[A study on the hearing protection and intervention effects of silicone earplug usage among manufacturing workers].

Objective: To assess the efficacy of silicone earplugs in protecting workers exposed to noise in a typical manufacturing environment, and to provide training interventions for workers who do not achieve the anticipated noise reduction levels, as well as examining the spectral characteristics of earplug attenuation. Methods: From June to August 2022, a total of 294 noise-exposed workers in two manufacturing enterprises equipped with the same type of earplug were studied by cluster sampling method, by conducting questionnaire surveys, collecting data, fitting tests, and providing trainings, the current noise exposure levels of workers in the industry as well as the perception about the earplug were understood. Additionally, the attenuation before and after intervention in workplace were measured, the spectral characteristics of noise reduction were were described and compared. Results: The percentage of workers with Personal Attenuation Rating (PAR) of 0 is 32.7% (96/294), and the baseline pass rates are all below 60%. There were no significant differences in pass rates based on gender, age, noise exposure, education level, or cognition of earplug effectiveness. After adjusting the way that earplugs are worn or changing the type of earplugs, all workers were able to meet their noise reduction requirements. The median PAR improvement for both companies is above 10 dB. The noise attenuation of the earplug vary with frequency, with lower attenuation at 4 000 Hz and higher attenuation at 8 000 Hz, showing some deviation from the nominal values. Conclusion: The difference between the actual sound attenuation value of earplugs and the nominal value is related to the noise frequency. When using silicone earplugs, attention should be paid to the spectral composition of the noise in the workplace.

A Scoping Review on Occupational Noise Mitigation Strategies and Recommendations for Sustainable Ship Operations.

Environmental and occupational noise has the potential to result in health risks. The presence of high noise levels aboard ships can cause substantial hazards that affect the well-being of those employed in the maritime industry. The study and implementation of occupational noise reduction aboard ships are of the highest priority for ensuring the well-being of marine workers, compliance with regulatory standards, protection of the environment, and improvement of overall operational efficiency and safety within the maritime sector. A scoping study was conducted to collect and summarize the existing scientific literature about approaches to preventing occupational noise in vessel operations. We searched electronic databases for papers published up to June 2024. Initially, 94 articles were identified for screening, and the present research produced 16 studies, which were finally analyzed. Resultantly, noise control may begin with elimination, substitution, engineering, administrative, and hearing protection (ear plugs or muffs). Noise control innovation would be started with engineering techniques. Hearing protection devices (HPDs) could be used to reduce noise and as an instrument of communication between sailors. More research needs to be carried out in order to find the best ways for maritime vessels to reduce noise at work and to see how well they work in lowering the risks that come with noise for workers on board.

Earmuff performance in the presence of high-level impulse from a recoilless weapon firing in a confined space.

A noise attenuation performance test was conducted on earmuffs using a recoilless weapon launch platform in a confined space, along with two acoustic test fixtures (ATFs). The overpressure at the ATF's effective tympanic membrane comprised direct sound at 185 dB sound pressure level (SPL) and reflected sound at 179 dB SPL. Wearing earmuffs reduced these peaks to 162 dB SPL and 169 dB SPL, respectively. The reflected sound from walls was defined as delayed sound. An analytical model for earmuff noise attenuation simulated their effectiveness. The simulation revealed that when the earmuffs attenuated delayed sound, the acoustic impedance of acoustic leakage and the acoustic impedance of the earmuff material decreased by 96% and 50%, respectively. The negative overpressure zone between direct and delayed sound decreased the earmuffs' fit against the ATF. Additionally, the enclosed volume between the earmuff and the ear canal decreased by 12%. After the installation of bandages on the earmuffs, the overpressure peak of delayed sound was reduced by 5 dB. Furthermore, the acoustic impedance of the earmuff's sound leakage path and the acoustic impedance of the earmuff material deformation path increased by 100% and 809%, respectively.

Oxidative Stress Assessment of Noise Exposure in the Workers Using Hearing Protection in a Pressing Industry.

BACKGROUND AND OBJECTIVE: Exposure to noise by generation of free radicals causes oxidative stress in body. The aim of this study was the evaluation of oxidative stress in workers who have used hearing protection devices during working time. MATERIAL AND METHOD: Pressing workers (n=24) of a home appliance industry were studied using hearing protection devices to reduce noise exposure. Twenty two office staff (without exposure to noise) were considered as a control group. Two groups were matched for age, work experience and smoking. Exposure to noise was measured by dosimeter method at workstations. By obtaining 3 ml blood sample, Malondialdehyde levels, Thiol groups and total antioxidant capacity were evaluated in all subjects. RESULTS: Exposure to sound pressure level in pressing workers by considering the noise reduction factor of the earplug was observed in 77.65 dB with minimum 75.1 dB and Maximum 81.22 dB. Plasma thiol groups (0.076 (0.041-0.119) vs (0.110 (0.076-0.197), mmol/l P =0.0001) and total antioxidant capacity (361.33± 54.65 vs 414.14± 96.82, µmol/ml P = 0.026) in pressing workers significantly decreased than control group. Pearson correlation showed significant results between exposure to noise and oxidative stress parameters. CONCLUSION: Exposure to noise wave cause oxidative stress in different site of body. Oxidative stress is an intermediate way for different disease due to noise exposure. Reducing of noise exposure by earplug in pressing workers is not efficient protection for oxidative stress generation. Therefore, hearing protection devices are not a barrier to the harmful effects of noise in occupational exposure.

