[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.

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.

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.

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.

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.

[Research on the protective effect of hearing protective device for workers exposed to noise in a motor manufacturing enterprise].

Objective: To understand the current situation of noise hazard in a motor manufacturing enterprise, and to explore the protective effect of workers wearing hearing protective device and its possible influencing factors. Methods: In November 2021, a total of 179 noise workers wearing hearing protective devices in a motor manufacturing company in a city were selected as research objects. Personal attenuation rating (PAR) of workers wearing hearing protective devices was measured. Baseline PAR was analyzed for different subgroups of basic demographic information, noise exposure, and the use of hearing protective devices to evaluate the effect of the intervention. Baseline PAR was compared using nonparametric tests. Results: There were 179 workers from 35 positions in 4 types of work, and the over-standard noise rate was 51.2% (42/82), among which the noise exposure intensity of motor equipment debugging workers was the highest [94.4 dB (A) ]. Compared the baseline PAR of different characteristics, it was found that the baseline PAR of male workers, workers whose daily noise exposure time were <8 h, workers who had used the hearing protective devices for 10 to 14 years, and workers who thought the hearing protective devices were comfortable were all higher, and the differences were statistically significant (P<0.05). Baseline PAR passing rate was 43.0% (77/179), and PAR of 102 workers who did not pass baseline test increased from 0 (0, 3) dB before intervention to 14 (12, 16) dB after intervention, with statistical significance (P<0.05) . Conclusion: The noise hazard in this motor manufacturing enterprise is serious, and the protective effect of workers wearing hearing protective devices is not good. Gender, daily noise exposure time, years and comfort of wearing hearing protective device are the possible influencing factors of poor protective effect.

Uso da dupla proteção auditiva na atenuação do ruído ocupacional: uma revisão sistemática / Use of double hearing protection for occupational noise attenuation: a systematic review / El uso duplo de protecctores auditivos para la reducción del ruido ocupacional: una revisión sistemática

Introdução: A Perda Auditiva Induzida por Ruído (PAIR) está associada à contínua exposição ao ruído dentro do ambiente ocupacional, é a segunda doença mais recorrente entre os trabalhadores. Objetivo: Verificar a efetividade e benefício do uso da dupla proteção auditiva na atenuação do ruído ocupacional. Método: A busca de artigos científicos foi realizada nas bases de dados MEDLINE (Pubmed), LILACS, SciELO, SCOPUS e WEB OF SCIENCE, sem restrição de idioma, período e localização. Para complementar e evitar viés de risco foi realizada uma busca por literatura cinzenta no Google Acadêmico. A revisão sistemática foi conduzida de acordo com as recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Análises (PRISMA). Estudos que pontuaram ≥ 6 pontos de acordo com o protocolo de pontuação qualitativa proposto por Pithon et al. (2015). Resultados: A dupla proteção auditiva deverá ser utilizada quando o protetor auditivo tipo concha ou plug não fornecerem atenuação suficiente para diminuir o ruído no ambiente laboral, contudo, a atenuação sonora pelos EPI auditivos pode ser um obstáculo à comunicação e localização espacial, principalmente aos trabalhadores que possuem algum grau de PAIR. Conclusão: o uso da dupla proteção auditiva pode ser uma estratégia considerável para proteção de perdas auditivas em ambientes controlados. Novos padrões sonoros para alarmes de alerta, prevendo o aviso de acidentes em ambiente ocupacional em que o uso combinado dos dispositivos auditivos utilizados em ambientes controlados e a implantação dos sinais de banda larga como sinal padrão poderão ser utilizados como estratégias de segurança coletiva. (AU)

Introduction: Noise-Induced Hearing Loss (NIHL) is associated with continuous exposure to noise within the occupational environment and is the second most common disease among workers. Objective: To verify the effectiveness and benefit of using double hearing protection in attenuating occupational noise. Search Strategy: The search for scientific articles was carried out in the MEDLINE (Pubmed), LILACS, SciELO, SCOPUS and WEB OF SCIENCE databases, without restriction of language, period and location. To complement and avoid risk bias, a search for gray literature was performed on Google Scholar. Methodology: The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Studies that scored ≥ 6 points according to the qualitative scoring protocol proposed by Pithon et al. (2015). Results: Double hearing protection should be used when the use of a shell or plug type hearing protector does not provide enough attenuation to reduce noise in the work environment, but this sound attenuation by hearing PPE can be an obstacle to communication and spatial location, especially to workers who have some degree of PAIR. Conclusion: the use of double hearing protection can be a considerable strategy for protecting against hearing loss in controlled environments. New sound patterns for warning alarms, providing for the warning of accidents in an occupational environment where the combined use of hearing devices used in controlled environments and the implementation of broadband signals as a standard signal can be used as collective safety strategies. (AU)

