In our study of the Hearing in Young Adults (HIYA) aged 18-25 years, there appeared to be little effect of social noise on hearing thresholds (Smith et al. 1998). There was however, a threefold increase in the reports of tinnitus in those subjects with significant social noise exposure (≥ 97 dB NIL). No other abnormality was found of hearing function for those who were exposed to the most social noise. In an attempt to investigate this further we invited a sub-sample of those tested in the earlier phase of the study, to conduct further examinations of their hearing function. The three groups eventually consisted of those in the most social noise group who reported tinnitus (n=15) and those who did not (n=15), plus a group of people who had no social noise exposure but who reported tinnitus (n=8). All the groups were retested for their hearing thresholds, using standard audiometry and also the Audioscan technique to look for notches in the audiogram. Speech tests were carried out using an adaptive FAAF test. Transient-evoked oto-acoustic emissions were measured and also suppressed with a contralateral broad-band noise. Some evidence has been found to suggest that those young people who reported tinnitus are affected by social noise exposure, in terms of pure tone thresholds, speech tests, oto-acoustic emissions and reported hearing problems. Lessons can be drawn from our attempt to follow up this interesting population. First, the population is highly mobile and follow-up is difficult. Second, the presumed noise exposure was often not appropriate because even after a year it was possible for several individuals with insignificant social noise to move into the group with significant social noise exposure. Third, there is a need for a larger multi-centre study to look at the effect of social noise in more detail using a common protocol. The results of our study will be very useful in calculating the numbers needed in such a multi-centre study.
Keywords: social noise exposure, tinnitus, young people
|How to cite this article:|
Davis A C, Lovell E A, Smith P A, Ferguson M A. The contribution of social noise to tinnitus in young people - a preliminary report. Noise Health 1998;1:40-6
|How to cite this URL:|
Davis A C, Lovell E A, Smith P A, Ferguson M A. The contribution of social noise to tinnitus in young people - a preliminary report. Noise Health [serial online] 1998 [cited 2023 Dec 1];1:40-6. Available from: https://www.noiseandhealth.org/text.asp?1998/1/1/40/31779
| Introduction|| |
Before personal cassette players (PCPs) became so widely used, the MRC Institute of Hearing Research reviewed the literature on exposure from leisure noise (MRC, 1986). They reported that previous studies had methodological difficulties and that there was little evidence that PCPs were used at damaging levels. They stressed the need for a large random sample study of exposure from social noise, especially amplified music. It was also reported that there had been little investigation of tinnitus resulting from social noise exposure and highlighted its importance in future studies.
West and Evans (1990) found evidence of early damage to hearing from exposure to amplified music. Their subjects were aged between 15 and 23 years and underwent high resolution Bekesy audiometry and frequency resolution tests. Audiometric notches were found in the 'exposed' group as well as wider auditory bandwidths. The effects of social noise exposure on hearing in young people were also investigated by Meyer-Bisch (1996). He found a significant difference between those who went to discotheques more regularly and control groups for "auditory suffering" (presence of tinnitus and/or hearing fatigue, even if only directly after exposure), as well as for PCP use. Spontaneous tinnitus however, was not investigated in detail. Hearing damage was found in those who had intense PCP use, more concert attendance, but not for discotheque attendance.
Jokitulppo et al. (1997) also investigated the effect of leisure noise, on the hearing of Finnish teenagers and estimated that 50% of teenagers were exposed to levels of leisure noise which may be harmful to hearing. Temporary tinnitus after leisure noise exposure was reported by 70% of the subjects, although it was not clear how many of the individuals tested reported spontaneous tinnitus.
Exposure from PCPs and discotheques was investigated by Ising et al. (1997) using subjects aged 10 to 17 years. Questionnaires were used to determine the amount of time spent using a PCP and the number of visits to discotheques per week. The subjects then used their own cassette tapes to set the volume to that which they would normally listen at outside. The calculation of risk to hearing was carried out by assuming a five-year constant exposure. Their results show that 10% of pupils might be expected to incur a noise induced hearing loss of _!10dB at 3kHz over a five year period of listening to music through earphones, using ISO 1999. However no change in hearing thresholds was measured. They concluded that action is needed to prevent noise-induced hearing loss from music.
We have previously reported at the PAN meeting in London (1997) our research investigating Hearing In Young Adults in the UK population.
This work has been conducted in a number of distinct phases. In the first phase we sent out a questionnaire to several thousand households asking about hearing, tinnitus, social and occupational noise. The questionnaire demonstrated that hearing problems and tinnitus were more likely to be reported by those who had higher social noise scores.