3D finite element modeling of earplug-induced occlusion effect in the human ear.

Poor utilization of earplugs among military personnel may be due to discomfort caused by the occlusion effect (OE). The OE occurs when an earplug occludes the ear canal, thereby changing bone conduction (BC) hearing and amplifying physiological noises from the wearer. There is a need to understand and reduce the OE in the human ear. A 3D finite element model of the human ear including a 3-chambered spiral cochlea was employed to simulate the OE caused by foam and aerogel earplugs. 90 dB sound pressure was applied at the ear canal entrance and BC sound was applied as vibration of the canal bony wall. The model reported the ear canal pressure and the displacements of the stapes footplate and cochlear basilar membrane with and without earplugs. Without BC stimulation, the foam earplug showed a greater pressure attenuation than the aerogel earplug. However, the foam earplug results were more affected by BC stimulation, with a maximum sound pressure increase of 34 dB, compared to the 21.0 dB increase with the aerogel earplug. The aerogel earplug's lower OE demonstrates its promise as an earplug material. Future work with this model will examine BC sound transmission in the cochlea.

Effect of Wearing Noise-Canceling Headphones on Delivery Process in Natural Childbirth Puerperae: A Single-Center Study.

OBJECTIVE: To investigate the effect of incorporating noise-canceling headphones into the delivery process for natural childbirth puerperae. METHODS: We conducted a retrospective analysis of clinical data encompassing natural childbirth puerperae in the People's Hospital of Suzhou New District from January 2021 to February 2023. The implementation of routine noise reduction management was done from January 2021 to January 2022. During this interval, 69 natural childbirth puerperae were selected as subjects, with 7 excluded, resulting in 62 participants constituting the reference group. Subsequently, noise-canceling headphones were distributed to natural childbirth puerperae from February 2022 to February 2023. In this phase, 66 subjects were selected, and 6 were excluded, resulting in 60 participants forming the observation group. Following admission, both groups underwent corresponding nursing management. Emotional states, pain levels, and various indicators were systematically collected and meticulously compared. RESULTS: The observation group exhibited significantly lower Hamilton Anxiety Rating Scale scores than the reference group before delivery and during the first stage of labor (P < 0.05). The observation group demonstrated significantly lower visual analog scale scores and substance P, nitric oxide, and prostaglandin E2 levels than the reference group during the first stage of labor (P < 0.001). During the second stage of labor, the visual analog) scale scores were significantly lower in the observation group than in the reference group (P < 0.05). The durations of first and second labor stages were significantly shorter in the observation group than in the reference group (P < 0.05). No significant difference existed in Apgar scores between the two groups (P > 0.05). CONCLUSION: The utilization of noise-canceling headphones emerges as an effective intervention, alleviating anxiety, reducing pain during T1, and abbreviating total labor time in natural childbirth puerperae, suggesting its substantial clinical application value and potential as a beneficial addition to maternity care practices.

Music to Define a Generation: Factors Associated With Hearing Protection Use at Music Venues.

OBJECTIVES: Excessive noise levels in music venues can negatively impact long-term hearing health. We investigated the prevalence, characteristics, and factors associated with hearing protection use among music event attendees. STUDY DESIGN: Cross-sectional cohort. METHODS: Adult participants (2,352) from online music forums completed a questionnaire assessing attendance at music events, hearing protection (HP) usage, type, and frequency, along with history of hearing-related symptoms and medical history. Primary outcome was defined as HP use at music venues. Data were characterized using descriptive statistics, paired t tests, and Pearson's chi-squared tests. Multivariable regression analysis elicited factors associated with any and regular HP use. RESULTS: Our 2,352 respondents were primarily male (61.3%) and on average 28.7 years old (SD = 7.0). Of the respondents, 60.6% reported using HP, and 33.2% reported regular use; high-fidelity earplugs were the most used HP type (57.5%). HP use was associated with significantly fewer reports of negative hearing-related symptoms. In a multivariable regression model, factors associated with less likelihood of HP use included being female (vs male, OR = 0.74, CI = [0.55-0.98]), less concern about effects on hearing (OR = 0.53, CI = [0.45-0.61]), and pop music event attendance (vs EDM, OR = 0.40, CI = [0.22-0.72]). Increased attendance frequency in the past year was associated with higher likelihood of regular HP use (OR = 1.07, CI = [1.04-1.09]). Decreased attendance duration was associated with decreased likelihood (OR = 0.09, CI = [0.03-0.33]). CONCLUSION: HP use prevalence was high, while frequent use remained low. HP use was significantly associated with reduced hearing-related symptoms. Demographic factors, otologic symp-tomology, and attendance-related characteristics were associated with HP use. These findings may guide interventions to increase adoption at music venues. LEVEL OF EVIDENCE: 4.

