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   Abstract
   Introduction
   Methods
   Results
   Discussion
   Acknowledgments
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ARTICLE  
Year : 2011  |  Volume : 13  |  Issue : 50  |  Page : 51-58
Noise sensitivity and hearing disability

1 Department of Public Health, The Hjelt Institute, University of Helsinki, Helsinki, Finland
2 Department of Health Sciences, Gerontology Research Centre, University of Jyväskylä, Jyväskylä, Finland
3 Department of Public Health, The Hjelt Institute, University of Helsinki, Helsinki; Department of Mental Health and Substance Abuse Services, National Institute of Health and Welfare, Helsinki and Institute for Molecular Medicine, Helsinki, Finland

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Date of Web Publication15-Dec-2010
 
  Abstract 

The aim of this study was to investigate the association of noise sensitivity with self-reported hearing disability and hearing levels, with consideration of the role of self-reported history of noise exposure and use of hearing protectors. The study is based on the Finnish Twin Cohort. In 1988, a noise questionnaire was sent to 1005 twin pairs, 1495 individuals (688 men, 807 women) replied. The age range was 31-88 years. Information on some potential confounders was obtained from the questionnaire in 1981 for the same individuals. A subsample of thirty-eight elderly women with noise sensitivity response from 1988 had audiometry data from 2000 to 2001. Noise sensitivity was associated with self-reported hearing disability among all subjects [odds ratio (OR) 1.55, 95% confidence interval (CI) 1.14-2.12] and among women (OR 1.90, 95% CI 1.19-3.04), but no-more significantly among men (OR 1.31, 95% CI 0.86-1.98). The association was primarily seen among younger subjects (50 years or less). The difference between noise sensitive and non-noise sensitive elderly women in the average of thresholds at frequencies of 0.5-4 kHz in the better ear was not significant (Pr = 0.18). Noise sensitivity did not modify the association of hearing disability with the self-reported history of occupational noise exposure. Noise sensitivity was associated with the use of hearing protectors at work. The study shows the importance of recognizing the noise sensitive in noise effect studies, since sensitivity in annoyance has implications in most of the effect categories.

Keywords: Noise sensitivity, hearing disability, hearing impairment, noise exposure, hearing protectors

How to cite this article:
Heinonen-Guzejev M, Jauhiainen T, Vuorinen H, Viljanen A, Rantanen T, Koskenvuo M, Heikkilä K, Mussalo-Rauhamaa H, Kaprio J. Noise sensitivity and hearing disability. Noise Health 2011;13:51-8

How to cite this URL:
Heinonen-Guzejev M, Jauhiainen T, Vuorinen H, Viljanen A, Rantanen T, Koskenvuo M, Heikkilä K, Mussalo-Rauhamaa H, Kaprio J. Noise sensitivity and hearing disability. Noise Health [serial online] 2011 [cited 2019 Jul 20];13:51-8. Available from: http://www.noiseandhealth.org/text.asp?2011/13/50/51/74000

  Introduction Top


Noise sensitivity refers to the internal states of any individual, which increase their degree of reactivity to noise in general [1] and so predicts noise annoyance. [2] It can act as a factor modifying the effects of noise exposure on the outcome measure, or as an independent variable, which may be directly related to outcomes such as health status. [3] No strong evidence for an auditory component at threshold levels in noise sensitivity has been found, since noise sensitivity has not been related to auditory acuity. [2],[4],[5]

Noise sensitivity is not a synonym of hyperacusis defined as loudness related hypersensitivity to sounds involving a perception of discomfort experienced at sound levels lower than the normal loudness discomfort level [6] which can appear with many different diseases of the auditory system involving either the ear or the central auditory pathways. [7] However, qualitative and content features of sounds also influence hyperacusis [8] as well as judgements of sounds as noise. [9],[10] Yet noise sensitivity is more likely related to disposition to react to noise in general than to the physical properties of noise [11] and it is also a self-perceived indicator of vulnerability to stressors in general, not only noise. [2]

In the elderly, presbycusis or age-related hearing impairment is the most common auditory impairment. Noise-induced hearing loss is the second most common form of sensorineural hearing deficit. [12] However, people exposed to the same level of occupational noise exhibit different levels of noise-induced hearing loss. [13],[14],[15] These results suggest that individual susceptibility plays a significant role in this process. We have found previously that genetic factors account for some of the inter-individual differences in noise sensitivity. [16] Thus, it can be hypothesized that noise sensitivity may also play a role in the individual susceptibility to noise-induced hearing loss.

