Personal music systems may be hazardous to hearing

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Improvements in digital technology have meant that an increasing number of people are listening to music via personal music systems such as MP3 players and mobile phones for prolonged periods of time. These music systems are increasingly small and lightweight with considerable storage capacity and improved sound quality – which has led to prolonged use at higher volume settings, particularly among young people.

A paper published in The Journal of Laryngology & Otology (JLO) finds, alarmingly, that large proportions of young adults are listening to personal music systems at levels higher than safety levels recommended by regulatory bodies. The study finds that listening to music through personal music systems at high volume through ear phones or ear buds may be potentially hazardous to hearing.

The paper’s co-authors – from the All India Institute of Speech and Hearing in Mysore, South India – recruited 60 participants between the ages of 15 and 30 years old for their study, which looked at regular users of personal music systems and non-users of personal music systems. The researchers also used manikins to measure the output of sound pressure levels of personal music systems.

Supported by India’s Department of Science and Technology, the study found that an alarming proportion of young adults were using personal music systems at levels that could potentially damage their hearing. The study found that people who listened to personal music systems at levels higher than 80 decibels had significantly poorer hearing thresholds in high frequencies when compared to other participants. The preferred range for listening to music among participants was 51 to 98 decibels – while workplace noise regulation in the UK, for example, limits the daily exposure levels to 80 decibels.

The study also found that 33 per cent of participants reached the maximum allowable noise level after listening to music for more than four hours, while 20 per cent reached the limit within one hour – with 30 per cent of used personal music systems at levels higher than the permissible limit.

People who listened to personal music systems at levels higher than 80 decibels also showed significant difficulty in perceiving speech in adverse listening conditions, compared to other participants in the study. The authors suggest that this reduced function may be linked to damage to the cochlear structure.

However, all the participants in the study had normal hearing in the conventional frequency range, the study found.

“Our results suggest that listening to music through personal music systems at higher volume levels (over 80 dB LAeq) may not result in clinically significant hearing loss, yet may cause subtle pre-clinical damage to the auditory system, and over the years such behaviour may be hazardous to hearing,” the authors conclude.

The full paper, published in The Journal of Laryngology & Otology, “Personal music systems and hearing” by U A Kumar and S R Deepashree, can be viewed free of charge until 31 August 2016 here.

More research and regulation needed on e-cigarettes “to protect health of public”

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More and more people around the world are switching to electronic cigarettes – known as ‘e-cigarettes’ – as a substitute for conventional cigarettes. An estimated 2.6 million people in the UK alone are using one of the nearly 500 brands of e-cigarettes available from high street shops, petrol stations and via the internet. And yet little is known about the health risks associated with e-cigarettes, which have been in use since they were invented 13 years ago in China.

The authors of a new article point out that – although e-cigarettes are often marketed as using only vapour and nicotine without the carcinogens such as tar found in conventional cigarettes – there have been various chemical compounds found in e-cigarettes that are “either already known to be carcinogens or may well prove to be carcinogenic in the future”. And since e-cigarettes are currently not regulated, users cannot be certain about which chemicals are found within each product.

The three co-authors – who are all experts in the field of respiratory medicine and otolaryngology from hospitals in England – set out to examine the regulations, trends and health risks associated with e-cigarettes, as well as summarising the evidence about the use of e-cigarettes in smoking cessation.

What they found is that many of the elements identified in e-cigarette aerosols are known to cause respiratory distress and disease.  One 2013 study found, for example, that tin, silver, iron, nickel, aluminium and silicate particles have all been found in e-cigarette aerosols. The same study also found that the concentrations of nine out of eleven elements in e-cigarette aerosols were higher than or equal to the corresponding concentrations found in conventional cigarette smoke.

A more recent 2015 study has confirmed that e-cigarettes contain toxic compounds, such as formaldehyde, nitrosamines and nickel, although these were in much lower concentrations than found in conventional cigarettes.

In addition, the authors report that there is limited evidence to prove whether e-cigarettes are an effective method for stopping tobacco smoking. Although several trials suggest that e-cigarettes may be beneficial to some smokers who are looking to quit or reduce smoking, the authors conclude that there is currently not enough long-term data available on the outcomes of using e-cigarettes as smoking cessation devices. At the moment, no e-cigarettes have been approved for smoking cessation purposes by governmental authorities, according to the authors. However, as a result of the European Commission’s Tobacco Products Directive issued in 2014, the Medicines and Healthcare Products Regulatory Agency (MHRA) in the UK is currently considering regulation of e-cigarettes and other nicotine-containing products.

