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ARTICLE  
Year : 2014  |  Volume : 16  |  Issue : 72  |  Page : 331-341
Hearing and loud music exposure in a group of adolescents at the ages of 14-15 and retested at 17-18

1 Centre for Research and Transfer in Acoustics (CINTRA), Unit Associated of CONICET, National Technological University (UTN), Cordoba Regional Faculty, Cordoba, Argentina
2 High Otorhinolaryngological Technology Center, Forming Center for Otorhinolaryngology Specialists, Cordoba, Argentina
3 Institute of Statistics and Demography, National University of Cordoba, Cordoba, Argentina

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Date of Web Publication10-Sep-2014
 
  Abstract 

Young people expose themselves to potentially damaging loud sounds while leisure activities and noise induced hearing loss is diagnosed in increasing number of adolescents. Hearing and music exposure in a group of adolescents of a technical high school was assessed at the ages of: 14-15 (test) and 17-18 (retest). The aims of the current study were: (1) To compare the auditory function between test and retest; (2) to compare the musical exposure levels during recreational activities in test and retest; (3) to compare the auditory function with the musical exposure along time in a subgroup of adolescents. The participants in the test were 172 male; in the retest, this number was reduced to 59. At the test and retest the conventional and extended high frequency audiometry, transient evoked otoacoustic emissions (TEOAEs) and recreational habits questionnaire were performed. In the test, hearing threshold levels (HTLs) were classified as: Normal (Group 1), slightly shifted (Group 2), and significantly shifted (Group 3); the Musical General Exposure (MGE), categorized in: Low, moderate, high, and very high exposure. The results revealed a significant difference (P < 0.0001) between test and retest in the HTL and global amplitude of TEOAEs in Group 1, showing an increase of the HTL and a decrease TEOAEs amplitude. A subgroup of adolescents, with normal hearing and low exposure to music in the test, showed an increase of the HTL according with the categories of MGE in the retest. To implement educational programs for assessing hearing function, ear vulnerability and to promote hearing health, would be advisable.

Keywords: Adolescents, hearing function, hearing health promotion, musical exposure

How to cite this article:
Biassoni EC, Serra MR, Hinalaf M, Abraham M, Pavlik M, Villalobo JP, Curet C, Joekes S, Yacci MR, Righetti A. Hearing and loud music exposure in a group of adolescents at the ages of 14-15 and retested at 17-18. Noise Health 2014;16:331-41

How to cite this URL:
Biassoni EC, Serra MR, Hinalaf M, Abraham M, Pavlik M, Villalobo JP, Curet C, Joekes S, Yacci MR, Righetti A. Hearing and loud music exposure in a group of adolescents at the ages of 14-15 and retested at 17-18. Noise Health [serial online] 2014 [cited 2020 Oct 27];16:331-41. Available from: https://www.noiseandhealth.org/text.asp?2014/16/72/331/140515

  Introduction Top


Noise-induced hearing loss (NIHL) is a significant social and public-health problem, diagnosed in an increasing number of adolescents. [1],[2] Particularly, young people expose themselves to potentially damaging loud sounds during leisure activities. [3]

In general, young people's exposure to loud noise increases with age as older adolescents attend nightclubs more frequently than younger ones, because in Argentina, many of such places only allow entrance to people aged 18 and older. To this entertainment, the more frequent daily use of personal music players (PMPs), and rock concert attendance must be added. The effects of being constantly exposed to high levels of music can manifest later in life. [4]

The exposure to high levels of music that could lead to NIHL has been of recent interest in literatures and the term music-induced hearing loss (MIHL) is being used at present instead of NIHL, in reference to listening to loud levels of music for long periods of time. [5],[6] Morata, [7] had already expressed the convenience to use the term MIHL when there is an overexposure to music.

It has been estimated that from the early 1980s through the 2000s, the number of young people with social noise exposure has tripled from 6.7% to 18.8%, respectively. [8] Some studies point to an increasing overall prevalence of high-frequency hearing impairment in young people between 1987 and 2005, compared to that in the '70s and early '80s. [9]

Sliwinska-Kowalska et al. [10] express that it should be recognized that the exposure to different types of noise since early childhood has potential cumulative effects on hearing impairment in adulthood and old age. The same authors [10] affirm that the major sources of sound/noise exposures in teenagers and young adults are nightclubs music, rock concerts and music from PMPs.

Williams et al. [11] have reported the cumulative effect of noise exposure from attendance to dance clubs and night clubs on whole-of-life. They found that 35% of attendees were 30 years of age or older and all had started to attend these places in their late teens or early 20s. The eldest individual was 42 years and had been clubbing for 25 years. Many of the clubbers are also exposed to additional noise sources of music-related activities and if all those exposures are quantified, the level of noise exposure becomes even more significant. Further studies at National Acoustic of Laboratories of Australia are under way to examine attendance rate over time (age). [11]

Smith et al., [8] working with a sample of 356 young people of 18-25 years, estimated that 11.3% of them had undergone significant exposure from night clubs. Jokitulppo [12] have reported that the 34% of their study population, aged 28-58 years, had attended a night club or pub during the week before. Although, both studies don't report about the number of years the participants had attended such places.

