometrie und Distorsionsprodukte otoakustischer Emissionen). In Folgeuntersuchungen sollen Veränderungen der Lärmbelastung und der Hörfähigkeit festgestellt werden. Unabhängig vom empirischen Beleg der gesundheitlichen Wirkungen sind aber bereits jetzt präventive Maßnahmen erforderlich, um das Risiko für Gehörschäden bei Jugendlichen und jungen Erwachsenen zu verringern.AbstractAlarming reports have been published about hearing loss in adolescents, and increasing leisure time noise exposure has been blamed. If the exposure limits from the Noise at Work Regulations are applied, discotheque music as well as music from portable music players are associated with the risk of hearing loss. The empirical evidence for this association, however, is not sufficient. Not even an increase in the prevalence of noise-induced hearing loss among adolescents can be documented. OHRKAN is a prospective cohort study aimed to produce information on the prevalence of hearing loss as well as its risk factors in adolescents. Currently, a total of 2,240 pupils in grade 9xa0at schools in the city of Regensburg, Germany, have been recruited. Data on noise exposure were collected using standardized questionnaires. In addition, hearing status was assessed by medical examination including tympanometry, audiometry, and distortion-product otoacoustic emissions. Developments in noise exposure as well as hearing status will be assessed in follow-up data collections. Independent of this empirical assessment preventive measures are already needed now to reduce the risk of hearing loss in adolescents and young adults.Alarming reports have been published about hearing loss in adolescents, and increasing leisure time noise exposure has been blamed. If the exposure limits from the Noise at Work Regulations are applied, discotheque music as well as music from portable music players are associated with the risk of hearing loss. The empirical evidence for this association, however, is not sufficient. Not even an increase in the prevalence of noise-induced hearing loss among adolescents can be documented. OHRKAN is a prospective cohort study aimed to produce information on the prevalence of hearing loss as well as its risk factors in adolescents. Currently, a total of 2,240 pupils in grade 9xa0at schools in the city of Regensburg, Germany, have been recruited. Data on noise exposure were collected using standardized questionnaires. In addition, hearing status was assessed by medical examination including tympanometry, audiometry, and distortion-product otoacoustic emissions. Developments in noise exposure as well as hearing status will be assessed in follow-up data collections. Independent of this empirical assessment preventive measures are already needed now to reduce the risk of hearing loss in adolescents and young adults.

Hörst du noch oder pfeift es schon

ZusammenfassungEine Zunahme an Hörverlusten bei Jugendlichen wird aufgrund hoher Freizeitlärmbelastungen befürchtet. Bei Übertragung der Schadensprinzipien aus dem Arbeitsschutz wird deutlich, dass Freizeitlärm, wie zum Beispiel häufiger Diskothekenbesuch, und häufiger lauter Musikkonsum über tragbare Abspielgeräte ein Gehörschadensrisiko bergen. Empirisch konnte dieses Risiko jedoch noch nicht eindeutig belegt werden. Es konnte bisher auch nicht gezeigt werden, dass die Prävalenz an lärmbedingten Hörverlusten unter Jugendlichen und jungen Erwachsenen überhaupt ansteigt. Mithilfe der prospektiven Kohortenstudie OHRKAN sollen daher sowohl Prävalenzen von Gehörschäden abgeschätzt als auch Risikofaktoren identifiziert werden. Derzeit werden an Regensburger Schulen 2240xa0Jugendliche der Jahrgangsstufexa09 rekrutiert. Bei den Jugendlichen werden Angaben zu Gehörschadensrisiken erfasst und zudem das Gehör untersucht (Tympanometrie, Audiometrie und Distorsionsprodukte otoakustischer Emissionen). In Folgeuntersuchungen sollen Veränderungen der Lärmbelastung und der Hörfähigkeit festgestellt werden. Unabhängig vom empirischen Beleg der gesundheitlichen Wirkungen sind aber bereits jetzt präventive Maßnahmen erforderlich, um das Risiko für Gehörschäden bei Jugendlichen und jungen Erwachsenen zu verringern.AbstractAlarming reports have been published about hearing loss in adolescents, and increasing leisure time noise exposure has been blamed. If the exposure limits from the Noise at Work Regulations are applied, discotheque music as well as music from portable music players are associated with the risk of hearing loss. The empirical evidence for this association, however, is not sufficient. Not even an increase in the prevalence of noise-induced hearing loss among adolescents can be documented. OHRKAN is a prospective cohort study aimed to produce information on the prevalence of hearing loss as well as its risk factors in adolescents. Currently, a total of 2,240 pupils in grade 9xa0at schools in the city of Regensburg, Germany, have been recruited. Data on noise exposure were collected using standardized questionnaires. In addition, hearing status was assessed by medical examination including tympanometry, audiometry, and distortion-product otoacoustic emissions. Developments in noise exposure as well as hearing status will be assessed in follow-up data collections. Independent of this empirical assessment preventive measures are already needed now to reduce the risk of hearing loss in adolescents and young adults.Alarming reports have been published about hearing loss in adolescents, and increasing leisure time noise exposure has been blamed. If the exposure limits from the Noise at Work Regulations are applied, discotheque music as well as music from portable music players are associated with the risk of hearing loss. The empirical evidence for this association, however, is not sufficient. Not even an increase in the prevalence of noise-induced hearing loss among adolescents can be documented. OHRKAN is a prospective cohort study aimed to produce information on the prevalence of hearing loss as well as its risk factors in adolescents. Currently, a total of 2,240 pupils in grade 9xa0at schools in the city of Regensburg, Germany, have been recruited. Data on noise exposure were collected using standardized questionnaires. In addition, hearing status was assessed by medical examination including tympanometry, audiometry, and distortion-product otoacoustic emissions. Developments in noise exposure as well as hearing status will be assessed in follow-up data collections. Independent of this empirical assessment preventive measures are already needed now to reduce the risk of hearing loss in adolescents and young adults.