In the second phase as many people as possible aged 18-25 years were tested in our clinic. We found evidence that exposure to significant social noise ( > 97 dB NIL) has increased threefold over the last decade, but with no evidence that hearing function (as indexed by hearing thresholds) accompanied this change (Smith et al. 1998).
There was however, a threefold increase in tinnitus report for those with significant social noise exposure. We did not investigate the tinnitus in great detail, as hearing function was the main focus in this phase of the study. Therefore, as this was the major reported symptom from those who were exposed to noisy leisure activities, we considered it important to conduct phase 3 of the study and look more closely at those with tinnitus, particularly those with significant leisure noise exposure.
The main aims of Phase 3 of the study were therefore:
- To investigate the nature of the tinnitus reported by those who have social noise exposure (≥ 97 dB NIL) and make a comparison with those who report tinnitus but do not exceed the criterion for significant leisure noise exposure
- To test whether there is evidence for abnormal auditory function in young adults who have been exposed to social noise for prolonged periods of time (≥ 97 dB NIL) and who complain of tinnitus, compared to:
- those with tinnitus and no social noise, and
- those with no tinnitus but who have substantial social noise exposure
| Materials and Methods|| |
The method for Phase 3 is described, where each of the subjects filled in questionnaires concerning their tinnitus and underwent a series of tests that were designed to test their hearing function and screen for any suspected middle ear problem. The complete test protocol lasted about 2.5-3 hours.
Otoscopy, admittance testing and an interview were used to screen for middle ear problems. Tympanometry was performed as well as contralateral reflexes at 1 kHz on both ears. The subjects were then questioned on their general health and hearing by an interview. This was aided by the use of a questionnaire which was sent to each subject prior to their visit, which covered similar topics to that in the interview. The interview and accompanying questionnaire was also used at Phase 2, with a few amendments for Phase 3.
In order to test hearing function, the following tests were used:
- Pure tone audiometry
- Speech testing: FAAF Test
- Spontaneous emission recording
- Contralateral suppression tests
- Personal Cassette Player volume selection
Air conduction thresholds were measured at eight frequencies (250, 500, 1k, 2k, 3k, 4k, 6k and 8k Hz) using the ISO 8253-1 (1989) technique. Bone conduction thresholds were also obtained at three frequencies (500, 1k and 2k Hz) with a fixed level of masking on both sides, starting with the ear which was poorer by air conduction. (Note: NBN masking at a level of 40 dB HL, where HL = SPL (of the noise measured in the nearest one third octave band) - RETSPL (for the appropriate pure tone ), via an earphone on the ear which was better by air conduction).
The Audioscan is an iso-intensity, sweep frequency audiometric technique devised by Meyer-Bisch (1996). It has the ability to detect even narrow dips (notches) in threshold which may occur in between those fixed frequencies tested in conventional audiometry. It has been shown to identify notches which associate with reported tinnitus pitch (Sirimanna et al., 1996). A speed of 30s per octave and initial sweep level of -10 dB HL were used with an increment step size of 5 dB. The stimulus was a pulsed tone presented at a rate of 2.5 per second, over the range 500 Hz to 8 kHz. Both ears were tested with a repeat test on the 'notchiest' ear in order to investigate test-retest reliability.
An adaptive version of the Four Alternative Auditory Feature Test (FAAF) was used with both noise (starting level of 40 dB) and speech (60 dB) being presented to both ears, via earphones. The noise level changed adaptively with an initial 4 dB step, changing to a 2 dB step for the last ten reversals. The final eight reversals were averaged to produce a signal-to-noise ratio at which the subject correctly identified 70.7% of the words presented. The test was repeated a further two times.
Spontaneous oto-acoustic emissions were recorded in each ear and if present, compared to the tinnitus (if reported). Transient evoked otoacoustic emissions were also recorded in each ear with an alternate presentation of a 50 dB SL broad-band noise contralaterally. Emissions were recorded 20 times for each no noise and noise condition and performed on both ears at 2 click levels (60 and 50 dB SPL), using the IHR POEMS equipment.
As in Phase 2, the subjects were asked to listen to a cassette tape (Nirvana - Unplugged in New York) on a Personal Cassette Player (PCP) and set the volume dial to a level at which they would usually listen in a quiet room. The questionnaires used were:
- IHR Tinnitus questionnaire - descriptions of tinnitus sounds, duration, occurrence etc.
