A questionnaire was used to collect data from 545 students of the Manchester Metropolitan University. The aim of the study was to investigate associations between the attendance of university students at night-clubs (NCs) that play loud music and the incidence and duration of post exposure tinnitus (PET) and spontaneous tinnitus (ST). The possible effects of taking social drugs in NCs on tinnitus was also investigated. Descriptive analyses and Chi squared association analyses were carried out. The study showed that 87% of students attended noisy NCs and there was a significant association between the attendance at NCs and the duration of PET. There was no significant association between frequency of attendance and the incidence of tinnitus, however non attendees were significantly less likely to get ST. The amount of social drug-taking was not as high as expected, only 19% taking drugs more than rarely, although the incidence may be under-reported. Taking drugs while at night-clubs would appear to exacerbate the effects of noise exposure on tinnitus. Non drug taking males were less susceptible to PET lasting longer than 2 hours and ST than non drug taking females, whereas drug taking males were more susceptible than drug taking females. Whereas PET has yet to be proved to be related to auditory damage, this study would suggest the effect of nightclub noise exposure impedes tinnitus recovery and could prove to be an early sign of permanent damage.
Keywords: tinnitus, noise, nightclubs, social drugs
|How to cite this article:|
Meecham E A, Hume K I. Tinnitus, attendance at night-clubs and social drug taking in students. Noise Health 2001;3:53-62
| Introduction|| |
Social noise exposure, such as found in noisy nightclubs (NCs), has increased in the last 15 years (Smith et al. 1997) giving rise to growing concern over potential damage to the auditory system. Studies carried out in this area, particularly in regard to hearing loss, have produced conflicting results (eg.Bickerdike, Gregory 1980; Hughes et al 1985; Smith et al 1997; Babisch 1989; Meyer-Biisch 1996; Hanson, Fearn 1995; West, Evans 1990; Merluzzi et al 1997).
The incidence of post exposure tinnitus (PET) is well known but has not generated a great deal of interest in the social noise damage debate.
Recovery is spontaneous and there has to date been no proven link between PET and permanent auditory damage, although a study on noise exposed workers (Griest, Bishop,1998) found evidence that reports of tinnitus may be useful in identifying workers at risk for hearing loss.
The importance of PET is twofold, one as a possible precursor of chronic tinnitus, which in itself can be very debilitating, or, as a possible early warning of auditory damage which could result in hearing loss. Although there is much controversy over whether hearing losses can be detected after night-club noise exposure, there is evidence (West and Evans,1990) to suggest that the occurrence of transient noise induced tinnitus may be an early warning of damage to the outer hair cells (OHCs) of the cochlea. It was the data from psychophysical testing that is of most concern, not only was there significant broadening of tuning curves in those exposed to loud music but those who complained of temporary hearing fatigue and PET had significantly broader tuning curves. The hypothesis of discordant hair cell damage giving rise to tinnitus could account for the incidence of PET. Damage to OHCs in young people, sufficient to broaden their tuning curves, is likely to result in reduced speech discrimination and an increased risk of hearing loss. By the time that a hearing loss is detected the damage is likely to be quite extensive and irreversible, up to 30% of OHCs can be damaged before a hearing loss is apparent (Bohne and Clark,1982, Eldridge et al, 1973, on work with chinchillas). If warning of potential auditory damage through regular exposure to loud music at NCs is to have any impact, evidence needs to accumulate that damage is occurring. Noise induced tinnitus has been linked to disorder of the efferent auditory system (Attias et al, 1996) and recent work suggests that OHC damage may be detected by weak transient evoked otoacoustic emissions (Mansfield et al, 1999).
This study was aimed at investigating associations between the attendance of university students at NCs and the incidence and duration of PET and ST. Due to the recent concern over the possible adverse effects of taking social drugs while exposed to loud music the study also looked at the associations between the taking of social drugs while at noisy NCs and the incidence and duration of PET and ST.
