Risks and music - patterns among young women and men in Sweden.

Music and high levels of sound have not traditionally been associated with risk-taking behaviors. Loud music may intensify and bring more power and meaning to the musical experience, but it can at the same time be harmful to hearing. The present study aims to increase the knowledge about young women's and men's risk judgement and behaviour by investigating patterns in adolescent risk activities among 310 adolescents aged 15-20 (143 women; 167 men). The Australian instrument ARQ was used with additional questions on hearing risks and a factor analysis was conducted. The main results showed that the factor structure in the judgement and behavior scale for Swedish adolescents was rather different from the factor structure in the Australian sample. Also, the factor structure was not similar to the Australian sample split on gender. The results are discussed from a gender- and existential perspective on risk taking, and it is emphasized that research on risk behavior needs to reconceptualize stereotypical ideas about gender and the existential period in adolescence.

Hearing, use of hearing protection, and attitudes towards noise among young American adults.

The purpose of the present study was to investigate possible associations between college students' attitudes, risk-taking behaviour related to noisy activities, and hearing problems such as threshold shifts or self-experienced hearing symptoms. The sample included 258 students aged between 17 and 21 enrolled at the University of Pennsylvania, USA. A questionnaire measuring attitudes towards noise, use of hearing protection, and self-reported hearing symptoms was distributed among the students. After completing the questionnaire a hearing screening, including pure-tone audiometry and tympanometry, was conducted. The result revealed that 26% had thresholds poorer than the screening level of 20 dBHL. Attitudes were significantly related to self-experienced hearing symptoms, but not to threshold shifts. Attitudes and noise sensitivity was, significantly related to use of hearing protection. Hearing protection use was found in activities such as using firearms, mowing lawns, and when using noisy tools but was less reported for concerts and discotheques. It can be concluded that the young adults in this study expose themselves to hearing risks, since the use of hearing protection is in general very low.

Reported hearing protection use in young adults from Sweden and the USA: effects of attitude and gender.

The present study investigates differences between a Swedish and an American sample of young students regarding attitudes towards noise and the use of hearing protection at concerts. The study population was comprised of 179 participants from Sweden and 203 participants from the United States, who ranged in age from 17 to 21 years. Questionnaires were used to gather information on hearing symptoms and attitudes towards noise (Youth Attitude to Noise Scale). Multivariate analysis of variance revealed that attitudes towards noise differed significantly due to gender and country. Men had slightly more positive attitude towards noise than women, and men from the USA had more positive attitudes than men from Sweden. Least positive were the women from Sweden (except regarding attitudes towards the ability to concentrate in noisy environments). Multivariate logistic regression analysis was used to examine the influence of attitudes towards noise and country on young people's use of hearing protection at concerts. The results indicated that attitudes and country explained 50% of the variance in use of hearing protection.

Self-reported tinnitus and noise sensitivity among adolescents in Sweden.

It seems to be a common opinion among researchers within the field of audiology that the prevalence of tinnitus will increase as a consequence of environmental factors, for example exposure to loud noise. Young people are exposed to loud sounds, more than any other age group, especially during leisure time activities, i.e. at pop concerts, discotheques and gyms. A crucial factor for the prevention of hearing impairments and hearing-related symptoms in the young population is the use of hearing protection. The focus of the present study is use of hearing protection and self-reported hearing-related symptoms, such as tinnitus and noise sensitivity in a young population of high-school students (N=1285), aged 13 to 19 years. The results show that the prevalence of permanent tinnitus and noise sensitivity, reported in the total group, was 8.7% and 17.1% respectively. Permanent tinnitus was not significantly related to level of socio-economic status, but age-related differences in the prevalence rates of experienced tinnitus and noise sensitivity were found to be significant. Older students reported such symptoms to a greater extent than younger students did. Those who reported tinnitus and other hearing-related symptoms protected their hearing to the highest extent and were the ones most worried.

The influence of socio-economic status on adolescent attitude to social noise and hearing protection.

The focus of the present study, of 1285 adolescents, was young people's attitudes towards noise and their use of hearing protection at discos and pop concerts. Comparisons were made between adolescents from different age groups, and with different socio-economic status. Logistic regressions indicated that "worry before attending noisy activities" and "hearing symptoms" such as tinnitus and noise sensitivity could, to some degree, explain the use of hearing protection in noisy environments. Another conclusion to be drawn from this study was that adolescents' attitudes and behaviours regarding hearing protection use differed between levels of socio-economic status. Individuals with high SES expressed more negative attitudes and used ear protection to a greater extent than those with lower SES. This result might indicate differences in the development of future auditory problems among individuals with different levels of socio-economic status. The cause of hearing impairment and tinnitus may not be restricted merely to noise exposure. Psychological aspects, such as attitudes towards noisy environments and the individual's behaviour regarding the use of hearing protection may be considered as important factors in the understanding of why the prevalence of hearing related problems has increased among adolescents.