With respect to the PMPs, there is an overexposure to noise due to young adults' using them, [5] and risk of MIHL has been reported by many researchers. [13],[14] In recent years, the popularity of PMPs has increased substantially and may represent one of the most common types of leisure noise exposure. [15] In their study Ahmed et al. [16] found that the 76.7% of university students at the University of Toronto at Mississauga used some type of PMPs.

Peng et al. [17] carried out research about the risk of damage due to listening to music coming from PMPs, applying both frequency ranges audiometry, in a group of 120 university students aged 19-23 years. They concluded that long-term use of PMPs can impair hearing function, and they indicate that extended high frequency audiometry (EHFA) is a sensitive method for early detection of NIHL.

Nevertheless, there is some controversy over the severity of hearing risks resulting from music exposure among teenagers. [7] For example, a study carried out in Germany reported that in a group of young people aged 18-25 who were not exposed to occupational noise, only a minimal difference - not statistically significant - was found between people who regularly go to discotheques and those who have never done so. [18] Similar findings had been reported for walkman users in 1998. [19] However, a research about the influence of leisure-time noise on outer hair cell activity in 88 medical students, with normal threshold hearing (better than 20 dB HL; frequency 0.125-10 kHz), showed that transient evoked otoacoustic emission (TEOAE) levels and reproducibility decreased significantly with an increased number of visits to nightclubs. [20]

With regards to typical occupational and recreational noise exposure (factory noise or nightclubs music for instance), permanent hearing threshold shifts frequently occur slowly over time by accumulating a gradually increasingly irreversible damage to the sensitive outer hair cells of the inner ear. Regular high-level noise exposure, e.g., at nightclubs, is expected to be harmful to hearing in the long run. [21]

Short-term studies demonstrate reversible hearing loss after exposure. [1] Our previous study on the topic, carried out in private schools, have demonstrate it is important to know what happens in the auditory function along time as a result of the constant exposure to high music during adolescence through longitudinally designed research. [3],[22]

With the aim to assess hearing, recreational habits, and sound exposure levels during adolescent entertainment activities, the program was designed to evaluate these variables in two moments of high school: 3 rd year (test) and 6 th year (retest). The program was implemented in public technical schools with students belonging to lower social, economic classes from Argentina, who are prospective applicants for jobs in factories and industries.

The present article describes the comparison of the results obtained in the two aforementioned instances: Test and retest at the first school where the program was implemented.

Aims

The aims are:

  1. To compare the auditory function of adolescents aged 14-15 (test) and 17-18 (retest);
  2. To describe the participation in musical recreational activities comparing test and retest;
  3. To compare the auditory function in relationship with loud music exposure along time in a subgroup of adolescents and in some individual cases.



  Methods Top


Participants

The study was carried out with students from the largest technical school in the city of Córdoba, Argentina, with the consent of the Ministry of Education of Córdoba.

The test sample consisted of 172 male 3 rd -year high school students aged 14-15 who had received their parents'/tutors' informed written consent to participate in the study. Unfortunately, at the moment of the retest, 3 years later, the number of participants, consisting of the adolescents who remained at the same school, dropped drastically to 59. This was because the Educational System in Argentina is divided into two cycles (basic cycle, from 1 st to 3 rd year and oriented cycle, from 4 th to 6 th year), which means that upon finishing the basic cycle, students must choose an orientation that, in many cases, involves changing schools. Furthermore, the percentage of adolescents drops out after finishing the basic cycle.

The inclusion criteria adopted for all participants were: Normal middle-ear function (pressure and compliance) by tympanometry and normal otoscopic examination.

Audiological assessment

Test and retest, were performed with the same procedure. The same audiologists conducted both studies, and the same measurement instruments were used.

The audiological studies were performed after approximately 10-12 h of auditory rest in the morning as adolescents were thought to have had auditory rest during the night. They were performed in a utilitarian vehicle adapted as a mobile audiometric booth, complying with international ISO 8253-1:2010 and national IRAM 4028-1:1992 standards [23],[24] with regards to background sound levels of noise; [25] The audiological evaluation was carried out in two sessions lasting approximately 20 min to avoid tiring the patients.

The audiological assessment consisted in:

