A study of hearing acuity and health of the external auditory canal in earphone users

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With the rise in internet usage, online education as well as online gaming, the use of personal listening devices has increased fourfold. The exposure to noise above 85 dB for a long duration is the most common cause of reduced hearing acuity. Normally the earphones and headphones tend to produce the volume of 78 to 136 dB. Hence continuous exposure to such amplitudes may cause hearing loss especially in adolescents. However the new feature of noise cancellation in earphones and headphones is said to reduce the cases of noise induced hearing loss by decreasing the ambient noises, thus leading to better hearing in low volumes even in crowded or noisy places. It is also seen that with continuous usage of earphones there are increased incidences of otomycosis and increased cerumen production as well. This study aims to establish a relationship between hearing loss and affects on health of external auditory canal in earphone users if any." } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/13-32", "name": "A study of hearing acuity and health of the external auditory canal..." } } ] } Home Browse A study of hearing acuity and health of the external auditory canal... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Ghoshmoulic A and Deshmukh P. A study of hearing acuity and health of the external auditory canal in earphone users [version 1; peer review: awaiting peer review] . F1000Research 2024, 13 :32 ( https://doi.org/10.12688/f1000research.141954.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Study Protocol A study of hearing acuity and health of the external auditory canal in earphone users [version 1; peer review: awaiting peer review] Ayushi Ghoshmoulic https://orcid.org/0009-0007-6924-7975 1 , Prasad Deshmukh 1 Ayushi Ghoshmoulic https://orcid.org/0009-0007-6924-7975 1 , Prasad Deshmukh 1 PUBLISHED 08 Jan 2024 Author details Author details 1 Department of ENT, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India Ayushi Ghoshmoulic Roles: Resources, Writing – Original Draft Preparation, Writing – Review & Editing Prasad Deshmukh Roles: Supervision, Validation, Writing – Review & Editing OPEN PEER REVIEW REVIEWER STATUS AWAITING PEER REVIEW This article is included in the Datta Meghe Institute of Higher Education and Research collection. Abstract Noise-induced hearing loss as seen in today’s young generation is primarily due to long-duration exposure to personal listening devices like earphones, headphones, earbuds, and other different types of personal listening devices. With the rise in internet usage, online education as well as online gaming, the use of personal listening devices has increased fourfold. The exposure to noise above 85 dB for a long duration is the most common cause of reduced hearing acuity. Normally the earphones and headphones tend to produce the volume of 78 to 136 dB. Hence continuous exposure to such amplitudes may cause hearing loss especially in adolescents. However the new feature of noise cancellation in earphones and headphones is said to reduce the cases of noise induced hearing loss by decreasing the ambient noises, thus leading to better hearing in low volumes even in crowded or noisy places. It is also seen that with continuous usage of earphones there are increased incidences of otomycosis and increased cerumen production as well. This study aims to establish a relationship between hearing loss and affects on health of external auditory canal in earphone users if any. READ ALL READ LESS Keywords earphones, noise induced hearing loss, hearing acuity, noise cancelling feature, adolescents Corresponding Author(s) Ayushi Ghoshmoulic ( [email protected] ) Close Corresponding author: Ayushi Ghoshmoulic Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2024 Ghoshmoulic A and Deshmukh P. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Ghoshmoulic A and Deshmukh P. A study of hearing acuity and health of the external auditory canal in earphone users [version 1; peer review: awaiting peer review] . F1000Research 2024, 13 :32 ( https://doi.org/10.12688/f1000research.141954.1 ) First published: 08 Jan 2024, 13 :32 ( https://doi.org/10.12688/f1000research.141954.1 ) Latest published: 08 Jan 2024, 13 :32 ( https://doi.org/10.12688/f1000research.141954.1 ) Introduction The term “noise-induced hearing loss” describes a decline in auditory acuity due to prolonged exposure to noise. The sources of such noise are common and various, recreational and occupational. Many examples can be given, but of particular concern in younger people is the use of personal music devices and regular attendance at clubs and concerts. 1 In light of the coronavirus 2019 (COVID-19) global pandemic, many countries opted for complete lockdowns due to an increasing number of cases. 2 In order to continue business while complying with the strict lockdown measures, the work-from-home concept has been implemented. 2 – 4 Furthermore, schooling students also require online learning to ensure learning is not interrupted. 3 , 4 Additionally, quality headphones are worn while playing video games, which simulate loud, unexpected noises like gunshots, explosions, screaming, and vehicle crashes delivered to the ear in close proximity and are typical causes of early hearing loss. Due to approximately 80% of the population working or studying from home, there is proven evidence of an increase in the use of electronic devices such as earphones for these activities. 