The above-mentioned studies have indicated that noise sensitivity is not related to auditory acuity, but it reflects a judgemental, evaluative predisposition toward the perception of affective features of sounds at suprathreshold levels. The aim of this study was to investigate the association of noise sensitivity with self-reported hearing disability and hearing levels, with consideration of the role of self-reported history of noise exposure and use of hearing protectors as well. Our primary hypothesis was to confirm that noise sensitivity is not related to hearing threshold impairment, but as a personality trait predicting annoyance, sensitivity can be related to other suprathreshold features of hearing.


  Methods Top


Subjects

The study is based on the Finnish Twin Cohort, which was compiled in 1974 from the Central Population Registry of Finland and consists of all Finnish adult same-sex twin pairs born before 1958 and with both members alive in 1967. [17] In 1988, a case-control study was carried out to examine the relationship between noise and hypertension. A questionnaire was sent to 1005 twin pairs discordant for hypertension. Of these, 1495 individuals (688 men, 807 women) replied, giving a response rate of 74.7%. The mean age of the respondents was 55.5 years with standard deviation 11.6 years, and the age range was 31-88 years (men 31-82 years, women 31-88 years). They were the participants of this study. Information on the use of medicines, somatic factors and smoking was obtained from the questionnaire in 1981 for the same individuals. The 1981 questionnaire study is described in detail elsewhere. [17]

Analyses were also made separately in the age groups of 50 years or less (n = 505) and more than 50 years (n = 990) and among men and women. The threshold of 50 years was chosen because in older age groups hearing disabilities due to aging often result in speech discrimination loss in conditions of competing noise, distortion and hyperacusis even before significant pure tone threshold loss is apparent, giving rise for subjective hearing disability. [18] Gender was taken into account in the analyses because according to previous studies, females tend to rate noise with greater sensitivity than males of same age and same hearing ability. [19] In some analyses, the threshold for self-reported history of noise exposure at work was 7 years because of the exposure categories of the occupational noise question.

Forty-eight women who had answered the 1988 questionnaire participated in the 2000-2001 Finnish Twin Study on Aging (FITSA), a project on the contribution of genetic and environmental factors to the disablement process in older women, where audiometric measurements were also conducted. Participants in the FITSA were twin pairs aged 63-76 years. [20],[21]

Measures

Data collection

Questionnaires

We assessed noise sensitivity, hearing disability, and other noise-related items. In addition, other questionnaire items (hypertension, use of pain relievers, smoking and stress) were used because they have been associated with noise sensitivity and hearing disability in previous studies, [22],[23],[24],[25] and thus were considered as potential confounders in the analyses.

Questionnaire items from 1988

Noise sensitivity was investigated using the question: "People experience noise in different ways. Do you experience noise generally as very disturbing, quite disturbing, not especially disturbing, not at all disturbing or can't say?" Noise sensitivity was determined from the answers in the following way: Subjects answering "very disturbing" and "quite disturbing" were classified as noise sensitive, and subjects answering "not especially disturbing" and "not at all disturbing" were classified as non-noise sensitive. Those with missing answers or who replied "can't say" were excluded from the analysis.

Self-reported hearing disability was measured using the question: "Is your hearing impaired?" The response alternatives were: "no"; "yes, to some extent"; "yes, markedly"; "yes, I am using a hearing aid"; "I don't know". In most analyses, subjects answering "no" were classified as not having a hearing disability and subjects answering the other alternatives were classified as having a hearing disability, except for the "I don't know" group that was treated as missing data.

Self-reported history of noise exposure at work was investigated using the question: "For how many years during your lifetime have you been in such work where noise has disturbed hearing normal speech?" The response alternatives were: "not at all"; "less than a year"; "1-2 years"; "3-6 years"; "7-12 years"; "13-19 years" and "more than 20 years". In some analyses, those who had answered "not at all" were classified as having no noise exposure at work and other answers as having noise exposure at work. We also made analyses where noise exposure at work was classified as less than 7 years or 7 years or more.

Use of hearing protectors at work was asked using the question: "Have you used hearing protectors at your work?" The response alternatives were "no" and "yes".

Self-reported history of noise exposure during leisure time hobbies was investigated using the question, "During your leisure time have you hobbies like shooting, hunting; some noisy motor leisure time hobby; wood or metal work; listening to noisy music; playing in a noisy orchestra; other noisy leisure time hobby: What is your hobby?" The response alternatives for each hobby were "no" and "yes". In the analyses those who had no noisy leisure time hobby were classified as not having leisure time noise exposure and those who had some noisy leisure time hobby as having leisure time noise exposure.