  1. Auditory State Questionnaire, to learn about the medical history of the hearing.
  2. Otoscopic examination, using a clinical otoscopy Heine, model Beta 100.
  3. Tympanometry to determine the condition of the middle ear, with an impedanciometro Kamplex Interacoustics, model Minitymp MT10.
    Note: 2 and 3 were performed to verify normal otoscopic examination and normal middle-ear function, the two inclusion criteria for all the participants.
  4. Standard audiometry in the conventional frequency range (250-8000) Hz and an EHFA (8000-16000) Hz to determine hearing threshold level (HTL) within the audible spectrum, using the bracketing method specified by the ISO 8253-1:2010 standard. [23] The test's signal level steps were fixed at 3 dB for HTL to be determined with greater precision than with traditional 5 dB steps.
    A digital audiometer Madsen, model Orbiter 922 DH/1, for both frequency ranges was used. Its calibration was controlled 3 times a year, in the conventional range, according to ISO 389-1:1998 and IRAM 4075:1995 standards; [26],[27] and in the extended high frequency, according to ISO 389-5:2006 standard, [28] using an artificial ear Brüel and Kjaer, type 415, equipped with a standard microphone, also Brüel and Kjaer type 4134, traceable to the reference standards of the European Community. [29] Also, a set of Sennheiser supra-aural earphones model HDA 200 for both audiometric ranges calibrated according to ISO 389-8:2004 standard [30] was used. The application force of the headband (10.3 N) complies with the specifications of ISO 389-5:2006 standard [28] (10.0 N ± 1.0 N).
    According to the HTL in both frequency ranges, three groups were established at the moment of the test:
    Group 1: With normal HTL (up to 18 dB) at all the frequencies.
    Group 2: With slight shift of HTL (up to 24 dB) at least in one frequency.
    Group 3: With a significant shift of HTL (over 24 dB) at least in one frequency.
  5. Transient evoked otoacustic emissions to detect mechanical cochlear status, using an otoacoustic emission equipment, Otodynamics Limited, model ECHOPORT ILO 292 USB II, with UGD TE and DPOAE Probe, provided by the equipment. Also, an ILO V6 OAE clinical analysis and data management software.
  6. Transient evoked otoacoustic emissions were evoked as follows: The stimulus was a nonlinear click, quick screen mode, the mean intensity of the stimulus was 80 dB pk, 260 presentations of click, the stability of the stimulus was maintained at ≥80%, and the peak noise rejection level applied was 47.7 dB.
    The presence of normal TEOAEs was determined by a whole reproducibility level of ≥70% and a signal-to-noise ratio of ≥6 dB in three of the frequencies was analyzed (1000, 1500, 2000, 3000, 4000) Hz.


Participation in musical recreational activities assessment

This aspect was assessed applying the "out-of-school activities questionnaire" used in the test as well as in the retest. The same psychologists conducted the same procedures in both moments.

The questionnaire was administered collectively during school hours. Detailed instructions about how to complete the survey were provided and the students were given the opportunity to ask questions. The duration was approximately of 20 min. and the teachers stayed in the classroom to help monitor the students' behavior.

The questionnaire, an adaptation of the instrument employed at the Institute for Industrial Medicine and Hygiene at the Faculty of Medicine of Otto von Guericke University of Magdeburg, Germany, [31] is composed of 42 questions. It was administered in order to establish in detail the different types of musical recreational activities among adolescents.

The analysis of the Questionnaire revealed adolescent participation in five different music-related recreational activities:

  1. Exposure to music at home;
  2. Playing a musical instrument and being part of a musical group;
  3. Live concert attendance;
  4. Nightclub attendance;
  5. Use of PMP (UPMP).


The questionnaire asks how often adolescents participate in each activity, since when, the time dedicated to each, and the self-reported sound levels they're exposed to, thus obtaining a "participation level" for each activity (doesn't participate, low level, medium level, and high level). From the combination of participation levels in the five musical activities four categories of Musical General Exposure (MGE) were obtained:

  • Low exposure to music, made up of doesn't participate and low level of participation in all recreational activities;
  • Moderate exposure to music, composed of a medium level of participation in one or more recreational activities;
  • High exposure to music, which includes a high level of participation in up to two recreational activities;
  • Very high exposure to music, which includes a high level of participation in three or more recreational activities.


Statistical analyses

Unvaried descriptive statistical procedures were used to obtain the means of HTL in both frequencies ranges and TEOAEs amplitude for test and retest of Group 1.

A multivariate model with repeated measures was applied to analyze the audiometric profile of Group 1, taking the ears and the test-retest situations as grouping factors.

In order to determine the significance of the differences in the values for each frequency, the Student test for dependent samples was performed to compare:

  1. The audiometric profiles and
  2. The curves of TEOAEs amplitude obtained in the test and retest.


Unvaried analyses of variance were used to compare: (a) The mean differences of the audiometric profiles according to MGE's categories (moderate, high and very high) between test and retest of a subgroup of adolescents belonging to Group 1 and (b) the mean hearing difference of the audiometric profiles among the three MGE's categories obtained in the retest.

Statistical analyses were performed using the InfoStat version 2013. Group Info Stat, FCA the (National University of Cordoba, Argentina) and SPSS program (version 19; SPSS Inc. Chicago, IL, USA).


  Results Top


The participants were classified according to their HTL in both frequencies ranges as follows:

Group 1: 112 adolescents (test) - 49 adolescents (retest).
Group 2: 21 adolescents (test) - 4 adolescents (retest).
Group 3: 39 adolescents (test) - 6 adolescents (retest).

For the retest, the adolescents remained in the same group that they had been classified at the moment of the test.