Defining the Concept of Acoustic Neuroprotection in the Neonate: A Concept Analysis.

BACKGROUND: It has long been understood and acknowledged that the Neonatal Intensive Care Unit (NICU) environment and the transport environments are extremely loud, with both long- and short-term sequelae to the neonate, being well over the recommended amount of noise by the American Academy of Pediatrics (AAP). This problem has yet to be properly addressed. The purpose of this manuscript is to define and explain the concept of acoustic neuroprotection. While we cannot change the internal structures of the neonates' auditory system, we could change the acoustics of the environment to be support neuroprotection of these sensitive patients. EVIDENCE ACQUISITION: Walker and Avant's concept analysis steps were followed to create and define the idea of acoustic neuroprotection, as it has not had a definition before. A total of 45 articles from multiple search engines were chosen. A combination of 2 concepts were used: acoustic protection and neurodevelopmental protection/support. The search was expanded past 20 years for lack of research and importance of seminal works. RESULTS: To achieve acoustic neuroprotection, a neonate should not be exposed to sound greater than 45 decibels (dBa) for longer than 10 s, and exposure to sound above 80 dBa should never occur. Appropriate interventions need to include supporting the neurodevelopment of the neonate through therapeutic sound, while decreasing the amount of toxic noise exposure to safe levels. IMPLICATIONS FOR PRACTICE AND RESEARCH: By further understanding and having a quantifiable goal of acoustic neuroprotection for neonates, neonatal clinicians can work together to create new interventions for how to better protect and support the care of our tiniest patients.

Counseling Protocol for a Transitional Intervention for Debilitating Hyperacusis.

INTRODUCTION: This clinical focus article describes a structured counseling protocol for use with protected sound management and therapeutic sound in a transitional intervention for debilitating hyperacusis. The counseling protocol and its associated visual aids are crafted as a teaching tool to educate affected individuals about hyperacusis and encourage their acceptance of a transitional intervention. DESCRIPTION OF COUNSELING COMPONENTS: The counseling protocol includes five components. First, the patient's audiometric results are reviewed with the patient, and the transitional intervention is introduced. An overview of peripheral auditory structures and central neural pathways and the concept of central gain are covered in the second and third components. Maladaptive hyper-gain processes within the auditory neural pathways, which underlie the hyperacusis condition, and associated connections with nonauditory processes responsible for negative reactions to hyperacusis are covered in the fourth component. Detrimental effects from misused hearing protection devices (HPDs) and the necessity to wean the patient from overuse of HPDs are also discussed. In the fifth component, the importance of therapeutic sound is introduced as a tool to downregulate hyper-gain activity within the auditory pathways; its implementation in uncontrolled and controlled sound environments is described. It is explained that, over the course of the transitional intervention, recalibration of the hyper-gain processes will be ongoing, leading to restoration of normal homeostasis within the auditory pathways. In turn, associated activation of reactive nonauditory processes, which contribute to hyperacusis-related distress, will be reduced or eliminated. As recalibration progresses, there will be less need for protected sound management and sound therapy. Sound tolerance will improve, hyperacusis will subside, and daily activities in typical healthy sound environments will again become routine. RESULTS AND CONCLUSION: The combination of counseling with protected sound management and therapeutic sound is highlighted in companion reports, including a summary of the outcomes of a successful trial of the transitional intervention.

Hearing protection field attenuation estimation systems and associated training for reducing workers' exposure to noise.

