Daily Earphone Use Is Associated with Elevated Hearing Thresholds in Young Adults

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Bhutkar, Navina Prahalya SR This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7136504/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background With growing trend of personal listening devices, young adults are at increased risk for early-onset hearing loss. This study investigates the association between earphone usage habits and audiometric thresholds among undergraduate students. A cross-sectional analytical study was conducted among 110 undergraduate students (aged 18–25 years), who regularly used earphones. Participants were recruited through purposive sampling after applying strict inclusion and exclusion criteria. Data on earphone usage habits were obtained using a structured, validated questionnaire. Audiometric evaluation was conducted in a sound-treated environment using pure tone audiometry at frequencies ranging from 125 to 8000 Hz. Participants were categorized into normal (< 20 dB HL) and raised (≥ 20 dB HL) auditory threshold groups. Statistical analysis included independent-samples t-tests, chi-square tests, and Fisher’s exact test (SPSS v16). Results Out of 110 participants, 52.73% had normal hearing thresholds and 47.27% had elevated thresholds. The raised threshold group demonstrated significantly higher mean hearing levels (M = 16.53 ± 5.48 dB HL) compared to the normal group (M = 8.43 ± 6.80 dB HL; p < 0.001). Daily earphone use was also significantly greater among those with raised thresholds (p = 0.009). A significant association was observed between higher audio output levels and elevated thresholds (χ² = 6.836, p = 0.033). Conclusions A combination of prolonged daily earphone use and higher output levels is significantly linked to early auditory threshold elevation and represents modifiable risk factors. This highlights the need for greater awareness of safe listening practices among young users. Hearing Loss Noise-Induced Audiometry Introduction Noise-induced hearing loss (NIHL), traditionally regarded as an occupational hazard, is now increasingly recognized as a recreational health concern [ 1 ]. With the widespread use of smartphones and easy access to music, use of personal listening devices (PLDs) is drastically increased[ 2 ]. Leisure-time noise exposure, particularly from PLDs, is now a leading contributor to non-occupational auditory risk [ 3 , 4 ]. According to the World Health Organization (WHO), over one billion young people worldwide are at risk of permanent hearing damage due to unsafe listening habits, primarily from prolonged PLD use and attendance at high-volume entertainment venues [ 5 ] Numerous studies have reported elevated hearing thresholds, tinnitus, and diminished speech discrimination scores among regular PLD users [ 6 , 7 ] The risk of auditory threshold shifts is influenced by duration of daily use, cumulative exposure, preferred output levels, and the type of earphones used [ 1 , 6 – 8 ]. In-ear or insert type earphones or EarPods are widely preferred by users because of their compact size. Their ease of portability makes them a convenient choice for everyday use. But these types of earphones may pose a higher risk of auditory threshold shift, as they deliver sound directly into the ear canal, at very high volume when the output level is set at 100% [ 9 ]. Despite increasing awareness, many young users do not follow safe listening practices. Their routine use of PLDs while traveling or leisure activities makes them more vulnerable [ 4 , 10 ] Hence, the impact of in-ear earphone use on auditory thresholds is the main subject of investigation. In this context, the present study aimed to assess hearing thresholds among regular users of insert-type earphones and to analyse their listening habits in relation to audiometric findings. Materials and Methods This analytical, observational study was focused on college-going young adults who were regular earphone users. Ethical approval was obtained from the Institutional Ethics Committee, and informed written consent was secured from all participants prior to data collection. Study Population and Sampling Participants were healthy undergraduate students aged 18–25 years. Inclusion criteria included use of in-ear or insert type earphones, for at least one hour on a minimum of three days per week. Exclusion criteria included a known history of hearing loss or ear diseases, presence of ENT symptoms (e.g., ear pain, congestion, discharge) within two weeks prior to audiometric testing, and recent use of known ototoxic medications (within the past three months). Participants using supra-aural headphones were excluded from the present study, as previous research has shown that hearing threshold shifts are generally less pronounced with over-the-ear (supra-aural) headphones compared to insert-type earphones due to lower sound pressure levels delivered directly into the ear canal. [ 3 , 4 , 9 , 11 ] Purposive, non-probability sampling was used to recruit participants. Based on a previously reported prevalence of hearing loss (18.3%) among chronic earphone users in India [ 12 ], a minimum sample size of 90 was estimated (95% confidence level, 8% margin of error). To account for potential non-response, 110 participants were recruited in the study. Questionnaire and Data Collection Data were collected using a structured questionnaire consisting of two sections. The first section captured demographic details and ENT-related medical history. The second section focused on earphone usage habits, including daily hours of use, number of days per week, cumulative years of use, preferred output volume levels and whether earphone use is continuous for over one hour or included intermittent breaks. The questionnaire was developed based on a review of relevant literature. It was validated by the experts and pilot tested with 10 students. Audiological Assessment Following questionnaire completion, a preliminary ear examination is done in the ENT department. Pure-tone audiometry was then conducted in a soundproof room using a standard pure-tone audiometer (Micra+, Auditivo Hearing, India). Air conduction thresholds were measured bilaterally at frequencies from 0.125 to 8 kHz. Using WHO grading system for hearing loss based on audiometric measurements, which categorizes "Normal hearing" as having a hearing threshold of < 20 dB in the better hearing ear [ 13 ], we categorized the participants into- Normal Auditory Thresholds : Hearing thresholds < 20 dB HL at all tested frequencies in both ears. Raised Auditory Thresholds : Hearing threshold ≥ 20 dB HL at any frequency in either ear. Statistical Analysis Data were analyzed using SPSS version 16. Descriptive statistics summarized participant demographics and usage patterns. Independent-samples t-tests were used to compare mean differences in earphone use between the normal and raised threshold groups. Welch's t-test was applied when assumptions for the t-test