Predictive factors for the severity of tinnitus.

The majority of patients with tinnitus experience a lessening of their symptoms during an 18-month period after their first consultation. The exception to this rule is severe incapacitating tinnitus, the sometimes very troublesome symptoms of which show no sign of diminishing with time. The aim of the present study was to investigate risk factors for incapacitating tinnitus, as measured by absence from work related to tinnitus (AWT) of more than 1 month during an 18-month period after the first visit to the tinnitus clinic. Audiometric data and the scores from the Tinnitus Severity Questionnaire and the Nottingham Health Profile at the first visit to the clinic were correlated to AWT by a logistic regression model. By using this risk model, an individual risk score for AWT could be estimated. Depression and physical immobility were strong predictors of AWT, and hearing loss was moderate. Based on these results, we suggest that the aetiology of tinnitus severity could be described as depression-/anxiety-related, somatic, and auditory tinnitus.

Prediction of quality of life in patients with tinnitus.

According to epidemiological studies of tinnitus prevalence, 0.5-1% of respondents report that tinnitus severely affects their ability to lead a normal life. In the present investigation quality of life and its association with tinnitus-related factors: psychological, psychosomatic and audiological, was studied based on a sample of 122 patients, who attended the hearing clinic for distress due to tinnitus. A stepwise regression analysis was performed with quality of life as a dependent variable. Six of 13 variables included in the model proved to be significant regressors and to explain 65% of the variance. The six predictor variables were: impaired concentration, feeling depressed, perceived negative attitudes, hypersensitivity to sounds, average hearing level (best ear) and tinnitus duration (the shorter the duration of tinnitus the more negative impact on quality of life). The three most significant predictors were directly related to perceived psychological distress and explained most of the variance in quality of life in tinnitus patients included in this study. An unexpected finding was that fluctuations in tinnitus, vertigo, headache or perceived social support did not prove to belong to the significant regressors. The results are discussed in view of the construct of quality of life, depressive cognitions and social support in general, as well as in tinnitus-specific life circumstances.

The subjective meaning of illness in severe otosclerosis: a descriptive study in three steps based on focus group interviews and written questionnaire.

The aim of this study of otosclerosis patients was to highlight the circumstances specific to an operable middle ear disease and to describe the psychologically unique aspects accompanying this disorder. In a first step five subjects participated in four focus group interviews, from which emanated a questionnaire answered in a second step by 28 randomly chosen subjects. Finally a second series of supplementary focus interviews were conducted with another group of subjects, after which the interview material was subjected to code-mapping, agreement and validation. The study results indicate that ear surgery was a very important occurrence in the lives of the patients and a unique aspect was that they were burdened by a sense of responsibility for deciding in favour of or against the ear surgery and in choosing the time for operation. An event as tangible as an operation impacts on the individual's psychological processing of the fact that one of his or her senses is damaged. The message to the person's surroundings is very clear: the operation makes others understand how serious the situation is, gives rise to a sense of sympathy. These factors together may promote adaptation to the handicap, or alternately, at least for some persons, may impede adaptation to the necessary hearing aids. To some individuals hearing aids were strongly associated with periods of deteriorating hearing and therefore had negative connotations. Thus the hearing aid was used while waiting for surgery or instead of surgery. The constant hope of regaining one's hearing through ear surgery, although not totally realistic in these cases of severe otosclerosis, always makes the hearing aid the second best solution. The overall conclusion from this study is that there are specific circumstances of an operable ear disease which have great impact upon quality of life, well-being and adaptation. The psychological situation is one of instability, feelings of responsibility and at times of anxiety. Patients with otosclerosis are sometimes told that they are better off than others with impaired hearing, because surgery can improve their hearing and because good amplification through hearing aids can be achieved in persons with conductive hearing losses. It is our hope that this study has helped to provide a fuller picture of the facts of life for persons with severe otosclerosis.

Ménière's disease: trauma, distress and adaptation studied through focus interview analyses.