BACKGROUND: Global Burden of Disease studies identify hearing loss as the third leading cause of years lived with a disability. Their estimates point to large societal and individual costs from unaddressed hearing difficulties. Workplace noise is an important modifiable risk factor; if addressed, it could significantly reduce the global burden of disease. In practice, providing hearing protection devices (HPDs) is the most common intervention to reduce noise exposure at work. However, lack of fit of HPDs, especially earplugs, can greatly limit their effectiveness. This may be the case for 40% of users. Testing the fit and providing instructions to improve noise attenuation might be effective. In the past two decades, hearing protection fit-test systems have been developed and evaluated in the field. They are called field attenuation estimation systems. They measure the noise attenuation obtained by individual workers using HPDs. If there is a lack of fit, instruction for better fit is provided, and may lead to better noise attenuation obtained by HPDs. OBJECTIVES: To assess: (1) the effects of field attenuation estimation systems and associated training on the noise attenuation obtained by HPDs compared to no instruction or to less instruction in workers exposed to noise; and (2) whether these interventions promote adherence to HPD use. SEARCH METHODS: We used CENTRAL, MEDLINE, five other databases, and two trial registers, together with reference checking, citation searching, and contact with study authors to identify studies. We imposed no language or date restrictions. The latest search date was February 2024. SELECTION CRITERIA: We included randomised controlled trials (RCTs), cluster-RCTs, controlled before-after studies (CBAs), and interrupted time-series studies (ITSs) exploring HPD fit testing in workers exposed to noise levels of more than 80 A-weighted decibels (or dBA) who use hearing protection devices. The unit 'dBA' reports on the use of a frequency-weighting filter to adjust sound measurement results to better reflect how human ears process sound. The outcome noise attenuation had to be measured either as a personal attenuation rating (PAR), PAR pass rate, or both. PAR pass rate is the percentage of workers who passed a pre-established level of sufficient attenuation from their HPDs, identified on the basis of their individual noise exposure. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study eligibility, risk of bias, and extracted data. We categorised interventions as fit testing of HPDs with instructions at different levels (no instructions, simple instructions, and extensive instructions). MAIN RESULTS: We included three RCTs (756 participants). We did not find any studies that examined whether fit testing and training contributed to hearing protector use, nor any studies that examined whether age, gender, or HPD experience influenced attenuation. We would have included any adverse effects if mentioned by the trial authors, but none reported them. None of the included studies blinded participants; two studies blinded those who delivered the intervention. Effects of fit testing of HPDs with instructions (simple or extensive) versus fit testing of HPDs without instructions Testing the fit of foam and premoulded earplugs accompanied by simple instructions probably does not improve their noise attenuation in the short term after the test (1-month follow-up: mean difference (MD) 1.62 decibels (dB), 95% confidence interval (CI) -0.93 to 4.17; 1 study, 209 participants; 4-month follow-up: MD 0.40 dB, 95% CI -2.28 to 3.08; 1 study, 197 participants; both moderate-certainty evidence). The intervention probably does not improve noise attenuation in the long term (MD 0.15 dB, 95% CI -3.44 to 3.74; 1 study, 103 participants; moderate-certainty evidence). Fit testing of premoulded earplugs with extensive instructions on the fit of the earplugs may improve their noise attenuation at the immediate retest when compared to fit testing without instructions (MD 8.34 dB, 95% CI 7.32 to 9.36; 1 study, 100 participants; low-certainty evidence). Effects of fit testing of HPDs with extensive instructions versus fit testing of HPDs with simple instructions Fit testing of foam earplugs with extensive instructions probably improves their attenuation (MD 8.62 dB, 95% CI 6.31 to 10.93; 1 study, 321 participants; moderate-certainty evidence) and also the pass rate of sufficient attenuation (risk ratio (RR) 1.75, 95% CI 1.44 to 2.11; 1 study, 321 participants; moderate-certainty evidence) when compared to fit testing with simple instructions immediately after the test. This is significant because every 3 dB decrease in noise exposure level halves the sound energy entering the ear. No RCTs reported on the long-term effectiveness of the HPD fit testing with extensive instructions. AUTHORS' CONCLUSIONS: HPD fit testing accompanied by simple instructions probably does not improve noise attenuation from foam and premoulded earplugs. Testing the fit of foam and premoulded earplugs with extensive instructions probably improves attenuation and PAR pass rate immediately after the test. The effects of fit testing associated with training to improve attenuation may vary with types of HPDs and training methods. Better-designed trials with larger sample sizes are required to increase the certainty of the evidence.

Noise or sound management in the neonatal intensive care unit for preterm or very low birth weight infants.

