Empirical research indicates that children and teachers are exposed to mean sound levels between 65 and 87 dB (A) and peak sound levels of 100 dB (A) in schools, which may lead to hearing loss and mental health problems. A questionnaire containing 13 targeted questions about noise and sensitivity to noise was distributed to 43 teachers aged between 25 and 64 years at five different primary schools in the Cologne municipal area. The small number of interrogated teachers leads to a wide range of deviation and little significance in the results. Thus, several results are reported following tendencies. Significant results are obtained when comparing younger and older teachers and part- and full-time occupation. Teachers experience highest sound levels in the schoolyard, corridors and classrooms, and 68% of the teachers are annoyed by the noise. Specially, teachers older than 45 years of age suffer from sleep disturbances (44%), and 90% of the full-time employees are tired and exhausted in the evening. Work is judged as physical and mental strain by 51% of the whole sample, and 81% of the older teachers report a significant increase of complaints with increasing years of professional activity. Work-related noise may contribute to physical and mental health problems in teachers. Measures to prevent disease, such as early sensitization of the children to the work-related stressor noise by adequate education with noise lights and dosimeters in the classroom and/or equipping rooms with sound-absorbing materials, have to be discussed.
Keywords: Disease prevention, occupational noise, primary school, teachers, work-related physical and mental strain
|How to cite this article:|
Eysel-Gosepath K, Daut T, Pinger A, Lehmacher W, Erren T. Effects of noise in primary schools on health facets in German teachers. Noise Health 2012;14:129-34
| Introduction|| |
Many studies report high sound levels in primary schools around the world: ambient noise levels varying from 45 dB (A) to over 80 dB (A) in Japanese schools, from 51 dB (A) to 70 dB (A) in Brazilian classrooms and from 60 dB (A) up to 85 dB (A) in German schools. ,,,, Children and teachers are exposed equally to these sound levels throughout the day. Besides the risk of inner ear damage, stress reactions such as fatigue, headache, deficits of concentration and sleep disturbances are to be anticipated. ,,, Early studies indicated that individuals living in permanent sound levels above 50 dB (A) produced by aircrafts have a 20% higher risk to develop hypertension, followed by a higher risk of cardiac infarction and stroke.  Beside physical symptoms, especially teachers describe numerous mental problems that they attribute to their daily work. ,,,, More than 50% of the German teachers (only 25-35% in other European countries) claim premature retirement. The reasons for this are psychiatric or psychosomatic diagnoses such as depression, stress disorders and exhaustion syndromes in 52% of the cases as well as an imbalance between too much effort and too little reward. ,, Permanent mean sound levels between 65 dB and 87 dB (A) and intermittent unanticipated peak sound levels of 100 dB during the workday may play a contributory role; international comparisons reveal the highest sound levels in German primary schools. ,,,,
In Germany, the occupational category of teachers is the group with the highest incidence of so-called burnout syndrome, with symptoms such as emotional exhaustion and depersonalisation.  Depending on the type of school (primary or secondary school), 10-35% are affected, feeling strained by the number and behavior of pupils, high work load and lack of support and reward.  It seems that teachers in secondary schools are concerned more often. ,, Importantly, while burnout is receiving considerable attention in these days, work-related stressors are also linked to cardiovascular problems and further mental health problems such as anxiety and depression in teachers. 
Several reasons are accountable for this, and high sound levels during the working time is one of them.  Resonance effects may reinforce noise, depending on structural circumstances of the building. Measurements have shown mean sound levels between 65 dB and 87 dB (A) and peak sound levels of 100 dB (A)  during the workday. As a consequence, not only physical health problems such as hearing loss but also mental health problems may occur in teachers and children equally.
For the present study, a questionnaire was conceived in order to obtain information about noise and sensitivity to high sound levels from teachers in German primary schools. In a previous work of this research group, a similar questionnaire revealed great strain in educators of nursery schools associated with high noise levels. 
The present study shows the outcome of a questionnaire about noise and sensitivity to noise in teachers working in primary schools. The results are also discussed in terms of possible preventive measures.
| Methods|| |
Following the publications by Khan and Thinschmidt,  Schoenwaelder et al. , and Nolting and colleagues,  a questionnaire was designed containing 13 targeted questions about noise and sensitivity to high sound levels. It was distributed to 43 teachers at five different primary schools in the Cologne municipal area. Completion of the questionnaire was voluntary. Translated questions are shown in [Figure 1]. The results were statistically compared with the help of the Wilcoxon signed rank test for paired samples and Mann-Whitney U-test for independent samples.
|Figure 1: Questionnaire containing 13 questions about noise, sensitivity to noise and its effects on efficiency and fitness for work|
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| Results|| |
The questionnaire was completed by 43 teachers, of which 39 were female and four were male. The mean age was 43 years (range: 25-64 years). Twenty-one of them were in full-time employment and 22 in part-time employment. The mean time of employment was 15 years, with a range of 1-42 years. Over half of the teachers (53%) had more than 5 years of experience, 28% of them having even more than 20 years. A total of 19 teachers had one, two or three children of their own living in their home. Children in the respective primary schools were aged between 6 and 10 years.