A history of physician-diagnosed hypertension was elicited by asking: "Has a doctor ever told you that you have elevated blood pressure?" The response alternatives were: "no" or "yes".

Questionnaire items from 1981

Information on the use of pain relievers was elicited by asking: "During the last year, on how many days together did you use pain relievers?" The response alternatives were: "have not used"; " less than 10 days"; "10-59 days"; "60-180 days (2-6 months)"; "over 180 days (over 6 months)". The first response alternative was classified as no use, and the other alternatives were classified as any use.

A detailed smoking history was elicited in 1981 and used to define subjects as current, former and never-smokers. [26] Never-smokers had smoked less than 100 cigarettes in their lifetime, while current smokers were smoking daily or almost daily at the time of the questionnaire.

The experienced stress of daily activities was measured on a scale developed by Reeder et al. [27] on the basis of the four self-reported statements of stress in daily activities. [28] The subjects were divided into the categories of high (4-13) and low stress (14-16).

Audiometry

In this study, 48 women were also participants of the FITSA, where audiometry was conducted by an audiometrician using a clinical audiometer Madsen OB 822, equipped with TDH 39 headphones. [20],[21] Air-conduction pure-tone hearing thresholds were measured at the frequencies of 0.125, 0.25, 0.5, 1, 2, 4, and 8 kHz for each ear according to ISO 8253-1 (1989). [29] In the analysis, the better ear hearing levels (BEHL) for the different audiometric frequencies and as an average for frequencies of 0.5-4 kHz were used. A person was defined as having at least a mild hearing impairment if the BEHL average was 21 dB.

Ten of the 48 women, who were also participants of the FITSA, had not answered the 1988 question on noise sensitivity or answered "can't say". Of these, 38 women who had determined their noise sensitivity, 19 were noise sensitive and the other 19 were non-noise sensitive.

Statistical methods

Because of possible confounders and intervariable effects, logistic regression was used to analyze the strength of the association. Because the study subjects were sampled as twin pairs, the data on individual twins are not statistically independent. To obtain correct standard errors and P values, robust estimates of variance were obtained using the cluster option in Stata. [30],[31]

Binary logistic regression analyses were carried out to explore the relationship of noise sensitivity with self-reported hearing disability and the relationship of self-reported hearing disability with self-reported history of noise exposure at work and during leisure time hobbies among noise sensitive and non-noise sensitive subjects. The association of noise sensitivity with increasing grades of hearing disability was examined with multinomial logistic regression models. Point biserial correlation was used to estimate the association of noise sensitivity with audiometric measured hearing.

Heterogeneity of effects by sex or age was tested by adding interaction terms to the regression models. The significance of the Wald test for the interaction term was used to evaluate whether interaction was present.


  Results Top


In [Table 1] are shown the distributions of subjects by the degree of hearing disability and in different categories of self-reported history of noise exposure at work and during leisure time hobbies by noise sensitivity and gender. A total of 1165 subjects had answered both noise sensitivity and hearing disability questions; 505 of them were noise sensitive [Table 1].
Table 1: Distribution of subjects in different self-reported hearing disability categories and in different categories of self-reported history of noise exposure at work and during leisure time hobbies by sex and by noise sensitivity

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Association of noise sensitivity with self-reported hearing disability

[Table 2] gives adjusted odds ratios (ORs) for two multivariate models, which were used to explain the relationship of noise sensitivity with self-reported hearing disability. Model 1 includes age, sex, noise sensitivity, hypertension, smoking, stress and use of pain relievers. Model 2 includes all the items in Model 1 plus self-reported history of noise exposure at work and during leisure time hobbies. The ORs are shown among all subjects and separately among men and women.
Table 2: Noise sensitivity in relation to self-reported hearing disability in two multivariate models

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The crude ORs for noise sensitivity relating to hearing disability were significant among all subjects and separately among men and women. In multivariate Models 1 and 2, noise sensitivity was associated with self-reported hearing disability among all subjects [in Model 2 OR 1.55, 95% confidence interval (CI) 1.14-2.12] and among women (in Model 2 OR 1.90, 95% CI 1.19-3.04), but no longer significantly among men (in Model 2 OR 1.31, 95% CI 0.86-1.98) [Table 2].