BACKGROUND: Infants in the neonatal intensive care unit (NICU) are subjected to different types of stress, including sounds of high intensity. The sound levels in NICUs often exceed the maximum acceptable level recommended by the American Academy of Pediatrics, which is 45 decibels (dB). Hearing impairment is diagnosed in 2% to 10% of preterm infants compared to only 0.1% of the general paediatric population. Bringing sound levels under 45 dB can be achieved by lowering the sound levels in an entire unit; by treating the infant in a section of a NICU, in a 'private' room, or in incubators in which the sound levels are controlled; or by reducing sound levels at the individual level using earmuffs or earplugs. By lowering sound levels, the resulting stress can be diminished, thereby promoting growth and reducing adverse neonatal outcomes. This review is an update of one originally published in 2015 and first updated in 2020. OBJECTIVES: To determine the benefits and harms of sound reduction on the growth and long-term neurodevelopmental outcomes of neonates. SEARCH METHODS: We used standard, extensive Cochrane search methods. On 21 and 22 August 2023, a Cochrane Information Specialist searched CENTRAL, PubMed, Embase, two other databases, two trials registers, and grey literature via Google Scholar and conference abstracts from Pediatric Academic Societies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) or quasi-RCTs in preterm infants (less than 32 weeks' postmenstrual age (PMA) or less than 1500 g birth weight) cared for in the resuscitation area, during transport, or once admitted to a NICU or stepdown unit. We specified three types of intervention: 1) intervention at the unit level (i.e. the entire neonatal department), 2) at the section or room level, or 3) at the individual level (e.g. hearing protection). DATA COLLECTION AND ANALYSIS: We used the standardised review methods of Cochrane Neonatal to assess the risk of bias in the studies. We used the risk ratio (RR) and risk difference (RD), with their 95% confidence intervals (CIs), for dichotomous data. We used the mean difference (MD) for continuous data. Our primary outcome was major neurodevelopmental disability. We used GRADE to assess the certainty of the evidence. MAIN RESULTS: We included one RCT, which enroled 34 newborn infants randomised to the use of silicone earplugs versus no earplugs for hearing protection. It was a single-centre study conducted at the University of Texas Medical School in Houston, Texas, USA. Earplugs were positioned at the time of randomisation and worn continuously until the infants were 35 weeks' postmenstrual age (PMA) or discharged (whichever came first). Newborns in the control group received standard care. The evidence is very uncertain about the effects of silicone earplugs on the following outcomes. • Cerebral palsy (RR 3.00, 95% CI 0.15 to 61.74)and Mental Developmental Index (MDI) (Bayley II) at 18 to 22 months' corrected age (MD 14.00, 95% CI 3.13 to 24.87); no other indicators of major neurodevelopmental disability were reported. • Normal auditory functioning at discharge (RR 1.65, 95% CI 0.93 to 2.94) • All-cause mortality during hospital stay (RR 2.07, 95% CI 0.64 to 6.70; RD 0.20, 95% CI -0.09 to 0.50) • Weight (kg) at 18 to 22 months' corrected age (MD 0.31, 95% CI -1.53 to 2.16) • Height (cm) at 18 to 22 months' corrected age (MD 2.70, 95% CI -3.13 to 8.53) • Days of assisted ventilation (MD -1.44, 95% CI -23.29 to 20.41) • Days of initial hospitalisation (MD 1.36, 95% CI -31.03 to 33.75) For all outcomes, we judged the certainty of evidence as very low. We identified one ongoing RCT that will compare the effects of reduced noise levels and cycled light on visual and neural development in preterm infants. AUTHORS' CONCLUSIONS: No studies evaluated interventions to reduce sound levels below 45 dB across the whole neonatal unit or in a room within it. We found only one study that evaluated the benefits of sound reduction in the neonatal intensive care unit for hearing protection in preterm infants. The study compared the use of silicone earplugs versus no earplugs in newborns of very low birth weight (less than 1500 g). Considering the very small sample size, imprecise results, and high risk of attrition bias, the evidence based on this research is very uncertain and no conclusions can be drawn. As there is a lack of evidence to inform healthcare or policy decisions, large, well designed, well conducted, and fully reported RCTs that analyse different aspects of noise reduction in NICUs are needed. They should report both short- and long-term outcomes.

Application of Noise Reduction Earplugs in Patients undergoing Total Knee Arthroplasty: A Retrospective Study.

BACKGROUND: Patients undergoing total knee arthroplasty (TKA) need to tolerate the effects of noise. MATERIALS AND METHODS: This study retrospectively analyzed the clinical data of 167 TKA patients at The Affiliated Hospital of Southwest Medical University from April 2019 to April 2021. A total of 154 patients who met inclusion criteria were divided into the conventional noise reduction management group (CMG) and the noise reduction earplug group (EPG), following different management schemes. The CMG received routine noise reduction management after surgery, while the EPG used noise reduction earplugs based on the CMG. The clinical indexes of the two groups were compared. RESULTS: In this study, 79 patients were included in the CMG, and 75 patients were included in the EPG. The results showed that the Pittsburgh Sleep Quality Index (PSQI) scores of both groups 2 weeks after surgery were significantly lower than those before management (ZEPG = 5.995, ZCMG = 4.109, all P < 0.001), and the EPG exhibited a significantly lower PSQI score than the CMG (Z = -2.442, P < 0.05). Two weeks after surgery, the EPG had significantly lower levels of systolic blood pressure (ZSBP = -4.303) and diastolic blood pressure (ZDBP = -3.115), as well as lower scores on the Hospital Anxiety and Depression Scale-Anxiety (HADS-A; ZHADS-A = -7.140) and Hospital Anxiety and Depression Scale-Depression (HADS-D; ZHADS-D = -4.545) compared to the CMG (all P < 0.05). In addition, no significant correlation existed between the duration of wearing earplugs and the HADS-A and HADS-D scores (r = -0.201, r = -0.002, P > 0.05). CONCLUSION: Noise reduction earplugs can improve sleep quality and regulate negative emotions of patients undergoing TKA treatment through a complex mechanism involving noise, which is beneficial to the prognosis of the disease.

