Similar susceptibility to temporary hearing threshold shifts despite different audiograms in harbor porpoises and harbor seals.

When they are exposed to loud fatiguing sounds in the oceans, marine mammals are susceptible to hearing damage in the form of temporary hearing threshold shifts (TTSs) or permanent hearing threshold shifts. We compared the level-dependent and frequency-dependent susceptibility to TTSs in harbor seals and harbor porpoises, species with different hearing sensitivities in the low- and high-frequency regions. Both species were exposed to 100% duty cycle one-sixth-octave noise bands at frequencies that covered their entire hearing range. In the case of the 6.5 kHz exposure for the harbor seals, a pure tone (continuous wave) was used. TTS was quantified as a function of sound pressure level (SPL) half an octave above the center frequency of the fatiguing sound. The species have different audiograms, but their frequency-specific susceptibility to TTS was more similar. The hearing frequency range in which both species were most susceptible to TTS was 22.5-50 kHz. Furthermore, the frequency ranges were characterized by having similar critical levels (defined as the SPL of the fatiguing sound above which the magnitude of TTS induced as a function of SPL increases more strongly). This standardized between-species comparison indicates that the audiogram is not a good predictor of frequency-dependent susceptibility to TTS.

Dolphin short-term auditory fatigue and self-mitigation.

Auditory brainstem responses (ABRs) were measured at 57 kHz in two dolphins warned of an impending intense tone at 40 kHz. Over the course of testing, the duration of the intense tone was increased from 0.5 to 16 s to determine if changes in ABRs observed after cessation of the intense sound were the result of post-stimulatory auditory fatigue or conditioned hearing attenuation. One dolphin exhibited conditioned hearing attenuation after the warning sound preceding the intense sound, but little evidence of post-stimulatory fatigue after the intense sound. The second dolphin showed no conditioned attenuation before the intense sound, but auditory fatigue afterwards. The fatigue was observed within a few seconds after cessation of the intense tone: i.e., at time scales much shorter than those in previous studies of marine mammal noise-induced threshold shifts, which feature measurements on the order of a few minutes after exposure. The differences observed between the two individuals (less auditory fatigue in the dolphin that exhibited the conditioned attenuation) support the hypothesis that conditioned attenuation is a form of "self-mitigation."

Temporary noise-induced underwater hearing loss in an aquatic turtle (Trachemys scripta elegans).

Noise pollution in aquatic environments can cause hearing loss in noise-exposed animals. We investigated whether exposure to continuous underwater white noise (50-1000 Hz) affects the auditory sensitivity of an aquatic turtle Trachemys scripta elegans (red-eared slider) across 16 noise conditions of differing durations and amplitudes. Sound exposure levels (SELs) ranged between 155 and 193 dB re 1 µPa2 s, and auditory sensitivity was measured at 400 Hz using auditory evoked potential methods. Comparing control and post-exposure thresholds revealed temporary threshold shifts (TTS) in all three individuals, with at least two of the three turtles experiencing TTS at all but the two lowest SELs tested, and shifts up to 40 dB. There were significant positive relationships between shift magnitude and exposure duration, amplitude, and SEL. The mean predicted TTS onset was 160 dB re 1 µPa2 s. There was individual variation in susceptibility to TTS, threshold shift magnitude, and recovery rate, which was non-monotonic and occurred on time scales ranging from < 1 h to > 2 days post-exposure. Recovery rates were generally greater after higher magnitude shifts. Sound levels inducing hearing loss were comparatively low, suggesting aquatic turtles may be more sensitive to underwater noise than previously considered.

Evaluation of kurtosis-corrected sound exposure level as a metric for predicting onset of hearing threshold shifts in harbor porpoises (Phocoena phocoena).

Application of a kurtosis correction to frequency-weighted sound exposure level (SEL) improved predictions of risk of hearing damage in humans and terrestrial mammals for sound exposures with different degrees of impulsiveness. To assess whether kurtosis corrections may lead to improved predictions for marine mammals, corrections were applied to temporary threshold shift (TTS) growth measurements for harbor porpoises (Phocoena phocoena) exposed to different sounds. Kurtosis-corrected frequency-weighted SEL predicted accurately the growth of low levels of TTS (TTS1-4 < 10 dB) for intermittent sounds with short (1-13 s) silence intervals but was not consistent with frequency-weighted SEL data for continuous sound exposures.