In further analyses, in the age group of 50 years or less in multivariate Models 1 and 2, noise sensitivity was associated with self-reported hearing disability among all subjects (in Model 2 OR 1.96, 95% CI 1.23-3.13) and among women (in Model 2 OR 3.26, 95% CI 1.40-7.62), but not among men (in Model 2 OR 1.54, 95% CI 0.86-2.76). In the age group of more than 50 years, noise sensitivity was not associated with self-reported hearing disability in multivariate Models 1 and 2 (data not shown).

We also tested for heterogeneity of effects by sex or age by adding interaction terms (sex by noise sensitivity or age by noise sensitivity) to the regression models. The interactions of sex (P for interaction 0.45) or continuous age (P for interaction 0.07) were not significant.

Association of noise sensitivity with the degree of self-reported hearing disability

In [Figure 1] are shown ORs and 95% CIs of different degrees of self-reported hearing disability for noise-sensitive subjects compared to non-noise sensitive subjects among all subjects and all ages in the multinominal Model 1 adjusted for age, sex, hypertension, smoking, stress and use of pain relievers. The elevation in risk was significant at all degrees of self-reported hearing disability and it was increasing linearly with the degree of self-reported hearing disability.
Figure 1: Risk (odds ratios) of different degrees of self-reported hearing disability for noise sensitive subjects compared to non-sensitive subjects in a multinomial logistic regression adjusted for age, sex, hypertension, smoking, stress and use of pain relievers, self-reported history of noise exposure at work

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Association of noise sensitivity with audiometric threshold impairment

The point biserial correlations of noise sensitivity with BEHL for different audiometric frequencies among the 19 noise sensitive and 19 non-noise sensitive women, who were also FITSA participants [Table 3], indicated that noise sensitivity was highly correlated with hearing level only at the frequency of 8 kHz and moderately correlated with hearing level at the frequency of 0.125 kHz. Correlations with hearing levels of other frequencies were not significant and were low or negligible in value.
Table 3: Point biserial correlations of noise sensitivity with BEHL at different audiometric frequencies among 38 elderly women

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The average of thresholds at frequencies of 0.5-4 kHz in the better ear among elderly noise sensitive women was 27.6 dB (95% CI 20.0-35.3) and among non-noise sensitive women was 31.5 dB (95% CI 27.3-35.6). The difference between these two groups was not statistically significant (Pr = 0.18).

The distributions of hearing levels (BEHL) at different frequencies among all non-noise sensitive (N) and noise sensitive (S) women at different frequencies in [Figure 2] show the variability in BEHL values.
Figure 2: Distributions of hearing levels (BEHL) at different frequencies among non-noise sensitive (N) and noise sensitive (S) elderly women at different frequencies. Each letter represents the value of one subject for the given frequency

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An analysis of mean BEHL at different frequencies among noise sensitive and non-noise sensitive subjects [Figure 3] showed that noise sensitive female subjects tended to have somewhat better hearing thresholds than non-noise sensitive ones. In both groups, the averaged pattern of audiograms represents those conventionally regarded to represent age-related threshold impairment, which is understandable as the mean age of the subjects was 70 years.
Figure 3: Mean BEHL at different frequencies among noise sensitive (n = 19) and non-noise sensitive elderly women ( n = 19); , noise sensitive; , non-noise sensitive

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Association of self-reported hearing disability with self-reported history of noise exposure at work among noise sensitive and non-noise sensitive subjects

In [Table 4] is presented the association of self-reported hearing disability with self-reported history of noise exposure at work among noise sensitive and non-noise sensitive subjects in multivariate Model 1 including age, sex, use of hearing protectors at work, hypertension, smoking, stress, use of pain relievers, self-reported history of noise exposure at work. The association was somewhat stronger among those who reported exposure of 7 years or more compared with those who reported exposure of less than 7 years. There were no significant differences in the association of self-reported hearing disability and self-reported history of noise exposure at work between noise sensitive and non-noise sensitive subjects [Table 4].
Table 4: Association (ORs) of self-reported hearing disability with self-reported history of noise exposure at work among noise sensitive and non-noise sensitive subjects


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Noise sensitivity and use of hearing protectors at work

Noise sensitivity was significantly associated with the use of hearing protectors at work among all subjects (age- and sex-adjusted OR 1.42, 95% CI 1.06-1.90) and among women (age-adjusted OR 1.70, 95% CI 1.00-2.90). Among men, age-adjusted OR was 1.35 and 95% CI was 0.95-1.93.