Quantification of suppressor effects on breech and action noise from AR-15 pattern firearms and its implications for the protection of human hearing.

Noise from firearms is well known to be harmful to human hearing. This problem has been addressed by various military units through the use of muzzle suppressors. However, as suppressor technology has advanced, shooters report hearing the mechanical action of gas-operated semi-automatic rifles (ArmaLite Rifle Model 15 style aka AR-15) as being louder than the suppressed muzzle noise. This study aims to evaluate if harmful noise is present in the shooter's ear, even when impulse noise emanating from the muzzle is suppressed. To characterize the impulse noise of the firearm action caused by the reciprocation of the bolt carrier group (BCG) and subsequent impact when it returns to battery (the forward locked position), the muzzle of a rifle was placed through a constructed plywood wall, and the noise of the action/breech was measured independently from the muzzle noise. This research finds that the impact of the BCG returning to battery (132 dBZ) has the potential to be harmful to the shooter's hearing even when the noise from the muzzle is effectively suppressed.

The influencing factors of hearing protection device usage among noise-exposed workers in Guangdong Province: a structural equation modeling-based survey.

BACKGROUND: There are numerous complex barriers and facilitators to continuously wearing hearing protection devices (HPDs) for noise-exposed workers. Therefore, the present study aimed to investigate the relationship between HPD wearing behavior and hearing protection knowledge and attitude, HPD wearing comfort, and work-related factors. METHOD: A cross-sectional study was conducted with 524 noise-exposed workers in manufacturing enterprises in Guangdong Province, China. Data were collected on hearing protection knowledge and attitudes, HPD wearing comfort and behavior, and work-related factors through a questionnaire. Using structural equation modeling (SEM), we tested the association among the study variables. RESULTS: Among the total workers, 69.47% wore HPD continuously, and the attitudes of hearing protection (26.17 ± 2.958) and total HPD wearing comfort (60.13 ± 8.924) were satisfactory, while hearing protection knowledge (3.54 ± 1.552) was not enough. SEM revealed that hearing protection knowledge had direct effects on attitudes (ß = 0.333, p < 0.01) and HPD wearing behavior (ß = 0.239, p < 0.01), and the direct effect of total HPD wearing comfort on behavior was ß = 0.157 (p < 0.01). The direct effect also existed between work shifts and behavior (ß=-0.107, p < 0.05). Indirect relationships mainly existed between other work-related factors, hearing protection attitudes, and HPD wearing behavior through knowledge. Meanwhile, work operation had a direct and negative effect on attitudes (ß=-0.146, p < 0.05), and it can also indirectly and positively affect attitudes through knowledge (ß = 0.08, p < 0.05). CONCLUSION: The behavior of wearing HPD was influenced by hearing protection knowledge, comfort in wearing HPD, and work-related factors. The results showed that to improve the compliance of noise-exposed workers wearing HPD continuously when exposed to noise, the HPD wearing comfort and work-related factors must be taken into consideration. In addition, we evaluated HPD wearing comfort in physical and functional dimensions, and this study initially verified the availability of the questionnaire scale of HPD wearing comfort.

[Study on the fit testing for the workers wearing hearing protection device in machinery manufacturing enterprises].