were violated. The Chi-square test examined associations between hearing threshold status and categorical variables such as preferred audio output levels and pattern of earphone use (continuous vs. intermittent). A p-value < 0.05 was considered statistically significant. Cohen’s d was calculated to quantify the magnitude of a difference between two groups. Results A total of 110 undergraduate students participated in the study, including 84 females (76.4%) and 26 males (23.6%). The mean age of the overall sample was 20.28 years (SD = 1.01). No significant difference was observed in mean age between female participants (20.26 ± 1.02 years) and male participants (20.35 ± 0.98 years; t = − 0.37, p = 0.71) (Table 1 ). The mean hearing threshold levels (average of all the tested frequencies of both the ears) were also comparable between genders, with females exhibiting an average of 12.28 ± 6.12 dB HL and males 12.18 ± 8.90 dB HL ( t = 0.07, p = 0.95). Although males reported slightly higher average daily earphone use (3.62 ± 1.20 hours) than females (3.02 ± 1.44 hours), this difference was not statistically significant ( t = − 1.90, p = 0.06). Weekly usage patterns were similar between genders, with females using earphones for an average of 6.48 ± 0.84 days/week and males for 6.46 ± 1.14 days/week ( t = 0.07, p = 0.94). In terms of cumulative years of earphone use, males had significantly longer exposure (4.04 ± 1.75 years) compared to females (3.14 ± 1.61 years; t = − 2.43, p = 0.02). Differences in preferred output levels and the pattern of use (continuous vs. intermittent) were not statistically significant across gender. The present study also revealed that 73% of male and 58% of female participants reported using earphones continuously for more than one hour without a break. However, the difference between genders was not statistically significant (χ² = 1.83, p = 0.18) (Table 1 ). Table 1 Gender-wise comparison of auditory thresholds and earphone usage habits among participants. Variable Female (n = 84) Male (n = 26) t / χ ² value p-value Age (years), Mean ± SD 20.26 ± 1.02 20.35 ± 0.98 t = -0.37 0.71 Hearing Threshold (dB HL), Mean ± SD 12.28 ± 6.12 12.18 ± 8.90 t = 0.07 0.95 Daily Earphone Use (hours/day), Mean ± SD 3.02 ± 1.44 3.62 ± 1.20 t = -1.90 0.06 Weekly Earphone Use (days/week), Mean ± SD 6.48 ± 0.84 6.46 ± 1.14 t = 0.07 0.94 Duration of use (Years) 3.14 ± 1.61 4.04 ± 1.75 t = -2.43 0.02* Output Level Category, n (%) χ ² = 1.12 0.57 - 85% 4 (4.76%) 2 (7.69%) Intermittent breaks, n(%) χ ² = 1.83 0.18 Yes 35 (41.67%) 7 (26.92%) No 49 (58.33%) 19 (73.08%) *Statistically significant, SD: Standard Deviation, n: Number Self-reported auditory symptoms included hearing difficulty in 2 participants (1.82%), one in each group, and tinnitus in 7 participants (6.36%) where 4 participants belong to raised threshold group. Since both the symptoms were almost evenly distributed in both the groups, no further analysis was performed. Comparison Between Normal and Raised Threshold Groups Auditory Thresholds As shown in Table 2 , based on audiometric data, 58 participants (52.73%) had normal hearing thresholds (< 20 dB HL across all tested frequencies), while 52 participants (47.27%) exhibited elevated thresholds at one or more frequencies in either ear. Among the raised threshold group, 29 individuals (55.77%) demonstrated unilateral elevation, and 23 (44.23%) showed bilateral involvement (data not shown in the table). An independent-samples t -test indicated that the raised threshold group had significantly higher average bilateral hearing thresholds (16.53 ± 5.48 dB HL) than the normal group (8.43 ± 6.80 dB HL), with a large effect size ( d = 1.30; p < 0.001) (Table 2 ). Comparison of the earphone usage habits in these groups revealed statistically significant relation with duration daily earphone use. Though the number of weekdays and total years of earphone use were higher in the raised threshold group than the normal threshold group, differences were not statistically significant (Table 2 ). Table 2 Comparison of earphone usage habits and average auditory thresholds between participants with normal and raised thresholds. Variable Normal Hearing threshold (n = 58) Raised Hearing Thresholds (n = 52) T value p-value Cohen’s d 95% confidence interval Average binaural hearing threshold (dB) Mean ± SD 8.43 ± 6.8 16.53 ± 5.48 -7.84 0.00* 1.30 -10.19 to -6.01 Duration of daily use (hours) Mean ± SD 2.81 ± 1.16 3.56 ±1.55 -4.02 0.00* 0.55 0.22 to 1.27 Frequency of earphone use (Days/week) Mean ± SD 6.45 ± 0.99 6.56 ±0.80 -0.3 0.77 0.12 -0.39 to 0.29 Years of usage Mean ± SD 3.31 ± 1.66 3.40 ±1.72 -0.29 0.77 0.06 -0.73 to 0.54 *Statistically significant, SD: Standard Deviation, n: Number Result of chi-square test showed a statistically significant association (χ²(2, N = 110) = 6.836, p = 0.033) between preferred volume level ( 85%) and hearing status (Table 3 ). Due to expected count limitations, Fisher’s exact test was conducted which also confirmed significance ( p = 0.033). Linear-by-linear association indicated a significant trend (χ²(1) = 6.460, p = 0.011), suggesting a positive relationship between increased output levels and raised hearing thresholds (Table 3 ). The present study found no statistically significant difference between the study groups in the continuous use of earphones for more than one hour without a break (χ² = 0.53, p = 0.47) (Table 3 ). Table 3 Association between categorized audio output levels and hearing threshold status. Variable Normal auditory threshold (n = 58) Raised auditory threshold (n = 52) Pearson Chi-Square Value (p) Fisher's Exact Test Linear-by-Linear Association Value (p) Preferred Output level (dB) n (%) n (%) 85 2 (3.45%) 4 (7.69%) Intermittent breaks Yes 24 (41.38%) 18 (34.62%) 0.53 (0.47) 0.56 -- No 34 (58.62%) 34 (65.38%) *Statistically significant, SD: Standard Deviation, n: Number Discussion The present study assessed gender differences and earphone use habits in relation to auditory threshold shifts among young adult in-ear type of earphone users. Gender Differences Previous studies have reported conflicting evidence regarding gender-specific differences in hearing threshold shifts associated with earphone or personal music player (PMP) use. While some studies suggest that males are more susceptible to threshold shifts [ 3 , 14 ], others report greater vulnerability in females [ 15 ], and a few have found no significant gender differences [ 8 , 16 – 19 ] In the present study, hearing thresholds were comparable between males and females despite males having a significantly longer duration of earphone use. This aligns with findings that suggest minimal gender-based differences in young adults, possibly due to similar cochlear structures and auditory function at the younger age [ 20 ]. The lack of observed difference in our study may also be influenced by the smaller proportion of male participants (24%), which could limit the detection of subtle gender-specific effects. Hearing