Due to the low number of participants in the retest, only the data corresponding to Group 1 (49 adolescents) could be statistically processed and compared with the results of the same adolescents in the test, in all the variables studied. Also, some individual cases are shown.

Group 1

Audiometric profile

The multivariate model with repeated measures showed absence of statistically significant differences between ears (F 1192 = 0,480), absence of ear-test/retest interaction (F 1192 = 0.079) and a significant effect between the profiles of test and retest (F 1192 = 107,437; P < 0.0001). Therefore, both ears were analyzed together (98 ears) for a comparison between the profiles obtained from the test and the retest.

The audiometric profiles of Group 1 (98 ears) obtained from the test and the retest are shown in [Figure 1].
Figure 1: Comparison of the audiometric profiles of Group 1 (98 ears) obtained from the test and retest

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The results of the Student's t-test for dependent samples applied for the audiometric profiles between the test and retest, are shown in [Table 1].
Table 1: Significant differences of the audiometric profiles between the test and retest in each of the frequencies evaluated

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Transient otoacoustic emissions

The TEOAEs responses, in particular the amplitude response were analyzed. In [Figure 2], the mean amplitude response obtained from the 49 adolescents classified as Group 1 (with normal HTL) in the test is compared with that obtained from the same adolescents in the retest, for both ears.
Figure 2: Comparison of the mean transient evoked otoacoustic emissions amplitude response of Group 1 (98 ears) obtained from the test and retest

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The results of the Student's t-test for dependent samples comparing the amplitude response values for each frequency measurement between the test and retest, are shown in [Table 2].
Table 2: Significant differences of the amplitude values for each frequency measurement between test and retest

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Participation in musical recreational activities

The 49 adolescents of Group 1 were classified according to their MGE in test and retest instances. In the retest, a group of adolescents was placed in the category very high exposure due to the increase of their participation in musical activities, especially "attendance to nightclubs" and "UPMP." In the test, no adolescent was categorized in it.

[Table 3] shows the classification of the adolescents comparatively, reflecting the increase in their participation in the musical activities evaluated
Table 3: Classification of the adolescents according to their test and retest MGE

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Special subgroup selected from Group 1

Within Group 1, an especial subgroup was selected from all the adolescents who, according to the out-of school activities questionnaire, had been classified at the moment of the test in the lower category of MGE: "Low exposure to music." This selected subgroup, consisting of 30 adolescents, was called "pure subgroup" because at the time of performing the test, their hearing was normal, and their participation in musical recreational activities was just beginning. That participation increased during the following 3 years until the moment of the retest. When the retest was performed, 8 of them had to be classified in the category of "moderate exposure to music", 12, in the category "high exposure to music" and 10, in the category "very high exposure to music", according to their questionnaire's answers.

In order to know if the hearing was in accordance with the increase of the MGE assessed in the retest of the adolescents of this subgroup, the difference was obtained between the test's and the retest's audiometric profiles for each category of MGE. Later, those mean differences were compared with the MGE's categories. The results are shown in [Table 4].
Table 4: Mean HTL difference between the test and retest audiometric profi les of the "pure subgroup" according to three categories of MGE and the comparison of the mean HTL difference among the MGE categories in the retest

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The results showed:

  1. Mean HTL difference between test and retest: Higher values of dB HL in the category "very high," which indicate a progressive increase of HTL among the adolescents belonging to this category.
  2. Comparison of the mean HTL difference among the MGE categories in the retest:
    1. When comparing the categories moderate and very high, mean HTL differences are higher at some conventional range frequencies (250, 500, 1000 and 3000) Hz and at some extended range frequencies (10,000, 11,200, 12,500, 14,000 and 16,000) Hz;
    2. When comparing the categories high and very high, mean HTL differences are higher at conventional range frequencies (6000 and 8000) Hz and at extended range frequencies (11,200, 12,500, 14,000 and 16,000) Hz.


Presentation of individual cases comparing the results obtained in the test and in the retest of Groups 1 and 3

Adolescents classified in Group 1

Two cases from Group 1 are presented below, showing audiometric profiles, TEOAEs amplitude response and TEOAEs reproducibility, with levels of MGE, comparing test and retest.

Adolescent N° 1:

(a) Audiometry


The [Figure 3] shows the audiometric profiles of right and left ears, of adolescent N° 1, comparing test and retest.
Figure 3: Comparison of the audiometric profiles of right and left ears obtained from the test and retest

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(b) Amplitude of transient evoked otoacoustic emissions

The [Figure 4] shows the mean transient evoked otoacoustic emissions amplitude response of right and left ears, of adolescent N° 1, comparing test and retest.
Figure 4: Comparison of the mean transient evoked otoacoustic emissions amplitude response of right and left ears obtained from the test and retest

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(c) Reproducibility of transient evoked otoacoustic emissions and musical general exposure levels

[Table 5] show the reproducibility of TEOAEs values by ear and MGE levels in test and retest of adolescent N° 1.
Table 5: Reproducibility of TEOAEs values and MGE levels in test and retest

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Adolescent N° 2:

(a) Audiometry


The [Figure 5] shows the audiometric profiles of right and left ears of adolescent N° 2, comparing test and retest.
Figure 5: Comparison of the audiometric profiles of right and left ears obtained from the test and retest

Click here to view


(b) Amplitude of transient evoked otoacoustic emissions

The [Figure 6] shows the mean transient evoked otoacoustic emissions amplitude response of right and left ears of adolescent N° 2, comparing test and retest.
Figure 6: Comparison of the mean transient evoked otoacoustic emissions amplitude response of right and left ears obtained from the test and retest

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(c) Reproducibility of transient evoked otoacoustic emissions and musical general exposure levels

[Table 6] show the reproducibility of TEOAEs values by ear and MGE levels in test and retest of adolescent N° 2.
Table 6: Reproducibility of TEOAEs values and MGE levels in test and retest

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Adolescent classified in Group 3

A case from Group 3 is presented below, showing audiometric profiles, TEOAEs amplitude response and TEOAEs reproducibility, with levels of MGE, comparing test and retest.

Adolescent N° 3:

(a) Audiometry


The [Figure 7] shows the audiometric profiles of right and left ears of adolescent N°3, comparing test and retest.
Figure 7: Comparison of the audiometric profiles of right and left ears obtained from the test and retest

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(b) Amplitude of transient evoked otoacoustic emissions

The [Figure 8] shows the mean transient evoked otoacoustic emissions amplitude response of right and left ears of adolescent N° 3, comparing test and retest.
Figure 8: Comparison of the mean transient evoked otoacoustic emissions amplitude response of right and left ears obtained from the test and retest

Click here to view


(c) Reproducibility of transient evoked otoacoustic emissions and musical general exposure levels

[Table 7] show the reproducibility of TEOAEs values by ear and MGE levels in test and retest of adolescent N° 3.
Table 7: Reproducibility of TEOAEs values and MGE levels in test and retest

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  Discussion Top


The longitudinal study conducted allowed tracking the auditory function and recreational habits associated with exposure to high sound levels of music throughout time (3 years) in a group of adolescents. The results showed the increasing tendency of adolescents to increase participation in musical activities as they grow older during the adolescence stage. Thus, in the retest, a group of adolescents had to be placed in the category very high exposure, while in the test no adolescent was classified in this category. That confirms what many researchers have stated [7],[8],[32],[33] as well as our previous studies. [3],[22] In the individual cases presented, it was also observed an increase in the adolescents' level of participation in musical activities along time, with the exception of adolescent N° 3, whose participation was a moderate level in the test as well as in the retest.

In our study, the audiometric profile of the 49 Group 1 adolescents, retested after a period of 3 years, showed an increase of the hearing threshold, statistically significant in all the frequencies of both ranges, compared with the threshold obtained in the test. Although, the hearing threshold obtained in the retest remained at normal levels, it showed progressive hearing changes observed in all the adolescents of this group [Figure 1]. In no case did the individual audiometric profile obtained in the retest showed stability or improvement in the audition with respect to the test (v. g. adolescent N° 1).

Regarding the early increase of the hearing threshold, it would be vital to know about the individual vulnerability to noise overexposure in advance, due to the fact that some subjects reveal "tender" ears, that is to say are more vulnerable to noise than subjects with "tough" ears, who tolerate a more extensive noise impact without harm. From the individual cases presented, adolescent N° 2 illustrates, as an example, a profile that would correspond to "tough ears," whereas the profile of adolescent N° 3 would correspond to "tender ears."

The underlying mechanism of the phenomenon described is not completely understood. Some studies suggest that the efferent medial olivocochlear (MOC) provides protection from noise overexposure and hence may be responsible for this characteristic. [34],[35],[36],[37],[38] Knowing an individual's susceptibility to cochlear damage after noise exposure would enhance the prevention of hearing deterioration and of NIHL.

Hannah et al. [39] have evaluated the predictive role of the olivocochlear efferent reflex strength in temporary hearing deterioration in young adults exposed to music, based on the noise-protective role of the MOC system observed in animals. Although, the authors couldn't establish a clear relationship between the protective effects of the MOC system and temporary hearing deterioration by reasons of design, they insist on the necessity to provide more insight on the olivocochlear efferent pathways and their role in auditory functioning, with new research projects.

In relation to Group 1 TEOAEs, an amplitude response decrease, statistically significant, was observed at all the frequencies in both ears when comparing it between test and retest. These results contributed to the identification of changes in the cochlear function produced in the 3-year interval. It is illustrated by the individual cases presented, particularly, adolescents N° 1 of Group 1, and adolescent N° 3 of Group 3, who presented a higher amplitude response decrease more accentuated. In general, the TEOAEs amplitude decrease was observed in the 3000 Hz and 4000 Hz frequencies. TEOAEs could provide ways to detect subtle inner-ear changes in normal-hearing ears before hearing loss occurs and ways to detect who is susceptible to NIHL. [40]

Different previous studies have shown that low OAE and reproducibility levels, together with normal HTLs, can indicate preclinical damage to the inner ear, [20],[41],[42],[43] as it was expressed above. A longitudinal study carried out by Konopka et al., [44] where the hearing effects of exposure to impulse noise were assessed, showed that high frequency hearing loss can be associated with lower-frequency TEOAEs changes.