Thresholds for noise induced hearing loss in harbor porpoises and phocid seals.

Intense sound sources, such as pile driving, airguns, and military sonars, have the potential to inflict hearing loss in marine mammals and are, therefore, regulated in many countries. The most recent criteria for noise induced hearing loss are based on empirical data collected until 2015 and recommend frequency-weighted and species group-specific thresholds to predict the onset of temporary threshold shift (TTS). Here, evidence made available after 2015 in light of the current criteria for two functional hearing groups is reviewed. For impulsive sounds (from pile driving and air guns), there is strong support for the current threshold for very high frequency cetaceans, including harbor porpoises (Phocoena phocoena). Less strong support also exists for the threshold for phocid seals in water, including harbor seals (Phoca vitulina). For non-impulsive sounds, there is good correspondence between exposure functions and empirical thresholds below 10 kHz for porpoises (applicable to assessment and regulation of military sonars) and between 3 and 16 kHz for seals. Above 10 kHz for porpoises and outside of the range 3-16 kHz for seals, there are substantial differences (up to 35 dB) between the predicted thresholds for TTS and empirical results. These discrepancies call for further studies.

Hair cell synaptic dysfunction, auditory fatigue and thermal sensitivity in otoferlin Ile515Thr mutants.

The multi-C2 domain protein otoferlin is required for hearing and mutated in human deafness. Some OTOF mutations cause a mild elevation of auditory thresholds but strong impairment of speech perception. At elevated body temperature, hearing is lost. Mice homozygous for one of these mutations, OtofI515T/I515T, exhibit a moderate hearing impairment involving enhanced adaptation to continuous or repetitive sound stimulation. In OtofI515T/I515T inner hair cells (IHCs), otoferlin levels are diminished by 65%, and synaptic vesicles are enlarged. Exocytosis during prolonged stimulation is strongly reduced. This indicates that otoferlin is critical for the reformation of properly sized and fusion-competent synaptic vesicles. Moreover, we found sustained exocytosis and sound encoding to scale with the amount of otoferlin at the plasma membrane. We identified a 20 amino acid motif including an RXR motif, presumably present in human but not in mouse otoferlin, which reduces the plasma membrane abundance of Ile515Thr-otoferlin. Together, this likely explains the auditory synaptopathy at normal temperature and the temperature-sensitive deafness in humans carrying the Ile515Thr mutation.

Estimating the effects of pile driving sounds on seals: Pitfalls and possibilities.

Understanding the potential effects of pile driving sounds on marine wildlife is essential for regulating offshore wind developments. Here, tracking data from 24 harbour seals were used to quantify effects and investigate sensitivity to the methods used to predict these. The Aquarius pile driving model was used to model source characteristics and acoustic propagation loss (16 Hz-20 kHz). Predicted cumulative sound exposure levels (SELcums) experienced by each seal were compared to different auditory weighting functions and damage thresholds to estimate temporary (TTS) and permanent (PTS) threshold shift occurrence. Each approach produced markedly different results; however, the most recent criteria established by Southall et al. [(2019) Aquat. Mamm. 45, 125-232] suggests that TTS occurrence was low (17% of seals). Predictions of seal density during pile driving made by Russell et al. [(2016) J. Appl. Ecol. 53, 1642-1652] were compared to distance from the wind farm and predicted single-strike sound exposure levels (SELss) by multiple approaches. Predicted seal density significantly decreased within 25 km or above SELss (averaged across depths and pile installations) of 145 dB re 1 µPa2⋅s. However, there was substantial variation in SELss with depth and installation, and thus in the predicted relationship with seal density. These results highlight uncertainty in estimated effects, which should be considered in future assessments.

Lack of reproducibility of temporary hearing threshold shifts in a harbor porpoise after exposure to repeated airgun sounds.