Threshold Status and Listening Behaviours Nearly half of the participants (47.27%) demonstrated elevated auditory thresholds at one or more tested frequencies. Though the average binaural auditory threshold is still within the normal limits which is < 20dB, it is significantly higher when compared with the normal threshold group (Table 2 ), indicating a concerning prevalence of early auditory threshold shift. Participants in the raised threshold group reported significantly greater daily duration of earphone use, supporting findings by Le Prell et al., Manisha et al and Haruna et al [ 2 , 8 , 18 ]. Cumulative years of use did not significantly differ between the groups, suggesting that duration of daily exposure and audio output level may be stronger predictors of threshold elevation than cumulative use alone. A significant association was observed between higher preferred audio output levels and raised auditory thresholds. Participants with elevated thresholds were more likely to use output levels exceeding 85%, whereas those with normal thresholds tended to listen at levels below 60%. This aligns with prior research indicating that sound levels above 85dB SPL increase the risk of temporary or permanent threshold shifts [ 21 , 22 ]. A linear trend analysis confirmed a dose–response relationship between output level and hearing threshold shifts, reinforcing the importance of sound intensity as a determinant of auditory health. These findings are supported by physiological evidence that cochlear synaptopathy can occur from repeated exposure to high-level sounds even in the absence of overt hearing loss [ 23 ] Additionally, excessive auditory stimulation may induce oxidative stress and metabolic overload in cochlear hair cells, ultimately resulting in cellular damage and sensorineural hearing loss [ 24 ]. According to exposure models, cumulative sound energy—rather than peak sound level alone—is the key predictor of cochlear damage [ 25 ]. Both intensity and duration of PLD use contribute to this "noise dose." WHO guidelines define safe exposure as no more than 80 dB for 40 hours per week [ 26 ], while NIOSH specifies a daily exposure limit of 85 dB for 8 hours, with a 3-dB exchange rate where allowable exposure time is reduced by half for every 3-dB increase in noise level. [ 25 ] In the current study, 61% of participants reported continuous listening beyond one hour without breaks, and 5.5% reported listening at output levels above 85%, suggesting insufficient awareness of safe listening practices. These findings emphasize the cumulative auditory stress associated with high-volume, prolonged earphone use. The statistically significant linear trend (p = 0.011) between output levels and threshold elevation further highlights the need for behavioural interventions targeting young users. Public Health and Clinical Implications The findings emphasize the importance of preventive strategies to mitigate early-onset auditory damage in young adults. The following measures are recommended: Educational interventions at school and university levels to promote the "60/60 rule"—listening at no more than 60% of maximum volume for 60 minutes at a time. Encouraging the use of noise-isolating earphones to reduce the need for high volume in noisy settings. Implementing regular hearing screenings for early detection of threshold shifts, particularly in habitual PLD users. Limitations and Future Directions This study is limited by its cross-sectional design, which precludes causal inference. The use of self-reported data introduces the potential for recall bias, and convenience sampling may limit generalizability. Future longitudinal research with objective measurement of sound exposure and larger, more diverse populations is needed to confirm causality and explore the trajectory of auditory decline in young earphone users. Conclusion This study demonstrated that young adult users of in-ear earphones with elevated auditory thresholds are more likely to engage in prolonged daily listening and use higher audio output levels. These behaviours are significantly associated with early auditory threshold elevation and represent modifiable risk factors. The results suggest that modern patterns of PLD use may constitute a chronic auditory stressor. Promoting awareness and safe listening habits among young users is essential to prevent long-term hearing impairment. Declarations Ethics Approval and Consent to Participate This study was approved by the Institutional Ethics Committee of Swamy Vivekanandha Medical College Hospital and Research Institute, Elayampalayam, Namakkal, India (Ref. no. SVMCHRI/IEC/2023/001 dated 24.02.2023). The study was conducted in accordance with the ethical standards of the institutional research committee and with Declaration of Helsinki. Consent to participate All participants provided informed consent prior to participation, and the study adhered to the principles outlined in the Declaration of Helsinki. Data Availability Statement The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request Funding The project was self-funded and did not receive any funding from external sources. The funding body had no role in the design of the study, collection, analysis, and interpretation of data, or in writing the manuscript. Clinical trial number: Not applicable Consent to Publish declaration : Not applicable Declaration of generative AI and AI-assisted technologies in the writing process During the preparation of this work the author(s) used ChatGPT in order to improve the grammar and readability of the manuscript. After using this tool/service, the author(s) reviewed and edited the content as needed and take(s) full responsibility for the content of the publication. References Aloni MS. Correlates of knowledge and habits on safe listening to personal listening devices: the case of multinomial regression analysis on risk of hearing loss. J Glob Health Sci.2024;6(2):1–11.​. Le Prell CG, Spankovich C, Lobarinas E, Griffiths SK. Extended high-frequency thresholds in college students: Effects of music player use and other recreational noise. J Am Acad Audiol. 2013;24(8):725–39. Kim MG, Hong SM, Shim HJ, Kim YD, Cha CI, Yeo SG. Hearing threshold of Korean adolescents associated with the use of personal music players. Yonsei Med J. 2009;50(6):771–6. Kumar A, Mathew K, Alexander SA, Kiran C. Output sound pressure levels of personal music systems and their effect on hearing. Noise Health. 2009;11(44):132–40. World Health Organization. 