Today's generation enjoys having music at their fingertips. This has led to an increase in the usage of personal listening devices (PLDs) over the past decade. There are significant concerns regarding harmful effects of PLD use. To find out the perception and practice of medical students regarding use of PLDs. Cross-sectional study was carried out in Mangalore, Coastal south India. Data were collected using a 31 item semi structured questionnaire that was distributed among 570 medical students, of which 485 completed questionnaire were received giving an overall response rate of 86.14%. The study was approved by the departmental review board. Statistical analysis used: data were analyzed using SPSS Version 11.5, Chi-square test for association was used and P<0.05 was considered statistically significant. Of the total study participants, 83.1% of them used PLDs regularly, of whom 77.7% used it for more than 1 h a day. Overall, 18.0% of the study population was aware that prolonged use of PLDs could be harmful to their health. Majority of the study subjects (72.4%) felt that the safe duration of listening to PLDs is 3 to 5 h. Among the subjects using PLDs ≥ 1 h, 60.1% preferred ear phones and among those using PLDs <1 h, 44.1% preferred earphones. Overall, 12.4% experienced temporary hearing loss on usage of PLDs. The use of PLDs among the medical students is on the rise, and they should be made more aware of the harmful effects associated with its use.
Keywords: Medical students, perception, personal listening device, practice, south India
|How to cite this article:|
Rekha T, Unnikrishnan B, Mithra PP, Kumar N, Bukelo MJ, Ballala K. Perceptions and practices regarding use of personal listening devices among medical students in coastal South India. Noise Health 2011;13:329-32
|How to cite this URL:|
Rekha T, Unnikrishnan B, Mithra PP, Kumar N, Bukelo MJ, Ballala K. Perceptions and practices regarding use of personal listening devices among medical students in coastal South India. Noise Health [serial online] 2011 [cited 2020 Apr 9];13:329-32. Available from: http://www.noiseandhealth.org/text.asp?2011/13/54/329/85500
| Introduction|| |
Today's generation loves to have music at their fingertips leading to an increase in the usage of personal listening devices (PLDs) over the past decade.  PLD's include all electronic gadgets that allow users to listen to music uninterrupted for prolonged periods without disturbing the people around. A significant concern regarding the PLD use among college students is the possibility of reduced awareness encountered by listeners while in noisy or other environments. 
Studies have indicated that prolonged exposure up to 60% of maximum volume for more than 1 h can cause noise-induced hearing loss.  This can help in formulating safe guidelines for the PLD use. However, it is important to explore whether PLD users actually follow such guidelines or still indulge in risky listening practices.
There is a dearth of literature regarding PLD use among medical students. This study has been conducted to assess the perceptions and practices of medical students regarding the PLD use. Medical students being future health care providers, it becomes imperative to know their perceptions and deleterious outcome after prolonged PLD usage, as this will influence their approach regarding this emerging problem.
| Methods|| |
The present cross-sectional study was carried out in Kasturba Medical College, Mangalore, south India. The study participants comprised of medical students using any type of PLD. A sample size of 563 was calculated taking into account the expected proportion of PLD use among students as 75% based on previous studies, with a relative precision of 5% and 95% confidence interval and taking into account a nonresponse rate of 10%. Data were collected using a pretested, semistructured questionnaire. The questionnaire was devised from the literature and formal discussions with experts. It consisted of 31 items pertaining to the demographic profile, perception and practice of use of PLDs. It was then pretested on 25 students and modified accordingly. These students were excluded from the final analysis. Prior to administering the questionnaire, the students were instructed regarding the objectives of the study. The study subjects were recruited after obtaining a written informed consent. The study questionnaire was then distributed among 570 students, of which 485 completed questionnaires were received giving an overall response rate of 86.14%. The study was approved by the departmental review board. The data were analyzed using SPSS version 11.5 and for the purpose of data analysis and presentation, the study subjects were divided into two groups-those using PLDs for more than 1 h per day and those using PLDs for less than 1 h per day. The Chi-square test for association was used and P<0.05 was considered statistically significant.
| Results|| |
The study population comprised of the Medical students from second to final year. The demographic profile of the study population is described in [Table 1]. Overall, 47.4% belonged to 18-20 years age group and majority of the subjects were females (56.3%). In addition, 77.7% of them used PLDs for more than 1 h a day and 83.1% of them used PLDs regularly.