Noise-induced temporary hearing threshold shift (TTS) was studied in a harbor porpoise exposed to impulsive sounds of scaled-down airguns while both stationary and free-swimming for up to 90 min. In a previous study, ∼4 dB TTS was elicited in this porpoise, but despite 8 dB higher single-shot and cumulative exposure levels (up to 199 dB re 1 µPa2s) in the present study, the porpoise showed no significant TTS at hearing frequencies 2, 4, or 8 kHz. There were no changes in the study animal's audiogram between the studies or significant differences in the fatiguing sound that could explain the difference, but audible and visual cues in the present study may have allowed the porpoise to predict when the fatiguing sounds would be produced. The discrepancy between the studies may have resulted from self-mitigation by the porpoise. Self-mitigation, resulting in reduced hearing sensitivity, can be achieved via changes in the orientation of the head, or via alteration of the hearing threshold by processes in the ear or central nervous system.

Evaluating temporary threshold shift onset levels for impulsive noise in seals.

The auditory effects of single- and multiple-shot impulsive noise exposures were evaluated in a bearded seal (Erignathus barbatus). This study replicated and expanded upon recent work with related species [Reichmuth, Ghoul, Sills, Rouse, and Southall (2016). J. Acoust. Soc. Am. 140, 2646-2658]. Behavioral methods were used to measure hearing sensitivity before and immediately following exposure to underwater noise from a seismic air gun. Hearing was evaluated at 100 Hz-close to the maximum energy in the received pulse, and 400 Hz-the frequency with the highest sensation level. When no evidence of a temporary threshold shift (TTS) was found following single shots at 185 dB re 1 µPa2 s unweighted sound exposure level (SEL) and 207 dB re 1 µPa peak-to-peak sound pressure, the number of exposures was gradually increased from one to ten. Transient shifts in hearing thresholds at 400 Hz were apparent following exposure to four to ten consecutive pulses (cumulative SEL 191-195 dB re 1 µPa2 s; 167-171 dB re 1 µPa2 s with frequency weighting for phocid carnivores in water). Along with these auditory data, the effects of seismic exposures on response time, response bias, and behavior were investigated. This study has implications for predicting TTS onset following impulsive noise exposure in seals.

SAVIOR ICU: sonification and vibrotactile interface for the operating room and intensive care unit.

Alarm fatigue is an issue for healthcare providers in the intensive care unit, and may result from desensitization of overbearing and under-informing alarms. To directly increase the overall identification of medical alarms and potentially contribute to a downstream decrease in the prevalence of alarm fatigue, we propose advancing alarm sonification by combining auditory and tactile stimuli to create a multisensory alarm. Participants completed four trials-two multisensory (auditory and tactile) and two unisensory (auditory). Analysis compared the unisensory trials to the multisensory trials based on the percentage of correctly identified point of change, direction of change and identity of three physiological parameters (indicated by different instruments): heart rate (drums), blood pressure (piano), blood oxygenation (guitar). A repeated-measures of ANOVA yielded a significant improvement in performance for the multisensory group compared to the unisensory group (p < 0.05). Specifically, the multisensory group had better performance in correctly identifying parameter (p < 0.05) and point of change (p < 0.05) compared to the unisensory group. Participants demonstrated a higher accuracy of identification with the use of multisensory alarms. Therefore, multisensory alarms may relieve the auditory burden of the medical environment and increase the overall quality of care and patient safety.

Long-term evidence of noise-induced permanent threshold shift in a harbor seal (Phoca vitulina).

In psychophysical studies of noise-induced hearing loss with marine mammals, exposure conditions are often titrated from levels of no effect to those that induce significant but recoverable loss of auditory sensitivity [temporary threshold shift (TTS)]. To examine TTS from mid-frequency noise, a harbor seal was exposed to a 4.1-kHz underwater tone that was incrementally increased in sound pressure level (SPL) and duration. The seal's hearing was evaluated at the exposure frequency and one-half octave higher (5.8 kHz) to identify the noise parameters associated with TTS onset. No reliable TTS was measured with increasing sound exposure level until the second exposure to a 60-s fatiguing tone of 181 dB re 1 µPa SPL (sound exposure level 199 dB re 1 µPa2s), after which an unexpectedly large threshold shift (>47 dB) was observed. While hearing at 4.1 kHz recovered within 48 h, there was a permanent threshold shift of at least 8 dB at 5.8 kHz. This hearing loss was evident for more than ten years. Furthermore, a residual threshold shift of 11 dB was detected one octave above the tonal exposure, at 8.2 kHz. This hearing loss persisted for more than two years prior to full recovery.