5 Noise-induced hearing loss is a progressive condition that can result in a temporary or permanent notch in the audiogram around 3, 4, or 6 kHz. However, it can also affect higher frequencies. 6 It is known that the prolonged usage of earphones causes cerumen impaction, which in turn predisposes to otomycosis, 1 , 4 – 6 due to the inability of wax extrusion. This study will be primarily concerned with hearing acuity as well as any other complaints related to the use of personal listening devices. Aim: To study the hearing acuity and health of the external auditory canal (EAC) in earphone users. Objectives: 1) To study the different types of earphones used and the purpose of using earphones. 2) To compare the volume and duration of use of earphones and their effects on hearing. 3) To analyse the degree of hearing loss in earphones users and nonusers. 4) To compare the status and health of the EAC in earphone users and nonusers. 5) To study the difference in hearing acuity between noise-cancelling and indigenous earphone users. Protocol Study design Study design - A cross-sectional study will be performed. Duration of study - The study will be carried out between the year 2022–2024. Study setting Between July 2022 and July 2024, a prospective, observational study will be carried out in the Department of otorhinolaryngology, Acharya Vinoba Bhave Rural Hospital Sawangi Wardha. After receiving institutional ethics committee permission, the study will contain a sample size of 65 people between the ages of 15 and 35 as the study group and 65 people between those ages as the control group, all of whom have complaints of hearing loss, otomycosis, and impacted wax. The results will be included to the proforma intended for the study. Additionally, informed written consent will be acquired for the same. Inclusion criteria • All patients between the age group of 15–35 years of age. • Any gender. • Patients with use of earphones for both professional and personal uses. • Patients with otomycosis, otalgia, impacted wax, tinnitus and reduced hearing. Exclusion criteria • Patients with congenital SNHL, occupational NIHL. • Patients with a known immunodeficiency disorder, hypertension. • Patients with perforation of the tympanic membrane, csom, and other causes of hearing loss. • Patients with a granulomatous disorder of temporal bone and vertigo. Methods All the chosen patients who have used a personal listening device for a significant amount of time and patients who meet the inclusion criteria will be taken into account and included in this study. A sample size of 130 people will be taken where comparison of hearing acuity between 65 people who use earphones and 65 people who do not use earphones will be done. According to the accompanying proforma, patients will receive a thorough physical examination, and baseline tests will be run. Those patients included in this study will be evaluated as follows: • Comprehensive history taking and clinical examination of ear, nose, and throat. • History of use of earphones, duration, purpose of using, and volume of usage. • Pure tone audiometry. • Impedance audiometry. • Otoacoustic emission will be done for assessment and grading of hearing impairment. • A questionnaire to determine the type of usage, duration, and quality of earphones used by the patients. A standardized form will be used to document clinical examination findings, results of the pure tone audiometry, and questionnaire responses, with photographic documentation taken as necessary. Bias Bias can be expected while taking the reading of pure tone audiometry which can be ruled out by proper calibration of the PTA machine and carefully monitoring the patient to reduce the amount of malingering. Sample size The sample size was calculated based on the parent article by R. Mazlan et al. 7 and formula reference by Cochran W. G. et al. 8 130 patients (130 pairs of ears). 1. 65 patients - group of earphone users 2. 65 patients - group of non-earphone users Sample size formula with the desired error of margin: n = Z ∝ 2 2 p 1 − p E 2 where, Z ∝ is the level of significance at 5% i.e. 95% confidence interval = 1.96 p = proportion of subjects having hearing impairment in either one or both ears = 21.2% = 0.212 E = error of margin = 10% = 0.10 n = { 1.96 ) 2 ∗ 0.212 ∗ 1 − 0.212 0.10 2 = 64.17 = 65 patients needed in each group Statistical analysis Statistical analysis of the data obtained will be done by chi-squared test. Expected outcome This study will be conducted in the age groups of 15 to 35 years where analysis and comparison of hearing acuity, frequency of cerumen production, and otomycosis will be done between earphone users and nonusers with varying volume range and duration of exposure as well as the presence or absence of noise cancelling feature. This study will aid in providing a data to establish a new protocol that will guide clinicians to prevent early noise-induced hearing loss and promote healthy earphone usage practice. Outcome variables Independent variables: gender/occupation/environmental noise exposure. Dependent variables: • Age/type of personal listening device/active noise cancellation/duration of usage/volume range of usage/type of usage. • Pure tone audiometry/otoacoustic emission/impedance audiometry. Dissemination Will be published in indexed journal. Study status Ethical approval has been obtained from Datta Meghe Institute of Higher Education and Research. Discussion Reduced hearing acuity caused due to excessive noise exposure for a long period of time refers to noise-induced hearing loss. 9 Exposure to sounds under 80 dB even for long durations is unlikely to cause hearing loss in human ears whereas exposure to sound levels of 130 dB or more even for shorter periods of time can lead to NIHL. The increased prevalence of NIHL in adolescents has been associated with the augmented use of personal music players with loud sound tones and a need for earbuds or headphones. 