Association of self-reported hearing disability with self-reported history of noise exposure during leisure time hobbies among noise sensitive and non-noise sensitive subjects

Among all subjects and for all ages, self-reported history of noise exposure during leisure time hobbies was not associated with self-reported hearing disability (OR 1.14, 95% CI 0.81-1.61) in a model adjusted for age, sex, hypertension, smoking, stress and the use of pain relievers. When analyzed separately among noise sensitive and non-noise sensitive subjects and among men and women in different age groups, self-reported history of noise exposure during leisure time hobbies was associated significantly with self-reported hearing disability in the age group of 50 years or less among all non-noise sensitive subjects (OR 2.43, 95% CI 1.15-5.13) and among non-noise sensitive men (OR 2.58, 95% CI 1.12-5.96), but not among non-noise sensitive women (OR 1.20, 95% CI 0.22-6.42).


  Discussion Top


In this study, noise sensitivity was associated with self-reported hearing disability particularly among younger subjects with evidence for a dose-response relationship, i.e., noise sensitivity was associated to a stronger degree with more severe hearing disability. However, the analyses of audiometric data of elderly female subjects demonstrated somewhat better hearing levels among noise sensitive women. Statistical significance was reached for the threshold differences at frequencies of 0.125 and 8 kHz, but difference between noise sensitive and non-noise sensitive women in the average of thresholds for frequencies of 0.5-4 kHz in the better ear was not statistically significant.

Our finding that the average hearing thresholds did not differ in noise sensitive and non-noise sensitive subjects is in concordance with previous studies. [2, 4, 5] In the study of Stansfeld (1992), no significant differences were found in noise sensitivity between those with normal threshold of hearing and those with threshold impairment according to pure tone threshold audiometry. [2] Likewise, Ellermeier et al. (2001) found no significant differences between two groups of low and high noise sensitivity in threshold levels, intensity discrimination, auditory reaction time or exponents for loudness functions. However, small but systematic differences were found in verbal loudness estimates and in ratings of the unpleasantness of natural sounds. [5] Moreira and Bryan [32] found a low correlation between self-assessed noise sensitivity and the slope of loudness function.

In loudness estimation experiments of Stansfeld et al. (1985 II), highly noise sensitive women rated the loudest tones as louder and the softest tones as softer than low noise sensitive women. [4] This suggests a relation between noise sensitivity and steeper loudness function. Thus, noise sensitivity can possess a perceptual feature at suprathreshold levels rather than at the threshold of hearing. This is also supported by the finding that higher rating of annoyance was found among men with noise-induced hearing loss compared to men with normal hearing in the activities in which noise interferes with speech perception. [33] Likewise, in the study of Abel et al. (1990), where the effects of different types of background noise given in relation to speech-to-noise ratio were investigated, the findings for subjects with noise sensitivity were regarded to reflect an increased upward spread of masking. [34]

There were no significant differences in the association of self-reported hearing disability and self-reported history of noise exposure at work between noise sensitive and non-noise sensitive subjects in the present study, i.e., noise sensitivity does not appear to modify that well-documented occupational risk. We did not find any previous studies on that association, except for a laboratory study of Aniansson et al. (1983) on the association of noise sensitivity with noise-induced hearing impairment. In that study, a higher prevalence of noise sensitivity was found among males with noise-induced hearing impairment compared with males having normal thresholds of hearing. [19] The noise exposure at work question used in the present study might be susceptible to over reporting from people who also report noise sensitivity. However, we had multiple items related to work exposure, including items on the use of protective equipment, items that are less likely to be associated with subjective assessments.

In this study, self-reported history of noise exposure during leisure time hobbies was associated with self-reported hearing disability to the greatest extent among younger (50 years or less) non-noise sensitive subjects, particularly among men. One explanation could be that noise sensitive subjects withdraw from noisy activities during their leisure time, and thus are not to that extent at risk for noise-induced hearing impairment. We were not able to find any previous studies comparable to the present study. In the study of Olsen Widen and Erlandsson (2004) on adolescents (age range 13-19 years) of noise exposure mainly during leisure time activities, older students reported tinnitus and noise sensitivity to a greater extent than younger students did.[35]

It is of interest that the association of noise exposure at work with self-reported hearing disability was not modified by noise sensitivity status, while noise exposure during leisure time hobbies' associations were faced only in non-noise sensitive subjects. Whether this is due to different levels of exposure or selective effects is worth investigating as it may have implications for occupational health prevention efforts.