Evaluation of the questions was considered by mode of employment (full-time, n = 21, versus part-time, n = 22) and by the age of the study participants. Two age groups were created: persons up to 44 years old (n= 27) and persons of 45 years and older (n = 16).
The group of the older teachers consisted entirely of females; all male teachers were between 32 and 43 years old, and only one of them was in part-time employment. Of the older persons, 56.3% were in full-time employment, whereas 55.6% of the younger teachers were part-time workers, most of them having small children of their own at home (P = 0.029, Mann-Whitney U-test).
The feeling of hearing impairment occurred in 12.5% of the teachers older than 45 years and in 11.1% of the younger individuals. Twenty-five percent of the older teachers were suffering from tinnitus versus 14.8% of the younger persons. All these teachers had full-time employment. A history of sudden sensorineural hearing loss was stated in 6.3% of the older teachers and in 7.4% of the younger individuals. Again, all of them were in full-time employment [Table 1]. None of the teachers was wearing a hearing aid.
|Table 1: Declaration of 43 interviewed teachers about hearing impairment and tinnitus|
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All teachers perceive highest sound levels in the schoolyard, in the corridors and in the classrooms [Figure 2], whereas external noise (traffic, construction work) does not seem to be a disturbing problem. During recesses, when children are playing outside in the schoolyard, 70% of the full-time employees, regardless of age, report high sound levels always or often. Sound levels in the corridors are considered "often high" in 48% of all interviewed persons. In the classroom, sound levels are estimated as "often high" by 47% of all teachers and by 62.5% of teachers older than 45 years.
|Figure 2: Self-assessment of all teachers about the sources of high sound levels at school|
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Teachers experience sound levels as higher in the afternoon than early in the morning (P < 0.001, Wilcoxon signed rank test for paired samples). This especially applies to older (93.8%, < 0.001, Wilcoxon signed rank test for paired samples). This especially applies to older (93.8%, P = 0.034 ) and full-time employed persons (96.7%, P = 0.009, Mann-Whitney U-test) [Figure 3].
|Figure 3: Perception of high sound levels dependent on time of day by age group and employment type|
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Regardless of age or working hours, 67.5% of the teachers are annoyed by high sound levels. According to tendency, teachers with children of their own at home are more annoyed than others. Nevertheless, 51.2% of all interviewed persons are able to stay calm in those situations of high sound levels [Figure 4].
Older teachers tend to suffer more often from sleep disturbances (43.8%) than younger ones (22.2%); 90% of the full-time employees are tired and exhausted in the evening. This is a significant difference to 69% of the part-time employed persons (P = 0.017, Mann-Whitney U-test). Half of the whole sample (51%) cannot help thinking about work in the evening. Hoarseness and voice affections do not seem to be a problem in 82% of all interviewed persons [Figure 5].
|Figure 5: Symptoms of stress stratified by age group and employment type|
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Work is judged as physical and mental strain by 51% of all teachers [Figure 6]. Older teachers (81.3%) especially report that they find it more difficult to tolerate noise today than in the beginning of their professional activity. This means a significant difference to the answers of younger teachers, of whom only 44.4% (P = 0.036, Mann-Whitney U-test) rated noise today as being harder than in the beginning [Figure 7].
|Figure 7: Estimation of high sound levels today in comparison with the beginning of the person's professional activity stratified by age group|
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| Discussion|| |
The aim of this study was to examine how noise and teachers' daily work may interact in primary schools and to line out its immediate consequences on health facets of the teachers. For this purpose, a questionnaire was conceived on the basis of reports by Khan and Thinschmidt,  Schoenwaelder et al, and Nolting et al [Figure 1]. A similar questionnaire has already been used in a previous study on educators in nursery schools. 
The evaluation of 43 questionnaires shows that highest sound levels are perceived in the schoolyards, in the corridors and in the classrooms. External noise (construction, traffic) does not seem to be a disturbing problem. This assessment of course varies depending on the school's location. Other studies identified considerable effects of external noise on the work in the classroom. ,,
Most of the interviewed individuals were not sports teachers, which may explain the answers to sound levels in gyms [Figure 2]. Sound levels produced by the children are estimated as being louder in the afternoon than in the morning by >90% of the older and full-time employed teachers [Figure 3]. The statistically significant difference to younger and part-time employed teachers may be due to the fact that younger teachers are more often employed in part-time. Their core-time of work at school is in the morning, because many of them have children of their own to look after in the afternoon.