Objective: To investigate the occupational noise hazards in five machinery manufacturing enterprises, and to evaluate the individual noise reduction values and influencing factors of workers wearing hearing protection device (HPD) by individual fit testing. Methods: From November 2021 to January 2022, 5 machinery manufacturing enterprises in Bao'an District of Shenzhen were selected to conduct an occupational health survey to understand the noise exposure level of workers. The 3MTM E-A-RfitTM fitness test system was used to test the baseline individual sound attenuation value level (PAR) of the daily wear of the ear protecters for 485 workers in typical noise working positions. Workers whose PAR values could not meet the requirements of noise reduction at work were instructed to wear and repeated tests were conducted. PAR results of the workers before and after the intervention were collected and analyzed. Results: The noise workers who received the suitability test were mainly distributed in 24 types of work, the job noise exposure level was 80.2 dB (A) ~ 95.0 dB (A), and the job noise excess rate was 52.5% (138/263). The median baseline PAR [M (Q(1), Q(3)) ] for 485 workers was 6.0 (0.0, 14.0) dB. The baseline PAR of male workers, those with more than 15 years of working experience, those with more than 15 years of using ear guards, those who considered ear guards comfortable to wear, those with college degree or above, and those exposed to noise level 90 dB (A) were higher, and the difference was statistically significant (P<0.05). A total of 275 workers (56.7%) did not pass the baseline PAR test, and there was no statistically significant difference in the intervention rate of workers in different noise groups (P>0.05). PAR in subjects who did not pass baseline after intervention increased from 0.0 (0.0, 3.0) dB to 15.0 (12.0, 18.2) dB. Conclusion: The workplace noise hazard of machinery manufacturing enterprises is serious, and there is a great difference between the baseline PAR and the nominal value of the hearing guard worn by the noise exposed workers. The intervention measures can effectively improve the protective effect of wearing ear protectors.

Strategies of Hearing Preservation With Military Personnel: A Scoping Review.

PURPOSE: The purpose of this study was to map the strategies used in hearing health education with military personnel during the Hearing Preservation Program (HPP). METHOD: This study is a scoping review, with electronic searches conducted in online databases and gray literature: Latin American and Caribbean Literature in Health Sciences, PubMed/Medline, Scopus, Web of Science, ASHAWire, Google Scholar, and ProQuest Dissertation & Theses. Only studies describing, analyzing, or evaluating the application of the HPP to active duty or training military personnel were included. RESULTS: A total of 3,478 references were retrieved, and 12 studies met the inclusion criteria. The strategies were classified into five categories: focus group aimed at exploring knowledge and perceptions regarding hearing health (five studies), training on the proper fitting of hearing protection devices (four studies), the utilization of audiovisual materials (seven studies), questionnaires administrated before and after educational intervention (five studies), and feedback survey concerning the implemented hearing health education (three studies). CONCLUSION: There are five strategies that aimed at assessing knowledge and attitudes, improving hearing health education, facilitating information access, and evaluating the applied actions. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25219589.

Training to Improve Spatial Hearing and Situation Awareness when Wearing Hearing Protection.

INTRODUCTION: Hearing protection devices (HPDs) are standard personal protective equipment in military settings, but many service members may choose to not use HPDs because they impair spatial hearing and situation awareness. In an effort to reduce barriers to compliance by improving situation awareness while wearing HPDs, this study investigated whether brief training could counteract spatial hearing deficits when wearing HPDs. Participant's ability to correctly apply the HPDs across days was also examined. MATERIALS AND METHODS: Young adults were randomly assigned to one of two groups: training or control (n = 25/group). Participants in each group performed a spatial hearing task while wearing HPDs and in an open ear condition without HPDs. Individual targets were battlefield sounds or white noise presented from a speaker array that surrounded the participant in the horizontal plane. After presentation of each target sound, the participant then controlled a white noise "auditory pointer," which they moved to the perceived location of the target. The two primary measures were the percent of trials with very large errors (> 45°), which were usually due to confusing front and back locations, and absolute localization, which is the difference between the pointer location and the true sound location. Both groups were tested on Days 1 (baseline) and 5 (post-test). On Days 2 to 4, the training group wore HPDs while receiving auditory and visual feedback after each trial. RESULTS: Across all participants on Day 1, wearing HPDs increased the frequency of very large errors by about 3× and impaired localization by about 40%, relative to the open ear condition. When comparing performance at baseline (Day 1) and post-training Day 5, the training group with HPDs had significant reductions in very large errors and improved absolute localization (P values < .001). The training group also had significant improvements from Days 1 to 5 in the open ear condition. When the control group wore HPDs, there were also significant improvements from Days 1 to 5 (fewer very large errors and better localization), with smaller effect sizes vs. the training group. Controls did not have significant improvement in the open ear condition, but had similar trends. Most participants consistently applied the HPDs, but a subset of ∼20% frequently failed to achieve the criterion attenuation of 15 dB (over 0.25-4.0 kHz) in both ears. CONCLUSIONS: These findings show that simple, relatively brief practice and training can substantially reduce HPD impairments on spatial hearing and situation awareness. The gains from training and practice can inform the development of relatively simple, brief methods to reduce HPD spatial hearing impairments, potentially leading to increased HPD compliance. Longitudinal data show that a subset of participants would not have received the full benefit of hearing protection because of improper application of the HPDs.

The effects of eye masks and earplugs on sleep quality, anxiety, fear, and vital signs in patients in an intensive care unit: A randomised controlled study.