The selection of the so-called "pure subgroup" within Group 1 was meant to analyze, in particular, the auditory function of the adolescents with low exposure to music at the moment of the test, in relation to the increase in their levels of participation in musical activities along time. This made it possible to prove that with the increase in the levels of MGE, the tendency to an increase of the hearing threshold was higher. Based on that, there are two observations to be made:

  1. The category "very high exposure to music" meant that the adolescents were certainly exposed to high sound levels, taking into account that such exposure implied also frequent participation and many hours dedicated to each musical activity.
  2. In general, the results showed a tendency to increase the HTLs, mainly in the high extended frequency range, in accordance with the increase of MGE.


Several studies have evaluated the relationship between the exposure to high sound levels in nightclubs music [11],[21] and through PMPs [45],[46] showing the effects of such exposures on hearing. However, the studies referred to evaluate the temporal effect of exposure on the auditory function of a single musical activity. The strength of our study is based on the estimation of the total sound exposure, taking into account all music-related recreational activities in which adolescents participate; and track their recreational habits and their hearing function over time.

Observation number two of the above paragraph would be consistent with what other authors have already expressed in reference to the fact that the high-frequency range is more sensitive to noise, [47],[48],[49],[50],[51] and with the results of our previous studies. [3],[22] Also, the individual case presented from Group 3 (with significant shift of HTL in the test) showed that the most important hearing threshold shift, occurred in the retest, especially in the higher frequencies of the extended range. It has been suggested that extended high-frequency audiometrics may be useful for early diagnoses of auditory sensitivity to noise, thus preventing hearing loss in frequencies especially involved in speech. [52]

As a summary of what has been analyzed so far, the findings point out that the continuous exposure to high levels of music could be one of the causes of the gradual shift of the hearing threshold in a 3-year interval. If such exposure continues, as it is expected to happen among older adolescents, [4],[8],[11],[12],[16],[17],[20] the increase of the hearing threshold found at the moment of the retest will likely increase with this exposure. In that case, the expression "music-induced-hearing threshold shifts" could be used. [7]

Henderson et al. [53] affirm that hearing damage cannot be fully manifested at the age of 19, but there is evidence that its effects are cumulative. [54] Hence, the effects of noise exposure may not to be yet clearly manifested in the audiological exams of the 14/15 and the 17/18 year olds within the 3-year period in which our program performed. This delay could be due to "redundancy" of hair cells in the cochlea that perform similar functions in accordance with their position in the cochlea, causing the manifestation of damage produced on them to become gradually evident later, when the adolescents are in their 20s. [54]

The continuity of our program will enable us to deepen into the topic and to widen the results obtained so far with a view to defining our findings in the first school.

An important aspect to be considered is the early detection of hearing impairment and to act upon it before it reaches irreversible levels. This has been clearly expressed by Müller et al. [21] "an important issue in establishing hearing conservation programs is, besides education and prevention, the early detection of NIHL" (pp. 1853).

Undoubtedly, the preventive aspect is also of vital importance in this issue. For this reason, educational programs in schools, [55],[56],[57] promoting hearing health, should be implemented on school-age children to increase their awareness of the risks of loud music. [58]


  Conclusion Top


Through our study, it was possible to know the behavior of the two variables assessed, hearing and exposure to music, along a period of the adolescence and to establish the relationship between them. The results obtained in a group of adolescents showed hearing threshold shifts after a 3-year-interval, in accordance with the increase of their levels of music exposure.

We stress the importance of implementing educational programs during the high school period with the inclusion of a psychoacoustic hearing screening applying audiological tests that allow to assess the hearing function and to know about the individual vulnerability to noise overexposure in advance, in order to advise adolescents adequately about the characteristics of their hearing and how to take care of it. At the same time, and based on our experience, those programs should organize educational campaigns with new strategies, as "peers education," in order to increase the awareness among adolescents about the risks of loud music exposure. [59],[60]

 
  References Top

1.Scientific Committee on Emerging and Newly Identified Health Risks - SCENIHR. Potential health risks of exposure to noise from personal music players and mobile phones including a music playing function (2008). Available from: http://ec.europa.eu/health/ph_risk/committees/04_scenihr/docs/scenihr_o_018.pdf. [Last accessed on 2008 Sep 23].  Back to cited text no. 1
    
2.Niskar AS, Kieszak SM, Holmes AE, Esteban E, Rubin C, Brody DJ. Estimated prevalence of noise-induced hearing threshold shifts among children 6 to 19 years of age: The Third National Health and Nutrition Examination Survey, 1988-1994, United States. Pediatrics 2001;108:40-3.  Back to cited text no. 2
    
3.Serra MR, Biassoni EC, Richter U, Minoldo G, Franco G, Abraham S, et al. Recreational noise exposure and its effects on the hearing of adolescents. Part I: an interdisciplinary long-term study. Int J Audiol 2005;44:65-73.  Back to cited text no. 3
    