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With the widespread use of smartphones and easy access to music, use of personal listening devices (PLDs) is drastically increased[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Leisure-time noise exposure, particularly from PLDs, is now a leading contributor to non-occupational auditory risk [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAccording to the World Health Organization (WHO), over one billion young people worldwide are at risk of permanent hearing damage due to unsafe listening habits, primarily from prolonged PLD use and attendance at high-volume entertainment venues [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] Numerous studies have reported elevated hearing thresholds, tinnitus, and diminished speech discrimination scores among regular PLD users [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eThe risk of auditory threshold shifts is influenced by duration of daily use, cumulative exposure, preferred output levels, and the type of earphones used [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In-ear or insert type earphones or EarPods are widely preferred by users because of their compact size. Their ease of portability makes them a convenient choice for everyday use. But these types of earphones may pose a higher risk of auditory threshold shift, as they deliver sound directly into the ear canal, at very high volume when the output level is set at 100% [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Despite increasing awareness, many young users do not follow safe listening practices. Their routine use of PLDs while traveling or leisure activities makes them more vulnerable [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] Hence, the impact of in-ear earphone use on auditory thresholds is the main subject of investigation.\u003c/p\u003e\u003cp\u003eIn this context, the present study aimed to assess hearing thresholds among regular users of insert-type earphones and to analyse their listening habits in relation to audiometric findings.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThis analytical, observational study was focused on college-going young adults who were regular earphone users. Ethical approval was obtained from the Institutional Ethics Committee, and informed written consent was secured from all participants prior to data collection.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy Population and Sampling\u003c/b\u003e\u003c/p\u003e\u003cp\u003eParticipants were healthy undergraduate students aged 18\u0026ndash;25 years. Inclusion criteria included use of in-ear or insert type earphones, for at least one hour on a minimum of three days per week. Exclusion criteria included a known history of hearing loss or ear diseases, presence of ENT symptoms (e.g., ear pain, congestion, discharge) within two weeks prior to audiometric testing, and recent use of known ototoxic medications (within the past three months). Participants using supra-aural headphones were excluded from the present study, as previous research has shown that hearing threshold shifts are generally less pronounced with over-the-ear (supra-aural) headphones compared to insert-type earphones due to lower sound pressure levels delivered directly into the ear canal. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e\u003cp\u003ePurposive, non-probability sampling was used to recruit participants. Based on a previously reported prevalence of hearing loss (18.3%) among chronic earphone users in India [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], a minimum sample size of 90 was estimated (95% confidence level, 8% margin of error). To account for potential non-response, 110 participants were recruited in the study.\u003c/p\u003e\u003cp\u003e\u003cb\u003eQuestionnaire and Data Collection\u003c/b\u003e\u003c/p\u003e\u003cp\u003eData were collected using a structured questionnaire consisting of two sections. The first section captured demographic details and ENT-related medical history. The second section focused on earphone usage habits, including daily hours of use, number of days per week, cumulative years of use, preferred output volume levels and whether earphone use is continuous for over one hour or included intermittent breaks. The questionnaire was developed based on a review of relevant literature. It was validated by the experts and pilot tested with 10 students.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAudiological Assessment\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFollowing questionnaire completion, a preliminary ear examination is done in the ENT department. Pure-tone audiometry was then conducted in a soundproof room using a standard pure-tone audiometer (Micra+, Auditivo Hearing, India). Air conduction thresholds were measured bilaterally at frequencies from 0.125 to 8 kHz. Using WHO grading system for hearing loss based on audiometric measurements, which categorizes \"Normal hearing\" as having a hearing threshold of \u0026lt;\u0026thinsp;20 dB in the better hearing ear [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], we categorized the participants into-\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eNormal Auditory Thresholds\u003c/b\u003e: Hearing thresholds\u0026thinsp;\u0026lt;\u0026thinsp;20 dB HL at all tested frequencies in both ears.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eRaised Auditory Thresholds\u003c/b\u003e: Hearing threshold\u0026thinsp;\u0026ge;\u0026thinsp;20 dB HL at any frequency in either ear.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eData were analyzed using SPSS version 16. Descriptive statistics summarized participant demographics and usage patterns. Independent-samples t-tests were used to compare mean differences in earphone use between the normal and raised threshold groups. Welch's t-test was applied when assumptions for the t-test were violated. The Chi-square test examined associations between hearing threshold status and categorical variables such as preferred audio output levels and pattern of earphone use (continuous vs. intermittent). A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. Cohen\u0026rsquo;s d was calculated to quantify the magnitude of a difference between two groups.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 110 undergraduate students participated in the study, including 84 females (76.4%) and 26 males (23.6%). The mean age of the overall sample was 20.28 years (SD\u0026thinsp;=\u0026thinsp;1.01). No significant difference was observed in mean age between female participants (20.26\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02 years) and male participants (20.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98 years; \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.37, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.71) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe mean hearing threshold levels (average of all the tested frequencies of both the ears) were also comparable between genders, with females exhibiting an average of 12.28\u0026thinsp;\u0026plusmn;\u0026thinsp;6.12 dB HL and males 12.18\u0026thinsp;\u0026plusmn;\u0026thinsp;8.90 dB HL (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.07, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.95). Although males reported slightly higher average daily earphone use (3.62\u0026thinsp;\u0026plusmn;\u0026thinsp;1.20 hours) than females (3.02\u0026thinsp;\u0026plusmn;\u0026thinsp;1.44 hours), this difference was not statistically significant (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;1.90, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.06). Weekly usage patterns were similar between genders, with females using earphones for an average of 6.