In order to investigate, in depth, the role of psychological factors in Ménière's disease, i.e. how the patients experience and interpret their symptoms during the process of this illness, a qualitative method "focus group interviews" was used as a study design. The focus group included four subjects; one woman and three men. In addition, semi-structured interviews were performed with each of four more subjects having the disease, three women and one man, in order to guarantee representativity in terms of gender and age. Through the focus interview analyses eight final codes and a number of sub-codes were developed. Results clearly pointed out the significance of the first traumatic attack of the disease as well as early signs; different "psychosomatic" symptoms prior to the attacks. The recognition of fear and phobic reactions in the manifestation of the vertigo attack was considered as an important observation, as attacks often were triggered by distressing thoughts as well as by sensory sensations. Other areas, touched upon for future investigation, were crisis adaptation and illness function.

Tinnitus characteristics in tinnitus complainers and noncomplainers.

The aim of this study was to describe the characteristics of tinnitus in 87 patients (mean age = 53.7 years); 43 patients seeking professional help (complainers) and 44 patients who do not seek help for their tinnitus (noncomplainers). 'Left-sided or mostly left-sided' tinnitus was reported by 42% of complainers and 30% of noncomplainers, whereas 'right-sided or mostly right-sided' tinnitus was equally prevalent in the two groups (26 v. 25%); the differences between groups were not significant. Tinnitus 'in the head' was reported by 14% of the complainers and 6% of the noncomplainers, a nonsignificant difference, whereas noncomplainers perceived tinnitus in 'both ears equally' significantly more frequently than complainers. Complainers had significantly more often 'combined' (tonal plus buzzing) tinnitus sounds (51 v. 30%) and 'non-fluctuating tinnitus' (49 v. 25%) than had noncomplainers, whereas 'tonal' tinnitus was significantly more frequent in noncomplainers than in complainers (43 v. 16%). Further, noncomplainers had worse hearing than complainers: pure-tone averages over vocal as well as high frequencies were significantly higher. Complainers scored significantly higher than noncomplainers on the psychological variables concentration difficulties, irritability and sleep disturbance. Patients with 'combined' tinnitus sounds scored significantly higher on irritability and sleep disturbance than subjects with 'tonal' tinnitus. Patients with 'non-fluctuating tinnitus' scored significantly higher on the three psychological variables than patients with 'fluctuating tinnitus'. A conclusion to be drawn is that 'combined' tinnitus sounds and 'non-fluctuating tinnitus' might be determinants of psychological problems.

Psychometric evaluation of the hearing measurement scale on patients registered in a Swedish hearing centre.

The hearing measurement scale (HMS), targeting the experience of being hearing impaired, was translated into Swedish and answered by 122 patients with slight to moderate hearing losses. According to the item analysis the test construction of the HMS functions well with a relevant division of the sections. In all sections there were individuals utilizing all response possibilities and the homogeneity (alpha) of the test was high. One exception was section II (hearing non-verbal sounds), which may be due to lack of awareness, indicating that it might not be possible to pursue this dimension by a questionnaire approach. Normative descriptions were given for two age groups: 40 to 60 and 61 to 74 years, including both sexes. The groups had a similar outcome on the HMS, even though the older subjects, on average, had worse hearing problems, measured by pure-tone audiometry. The section covering speech perception had the strongest correlation with hearing loss, while the section covering emotional response entirely lacked such correlations for the younger group.

Psychological and audiological correlates of perceived tinnitus severity.

Beliefs and attitudes towards tinnitus have been found to play an important role in the process of rehabilitation. The relationship between audiological, psychological and psychosomatic factors (self-assessment of vertigo and headache and the perceived severity of tinnitus) was investigated in a clinical population of 163 subjects. Audiological descriptives comprised pure-tone average (dB HL), etiology of hearing loss, duration of tinnitus and tinnitus localisation. Perceived severity of tinnitus was assessed with a questionnaire focusing on tinnitus impact on aspects of quality of life, concentration and sleep. A 28-item handicap and support questionnaire was used and factor analysed, resulting in three factors: perceived attitudes, social support and disability/handicap. Tinnitus severity was significantly related to perceived attitudes. The influence of social support on tinnitus severity did not seem to be crucial. The results showed that significantly more women than men complained about vertigo. Unilateral tinnitus localisation was also more prevalent in females. The subjects with multiple tinnitus localisations were older and had significantly more sleep disturbance than subjects with tinnitus localized to the ears only. In accordance with previously reported observations, the frequency of headaches was strongly correlated with the severity of tinnitus.

Tinnitus: evaluation of biofeedback and stomatognathic treatment.