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5.Kim J. Analysis of Factors Affecting Output Levels and Frequencies of MP3 Players. Korean J Audiol 2013;17:59-64.  Back to cited text no. 5
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6.Portnuff CD, Fligor BJ, Arehart KH. Teenage use of portable listening devices: A hazard to hearing? J Am Acad Audiol 2011;22:663-77.  Back to cited text no. 6
    
7.Morata TC. Young people: Their noise and music exposures and the risk of hearing loss. Int J Audiol 2007;46:111-2.  Back to cited text no. 7
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8.Smith PA, Davis A, Ferguson M, Lutman ME. The prevalence and type of social noise exposure in young adults in England. Noise Health 2000;2:41-56.  Back to cited text no. 8
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20.Rosanowski F, Eysholdt U, Hoppe U. Influence of leisure-time noise on outer hair cell activity in medical students. Int Arch Occup Environ Health 2006;80:25-31.  Back to cited text no. 20
    
21.Müller J, Dietrich S, Janssen T. Impact of 3 h of discotheque music on pure-tone thresholds and distortion product otoacoustic emissions. J Acoust Soc Am 2010;128:1853-69.  Back to cited text no. 21
    
22.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.  Back to cited text no. 22
    
23.ISO 8253-1. Acoustics - Audiometric test methods - Part 1: Pure-tone air and bone conduction audiometry. International Organization for Standardization; 2010.  Back to cited text no. 23
    
24.IRAM 4028-1. Tone audiometry. Basic methods of test. Argentine Institute of Standardization and Certification; 1992.  Back to cited text no. 24
    
25.Serra MR, Biassoni EC, Hinalaf M, Pavlik M, Villalobo JP, Curet C, et al. Program for the conservation and promotion of hearing among adolescents. Am J Audiol 2007;16:S158-64.  Back to cited text no. 25
    
26.ISO 389-1. Acoustics - Reference zero for the calibration of audiometric equipment - Part 1: Reference equivalent threshold sound pressure levels for pure tones and supra-aural earphones. International Organization for Standardization; 1998.  Back to cited text no. 26
    
27.IRAM 4075. Electroacoustic. Audiometer. Argentine Institute of Standardization and Certification; 1995.  Back to cited text no. 27
    
28.ISO 389-5. Acustics - Reference zero for the calibration of audiometric equipment-Part 5: Reference equivalent threshold sound pressure levels for pure tones in the frequency range 8 kHz to 16 kHZ. International Organization for Standardization; 2006.  Back to cited text no. 28
    
29.Serra MR, Biassoni EC, Richter U. Development of hearing disorders in adolescents. A Founded Argentine-German Project in the Field of Hearing Conservation. Physikal: Technical Institute Report; 2003. p. 1-61.  Back to cited text no. 29
    
30.ISO 389-8. Acoustics - Reference zero for the calibration of audiometric equipment - Part 8: Reference equivalent threshold sound pressure levels for pure tones and circumaural earphones. International Organization for Standardization; 2004.  Back to cited text no. 30
    
31.Schuschke G, Rudloff F, Grasse S, Tannis E. Study on the extent and possible consequences of music consumption in young - Part I. Z. AQ5 Lambekampfung 1994;41:121-28.  Back to cited text no. 31
    
32.Bohlin MC, Erlandsson SI. Risk behaviour and noise exposure among adolescents. Noise Health 2007;9:55-63.  Back to cited text no. 32
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33.Ising H, Babisch W., Hanee J, Kruppa B. Loud music and hearing risk. J Audiol Med 1997;6:123-33.  Back to cited text no. 33
    
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37.Hinalaf M, Pavlik ML, Biassoni EC, Serra MR, Curet CA, Abraham M, et al. Study on the contralateral suppression of otoacoustic emissions transient noise, hearing thresholds and recreational habits in adolescents. Arete J Fonoaudiol 2011;11:55-69.  Back to cited text no. 37
    
38.Hinalaf M, Pavlik M, Serra MR, Curet C, Joekes S, Yacci MR. Recreational Habits and hearing sensitivity in adolescents. In: Richard MC, Lemos V, editors. Summary of current research in psychology and allied sciences. 1 st ed. Libertador San Martín: Ediciones CIIPME-Plate Adventist University; 2011. p. 505-23.  Back to cited text no. 38
    
39.Hannah K, Ingeborg D, Leen M, Annelies B, Birgit P, Freya S, et al. Evaluation of the olivocochlear efferent reflex strength in the susceptibility to temporary hearing deterioration after music exposure in young adults. Noise Health 2014;16:108-15.  Back to cited text no. 39
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40.Lapsley Miller JA, Marshall L. Otoacoustic emissions as a preclinical measure of noise-induced hearing loss and susceptibility to noise-induced hearing loss. In: Robinette MS, Glattke TJ. editors. Otoacoustic Emissions. Clinical Applications. 3 rd ed. New York: Thieme; 2007. p. 321-41.  Back to cited text no. 40
    