Noise sensitivity was investigated using a short question about the experience of noise in general. Our previous validation of that question indicated that it is markedly correlated (r = 0.60) with Weinstein's Noise Sensitivity Scale. [22] Among only 38 women, who could be classified by noise sensitivity status, data on audiometric measured hearing were also available. No audiometric data were obtained for men to demonstrate their hearing levels in relation to women and in relation to noise sensitivity. Noise sensitivity was measured about 12 years earlier (in 1988) than the audiometry was conducted (2000/2001). We have previously shown that noise sensitivity is a quite stable trait, but it is decreasing with age. [22] Thus, some of the noise sensitive women in 1988 may have become non-sensitive in 2000/2001.

Hearing disability was measured using a short question. A similar short question of self-rated hearing was used in the study of Viljanen et al. (2007a) and it was moderately correlated with audiometric threshold measurements also used in this study with a polyserial correlation between self-rated hearing and BEHL of −0.482. [20] However, hearing disability is also, or even more, influenced by auditory abilities at suprathreshold levels such as speech recognition in different acoustic environments. [36]

There were some gender differences in this study in the association of noise sensitivity with self-reported hearing disability. Noise sensitivity was associated significantly with self-reported hearing disability among women but not among men. However, the interaction of sex and noise sensitivity for risk of self-reported hearing disability was not statistically significant. Aniansson et al. (1983) found that females tend to rate noise with greater sensitivity than males of same age and same hearing ability. [19] Neuhoff and Heckel (2004) explained the sex differences of reactions to sounds by greater sensitivity of females to detect loudness increase compared to men who are more sensitive to loudness decrease. [37]

Although the interaction of age with noise sensitivity for self-reported hearing disability was not statistically significant, we found some suggestive age differences. The lack of an association between noise sensitivity and hearing disability in subjects over 50 years may indicate an increasing role of neural presbycusis with age, whereby the loudness function may turn to a gentler one. Previous studies on noise sensitivity, hearing levels and loudness estimation have mainly been conducted on younger subjects (53 years or less). [2, 4, 5] In the study of Aniansson et al. (1983), the age range was 30-75 years. In that study, women with presbycusis considered themselves more sensitive to noise than men with presbycusis did. [19] In our previous study, noise sensitivity was decreasing with age (age range 31-70 years) and the age-related differences in noise sensitivity were statistically significant among men and women. Women were not more sensitive to noise than men.[22] Gender- and age-related findings may thus only indicate that aging of the auditory system takes place in a more rapid rate in men than in women. [38]

In this study, noise sensitivity was significantly associated with the use of hearing protectors at work. Studies comparable to the present study have not previously been conducted according to the available literature. In the study on adolescents of Olsen Widen and Erlandsson (2004), those who reported tinnitus and noise sensitivity protected their hearing to the highest extent in noisy activities. [35]

In conclusion, we found that noise sensitivity was associated with self-reported hearing disability with evidence for a dose-response relationship. However, as in previous studies, noise sensitivity was not associated with auditory acuity.

The present study shows the importance of recognizing the noise sensitive in most of the noise effect studies, since sensitivity in annoyance has implications in most of the effect categories. Subsequently, their role may need revision for limit values of environmental noise in some subpopulations or noise exposure conditions.

Noise sensitivity is not only related to problems of hearing speech, but also to overall increased annoyance to noise exposure. It appears to be more of a psychoacoustic perception with affective loading and as thus irrespective of noise masking of speech or other important signals, rather accompanied with feeling of limitations for rest, relaxation, and access to control of the acoustic environment. It is also regarded to parallel increased sensitivity for chemicals, [39] olfactory exposures, [40] or other environmental factors causing disturbance or adverse health effects. [41] Further studies need to be conducted to explore the entire concept of noise sensitivity along these perspectives. They are needed to investigate the association of noise sensitivity with hearing ability at suprathreshold levels.


  Acknowledgments Top


This study was carried out as part of the Finnish Twin Cohort Study at the Department of Public Health of the University of Helsinki, Finland. The Finnish Twin Cohort Study is supported by the Academy of Finland Centre of Excellence in Complex Disease Genetics. The study was financially supported by The Finnish Work Environment Fund, which is gratefully acknowledged.

 
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Correspondence Address:
Marja Heinonen-Guzejev
Department of Public Health, PO Box 41, University of Helsinki, Fin-00014
Finland
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Source of Support: The Finnish Work Environment Fund, Conflict of Interest: None


DOI: 10.4103/1463-1741.74000

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    Tables

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