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84 days/week and males for 6.46\u0026thinsp;\u0026plusmn;\u0026thinsp;1.14 days/week (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.07, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.94).\u003c/p\u003e\u003cp\u003eIn terms of cumulative years of earphone use, males had significantly longer exposure (4.04\u0026thinsp;\u0026plusmn;\u0026thinsp;1.75 years) compared to females (3.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.61 years; \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;2.43, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.02). Differences in preferred output levels and the pattern of use (continuous vs. intermittent) were not statistically significant across gender. The present study also revealed that 73% of male and 58% of female participants reported using earphones continuously for more than one hour without a break. However, the difference between genders was not statistically significant (χ\u0026sup2; = 1.83, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.18) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eGender-wise comparison of auditory thresholds and earphone usage habits among participants.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;84)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003et / χ \u0026sup2; value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years), Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20.26 \u0026plusmn; 1.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.35 \u0026plusmn; 0.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et = -0.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.71\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHearing Threshold (dB HL), Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12.28\u0026thinsp;\u0026plusmn;\u0026thinsp;6.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.18\u0026thinsp;\u0026plusmn;\u0026thinsp;8.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDaily Earphone Use (hours/day), Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.02\u0026thinsp;\u0026plusmn;\u0026thinsp;1.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.62\u0026thinsp;\u0026plusmn;\u0026thinsp;1.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et = -1.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeekly Earphone Use (days/week), Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.46\u0026thinsp;\u0026plusmn;\u0026thinsp;1.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.94\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of use (Years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.04\u0026thinsp;\u0026plusmn;\u0026thinsp;1.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et = -2.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.02*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOutput Level Category, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eχ\u003c/b\u003e \u0026sup2; = 1.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.57\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e- \u0026lt;60%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35 (41.67%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (50.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;60\u0026ndash;85%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45 (53.57%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (42.31%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e- \u0026gt;85%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (4.76%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (7.69%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntermittent breaks, n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eχ\u003c/b\u003e \u0026sup2; = 1.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.18\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35 (41.67%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (26.92%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e49 (58.33%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19 (73.08%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003e*Statistically significant, SD: Standard Deviation, n: Number\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e Self-reported auditory symptoms included hearing difficulty in 2 participants (1.82%), one in each group, and tinnitus in 7 participants (6.36%) where 4 participants belong to raised threshold group. Since both the symptoms were almost evenly distributed in both the groups, no further analysis was performed.\u003c/p\u003e\u003cp\u003e\u003cb\u003eComparison Between Normal and Raised Threshold Groups\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eAuditory Thresholds\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAs shown in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, based on audiometric data, 58 participants (52.73%) had normal hearing thresholds (\u0026lt;\u0026thinsp;20 dB HL across all tested frequencies), while 52 participants (47.27%) exhibited elevated thresholds at one or more frequencies in either ear. Among the raised threshold group, 29 individuals (55.77%) demonstrated unilateral elevation, and 23 (44.23%) showed bilateral involvement (data not shown in the table).\u003c/p\u003e\u003cp\u003eAn independent-samples \u003cem\u003et\u003c/em\u003e-test indicated that the raised threshold group had significantly higher average bilateral hearing thresholds (16.53\u0026thinsp;\u0026plusmn;\u0026thinsp;5.48 dB HL) than the normal group (8.43\u0026thinsp;\u0026plusmn;\u0026thinsp;6.80 dB HL), with a large effect size (\u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.30; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Comparison of the earphone usage habits in these groups revealed statistically significant relation with duration daily earphone use. Though the number of weekdays and total years of earphone use were higher in the raised threshold group than the normal threshold group, differences were not statistically significant (Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of earphone usage habits and average auditory thresholds between participants with normal and raised thresholds.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNormal Hearing threshold (n\u0026thinsp;=\u0026thinsp;58)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRaised Hearing Thresholds (n\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eT value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCohen\u0026rsquo;s d\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e95% confidence interval\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAverage binaural hearing threshold (dB) Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e8.43\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e16.53\u0026thinsp;\u0026plusmn;\u0026thinsp;5.