10 Personal music players or smartphones, which are connected to earphones or headphones, have powerful sound tones, and their maximum volume level can reach 78–136 dB. Noise exposure for a long duration at these levels can lead to noise-induced hearing loss in people using personal listening devices for recreational as well as official purposes. In the post-COVID-19 era, with the new trend of online classes and ‘work from home’, there has been a massive rise in the usage of personal listening devices which has also increased the complaints of hearing loss in adults as well as adolescents. Amongst all impairments, hearing loss is the fourth most common, according to the Global Burden of Disease Study. 11 , 12 Impaired communication which is a major consequence of hearing loss also has an unfavourable impact on interpersonal relations as well as professional life. Adults with hearing loss that is left untreated not only face physical discomfort but also emotional and financial consequences which lead to social isolation and reduced quality of life. 11 According to numerous prior studies, teenagers have symptoms including tinnitus, transient hearing loss, and noise-induced hearing loss because there is insufficient instruction on how to use portable audio devices at acceptable noise levels and for moderate amounts of time to safeguard hearing. 12 , 13 Along with that, unhealthy practices in using earphones like multiuser sharing or unhygienic use can also lead to conditions like otomycosis and increased wax production. The cochlea is typically the primary locus for pathological signs of noise-induced hearing loss. The increased release of neurotransmitters linked to the cochlea’s transduction function may occur as a result of acoustic overstimulation. Animal studies have provided ample experimental support for the idea that sonic stimulation alters the cochlear blood flow. 14 In particular, there are signs that stimulation with moderately loud sounds increases cochlear blood flow while stimulation with high intensity decreases it (this is a possible mechanism for cochlear dysfunction brought on by noise exposure due to increased metabolic demand). 14 The function of glucocorticoid receptors, oxidative stress, and the fluidity of outer hair cell (OHC) plasma membranes are other metabolic cochlear systems that are the subject of experimental research. Changes to the micromechanical structures within the cochlea have been reported as possible mechanisms of NIHL. It has been suggested that depolymerization of actin filaments in stereocilia may be a substrate of temporary threshold shift. 15 There is evidence that both apoptosis (programmed cell death) and necrosis play a role in NIHL and OHC is particularly vulnerable in such cases. 16 , 17 It is implied that the progression of OHC death, well after the cessation of noise is due to apoptotic mechanisms. Following an impulse noise exposure, apoptotic changes in chinchilla OHC (specifically nuclear condensation and cell body shrinkage) were detected after 5 minutes, whereas necrotic change (nuclear swelling) appeared after 30 minutes. 17 The adverse effects of excessive noise are not limited to the cochlear hair cells. There is an increasing body of evidence that the synaptic connections between the inner hair cells (IHCs) and spiral ganglion cells may be especially susceptible to noise insults (and indeed to aging), and that this may occur even when the hair cells themselves remain intact. 13 According to several surveys, at least 90% of teenagers use personal music players and headphones from the manufacturer. 18 In environments with ambient noise, such as crowded streets and public places, they also exhibited a tendency to listen at greater volumes. 18 For instance, the results of a Delphi survey revealed that most teenagers intended to turn up the music volume when there was background noise in order to hear the music better. 19 These unwanted ambient noises can be minimized by a new noise-cancelling feature in earphones and headphones. 