In the meantime, the authors recommend that professionals should not be advocating the use of e-cigarettes as a smoking cessation tool.

“Regulation of e-cigarettes is necessary to establish a scientific basis on which to judge the effects of their use,” they conclude. In addition, they recommend that adequate research is needed on the long-term health effects of e-cigarettes, “firstly so that the public has current and reliable information as to the potential risks and benefits and secondly so that the health of the public is protected.”

 

The full paper by Miss Nicola Stobbs, Dr Aoife Lillis and Professor Nirmal Kumar is available online in The Journal of Laryngology & Otology (JLO) here.

A looming danger…

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This paper reports on four paediatric patients who presented with a loom band associated foreign body in the nose over a 7-day period at a district general hospital in Scotland. The patients were two three-year old and two four-year old children with either loom bands or the S-shaped hooks in their noses.

There has been a surge in the popularity of loom bands amongst children in recent months. These small rubber bands, which can be woven together to make colourful bracelets and necklaces, have become the world’s most popular toy. Foreign bodies in paediatric nasal and aural cavities are a common presentation to ENT units across the country. Whilst most are removed without incident, foreign bodies in nasal passages represent a potential risk for inhalation, leading to airway obstruction.

Two of the cases resulted in the item being removed with local anaesthetic and forceps, and in one case, forceps without anaesthetic. In the fourth case, the hook was originally visible deep within the nasal passage, but partial inhalation into the posterior nasal passage meant that the hook was no longer visible. Whilst waiting for a senior medical review, the patient was observed to choke.  After examination, it was assumed that the patient had ingested the foreign body and after a short period of observation, the patient was released.

Although the four cases presented were resolved without the need for general anaesthetic, the ever-soaring prevalence and popularity of loom bands necessitates a degree of caution and vigilance from parents, retailers and manufacturers alike.

The authors said, “Foreign body airway obstructions in children are potentially avoidable, life-threatening events. The case series presented reflects a poor public understanding of the complications of inhaled foreign bodies in children and limited hazard advertising by the manufacturers of loom bands. There is a great urgency to rectify this in light of the ever-increasing popularity and availability of loom bands.”

 

 The full paper, published in The Journal of Laryngology & Otology, “Loom bands and young children – a tragedy waiting to happen?” by I R M Bohler, C Douglas and S Ansari, can be viewed free of charge here for a limited period.

International Ear Care day 2014

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The International Ear Care day was the outcome of the Beijing Declaration made during the 1st International Conference on Prevention and Rehabilitation of Hearing Loss in 2007. The date ‘3 March’ was selected due to the similarity of the figures 3.3 with the shape of our ears. The day is observed with a designated theme, decided by WHO in collaboration with its partners, collaborating centres and experts. The ‘day’ provides a unique opportunity to work together to draw the attention of media, policy-makers, administrators, health professionals and the general public towards the cause of hearing loss. By observing this day, we can all help create a global movement, which will compel others to give ear and hearing care the attention it deserves and to persons with hearing loss, their due respect.

The 2014 theme is Ear care can avoid hearing loss. At least half of all cases of hearing loss are avoidable through primary prevention, including healthy ear care practices.

Dr Shelly Chadha, Technical Officer, Prevention of Blindness and Deafness, World Health Organization, Geneva, commented, “In order to raise the profile of ear and hearing care on the global health agenda, all of us: ear and hearing care professionals; nongovernmental organizations; collaborating centres; persons with hearing loss and their caregivers, must be a part of this movement. As members of the health profession, we dedicate ourselves every day to caring for our patients and their wellbeing. By devoting one day to the public health aspect of our chosen field, we can reach many more and be a part of a worldwide effort to raise awareness and resources for ear and hearing care.”

In 2012, WHO released estimates which suggest that 360 million persons across the world live with disabling hearing loss. Amongst persons above 65 years of age, one out of three is reported to have hearing loss, yet less than 3% of persons receive the hearing aids they require.