With increasing age and years of profession of the teachers, we saw a tendency of increasing appearance of hearing problems and tinnitus [Table 1]. This may due to normal aging processes, as seen in the whole population. Albera et al. point out in their study that the evolution of hearing loss is found to be more related to age than to noise exposure.
In our sample, hoarseness and voice affections did not seem to be a problem. This is not in line with other studies, where psychological and functional voice disturbances are described as being dependent on working time, history of asthma or laryngitis, background noise, long speaking distance, poor room acoustics and number of pupils. ,,,
Parents expect the teachers of their children to stay calm even in situations of stress and high sound levels. This may put high mental pressure on the teachers. Two-thirds of our sample (67.5%) is annoyed by high sound levels, especially those who have children of their own at home. Nevertheless, more than half of our sample succeed in this task, independent of age, daily working hours and own children [Figure 4]. On the other hand, this strain may have consequences on the teachers' general well-being. Work is judged as physical and mental strain by 51% of all included teachers. Also, 51% cannot avoid thinking about the events of the day in the evening at home, which may contribute to sleep disturbances. In our study, sleep disturbances occurred significantly more often in older individuals (44%). Ninety percent of the full-time employees feel exhausted in the evening, which is a significant difference to 69% of the part-time employed persons. Older teachers (81.3%) especially report that they find it more demanding to cope with noise today than in the beginning of their professional activity, whereas only 44% of the younger teachers rated noise today as being harder than in the beginning. Psychoacoustic parameters may also play a role in the individual estimation of noise.  These findings are in line with other studies ,, and underline once more the relevance of the physical and mental strain that teachers are exposed to. Resulting high levels of premature retirement of teachers may evoke dissatisfaction. Brown et al. report on 537 Scottish teachers who retired due to ill health: 48% of them said they would like to work again.  Another problem of premature retirement has to be mentioned here: the burden on national economies. Inability to work because of mental health diseases rose to 70% from 1997 to 2004. Thereby, costs of 20 thousand millions EUR arise in the EU. 
Overall, our current study is, clearly due to the small sample, hypothesis-generating in nature. And, equally clearly, to what extent the complaints and perceptions are causally linked to ambient noise levels in schools where teachers face increasingly demanding and complex work-related stressors needs to be explored in future studies. Finally, our results mainly refer to female teachers because only four male teachers filled in the questionnaire.
In the meantime though, the fact that causal links between work-related noise and adverse health perceptions and conditions are very plausible should already lead to preventive measures against noise in schools. Besides equipping rooms with sound-absorbing materials, effective sensitization to noise and education of the children and teachers as well seems to be important. This may be considered by ritual acoustical or hand signs used by the teachers, with noise-indicating lights and dosimeters in the daily practise. Promising results are described in the literature. ,,,
Indeed, children are able to recognize situations with high sound levels and resulting difficulties to understand their teachers.  Information and education about the physiology of hearing processes, inner ear damage caused by high sound levels and pathophysiological consequences such as fatigue, headache and concentration deficits due to noise are understood very well and children are able to follow advices concerning noise reduction.  Of course, noise education needs to be offered regularly in order to allow a stable effect and lasting sensitization. Performance of the same questionnaire after a period of using dosimeters and noise lights in classrooms is planned. Ultimately, long-term studies documenting the success of noise education are required.
| Conclusion|| |
Teachers are exposed to sound levels of up to 85 dB(A) at primary schools, which may have consequences on their health facets. Because of the small number of interrogated teachers, several results have to be reported as tendencies. Nevertheless, we found significant results when comparing younger and older teachers and part- and full-time employees. Older teachers especially suffer from sleep disturbances (44%), and 90% of the full-time employed individuals are tired and exhausted in the evening. Eighty-one percent of the older teachers report that they find it more difficult to tolerate noise today than in the beginning of their professional activity.
In order to avoid high levels of premature retirement of teachers, preventive action has to be considered. Besides equipping classrooms with sound-absorbing materials, children and teachers as well have to be sensitized to minimize sound levels. This may be supported by noise education and by use of noise-indicating lights and dosimeters in the daily practise.
| Acknowledgments|| |
The investigation has been approved by the appropriate ethics committee and has been conducted in accordance with the ethical standards laid down in the Declaration of Helsinki and its later amendments. Completion of the questionnaire was voluntary after the nature of the procedures had been fully explained. All persons gave their informed consent prior to their inclusion in the study.
The authors declare that this manuscript is not under simultaneous consideration by another publication.
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