Introdución: La pérdida de audición inducida por el ruido es associada com la exposición continua el lo ambiente de trabajo y es la segunda enfermedad más comum em los trabajadores. Objectivo: Verificar la eficácia y beneficio del doble uso de los protectores auditivos em la atenuación del ruído. Método: La revisión sistemática se realizó de acuerdo con las recomendaciones para revisiones sistemáticas y metanálisis (PRISMA). Los estudios que obtuvieron ≥ 6 puntos según el protocolo de puntuación cualitativa propuesto por Pithon et al. (2015). Resultados: La protección auditiva doble és utilizada cuando el uso de un protector auditivo tipo concha o enchufe no proporciona la atenuación suficiente para reducir el ruido en el ambiente de trabajo, pero esta atenuación del sonido por los EPP auditivos puede ser un obstáculo para la comunicación y la ubicación espacial, especialmente para los trabajadores con perdida de audición. Conclusión: el uso de doble protección auditiva es una estrategia considerable en ambientes controlados y seguros. Nuevos padrones sonoros para alarmas de aviso de accidentes en un entorno laboral y la implementación de señales de banda ancha como señal estándar, pueden utilizarse como estrategias de seguridad colectiva.(AU)

Perforated Concave Earplug (pCEP): A Proof-of-Concept Earplug to Improve Sound Localization without Compromising Noise Attenuation.

Combat soldiers are currently faced with using a hearing-protection device (HPD) at the cost of adequately detecting critical signals impacting mission success. The current study tested the performance of the Perforated-Concave-Earplug (pCEP), a proof-of-concept passive HPD consisting of a concave bowl-like rigid structure attached to a commercial roll-down earplug, designed to improve sound localization with minimal compromising of noise attenuation. Primarily intended for combat/military training settings, our aim was an evaluation of localization of relevant sound sources (single/multiple gunfire, continuous noise, spoken word) compared to 3M™-Combat-Arms™4.1 earplugs in open-mode and 3M™-E-A-R™-Classic™ earplugs. Ninety normal-hearing participants, aged 20-35 years, were asked to localize stimuli delivered from monitors evenly distributed around them in no-HPD and with-HPD conditions. The results showed (1) localization abilities worsened using HPDs; (2) the spoken word was localized less accurately than other stimuli; (3) mean root mean square errors (RMSEs) were largest for stimuli emanating from rear monitors; and (4) localization abilities corresponded to HPD attenuation levels (largest attenuation and mean RMSE: 3M™-E-A-R™-Classic™; smallest attenuation and mean RMSE: 3M™-Combat-Arms™4.1; pCEP was mid-range on both). These findings suggest that the pCEP may benefit in military settings by providing improved sound localization relative to 3M™ E-A-R™-Classic™ and higher attenuation relative to 3M™-Combat Arms™-4.1, recommending its use in noisy environments.

Eye-mask and earplugs compared with sleep advice leaflet to improve night sleep duration in pregnancy: a randomized controlled trial.

STUDY OBJECTIVES: To evaluate at-home use of eye-mask and earplugs (EMEP) versus sleep hygiene advice leaflet (AL) on actigraphy-derived night sleep duration in sleep-deprived pregnant women. METHODS: A randomized controlled trial was conducted in the antenatal clinic of University Malaya Medical Centre from June 2021 to June 2022. Women at 34-36 weeks gestation with self-reported night sleep duration ≤6 hours were recruited. Participants wore an actigraphy device at night for seven consecutive nights (Observation/Baseline week). Only women whose actigraphy-derived night sleep duration was confirmed to be ≤360 minutes were randomized to use EMEP or AL. Actigraphy was continued for another week (Intervention week). Primary outcome was change in actigraphy-derived night sleep duration from observation to intervention week across trial arms. Secondary outcomes include participants' sleep quality, labor, and neonatal outcome. Comparisons were by Student t-test, Mann-Whitney U test, and chi-square test. RESULTS: A total of 210 women were randomized: 105 each to EMEP and AL. The increase in night sleep duration over baseline was significantly longer with both EMEP (mean ±â€…SD) 23 ±â€…41 minutes, p < .001, and AL 10 ±â€…35 minutes, p = .007. Night sleep duration was longer by 12.9 (95% CI = 2.2 to 23.7) minutes, p = .019 with EMEP over AL. Sleep quality (Global Pittsburgh Sleep Quality Index score) was significantly improved with EMEP (mean ±â€…SD) -2.0 ±â€…2.5, p < .001, but not with AL -0.3 ±â€…2.2, p = .246. Labor and neonatal outcomes were not significantly different. CONCLUSION: EMEP significantly lengthened night sleep duration in sleep-deprived women in late pregnancy and is superior to AL. CLINICAL TRIAL INFORMATION: "Use of eye masks and earplugs compared with standard advice to improve sleep in pregnancy". https://doi.org/10.1186/ISRCTN19061849. Registered with ISRCTN on 07 May 2021, trial identification number: ISRCTN19061849.