Despite the fact that two thirds of people with hearing loss live in developing countries, services for hearing care remain elusive where they are most needed. The number of ENT surgeons per million ranges from 0 to 4 in low-income countries as compared to 9-178 in high-income countries. In 18 countries of sub-Saharan Africa, there is an average of less than 1 ENT surgeon per 100 000 persons. Moreover, the current global health priorities for developing countries have yet to pay attention to hearing loss. The overall low level of awareness about ear diseases and hearing loss at all levels within the society adds to the growing burden.

This blog post is based on the Editorial that Dr Chadha wrote for the March issue of The Journal of Laryngology & Otology, the full article can be read free of charge here.

Find out more about the WHO International Ear Care Day here.

Turn down the Volume? An examination of the effects of nightclubs on hearing

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There is a growing body of evidence that suggests excessive noise levels in nightclubs have an adverse effect on hearing, and may ultimately be responsible for noise-induced hearing loss.

A study by researchers at the University of Birmingham found that although students didn’t want to alter their attendance, the majority would rather see noise limits reduced to safe limits, contrary to the widely held preconception that high volume levels in nightclubs are demanded by young people.

The hearing of all employees in the music and entertainment sector is now protected by The Control of Noise at Work Regulations (2005), which require employers to prevent or reduce risks to employees’ hearing in the workplace when exposed to noise levels above 85 dB. However, this law does not apply to members of the public attending nightclubs, as it is presumed they are making an informed decision to attend such venues.

This study investigated the prevalence of symptoms related to noise-induced hearing loss that were experienced by students after attending nightclubs. It also aimed to explore students’ awareness of the association between noise-induced hearing loss and nightclub attendance, and examine their attitudes towards this.

A questionnaire was distributed to students entering or leaving the University of Birmingham Medical School over a 5-day period during March 2012, with a total of 357 individuals completing the questionnaire, with almost half the students attending a nightclub at least once per week.

Of those students surveyed in the present study (excluding those who never attended nightclubs and those with pre-existing hearing problems), 88% had experienced transient tinnitus after attending a nightclub. This finding is important because transient tinnitus can also be a precursor to other noise-induced hearing loss symptoms, including permanent tinnitus, hyperacusis or irreversible hearing loss.

The majority of students in the sample population (90%) were aware that current nightclub noise levels are potentially damaging to hearing. However, most students who attended nightclubs (73%) reported that they would not alter their attendance, despite being told that the noise levels could lead to permanent hearing loss. Nonetheless, 70% of nightclub attendees agreed that noise levels should be limited to volumes that are not damaging to hearing.

Mr Oliver Johnson, one of the paper’s authors, commented. “This is encouraging for policy makers, as noise levels could potentially be lowered below the threshold for hearing damage without nightclub attendance being significantly compromised. The implementation of relevant legislation could therefore potentially reduce the long-term risks of irreversible hearing loss in this young age group without damaging the nightclub industry.”

The study also demonstrated that 87% of students with normal hearing had never received information about noise-induced hearing loss or had earplugs recommended in the nightclub setting. The findings and those of other research groups indicate that young people attending nightclubs are at high risk of noise-induced hearing loss, and it is therefore of the utmost importance that they should be provided with adequate information regarding the potential damage that excessive music levels in nightclubs may cause.

Mr Johnson added, “We believe the current assumption implied by legislation, namely that nightclub attendees are consenting to the risks of hearing damage, is spurious, as the majority of young people in nightclubs are likely to be unaware of these risks.”

The full paper “British university students’ attitudes towards noise-induced hearing loss caused by nightclub attendance” is published in The Journal of Laryngology & Otology and can be read free of charge for a limited time here.

Is the ladette culture resulting in more women with broken noses?

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The word “ladette”, defined by the Oxford Dictionary as “a young woman who behaves in a boisterous, assertive or crude manner and engages in heavy drinking sessions”, and the related culture of alcohol-fuelled anti-social behaviour has been quoted as being on the rise in the UK.

A retrospective study in three district hospitals has shown an 825 per cent increase in females aged 13–20 years attending for nasal fractures from 2002 to 2009.

The study supports the notion that violence amongst young women is increasing with a significant proportion of injuries being caused by non-domestic violence.

A retrospective study was performed in three district UK hospitals (Luton and Dunstable Hospital, The Lister Hospital and the Royal United Bath Hospital), serving a catchment population of approximately 1.5 million.