Overall, 18.0% of the study population was aware that use of PLDs could be harmful to the health, 24.1% opined that PLDs could lead to ear problems [Table 2]. Also, 16.7 % felt PLD use would be risk factors for many diseases and 13.4% opined they could be one of the causes of headache among the users. But the association of perceptions and duration of PLDs were not statistically significant. The perceptions about lack of concentration and behavioural changes related to the use of PLDs were significantly different across the groups of those using for more than 1 h and less than 1 h of PLDs (P=0.022 and 0.026, respectively). Among the subjects, 72.4% felt that the safe duration of listening to PLDs is 3 to 5 h; among them 79% used the PLDs for ≥ 1 h and among them 15.4% opined <1 h, 12% opined 1-3 h. Overall, 0.2% had no idea about the safe duration for using PLDs.
|Table 2: Perceptions and Knowledge of the study population about the PLDs (n=485) |
Click here to view
[Table 3] describes the practices of the subjects with respect to the use of PLDs. Overall, 43.2% used PLDs while studying and 86.8% of them used PLDs for more than 1 h. Among those using PLDs ≥1 h, 47.6% and among those using for <1 h, 26.7% used the PLDs while studying. This difference was found to be statistically significant (Chi square = 14.1 and P<0.0001). Overall, while studying, 35.1% listened in high volume, 64.4% in medium volume, and 0.5% in low volume. However, this difference of volume of listening between those using≥ 1 h and less than 1 h of PLDs was not statistically significant (P=0.172). Among the subjects using PLDs ≥ 1 h, 60.1% preferred ear phones and among those using PLDs <1 h, 44.1% preferred earphones. This difference was found to be statistically significant (P=0.0001). In-ear devices were preferred over out ear devices by both the groups, but this difference was not statistically significant (P=0.997). Overall, 48.4% of the subjects had been using PLDs for 1 to 3 years. Also, 22.2% of the study population used high volume, 66.3% medium volume and 14.5% low volume to listen to PLDs. More subjects in both the categories listened to soft music more compared to other categories of music. This difference was statistically significant (P=0.010) across the groups. Among the total study population, 21.1% had reduced concentration after listening to PLDs. This was more among those using <1 h owning the PLDs (27.6% vs. 19.9%). Use of PLDs during the exercise was more among those using the PLDs ≥ 1 h. This difference was statistically significant (P=0.004).
The perceived effects of listening to PLDs, among the subjects are described in [Table 4]. Overall, 12.4% felt temporary hearing on usage of PLDs. The percentage was higher among those using PLDs <1 h (16% vs. 11.5%). This difference was statistically not significant (P=0.226). Similarly, the hard of hearing feeling while conversing (40%) and suffering from lack of sleep (35.3%) was higher among those not owning the PLDs. These differences were not statistically significant. The whistling/buzzing sounds in the ear without PLDs (18.7%), sleeping with PLDs plugged in (24.2%) was higher among those using PLDs ≥ 1 h. However, these differences were not statistically significant.
|Table 4: Perceived effects of listening to PLDs among the study population (n=485) |
Click here to view
| Discussion|| |
This study was conducted to evaluate the knowledge, perceptions and practices of the medical students regarding the use of PLDs. This study would help us shed light on to the current patterns of PLD use, and its harmful health effects as perceived by them.
Most of our study subjects were in the age group of 18-20 years (47.4%). Majority (77.7%) of the subjects were using PLD for more than 1 h/day. However, in studies conducted in Korea  (47.6%), Alabama, USA  (51.7%), Zogby International  (31%), and California  (50%) the proportion of students using PLDs for more than 1 h is lower compared to our study. The higher proportion of students using PLDS for more than 1 h/day could be attributed to the fact that we have included all the sources of PLDs in our study. It has been stated that regular use of PLDs for more than an hour a day may have an impact on hearing. 