Thirty-two patients with disabling tinnitus received stomatognathic treatment and biofeedback therapy according to a cross-over design. The evaluation of treatment outcomes showed some improvements at the group level: decrease of tinnitus intensity, mood improvement and reduction of clinical signs of dysfunction in the masticatory system. Qualitative observations indicated numerous positive changes in patients' emotional and cognitive orientation vis à vis tinnitus. Some possible predictors of positive treatment outcome were observed: comparatively low severity of tinnitus, normal hearing or compensated hearing loss, occlusal interferences, jaw fatigue, diurnal bruxism and fluctuations in tinnitus intensity. Left-sided tinnitus seemed to be a negative predictor of stomatognathic and biofeedback treatment outcome. Consequently, stomatognathic and biofeedback treatment seem to have some positive effects on subgroups of tinnitus patients.

A stomatognathic analysis of patients with disabling tinnitus and craniomandibular disorders (CMD).

Forty-two patients with disabling tinnitus and reported symptoms of craniomandibular disorders (CMD) were investigated by means of questionnaire, semistructured interview, stomatognathic examination and 2-week diary with thrice-daily ratings of tinnitus and mood. The findings have been analysed in order to identify symptoms of CMD related to tinnitus, and it was concluded that awareness of diurnal bruxism and feeling of jaw tenderness/fatigue may be related to fluctuating tinnitus, vertigo and hyperacusis.

Psychological dimensions in patients with disabling tinnitus and craniomandibular disorders.

Forty-two patients with severe tinnitus and craniomandibular disorders (CMD) are presented from an audiological and psychological point of view. During a 2-week period, the patients rated their mood and their tinnitus. Based upon mood ratings, patients were grouped into three clusters (high, medium and low mood). The three groups differed in a number of respects, audiological as well as psychological. Patients in the low mood group experienced significantly more intense and severe tinnitus and more daily stress than patients in the high mood group. Ratings of irritation and concentration difficulties seemed to be mood related, and discriminated between patients in the low mood group and patients in the moderate and the high mood groups. Difference in hearing level between the left and the right ear was more pronounced in patients with low mood. There were, however, no significant differences between the groups in the stomatognathic variables. It is concluded that the above mentioned audiological and psychological observations should be considered as potentially important for satisfactory management of individual tinnitus patients. Further studies of the effects of optimally compensated hearing on depressed mood in patients with noise-induced hearing loss (NIHL) and tinnitus are required.

Validation of a Swedish version of the Mishel Uncertainty in Illness Scale.

Uncertainty and fear are realities patients often have to face in illness and hospitalization. Mishel has described how perceived uncertainty under these circumstances can affect the patient's coping strategies. The Mishel Uncertainty in Illness Scale (MUIS), along with a diagnosis-specific version of the MUIS, the Cardiovascular Population Scale, was translated into Swedish with the purpose of testing the usefulness of the scale on a Swedish coronary population. The sample included 60 patients, 40 males and 20 females, with coronary pain, cared for on two intensive coronary care units. The Swedish version of the MUIS seems to be in most instances a reliable instrument for measuring perceived uncertainty. Coefficient alpha was .82, compared with Mishel's reported .84. The reliability of the Cardiovascular Population Scale was .74. Study findings revealed that recency of prior hospitalization was significantly related to perceived uncertainty. Results point to the necessity of further validity testing.

Habituation and tinnitus: an experimental study.

The study is an experimental test of Hallam's habituation theory of tinnitus; this theory implies that the huge variation in suffering among individuals with about the same amount of tinnitus is due to differences in habituation to the perceived sound. Fourteen patients, seven 'complainers' and seven 'noncomplainers', participated in an experiment where we studied changes in skin conductance and heart rate responses to a series of tinnitus-like sound stimuli. No group differences in habituation were observed. We suggest that facilitatory processes, like disinhibition, may be more important than deficient habituation for the inability, in some individuals, to adapt to their tinnitus.

The psychological importance of nonverbal sounds. An experiment with induced hearing deficiency.

An experiment is described where marked hearing deficiency was induced in 28 normal-hearing subjects by means of occlusion. The primary aims were to investigate to what extent feelings of security and control are affected when hearing is suddenly reduced or distorted, and to explore the relative psychological importance attached to different sound categories other than speech. It was found that the inability to hear the movements of other people produces tension and stress and leads to feelings of insecurity and loss of control of the situation. The distortion of one's own voice leads to inhibition from speaking and might affect motivational and affectional factors. Experimental hearing deficiency can elucidate some initial disadvantages of hearing loss or use of hearing aids that are not easily seen in a clinical study.