- Tinnitus severity questionnaire - taken from Coles et al. (1991)
- Tinnitus reaction and handicap questionnaire - based on that devised by Wilson et al. (1991), with additional questions based upon selected questions from Kuk et al. (1990)
- IHR Recreational activities questionnaire - covering use of alcohol, cigarettes and drugs and their affect on the tinnitus
- Crown-Crisp Experiential Index
- Tinnitus pitch match was measured prior to any other tests, only if the subject had tinnitus at time of testing (not by memory), using a bracketing technique
- Noise imission rating interview - covering occupational, social and gunshot noise exposure since the previous Phase 2 visit. This interview was also undertaken at Phase 2 enabling a total lifetime value to be calculated post-Phase 3 testing. A detailed description of how the social noise exposure was calculated can be found in Davis (1995), Lutman and Spencer (1991) and Smith et al. (1998).
The subjects for the present investigation (Phase 3) were selected from those who took part in Phase 2. These subjects had been randomly selected from the postal address register file in Nottingham in 1994-1996 in Phase 1. Two groups of subjects were chosen: 33 subjects who reported tinnitus in Phase 2 of the study and 15 who did not report tinnitus but had significant noise exposure.
All of the subjects who reported tinnitus at Phase 2 were contacted, now aged 19-27 years (mean age = 23 years), except one individual who was omitted due to unreliable responses during testing at Phase 2. Out of those who were contacted (32), 23 responded and were seen (11 men and 12 women). Using data collected at the initial visit, 8/23 subjects had significant ( > 97 dB NIL) social noise exposure and 15 had insignificant exposure. However at the second visit, there was an increase to 15/23 subjects who had significant social noise exposure when interviewed. Many subjects experienced more social noise exposure (eg going to University, change in lifestyle) in the interim period between testing and so had moved up a category in social noise exposure.
At present, testing is being undertaken on the 15 individuals with no tinnitus, who were matched for the 15 subjects tested with tinnitus and significant social noise exposure (in Group 1) on age, sex, occupational noise, social noise and occupational group.
| Results|| |
Phase 2 results - tinnitus report (n = 341)
Initial analysis carried out on the 341 subjects seen at Phase 2 (aged 18-25 years) comprised of T-tests, using prolonged spontaneous tinnitus report as a grouping variable. These subjects had varying social noise exposure.
Hearing function tests
Certain air conduction thresholds were significantly worse for those with tinnitus than those not reporting tinnitus; the largest difference being at 2 kHz in the better ear of 3.6 dB (P = 0.009). Differences were also seen in air-bone gaps where those reporting tinnitus had larger values than those without tinnitus, as much as 2.63 dB in the better ear (P = 0.005).
Tinnitus report was also related to linear otoacoustic emission amplitudes where those with tinnitus had smaller emission amplitudes (at the highest click level) than those not reporting tinnitus with the largest difference being in the right ear of 0.79 dB (P = 0.038). PCP volume selection was slightly higher in those with tinnitus, where they set the volume about 8.13 dB higher than those without tinnitus (P < 0.001).
Factors from interview
Social noise exposure was found to be significantly greater in those with tinnitus (P = 0.033) as well as reported hearing impairment (P<0.02). Eye colour also seemed to be a significant factor where those individuals reporting tinnitus had a 32% likelihood of nonbrown eyes compared to a 9% likelihood for those without tinnitus.
Phase 2 results - social noise exposure (n=32)
The individuals who reported tinnitus at Phase 2 were analysed to investigate any differences due to social noise exposure. At Phase 2, half of the group had significant social noise and the other half did not meet the significance criterion. Preliminary analysis used T-tests with social noise exposure as the grouping variable.
Hearing function tests
Those with significant social noise exposure were found to have significantly worse air conduction thresholds at certain frequencies than those with less exposure, the largest difference being at 3 kHz in the left ear of 8.53 dB (P = 0.03).
Oto-acoustic emissions were also affected by social noise where those with more social noise had ~1.19 dB smaller amplitudes (for all click levels) than those without social noise (P< 0.04). Again PCP volume selection showed a significant difference between groups of social noise exposure where those with social noise set the volume dial to about 6 dB higher than those without noise exposure (P< 0.05).
Factors from interview
Reported hearing impairment for both ears (P<0.01); deterioration of hearing, largest in the (R) ear (P=0.005); ear disease for both ears (P=0.021); deafness at any time in the (R) ear (P=0.021), were all reported more for those with significant social noise exposure.
Phase 3 results - social noise exposure (n = 32)
The analysis for Phase 2 data (described above) for social noise was repeated using the individuals' Phase 3 data, to see if social noise had an effect on those with tinnitus.