Regarding the perceptions of the students about the PLDs, most of the respondents were of the opinion that PLDs causes harm, either to their hearing or to their general health. Subjects who used PLDs for more than 1 h perceived a lack of concentration and behaviour change compared to those who used PLDs for less than 1 h. This association was found to be statistically significant. This difference could be due to the fact that the students, who are using PLDs for a longer duration, may have experienced some of the effects, or they might have come across some of their friends who have complained of the same.
Majority of our study subjects listened to their PLDs at a medium volume (63.3%). In a study conducted in California,  53% of the respondents listened to PLDs at medium volume. Only 11.5% students in our study had been using PLDS for less than a year. Contrary to these findings, the study conducted in Korea  revealed that majority of students had been using PLDs for more than a year. Most of the respondents in our study preferred earphones (56.7%), and among these the preference was for in ear compared to out ear type. A study conducted in Pennsylvania  revealed that majority (86.7%) of the participants use the ear bud type of head phones. Similar findings were reported in other studies. , This could be attributed to the simple fact that most of the commercially available MP3 players, mobile phones etc. come equipped with ear phones rather than head phones. Also, earphones are more portable and easily stocked as compared to headphones.
Few of the respondents felt they had a temporary loss of hearing after the use of PLDs, which was complained more by those using PLDs for less than 1 h. This could be attributed to the limited time frame of PLD use by these students and hence, were better able to appreciate the difference in their hearing. Among those who had difficulty in hearing while conversing, majority of them were ones who had been using PLDs for more than an hour. This could be explained by the possibility that the hearing of these had deteriorated or the hearing threshold of these students has increased over a period of time. Almost an equal number of respondents from both the groups could hear whistling or buzzing sounds in their ears while not listening to PLDs.
The study conducted in California  also reported similar findings, where 11% noticed some hearing problem after using PLD, 15.9% reported ringing in their ears, 11.2% felt they had hearing loss. Similar findings were also reported by the Pennsylvanian study.  A study done by Warwick Williams in Australia  showed that significant hearing loss (21.8%) and tinnitus (21.8%) were the common side effects on personal stereo usage. Few other studies have also reported that hearing loss and tinnitus were found in 5-20% of the PLD users. , The results of our study indicate that medical students are frequent PLD users, practice several potentially harmful PLD listening behaviours, most notably using earphone headphones and setting volume levels at higher levels.
| References|| |
|1.||Danhauer JL, Johnson CE, Byrd A, DeGood L, Meuel C, Pecile A, et al. Survey of college students on iPod use and hearing health. J Am Acad Audiol 2009;20:5-27. |
|2.||Hoover A, Krishnamurti S. Survey of college students' MP3 listening: Habits, safety issues, attitudes, and education. Am J Audiol 2010;19:73-83. |
|3.||Fligor BJ, Cox LC. Output levels of commercially available portable compact disc players and the potential risk to hearing. Ear Hear 2004;25:513-27. |
|4.||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;50:771-6. |
|5.||Zogby International. Survey of teens and adults about the use of personal electronic devices and head phones [Report submitted to the American Speech-Language-Hearing Association]. Available from: www.awasha.org/uploadedFiles/about/news/atitbtot/zogby_survey2006.pdf. [Last retrieved on 2010 Dec 20]. |
|6.||Torre P 3rd. Young adults' use and output level settings of personal music systems. Ear Hear 2008;9:791-9. |
|7.||Novaleski C, Benedict J, Erway L, Fenton C, Horan K, Jacobs M, et al. Survey on Behaviors and Opinions about iPod Use among College Students. Keystone J Undergrad Res 2010;1:1-7. |
|8.||Williams W. Noise exposure levels from personal stereo use. Int J Audiol 2005;44:231-6. |
|9.||Biassoni EC, Serra MR, Richtert U, Joekes S, Yacci MR, Carignani JA, et al. Recreational noise exposure and its effects on the hearing of adolescents. Part II: development of hearing disorders. Int J Audiol 2005;44:74-85. |
|10.||Lee PC, Senders CW, Ganz BJ, Otto SR. Transient sensorineural hearing loss after overuse of portable headphone cassette radios. Otolaryngol Head Neck Surg 1985;93:622-5. |
Department of Community Medicine, Kasturba Medical College, Mangalore, Karnataka
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4]