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-7.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.00*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-10.19 to\u003c/p\u003e\u003cp\u003e-6.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of daily use (hours) Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2.81 \u0026plusmn; 1.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.56 \u0026plusmn;1.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-4.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.00*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.22 to 1.27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFrequency of earphone use (Days/week) Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e6.45 \u0026plusmn; 0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e6.56 \u0026plusmn;0.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.39 to 0.29\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYears of usage Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.31 \u0026plusmn; 1.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.40 \u0026plusmn;1.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.73 to 0.54\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cem\u003e*Statistically significant, SD: Standard Deviation, n: Number\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eResult of chi-square test showed a statistically significant association (χ\u0026sup2;(2, N\u0026thinsp;=\u0026thinsp;110)\u0026thinsp;=\u0026thinsp;6.836, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.033) between preferred volume level (\u0026lt;\u0026thinsp;60%, 60\u0026ndash;85%, and \u0026gt;\u0026thinsp;85%) and hearing status (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Due to expected count limitations, Fisher\u0026rsquo;s exact test was conducted which also confirmed significance (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.033). Linear-by-linear association indicated a significant trend (χ\u0026sup2;(1)\u0026thinsp;=\u0026thinsp;6.460, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.011), suggesting a positive relationship between increased output levels and raised hearing thresholds (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The present study found no statistically significant difference between the study groups in the continuous use of earphones for more than one hour without a break (χ\u0026sup2; = 0.53, p\u0026thinsp;=\u0026thinsp;0.47) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssociation between categorized audio output levels and hearing threshold status.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNormal auditory threshold (n\u0026thinsp;=\u0026thinsp;58)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRaised auditory threshold (n\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePearson Chi-Square Value (p)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eFisher's Exact Test\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eLinear-by-Linear Association Value (p)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreferred Output level (dB)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32 (55.17%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16 (30.77%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003e6.85 (0.03)*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003e0.033*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003e6.46 (0.01)*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e60\u0026ndash;85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24 (41.38%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32 (61.54%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (3.45%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (7.69%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntermittent breaks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24 (41.38%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (34.62%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.53 (0.47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e--\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34 (58.62%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34 (65.38%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003e*Statistically significant, SD: Standard Deviation, n: Number\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study assessed gender differences and earphone use habits in relation to auditory threshold shifts among young adult in-ear type of earphone users.\u003c/p\u003e\u003cp\u003e\u003cb\u003eGender Differences\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePrevious studies have reported conflicting evidence regarding gender-specific differences in hearing threshold shifts associated with earphone or personal music player (PMP) use. While some studies suggest that males are more susceptible to threshold shifts [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], others report greater vulnerability in females [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], and a few have found no significant gender differences [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR17 CR18\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] In the present study, hearing thresholds were comparable between males and females despite males having a significantly longer duration of earphone use. This aligns with findings that suggest minimal gender-based differences in young adults, possibly due to similar cochlear structures and auditory function at the younger age [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The lack of observed difference in our study may also be influenced by the smaller proportion of male participants (24%), which could limit the detection of subtle gender-specific effects.\u003c/p\u003e\u003cp\u003e\u003cb\u003eHearing Threshold Status and Listening Behaviours\u003c/b\u003e\u003c/p\u003e\u003cp\u003e Nearly half of the participants (47.27%) demonstrated elevated auditory thresholds at one or more tested frequencies. Though the average binaural auditory threshold is still within the normal limits which is \u0026lt;\u0026thinsp;20dB, it is significantly higher when compared with the normal threshold group (Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), indicating a concerning prevalence of early auditory threshold shift. Participants in the raised threshold group reported significantly greater daily duration of earphone use, supporting findings by Le Prell et al., Manisha et al and Haruna et al [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Cumulative years of use did not significantly differ between the groups, suggesting that duration of daily exposure and audio output level may be stronger predictors of threshold elevation than cumulative use alone.