The City of Manchester has a large undergraduate population, with a well developed culture of night-club attendance (NCA), making it a good location to carry out such research.
| Method|| |
A questionnaire was used to collect data from 545 science students attending The Manchester Metropolitan University, 308 of whom were female and 434 were aged between 18 and 25 years. Respondents with established causes of tinnitus, eg. perforated ear drums, were excluded from the analysis as were any inconsistent or substantially incomplete replies. This reduced the sample to 494. The questionnaire was kept to one A4 size sheet to encourage good compliance (Appendix 1).
Average sound levels in Manchester NCs were obtained from the Environmental Health division of Manchester City Council. The mean values of 97 - 106dB(A) (not averaged over time) on the dance floors equate well with data from French NCs (Meyer-Bisch, 1996). The questionnaire specified NCs that play loud music, this was defined as when conversation was difficult or impossible. The sound level that requires shouting to be heard has been estimated at being around 90dB(A) (Stranks, 1997). Incidence of PET and ST were scaled on a five point grade-scale from 'never' to 'always', and the duration of PET and ST were given a six point grade-scale from, 'less than 5mins' duration to 'more than 24hrs'. (ST was defined as tinnitus which occurs spontaneously and lasts for longer than 5 minutes.) The possible confounding effects of alcohol, other types of noise exposure, illness and swimming were also included in the questionnaire but, due to a design fault, these data were not useable.
Data analysis consisted of descriptive analysis and Chi squared association analyses. Association analyses examined were between:
- NCA and the incidence of PET
- NCA and the incidence of ST
- NCA and the duration of PET
- NCA and the duration of ST
- the taking of social drugs at night-clubs and the incidence of PET
- the taking of social drugs at night
-clubs and the duration of PET.
The data was then filtered to remove drug takers. Descriptive analysis was carried out and the following Chi squared association analyses:
- NCA and the incidence of PET in non drug takers
- NCA and the incidence of ST in non drug takers
- NCA and the duration of PET in non drug takers
- NCA and the duration of ST in non drug takers
In order to ensure adequate numbers in expected data cells ie. five or greater, some categories were pooled, eg. frequency of taking drugs at NCs 'usually' and 'always' were combined. The data was subdivided into gender and age band categories but insufficient data was available to carry out meaningful association analyses.
A spread sheet was used to produce contingency tables rather than using the Chi squared function. This enabled the data to be seen visually in table form and, more importantly, allowed the standard residual values to be examined, showing which values contributed most weight to the Chi squared value. The significance criteria used was < 0.05.
| Results|| |
The range of drugs claimed to have been taken are given here in the decreasing order of use: Amphetamines (including speed and ecstacy), cannabis, cocaine, LSD, heroin, amyl nitrate.
Chi squared association analyses
| Discussion|| |
A higher percentage of males were attendees than females; 91% males as compared to 84% females. 81% of over 26's attended and 87% of 18 - 25 year olds [Table - 1]. Overall the attendance at NCs was high. The percentage of attendees with PET was 80%, which is slightly higher than other reports of 75% (Smith et al. 1997). 60% of attendees went more than twice a month and 32% more than four times a month [Table - 2].
Chi squared association analysis showed a significant association between attendance at NCs and the duration of PET [Table - 4]. Of those who attended less than once a month, more than expected had PET lasting less than 5mins (SR6.5) and less had PET lasting for more than 4hrs (SR2.9). Of those who attended more than twice a month, less than expected had PET lasting for less than 5mins (SR 2.1) and more had PET lasting for more than 4hrs (SR 1.7)[Table - 6]. Although the association between NC attendance and the occurrence of PET was not significant, more than expected who attended less than once a month never got PET (SR 1.4) whereas less than expected who attended more than twice a month never got PET (SR 1.2). [Table - 6]. It would appear that more frequent attendance at NCs increases the risk of and reduces recovery from PET.
Although there was no significant Chi squared association between attendance at NCs and the incidence or duration of ST [Table - 4], the incidence of ST in attendees was higher than that in non attendees (NAs), 31% and 21% respectively [Table - 3]. Also, of NAs less than expected had ST lasting more than 5mins (SR 3.6) and less than expected had ST more than rarely (SR 1.9) [Table - 6]. It would appear that NAs are less likely to get ST.