Effect of impact pile driving noise on marine mammals: A comparison of different noise exposure criteria.

Regulators in Europe and in the United States have developed sound exposure criteria. Criteria range from broadband levels to frequency weighted received sound levels. The associated differences in impact assessment results are, however, not yet understood. This uncertainty makes environmental management of transboundary anthropogenic noise challenging and causes confusion for regulators who need to choose appropriate exposure criteria. In the present study, three established exposure criteria frameworks from Germany, Denmark, and the US were used to analyse the effect of impact pile driving at a location in the Baltic Sea on harbor porpoise and harbor seal hearing. The acoustic modeling using MIKE showed that an unmitigated scenario would lead to auditory injury for all three criteria. Despite readily apparent variances in impact ranges among the applied approaches, it was also evident that noise mitigation measures could reduce underwater sound to levels where auditory injuries would be unlikely in most cases. It was concluded that each of the frameworks has its own advantages and disadvantages. Single noise exposure criteria follow the precautionary principle and can be enforced relatively easily, whereas criteria that consider hearing capabilities and animal response movement can improve the accuracy of the assessment if data are available.

What's all that noise-Improving the hospital soundscape.

Hospital noise levels regularly exceed those recommended by the World Health Organization (WHO). It is uncertain whether high noise levels have adverse effects on patient health. High levels of noise increase patient sleep loss, anxiety levels, length of hospital stay, and morbidity rates. Staff conversation and auditory medical alarms are amongst the leading noise producing stimuli, with combinations of stimuli accounting for much of the high noise levels. The Hospital Consumer Assessment of Healthcare Providers and Systems survey shows a slight improvement in overall hospital noise levels in the United States, indicating a minor reduction in noise levels. Alarm ambiguity, alarm masking and inefficient alarm design contributes to a large portion of sounds that exceed the environmental noise level in the hospital. Improving the hospital soundscape can begin by training staff in noise reduction, enforcing noise reduction programs, reworking alarm design and encouraging research to evaluate the relative effects of noise producing stimuli on the hospital soundscape.

False Alarms and Overmonitoring: Major Factors in Alarm Fatigue Among Labor Nurses.

BACKGROUND: Nurses can be exposed to hundreds of alarms during their shift, contributing to alarm fatigue. PURPOSE: The purposes were to explore similarities and differences in perceptions of clinical alarms by labor nurses caring for generally healthy women compared with perceptions of adult intensive care unit (ICU) and neonatal ICU nurses caring for critically ill patients and to seek nurses' suggestions for potential improvements. METHODS: Nurses were asked via focus groups about the utility of clinical alarms from medical devices. RESULTS: There was consensus that false alarms and too many devices generating alarms contributed to alarm fatigue, and most alarms lacked clinical relevance. Nurses identified certain types of alarms that they responded to immediately, but the vast majority of the alarms did not contribute to their clinical assessment or planned nursing care. CONCLUSIONS: Monitoring only those patients who need it and only those physiologic values that are warranted, based on patient condition, may decrease alarm burden.

Effect of pile-driving sounds on harbor seal (Phoca vitulina) hearing.