41.Lepage EL, Murray NM. Click-evoked otoacoustic emissions: Comparing emission strengths with pure tone audiometric thresholds. Aust J Audiol 1993;15:9-22.  Back to cited text no. 41
    
42.Lepage EL, Murray NM, Tran K, Harrap MJ. The ear as an acoustical generator: otoacoustic emissions and their diagnostic potential. Acoust Aust 1993;21:86-90.  Back to cited text no. 42
    
43.Murray NM, Lepage EL. Age dependence of otoacoustic emissions and apparent rates of ageing of the inner ear in an Australian population. Aust J Audiol 1993;15:59-70.  Back to cited text no. 43
    
44.Konopka W, Pawlaczyk-Luszczynska M, Sliwinska-Kowalska M, Grzanka A, Zalewski P. Effects of impulse noise on transiently evoked otoacoustic emission in soldiers. Int J Audiol 2005;44:3-7.  Back to cited text no. 44
    
45.Hellström PA, Axelsson A, Costa O. Temporary threshold shift induced by music. Scand Audiol Suppl 1998;48:87-94.  Back to cited text no. 45
    
46.Muchnik C, Amir N, Shabtai E, Kaplan-Neeman R. Preferred listening levels of personal listening devices in young teenagers: Self reports and physical measurements. Int J Audiol 2012;51:287-93.  Back to cited text no. 46
    
47.Fausti SA, Erickson DA, Frey RH, Rappaport BZ, Schechter MA. The effects of noise upon human hearing sensitivity from 8000 to 20 000 Hz. J Acoust Soc Am 1981;69:1343-7.  Back to cited text no. 47
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48.Dieroff HG. Behaviour of high-frequency hearing in noise. Audiology 1982;21:83-92.  Back to cited text no. 48
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49.Ahmed HO, Dennis JH, Badran O, Ismail M, Ballal SG, Ashoor A, et al. High-frequency (10-18 kHz) hearing thresholds: Reliability, and effects of age and occupational noise exposure. Occup Med (Lond) 2001;51:245-58.  Back to cited text no. 49
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50.Porto MA, Gahyva DL, Lauris JR, Lopes AC. Audiometric evaluation in extended high frequencies of individuals exposed to occupational noise. Pro Fono 2004;16:237-50.  Back to cited text no. 50
    
51.Singh R, Saxena RK, Varshney S. Early detection of noise-induced hearing loss by using ultra-high frequency audiometry. Int J Otorhinolaryngol 2009;10:1-5.  Back to cited text no. 51
    
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53.Henderson E, Testa MA, Hartnick C. Prevalence of noise-induced hearing-threshold shifts and hearing loss among US youths. Pediatrics 2011;127:e39-46.  Back to cited text no. 53
    
54.Harrison RV. Noise-induced hearing loss in children: A ′less than silent′ environmental danger. Paediatr Child Health 2008;13:377-82.  Back to cited text no. 54
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55.Folmer RL, Griest SE, Martin WH. Hearing conservation education programs for children: A review. J Sch Health 2002;72:51-7.  Back to cited text no. 55
    
56.Vogel I, Brug J, van der Ploeg CP, Raat H. Strategies for the prevention of MP3-induced hearing loss among adolescents: Expert opinions from a Delphi study. Pediatrics 2009;123:1257-62.  Back to cited text no. 56
    
57.Weichbold V, Zorowka P. Effects of a hearing protection campaign on the discotheque attendance habits of high-school students. Int J Audiol 2003;42:489-93.  Back to cited text no. 57
    
58.Abraham M, Righetti A, Biassoni EC, Yacci MR, Jiménez JA. Risk behaviors for hearing health in the adolescent stage. In: Richard MC, Lemos V, editors. Summary of Current Research in Psychology and Allied Sciences. 1 st ed. Libertador San Martin: Ediciones CIIPME-Plate Adventist University; 2011. p. 525-43.  Back to cited text no. 58
    
59.Abraham M, Gauchat S, Biassoni EC. Prevention program and promoting hearing health in adolescents from a technical school in the city of Cordoba. An intervention strategy. In: University Extension Secretary, editor. III Forum of University Extension. 1 st ed. Argentina: Editorial National Cordoba University; 2009. CD Room.  Back to cited text no. 59
    
60.Gauchat S, Abraham M, Biassoni EC, Cardoso G, Pavlik M, Mohaded C, et al. Education program for promoting hearing health in adolescents. In: University Extension Secretary, editor. III Forum of University Extension. 1 st ed. Argentina: Editorial National Cordoba University; 2010. CD Room.  Back to cited text no. 60
    

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Correspondence Address:
Dr. Ester C Biassoni
National Technological University, Cordoba Regional Faculty, Argentina, Maestro. M. Lopez esq. Cruz Roja Argentina, 5016 Cordoba
Argentina
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Source of Support: National Agency for Scientifi c and Technologic Promotion, National Technical University and National Scientifi c and Technical Research Council, Argentina., Conflict of Interest: None


DOI: 10.4103/1463-1741.140515

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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