\u003c/p\u003e\u003cp\u003eA significant association was observed between higher preferred audio output levels and raised auditory thresholds. Participants with elevated thresholds were more likely to use output levels exceeding 85%, whereas those with normal thresholds tended to listen at levels below 60%. This aligns with prior research indicating that sound levels above 85dB SPL increase the risk of temporary or permanent threshold shifts [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. A linear trend analysis confirmed a dose\u0026ndash;response relationship between output level and hearing threshold shifts, reinforcing the importance of sound intensity as a determinant of auditory health. These findings are supported by physiological evidence that cochlear synaptopathy can occur from repeated exposure to high-level sounds even in the absence of overt hearing loss [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] Additionally, excessive auditory stimulation may induce oxidative stress and metabolic overload in cochlear hair cells, ultimately resulting in cellular damage and sensorineural hearing loss [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAccording to exposure models, cumulative sound energy\u0026mdash;rather than peak sound level alone\u0026mdash;is the key predictor of cochlear damage [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Both intensity and duration of PLD use contribute to this \"noise dose.\" WHO guidelines define safe exposure as no more than 80 dB for 40 hours per week [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], while NIOSH specifies a daily exposure limit of 85 dB for 8 hours, with a 3-dB exchange rate where allowable exposure time is reduced by half for every 3-dB increase in noise level. [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] In the current study, 61% of participants reported continuous listening beyond one hour without breaks, and 5.5% reported listening at output levels above 85%, suggesting insufficient awareness of safe listening practices. These findings emphasize the cumulative auditory stress associated with high-volume, prolonged earphone use. The statistically significant linear trend (p\u0026thinsp;=\u0026thinsp;0.011) between output levels and threshold elevation further highlights the need for behavioural interventions targeting young users.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePublic Health and Clinical Implications\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe findings emphasize the importance of preventive strategies to mitigate early-onset auditory damage in young adults. The following measures are recommended:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eEducational interventions\u003c/b\u003e at school and university levels to promote the \"60/60 rule\"\u0026mdash;listening at no more than 60% of maximum volume for 60 minutes at a time.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eEncouraging the use of noise-isolating earphones\u003c/b\u003e to reduce the need for high volume in noisy settings.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eImplementing regular hearing screenings\u003c/b\u003e for early detection of threshold shifts, particularly in habitual PLD users.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations and Future Directions\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study is limited by its cross-sectional design, which precludes causal inference. The use of self-reported data introduces the potential for recall bias, and convenience sampling may limit generalizability. Future longitudinal research with objective measurement of sound exposure and larger, more diverse populations is needed to confirm causality and explore the trajectory of auditory decline in young earphone users.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrated that young adult users of in-ear earphones with elevated auditory thresholds are more likely to engage in prolonged daily listening and use higher audio output levels. These behaviours are significantly associated with early auditory threshold elevation and represent modifiable risk factors. The results suggest that modern patterns of PLD use may constitute a chronic auditory stressor. Promoting awareness and safe listening habits among young users is essential to prevent long-term hearing impairment.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Institutional Ethics Committee of Swamy Vivekanandha Medical College Hospital and Research Institute, Elayampalayam, Namakkal, India (Ref. no. SVMCHRI/IEC/2023/001 dated 24.02.2023). The study was conducted in accordance with the ethical standards of the institutional research committee and with Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants provided informed consent prior to participation, and the study adhered to the principles outlined in the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe project was self-funded and did not receive any funding from external sources. The funding body had no role in the design of the study, collection, analysis, and interpretation of data, or in writing the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish declaration\u003c/strong\u003e: Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of generative AI and AI-assisted technologies in the writing process\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the preparation of this work the author(s) used ChatGPT in order to improve the grammar and readability of the manuscript. After using this tool/service, the author(s) reviewed and edited the content as needed and take(s) full responsibility for the content of the publication.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAloni MS. Correlates of knowledge and habits on safe listening to personal listening devices: the case of multinomial regression analysis on risk of hearing loss. J Glob Health Sci.2024;6(2):1\u0026ndash;11.\u0026amp;#8203.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLe Prell CG, Spankovich C, Lobarinas E, Griffiths SK. Extended high-frequency thresholds in college students: Effects of music player use and other recreational noise. J Am Acad Audiol. 2013;24(8):725\u0026ndash;39.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKim MG, Hong SM, Shim HJ, Kim YD, Cha CI, Yeo SG. Hearing threshold of Korean adolescents associated with the use of personal music players. Yonsei Med J. 2009;50(6):771\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKumar A, Mathew K, Alexander SA, Kiran C. Output sound pressure levels of personal music systems and their effect on hearing. Noise Health. 2009;11(44):132\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. WHO releases new standard to tackle rising threat of hearing loss. 2022 Mar 2. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news/item/02-03-2022-who-releases-new-standard-to-tackle-rising-threat-of-hearing-loss​\u003c/span\u003e\u003cspan address=\"https://www.who.int/news/item/02-03-2022-who-releases-new-standard-to-tackle-rising-threat-of-hearing-loss​\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e Accessed 30 January 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWandadi M, Rashedi V, Heidari A. Prevalence of using personal music player and listening habit in students. J Rehabil Sci Res. 2014;1(2):30\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSulaiman AH, Seluakumaran K, Husain R. 