Seals exposed to intense sounds may suffer hearing loss. After exposure to playbacks of broadband pile-driving sounds, the temporary hearing threshold shift (TTS) of two harbor seals was quantified at 4 and 8 kHz (frequencies of the highest TTS) with a psychoacoustic technique. The pile-driving sounds had: a 127 ms pulse duration, 2760 strikes per h, a 1.3 s inter-pulse interval, a ∼9.5% duty cycle, and an average received single-strike unweighted sound exposure level (SELss) of 151 dB re 1 µPa2s. Exposure durations were 180 and 360 min [cumulative sound exposure level (SELcum): 190 and 193 dB re 1 µPa2s]. Control sessions were conducted under low ambient noise. TTS only occurred after 360 min exposures (mean TTS: seal 02, 1-4 min after sound stopped: 3.9 dB at 4 kHz and 2.4 dB at 8 kHz; seal 01, 12-16 min after sound stopped: 2.8 dB at 4 kHz and 2.6 dB at 8 kHz). Hearing recovered within 60 min post-exposure. The TTSs were small, due to the small amount of sound energy to which the seals were exposed. Biological TTS onset SELcum for the pile-driving sounds used in this study is around 192 dB re 1 µPa2s (for mean received SELss of 151 dB re 1 µPa and a duty cycle of ∼9.5%).

Negative hearing effects of a single course of IV aminoglycoside therapy in cystic fibrosis patients.

OBJECTIVE: Identify hearing effects of a single course of intravenous (IV) aminoglycoside antibiotics (AGs) therapy in adult cystic fibrosis (CF) patients. Determine whether the change is large enough to enable a proof-of-concept study of a new drug preventing AG-associated hearing loss. DESIGN: Retrospective case review of CF patients with sequential audiograms ± an intervening course of IV AG therapy. STUDY SAMPLE: 84 patients with no intervening IV AG treatment, 38 patients undergoing a single course of IV AGs. RESULTS: Using ASHA ototoxicity metrics, 45% of adult CF patients in the Single-IV group met the criteria for ototoxicity compared to 23% of the No-IV patients. Other hearing metrics including the average maximal threshold shift (TS) and average high frequency TS showed highly significant differences between groups. Testing only participants with mild or greater pre-therapy high frequency hearing loss further increased the differences between the two groups by every metric tested. CONCLUSION: Adult CF patients exposed to a single course of IV AGs have significantly greater TS than patients without IV AG exposure. Patients with mild to moderate hearing loss prior to AG-IVs are at increased risk of developing ototoxicity from subsequent parenteral AG therapy.

Effects of Hearing Impairment and Hearing Aid Amplification on Listening Effort: A Systematic Review.

OBJECTIVES: To undertake a systematic review of available evidence on the effect of hearing impairment and hearing aid amplification on listening effort. Two research questions were addressed: Q1) does hearing impairment affect listening effort? and Q2) can hearing aid amplification affect listening effort during speech comprehension? DESIGN: English language articles were identified through systematic searches in PubMed, EMBASE, Cinahl, the Cochrane Library, and PsycINFO from inception to August 2014. References of eligible studies were checked. The Population, Intervention, Control, Outcomes, and Study design strategy was used to create inclusion criteria for relevance. It was not feasible to apply a meta-analysis of the results from comparable studies. For the articles identified as relevant, a quality rating, based on the 2011 Grading of Recommendations Assessment, Development, and Evaluation Working Group guidelines, was carried out to judge the reliability and confidence of the estimated effects. RESULTS: The primary search produced 7017 unique hits using the keywords: hearing aids OR hearing impairment AND listening effort OR perceptual effort OR ease of listening. Of these, 41 articles fulfilled the Population, Intervention, Control, Outcomes, and Study design selection criteria of: experimental work on hearing impairment OR hearing aid technologies AND listening effort OR fatigue during speech perception. The methods applied in those articles were categorized into subjective, behavioral, and physiological assessment of listening effort. For each study, the statistical analysis addressing research question Q1 and/or Q2 was extracted. In seven articles more than one measure of listening effort was provided. Evidence relating to Q1 was provided by 21 articles that reported 41 relevant findings. Evidence relating to Q2 was provided by 27 articles that reported 56 relevant findings. The quality of evidence on both research questions (Q1 and Q2) was very low, according to the Grading of Recommendations Assessment, Development, and Evaluation Working Group guidelines. We tested the statistical evidence across studies with nonparametric tests. The testing revealed only one consistent effect across studies, namely that listening effort was higher for hearing-impaired listeners compared with normal-hearing listeners (Q1) as measured by electroencephalographic measures. For all other studies, the evidence across studies failed to reveal consistent effects on listening effort. CONCLUSION: In summary, we could only identify scientific evidence from physiological measurement methods, suggesting that hearing impairment increases listening effort during speech perception (Q1). There was no scientific, finding across studies indicating that hearing aid amplification decreases listening effort (Q2). In general, there were large differences in the study population, the control groups and conditions, and the outcome measures applied between the studies included in this review. The results of this review indicate that published listening effort studies lack consistency, lack standardization across studies, and have insufficient statistical power. The findings underline the need for a common conceptual framework for listening effort to address the current shortcomings.