In intensive care units, environmental factors like loud noises and bright lights can cause fear, anxiety, changes in vital signs, and sleep disturbances. The aim of this study was to find out how using earplugs and eye masks during the night affected sleep quality, anxiety, fear, and vital signs of patients in an intensive care unit. A total of 70 patients, 35 in the intervention and 35 in the control group, were included in this randomised controlled study. While the patients in the intervention group were provided with earplugs and eye masks for 3 nights in addition to their routine care, only routine care was given to the patients in the control group. The 'Introductory Information Form', 'Visual Analogue Scale-Fear (VAS-F)', 'Visual Analogue Scale-Anxiety (VAS-A)', 'Vital Signs Monitoring Form', and 'Richards-Campbell Sleep Questionnaire' were used for data collection. It was found that the mean scores of VAS-F, VAS-A, heart rate, diastolic and systolic blood pressure of the intervention group decreased significantly after the intervention, while their sleep quality increased significantly. In this study, it was found that using earplugs and eye masks for patients in an intensive care unit during the night was effective in improving patients' sleep quality and reducing fear, anxiety, and problems in vital signs.

The efficacy of earplugs and eye masks for delirium severity and sleep quality in patients undergoing coronary artery bypass grafting in cardiac intensive care units: A single-blind, randomised controlled trial.

BACKGROUND AND PURPOSE: Delirium is a neuropsychiatric syndrome with a wide range of possible causes and multiple complications in patients admitted to intensive care units. It is, therefore, necessary to seek appropriate and safe strategies to prevent and manage delirium. This study is intended to examine the efficacy of eye masks and earplugs for delirium severity and sleep quality in patients with coronary artery bypass grafting in a cardiac intensive care unit. MATERIALS AND METHODS: This single-blind, randomised controlled trial was conducted on 114 patients who were consecutively enrolled and randomly assigned to either the experimental group or the control group. The experimental group received routine care plus eye masks and earplugs, and the control group received only routine care. The delirium severity and sleep quality were measured with the Neelon and Champagne confusion scale and the Verran and Snyder-Halpern sleep scale. RESULTS: The mean delirium severity score differed significantly between the two groups on the second, third, and fourth postoperative days (p < 0.001). Although the trend of changes in the mean delirium severity score from the first postoperative day (before the intervention) to the second, third, and fourth postoperative days was downward in the two groups (trending towards higher delirium severity), the control group experienced greater changes than the experimental group. An intragroup analysis of delirium severity detected a statistically significant difference in both the experimental and control groups (p < 0.001). The sleep quality domains (sleep disturbance, sleep effectiveness, sleep supplementation) showed a statistically significant difference between the two groups across the three intervention days (p < 0.001). CONCLUSION: The overnight use of eye masks and earplugs were found to have positive effects on sleep quality domains (sleep disturbance, sleep effectiveness, sleep supplementation) and delirium severity in coronary artery bypass grafting patients admitted to the cardiac intensive care unit for several days. It was also found that a significant interaction effect between the sleep disturbance subscale and delirium severity exists. CLINICAL TRIAL REGISTRATION NUMBER: (https://en.irct.ir): IRCT20210523051370N2.

Measuring earplug noise attenuation: A comparison of laboratory and field methods.

Hearing protection device (HPD) fit-testing is a recommended best practice for hearing conservation programs as it yields a metric of the amount of attenuation an individual achieves with an HPD. This metric, the personal attenuation rating (PAR), provides hearing health care, safety, and occupational health personnel the data needed to select the optimal hearing protection for the occupational environment in which the HPD will be worn. Although commercial-off-the-shelf equipment allows the professional to complete HPD fit tests in the field, a standard test methodology does not exist across HPD fit-test systems. The purpose of this study was to compare the amount of attenuation obtained using the "gold standard" laboratory test (i.e., real-ear attenuation at threshold [REAT]) and three commercially available HPD fit-test systems (i.e., Benson Computer Controlled Fit Test System [CCF-200] with narrowband noise stimuli, Benson CCF-200 with pure tone stimuli, and Michael and Associates FitCheck Solo). A total of 57 adults, aged 18 to 63, were enrolled in the study and tested up to seven earplugs each across all fit-test systems. Once fitted by a trained member of the research team, earplugs remained in the ear throughout testing across test systems. Results revealed a statistically significant difference in measured group noise attenuation between the laboratory and field HPD fit-test systems (p < .0001). The mean attenuation was statistically significantly different (Benson CCF-200 narrowband noise was +3.1 dB, Benson CCF-200 pure tone was +2.1 dB, and Michael and Associates FitCheck Solo was +2.5 dB) from the control laboratory method. However, the mean attenuation values across the three experimental HPD fit-test systems did not reach statistical significance and were within 1.0 dB of one another. These findings imply consistency across the evaluated HPD fit-test systems and agree with the control REAT test method. Therefore, the use of each is acceptable for obtaining individual PARs outside of a laboratory environment.