As 87% of students attended NCs the NA numbers were necessarily small. A much larger sample number would be needed to increase this cohort and add weight to the findings.
Of NC attendees, 84% who took drugs got PET compared to 78% of non drugs takers. More female non drug takers had PET lasting longer than 2hrs and ST, 38% and 33% respectively, than male non drug takers, 21% and 24%. More male drug takers however had PET lasting longer than 2hrs and ST, 36% and 32% respectively, than female drug takers, 17% and 26% [Table - 3]. The auditory response to these drugs by males and females was clearly different. Male non drug takers appear to be less susceptible to tinnitus than females, whereas male drug takers appear to be more susceptible than females. Possible explanations for this could include differences in gender behaviour or total noise exposure, or a, as yet unknown, physiological factor similar to the increased susceptibility to tinnitus found in non brown eyed subjects (Davis et al 1998).
There was a significant association between taking drugs at NCs and the duration of PET [Table - 4]. Of the students who took drugs more than rarely, those that had PET lasting less than 5mins. was less than expected (SR 2.1) and those with PET lasting more than 2hrs was more than expected (SR 4.5)[Table - 6]. Although there was not a significant association between taking drugs at NCs and the incidence of PET, of those who took drugs more than rarely those who never got PET was less than expected (SR 1.0) and those who usually or always got PET was more than expected (SR1.9)[Table - 6]. This would indicate that taking drugs at NCs increases the risk of PET and impedes recovery, this was reinforced by the finding that 5% more drug taking attendees got PET than non drug taking attendees. However, as association analyses carried out on non drug takers showed similar patterns to those carried out on the full data, it would suggest that it is the frequency of attendance at NCs which is the primary factor though this may be exacerbated by drug taking.
The percentage of students taking drugs was not as high as might have been expected, 29% took drugs, of those only 19% took drugs more than rarely. However, although the question on the taking of social drugs reminded the participants of the anonymity of the questionnaire, it is highly likely that there will have been a low response to the question. Females admitting to taking social drugs at NCs was 5% less than males. This may have been due to the fact that more males take drugs or that more males are willing to admit to taking drugs. As all available students were asked to fill in the questionnaire during lecture time the issue of self selection was largely circumvented. Those who were less motivated may have been more inclined to incomplete replies but the percentage of these was low (9%, including inconsistent replies and established causes of tinnitus). Estimates of the incidence and duration of tinnitus was subjective, which could have led to some bias in the results, eg. if PET is associated positively with a good night out the incidence may be unreported whereas if the tinnitus was found annoying there may have been a tendency to overestimate the duration.
Chi squared association analysis on data subdivided for gender and age bands proved not to be viable as, even with pooling of categories, expected data samples were too small. Due to the different auditory susceptibility to drugs shown in males and females however, a study with sufficient numbers to subdivide for gender would be of real interest. Further studies could also include investigating the possible synergistic effects of loud noise exposure, alcohol and taking social drugs, taking into account total noise exposure. The questionnaire would also have been improved by the inclusion of a question on the amount of alcohol consumed.
The levels of noise exposure within NCs is highly variable. The highest sound levels are found on the dance floor, and many clubs turn up the music as the evening progresses. Although the study looked specifically at noisy NCs, defined as where conversation is difficult or impossible, it did not attempt to estimate degree of exposure to the highest levels, ie. time spent on the dance floor or time spent in the club late at night when volumes were increased.
| Conclusion|| |
This study shows that the attendance of university students at noisy nightclubs is high and that frequency of attendance is a significant factor in impeding post exposure tinnitus recovery. The likelihood of getting spontaneous is reduced by not attending night-clubs.
It would appear that taking drugs at night clubs may exacerbate the effects of noise exposure on tinnitus. Drugs taken at night-clubs would also appear to effect a different auditory response in males and females. Male non drug takers appear to be less susceptible to tinnitus than females, whereas male drug takers appear to be more susceptible than females.[Appendix in PDF] 
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E A Meecham
Department of Biological Sciences, The Manchester Metropolitan University, John Dalton Building, Chester St., Manchester M1 5GD
Source of Support: None, Conflict of Interest: None
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6]