Hearing function tests
As previously seen, there were differences in certain pure tone thresholds, more specifically for the left ear air conduction average thresholds (over 0.5, 1, 2 and 4 kHz) where those with more social noise had higher average thresholds of about 10.6 dB (P = 0.006). Middle ear pressure was also affected by social noise for the left ear only (P = 0.0198). The FAAF speech test showed a difference when looking at the average signal-to-noise ratio of the second and third runs. Those with significant social noise exposure had a more positive signal-to-noise ratio of 2.64 dB than those without social noise exposure (P = 0.03). There were no apparent differences between groups in the Audioscan results, although more analysis is needed to investigate this in more detail.
Factors from interview
Those with significant social noise exposure reported more deafness and dizziness problems than those without social noise (P~0.07)
Those with more social noise scored higher on certain questions on both the Tinnitus Severity Questionnaire (TSQ) and the Tinnitus Reaction Questionnaire (TRQ). The factor concerning Tinnitus Affect on the TSQ had the largest difference between groups, where those with significant social noise scored higher than those without (P = 0.012).
Phase 3 results - tinnitus report
Although all the subjects in Group 2 have not been tested (n=8), preliminary analysis has shown that those with tinnitus had higher average thresholds (over 0.5, 1, 2 and 4 kHz) of 3.75 dB for the better ear (P=0.07) than those not reporting tinnitus. Those with tinnitus also reported more dizziness and jaw problems than those without tinnitus (P~0.07).
| Discussion|| |
Analysis on both Phase 2 and 3 of the study have looked at different groups of people enabling the investigation of the effects of tinnitus and social noise exposure on young people. The analysis was carried out in four distinct parts:
(i) looking at the effect of tinnitus report on a group of young people with varying social noise exposure - Phase 2 data
(ii) looking at the effect of social noise exposure on those with tinnitus only - Phase 2 data
(iii) looking at the effect of social noise exposure on those with tinnitus only - Phase 3 data
(iv) looking at the effect of tinnitus report on those with significant social noise exposure (testing at present) - Phase 3 data
Firstly, considering the effect of tinnitus report, air conduction thresholds do seem to be affected on both a group of people with varying social noise and those with purely significant social noise exposure. Both groups were also affected by tinnitus report in terms of reporting more problems concerning hearing and related issues, such as dizziness. Emission amplitudes were also affected by tinnitus report, for those with varying social noise (Phase 2 data) although this result was not borne out in preliminary analysis on those with significant social noise only at Phase 3. Further analysis is needed on Phase 3 data for emission amplitudes. Those with tinnitus also set the PCP volume higher than those without tinnitus which may be connected to the fact that those with tinnitus also had more social noise exposure.
The effect of social noise exposure was then investigated using all those who reported tinnitus. The same individuals were used at both phases. Analysis of both phase 2 and 3 data shows that, like tinnitus report, air conduction thresholds are affected by social noise as well as reported hearing problems. Phase 2 data also showed differences in emission amplitude and PCP volume selection. Phase 3 data indicated further abnormal auditory function in those with more social noise and tinnitus. Questionnaires were also used to investigate tinnitus in more detail and it was found that those with social noise exposure scored higher on certain questions in the tinnitus questionnaires.
It has been shown by the preliminary analysis that tinnitus and social noise can affect auditory function but it may be the case that the tinnitus is a result of the social noise for some individuals, as is the reduction in hearing function as seen in some of the tests. More detailed analysis will follow, to investigate and compare those with tinnitus and significant social noise to those without tinnitus and without social noise exposure at Phase 2, in order to fully appreciate the effects of tinnitus and social noise together.
In conclusion, our initial analysis suggests that those young people who report tinnitus differ in their audiological and other characteristics dependent on the level of social noise exposure that they have had. This is evident in terms of pure tone thresholds, speech in noise tests, otoacoustic emissions and reported problems concerning hearing.
It has been shown that there is some evidence of abnormal auditory function in those reporting tinnitus who have significant social noise exposure compared to those who do not report tinnitus and also to those who have not experienced similar leisure noise. Much larger collaborative studies are needed however, to investigate this important area and make definitive and generalisable statements about the effects of leisure noise - especially tinnitus.
This paper was presented at the 3rd European Conference on Protection Against Noise (PAN), 12-15 March 1998, Stockholm Sweden organised and supported by the European Commission BIOMED 2 concerted action PAN (Contract BMH 4-CT96-0110).
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A C Davis
MRC Institute of Hearing Research, University Park, Nottingham, NG7 2RD
Source of Support: None, Conflict of Interest: None