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Prevalence of sensorineural hearing loss among medical students who are chronic mobile phone and earphone users in Trivandrum, South Kerala, India. Indian J Forensic Community Med. 2019;6(2):81\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. World report on hearing. 3rd March 2021. Page 38. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/9789240020481\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/9789240020481\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e Accessed 30 January 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMohammadpoorasl A, Hajizadeh M, Marin S, Heydari P, Ghalenoei M. Prevalence and pattern of using headphones and its relationship with hearing loss among students. Health Scope. 2018;7(4):4\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePrendergast G, Guest H, Munro KJ, Kluk K, L\u0026eacute;ger A, Hall DA, Heinz MG, Plack CJ. Effects of noise exposure on young adults with normal audiograms I: Electrophysiology. Hear Res. 2017;344:68\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEngdahl B, Aarhus L. Personal music players and hearing loss: the HUNT cohort study. Trends Hear. 2021;25:23312165211015881.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePhilip P, Bhandary SK, Aroor R, Bhat V, Pratap D. The effect of mobile phone usage on hearing in adult population. Indian J Otology. 2017;23(1):1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHaruna K, Salisu AD, Labaran SA, Fufore MB. Correlation between Hearing Thresholds and Habitual use of Headphones/Earphones among Students of Tertiary Institutions in Northwestern Nigeria. Res J Health Sci. 2024;12(1):22\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMatthews K, Dawes P, Elliot R, Maharani A, Pendleton N, Tampubolon G. Allostatic load and risk of hearing impairment. Brain, Behavior, and Immunity-Health.2022;25:100496.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGates GA, Cooper JC Jr, Kannel WB, Miller NJ. Hearing in the elderly: The Framingham Cohort, 1983\u0026ndash;1985: Part 1. Basic audiometric test results. Ear Hear. 1990;11(4):247\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePortnuff CD, Fligor BJ, Arehart KH. Teenage use of portable listening devices: A hazard to hearing? J Am Acad Audiol. 2011;22(10):663\u0026ndash;77.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKeppler H, Dhooge I, Vinck B. Hearing in young adults. Part II: The effects of recreational noise exposure. Noise Health. 2010;12(49):49\u0026ndash;58.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKujawa SG, Liberman MC. Adding insult to injury: Cochlear nerve degeneration after temporary noise-induced hearing loss. J Neurosci. 2006;29(45):14077\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHenderson D, Bielefeld EC, Harris KC, Hu BH. The role of oxidative stress in noise-induced hearing loss. Ear Hear. 2006;27(1):1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNational Institute for Occupational Safety and Health. Understanding Noise Exposure Limits: Occupational vs. General Environmental Noise, NIOSH Science Blog. 2016 Feb 8. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://blogs.cdc.gov/niosh-science-blog/2016/02/08/noise/​\u003c/span\u003e\u003cspan address=\"https://blogs.cdc.gov/niosh-science-blog/2016/02/08/noise/​\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e Accessed 13 November 2023.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. Safe listening devices and systems: a WHO-ITU standard. 2019 Sep 18. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/9789241515276\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/9789241515276\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e Accessed 8 November 2023.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hearing Loss, Noise-Induced, Audiometry","lastPublishedDoi":"10.21203/rs.3.rs-7136504/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7136504/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eWith growing trend of personal listening devices, young adults are at increased risk for early-onset hearing loss. This study investigates the association between earphone usage habits and audiometric thresholds among undergraduate students. A cross-sectional analytical study was conducted among 110 undergraduate students (aged 18\u0026ndash;25 years), who regularly used earphones. Participants were recruited through purposive sampling after applying strict inclusion and exclusion criteria. Data on earphone usage habits were obtained using a structured, validated questionnaire. Audiometric evaluation was conducted in a sound-treated environment using pure tone audiometry at frequencies ranging from 125 to 8000 Hz. Participants were categorized into normal (\u0026lt;\u0026thinsp;20 dB HL) and raised (\u0026ge;\u0026thinsp;20 dB HL) auditory threshold groups. Statistical analysis included independent-samples t-tests, chi-square tests, and Fisher\u0026rsquo;s exact test (SPSS v16).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003e Out of 110 participants, 52.73% had normal hearing thresholds and 47.27% had elevated thresholds. The raised threshold group demonstrated significantly higher mean hearing levels (M\u0026thinsp;=\u0026thinsp;16.53\u0026thinsp;\u0026plusmn;\u0026thinsp;5.48 dB HL) compared to the normal group (M\u0026thinsp;=\u0026thinsp;8.43\u0026thinsp;\u0026plusmn;\u0026thinsp;6.80 dB HL; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Daily earphone use was also significantly greater among those with raised thresholds (p\u0026thinsp;=\u0026thinsp;0.009). A significant association was observed between higher audio output levels and elevated thresholds (χ\u0026sup2; = 6.836, p\u0026thinsp;=\u0026thinsp;0.033).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eA combination of prolonged daily earphone use and higher output levels is significantly linked to early auditory threshold elevation and represents modifiable risk factors. This highlights the need for greater awareness of safe listening practices among young users.\u003c/p\u003e","manuscriptTitle":"Daily Earphone Use Is Associated with Elevated Hearing Thresholds in Young Adults","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-11 15:56:37","doi":"10.21203/rs.3.rs-7136504/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3db65fa1-bb35-4420-ac18-fe27b9947361","owner":[],"postedDate":"August 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-24T15:38:13+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-11 15:56:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7136504","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7136504","identity":"rs-7136504","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}