Operating theatre data for all females who attended hospital for manipulation of a nasal fracture under anaesthesia between January 2002 and December 2009 were retrieved. Case notes of all female patients attending Luton and Dunstable Hospital for assessment of a nasal fracture over a five-year period, from January 2004 to December 2009, were also reviewed, regardless of whether the patients underwent manipulation of their fracture under anaesthesia or not.

From 2002 to 2009, the collected data demonstrated an increase in the number of women presenting with nasal fractures, in all age groups. The greatest increase in incidence was seen in the 13–20 year age group. There were only 4 girls who underwent manipulation under anaesthesia across the 3 sites in 2002, whereas the respective number in 2009 had risen to 33, representing an 825 per cent increase. By comparison, the incidence in males had only risen from 47 to 102 during the same time period, a 217 per cent increase.

Accidental injury was the most common cause of nasal fracture. Falls and occupational accidents seem to play an increasing role in the epidemiology of nasal injuries in women, as they become more exposed to the respective risk factors in a society that considers them stronger and more independent compared with previous decades. Domestic accidental injuries are also frequently reported; a comment on how many of these are truthfully accidental would be purely speculative. Indeed, domestic violence continues to be under-reported by many victims, and was only cited in 2 per cent of the case notes reviewed in the present study. Sport-related injury was also a common cause of nasal trauma in the present study; an overall increase in nasal fractures amongst young women could also be related to an increased participation in sport.

In almost a quarter of cases in the Luton and Dunstable Hospital, nasal injury was the result of non-domestic violence. This type of violence stems from interpersonal conflicts, and its rates have been associated with the consumption of alcohol. Moreover, at least two UK studies from the past decade showed that alcohol consumption was closely associated with a rise in anti-social behaviour, violence and criminality in young girls. In addition, a significant correlation between cheap, readily-available alcohol and violent injury was found in a study involving 58 accident and emergency departments in 10 distinct economic regions of the UK. Therefore, the increased incidence of nasal fractures amongst young women in the present study may, at least in part, be attributed to increasingly violent behaviour amongst young women.

View the full paper “Is there a change in the epidemiology of nasal fractures in females in the UK?” free for a limited time here.

Is Blu-tack as effective at attenuating sound as over-the-counter ear plugs?

ear plugsA new study has revealed that using Blu-tack to protect the ears can be as effective as inserting custom-made, shop-bought earplugs from Boots and Aearo.

Researchers from the University Hospital of South Manchester and the Withington Community Hospital have reported their findings in The Journal of Laryngology & Otology. They conclude that Blu-tack – a non-toxic adhesive putty produced by Bostik since the 1970s – is a ‘comfortable alternative to over-the-counter ear plugs for the attenuation of everyday sound.’

Numerous means of hearing protection are available to prevent the negative physiological and psychological effects that can be caused by the noise we are exposed to on a daily basis. Designed to be ‘affordable, comfortable, and disposable’, they aim to attenuate mid to high frequency sounds by 20-30 dB. They are usually made from foam, putty, wax, and silicone polymers and can be purchased at most pharmacies. Blu-tack can now be counted as an additional option when it comes to defending against noise.

The idea for the investigation came from main author G J Watson who, when using Blu-tack to prevent water from entering the ears following the insertion of ventilation tubes, noticed that it attenuated sound.

Nineteen volunteers participated in the study. They were provided with E-A-Rsoft disposable yellow foam plugs (Aearo), Boots Muffles wax ear plugs, Boots Flight ear plugs, and Blu-tack. Their hearing thresholds were assessed before and after the insertion of the ear plugs at 0.5, 1, 2, 3, 4, 6 and 8 kHz. The results were compared with hearing thresholds after the insertion of Blu-tack.

Volunteers were also asked to assess how easy to insert the ear plugs and Blu-tack were, how comfortable they were, and how much peace of mind they offered.

Blu-tack was not as effective as the ear plugs at attenuating sound at low frequencies, but performed as well as the ear plugs at frequencies over 3 kHz. And, perhaps surprisingly, Blu-tack was rated as significantly more comfortable to wear. Participants found that Blu-tack was as easy to insert as the ear-plugs, and offered them the same peace of mind.

The authors conclude that Blu-tack is

as effective as over-the-counter ear plugs at attenuating frequencies above 3 kHz. It was considered comfortable and safe to use and could therefore be regarded as an alternative option when wishing to attenuate everyday sound.

The full paper is available free for a limited time via the following link:

Journals.cambridge.org/JLO/blutack

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