19 The basic mechanism involves the production of an anti-noise signal, i.e. a sound wave with a phase exactly opposite to that of the background noise by the noise cancelling circuit which prevents the environmental noise from reaching the tympanic membrane. Low-frequency noise (less than 1 kHz) is effectively reduced by this active circuit, however, the attenuation of higher frequencies is comparatively less effective. Passive noise reduction can be done for higher frequencies by simply wearing a headphone. Theoretically by combining these two mechanisms i.e. active and passive, the NCH (noise cancelling headphones) are considered a good choice for the diminution of ambient noises thus allowing the users to enjoy music in noisy environments without risking hearing loss. 20 Interpretation This study aims to analyse and compare the various aspects of hearing acuity and health of the auditory canal in earphone users so as to prevent any early noise induced hearing loss and provide protocols for healthy practices for using the personal listening device. Ethical considerations Ethical approval obtained from Datta Meghe Institute Of Higher Education and Research. Approval no. DMIMS (DU)/IEC/2022/11 dated 15/07/2022. Written informed consent will be obtained from all study participants/relatives for participation in study and publication of their data. Data availability Underlying data No data is associated with this article. References 1. Dobie RA: The burdens of age-related and occupational noise-induced hearing loss in the United States. Ear Hear. 2008 Aug; 29 (4): 565–577. PubMed Abstract | Publisher Full Text 2. Rasmitadila R, Aliyyah R, Rachmadtullah R, et al. : The Perceptions of Primary School Teachers of Online Learning during the COVID-19 Pandemic Period: A Case Study in Indonesia. J. Ethn. Cult. Stud. 2020; 7 (2): 90–109. Publisher Full Text 3. Dey S, Dey I: Health concerns during lockdown: an observational study among adults of West Bengal. International Journal of Community Medicine And. Public Health. 2020; 7 (9): 3674. Publisher Full Text 4. Fligor BJ, Cox L, Clarke L: Output levels of commercially available portable compact disc players and the potential risk to hearing. Ear Hear. 2004; 25 : 513–527. PubMed Abstract | Publisher Full Text 5. Suresh S, Suresh S, Sivasamy S: Prevalence of otomycosis in patients with cerumen impaction due to ear-phone usage during COVID-19.Indones. J. Med. Sci. Public Health.2021; 2 (1): 28–39. Publisher Full Text 6. Ogbe S, Akor-Dewu M, Saleh M, et al. : Effects of headphones on hearing acuity of students of Ahmadu Bello University, Zaria, Nigeria. Res. J. Environ. Sci. 2014; 3 : 5–8. Publisher Full Text 7. Mazlan R, Saim L, Thomas A, et al. : Ear infection and hearing loss amongst headphone users. Malays. J. Med. Sci. 2002 Jul; 9 (2): 17–22. PubMed Abstract | Free Full Text 8. Cochran WG: Sampling Technique. 2nd ed.New York: John Wiley and Sons Inc.; 1963. 9. Babar V: MD, Sample size Determination in Health Studies. NTI Bullet in. 2006; 42 (3&4): 55–62. 10. Byeon H: Associations between adolescents’ earphone usage in noisy environments, hearing loss, and self-reported hearing problems in a nationally representative sample of South Korean middle and high school students. Medicine (Baltimore). 2021 Jan 22; 100 (3): e24056. PubMed Abstract | Publisher Full Text | Free Full Text 11. Dehankar SS, Gaurkar SS: Impact on Hearing Due to Prolonged Use of Audio Devices: A Literature Review. Cureus. 2022 Nov 2; 14 (11): e31425. PubMed Abstract | Publisher Full Text | Free Full Text 12. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators: Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016 Oct 8; 388 (10053): 1545–1602. Erratum in: Lancet. 2017 Jan 7;389(10064):e1. PubMed Abstract | Publisher Full Text | Free Full Text 13. Liberman MC: Noise-induced and age-related hearing loss: new perspectives and potential therapies. F1000Res. 2017; 6 (6): 927. Publisher Full Text 14. Le Prell CG, Yamashita D, Minami SB, et al. : Mechanisms of noise-induced hearing loss indicate multiple methods of prevention. Hear. Res. 2007 Apr; 226 (1-2): 22–43. Epub 2006 Dec 4. PubMed Abstract | Publisher Full Text | Free Full Text 15. Lim DJ: Effects of noise and ototoxic drugs at the cellular level in the cochlea: a review. Am. J. Otolaryngol. 1986 Mar-Apr; 7 (2): 73–99. PubMed Abstract | Publisher Full Text 16. Yang WP, Henderson D, Hu BH, et al. : Quantitative analysis of apoptotic and necrotic outer hair cells after exposure to different levels of continuous noise. Hear. Res. 2004 Oct; 196 (1-2): 69–76. PubMed Abstract | Publisher Full Text 17. Hu BH, Henderson D, Nicotera TM: Extremely rapid induction of outer hair cell apoptosis in the chinchilla cochlea following exposure to impulse noise. Hear. Res. 2006; 211 : 16–25. PubMed Abstract | Publisher Full Text 18. Lee S, Bae J, In S: Effects of Usage of Earphones on Health in University Student. The Korean Association for Crisis and Emergency Management. 2013; 5 : 17–25. 19. Vogel I, Brug J, van der Ploeg CP , et al. : Strategies for the prevention of MP3-induced hearing loss among adolescents: expert opinions from a Delphi study. Pediatrics. 2009; 123 : 1257–1262. Publisher Full Text 20. France J: Best Noise-Cancelling Headphones, cnet Reviews.2009. (Last viewed 3/18/11). Reference Source Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 08 Jan 2024 ADD YOUR COMMENT Comment Author details Author details 1 Department of ENT, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India Ayushi Ghoshmoulic Roles: Resources, Writing – Original Draft Preparation, Writing – Review & Editing Prasad Deshmukh Roles: Supervision, Validation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 08 Jan 2024, 13:32 https://doi.org/10.12688/f1000research.141954.1 Copyright © 2024 Ghoshmoulic A and Deshmukh P. 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