Effects of exposure to sonar playback sounds (3.5 - 4.1 kHz) on harbor porpoise (Phocoena phocoena) hearing.

Safety criteria for naval sonar sounds are needed to protect harbor porpoise hearing. Two porpoises were exposed to sequences of AN/SQS-53C sonar playback sounds (3.5-4.1 kHz, without significant harmonics), at a mean received sound pressure level of 142 dB re 1 µPa, with a duty cycle of 96% (almost continuous). Behavioral hearing thresholds at 4 and 5.7 kHz were determined before and after exposure to the fatiguing sound, in order to quantify temporary threshold shifts (TTSs) and hearing recovery. Control sessions were also conducted. Significant mean initial TTS1-4 of 5.2 dB at 4 kHz and 3.1 dB at 5.7 kHz occurred after 30 min exposures (mean received cumulative sound exposure level, SELcum: 175 dB re 1 µPa2s). Hearing thresholds returned to pre-exposure levels within 12 min. Significant mean initial TTS1-4 of 5.5 dB at 4 kHz occurred after 60 min exposures (SELcum: 178 dB re 1 µPa2s). Hearing recovered within 60 min. The SELcum for AN/SQS-53C sonar sounds required to induce 6 dB of TTS 4 min after exposure (the definition of TTS onset) is expected to be between 175 and 180 dB re 1 µPa2s.

Temporary hearing threshold shift in a harbor porpoise (Phocoena phocoena) after exposure to multiple airgun sounds.

In seismic surveys, reflected sounds from airguns are used under water to detect gas and oil below the sea floor. The airguns produce broadband high-amplitude impulsive sounds, which may cause temporary or permanent threshold shifts (TTS or PTS) in cetaceans. The magnitude of the threshold shifts and the hearing frequencies at which they occur depend on factors such as the received cumulative sound exposure level (SELcum), the number of exposures, and the frequency content of the sounds. To quantify TTS caused by airgun exposure and the subsequent hearing recovery, the hearing of a harbor porpoise was tested by means of a psychophysical technique. TTS was observed after exposure to 10 and 20 consecutive shots fired from two airguns simultaneously (SELcum: 188 and 191 dB re 1 µPa2s) with mean shot intervals of around 17 s. Although most of the airgun sounds' energy was below 1 kHz, statistically significant initial TTS1-4 (1-4 min after sound exposure stopped) of ∼4.4 dB occurred only at the hearing frequency 4 kHz, and not at lower hearing frequencies tested (0.5, 1, and 2 kHz). Recovery occurred within 12 min post-exposure. The study indicates that frequency-weighted SELcum is a good predictor for the low levels of TTS observed.

Big brown bats (Eptesicus fuscus) maintain hearing sensitivity after exposure to intense band-limited noise.

Thresholds to short-duration narrowband frequency-modulated (FM) sweeps were measured in six big brown bats (Eptesicus fuscus) in a two-alternative forced choice passive listening task before and after exposure to band-limited noise (lower and upper frequencies between 10 and 50 kHz, 1 h, 116-119 dB sound pressure level root mean square; sound exposure level 152 dB). At recovery time points of 2 and 5 min post-exposure, thresholds varied from -4 to +4 dB from pre-exposure threshold estimates. Thresholds after sham (control) exposures varied from -6 to +2 dB from pre-exposure estimates. The small differences in thresholds after noise and sham exposures support the hypothesis that big brown bats do not experience significant temporary threshold shifts under these experimental conditions. These results confirm earlier findings showing stability of thresholds to broadband FM sweeps at longer recovery times after exposure to broadband noise. Big brown bats may have evolved a lessened susceptibility to noise-induced hearing losses, related to the special demands of echolocation.