The validity of using a self-report single question as a means to detect hearing loss in an adolescent population.

OBJECTIVE: The overall objective in the study was to compare self-reported hearing based on a single question ("how good would you currently rate your hearing?") to measure hearing loss determined by audiometry in a cohort of adolescents. Prevalence of audiometrically measured hearing loss and frequencies of self-reported poor hearing as well as factors that have an impact on self-reported hearing were examined. DESIGN: Baseline and 5-year follow-up data of the Ohrkan study were used. Participants filled in a questionnaire and underwent audiometric measurements. STUDY SAMPLE: Data from 979 adolescents were analysed. Participants were 54.7% female and aged between 13 and 18 years at baseline and 17-21 years at 5-yr follow-up. RESULTS: The single question on self-reported hearing ability achieved a sensitivity of 41.9% and a positive predictive value of 7.1% at baseline. For the 5-yr follow-up, sensitivity was 40.0%, positive predictive value was 13.9%. Factors influencing self-reported poor hearing were gender, tinnitus, "muffled" ears after exposure to loud noise (e.g. after a concert) and low-frequency hearing loss. CONCLUSIONS: The single question about hearing ability used in the Ohrkan study is not sufficient to replace audiometry to detect hearing loss as defined in the study in adolescents.

The Relevance of Leisure Noise to Hearing Threshold Shifts: A Longitudinal Analysis Among Adolescents.

PURPOSE: The aim of this study was to analyze the association of total leisure noise exposure and hearing threshold shifts over 5 years among adolescents enrolled in the Ohrkan cohort study. METHOD: The Ohrkan cohort of 2,148 students aged 13-19 years was recruited from 2009 to 2011 and followed up 5 years later. Complete baseline and follow-up reports on exposure and outcome were available for 989 participants. Leisure noise exposure was assessed by questionnaires, and clinical audiometric examinations were performed. Two outcomes were defined: occurrence of the Niskar notch pattern and audiometry showing maximum hearing threshold values at 3, 4, and 6 kHz (both ears). Longitudinal analysis using generalized estimating equations was performed. RESULTS: High total leisure noise exposure, defined as an energy equivalent of a 40-hr week of > 85 dBA, was estimated for 32.7% of students at baseline and 63.8% at follow-up. A noise notch was observed in 1.1% of adolescents at baseline and 3.3% at follow-up. At baseline, the maximum measured threshold shift was 55 dB, which increased to 85 dB at the follow-up. Longitudinal analysis did not reveal an association between leisure noise exposure and hearing thresholds. Hearing threshold shifts or noise notches were associated with sex, school type, and time point of measurement. CONCLUSIONS: No relationship was found between leisure noise and hearing thresholds. Male adolescents and those attending secondary general schools, with graduation following completion of ninth or 10th grade, had a greater likelihood of developing hearing threshold shifts. Prevention programs should focus on these risk groups. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.19233462.

Compensating for missing data in the OHRKAN cohort study examining total leisure noise exposure among adolescents.

OBJECTIVE: Investigating determinants of total leisure noise (TLN) exposure among adolescents over 7.5 years and compensating for missing data due to loss to follow-up. DESIGN: In the OHRKAN cohort study, data were collected by questionnaires at four waves. TLN was calculated from self-reported duration spent participating in 18 leisure activities. High exposure was defined as exceeding 85 dB(A) of equivalent continuous average sound pressure level (SPL) during a 40-h week. Multiple imputation (MI) and generalised estimating equations (GEE) were used to analyse odds ratios (OR) of determinants of TLN exposure and compared to complete-case analysis. STUDY SAMPLE: Closed cohort of 2148 students enrolled in grade 9 of any school in Regensburg (Germany), recruited from 2009 to 2011. RESULTS: Up to 74% of adolescents had risky TLN exposure, depending on wave. The most significant sources were discotheques, portable listening devices (PLD) and stereo systems. Higher TLN exposure was associated with time point, education, single-parent households and gender. MI under MAR assumption changed results only slightly compared to complete-case analysis. CONCLUSIONS: Prevalence of risky TLN is high during adolescence. MI reinforced trends detected in former results of OHRKAN. Preventive measures should consider the main drivers of noise exposure including changes by age and high risks groups.

Longitudinal analysis of leisure noise exposure among adolescents with special focus on portable listening devices: the OHRKAN cohort study.

The aim was to investigate leisure noise exposure and sociodemographic determinants of risky leisure noise exposure over five years in 2148 students visiting grade 9 of any school type in a German city from 2009-2011. Within the OHRKAN cohort study, leisure noise exposure was calculated from literature-retrieved sound pressure levels (SPLs) and self-reported duration of 18 leisure activities at baseline and two follow-ups. Risky exposure was defined as exceeding 85 dB(A) averaged over a 40-h-week. Determinants of risky total leisure noise (TLN) exposure and risky exposure to portable listening devices (PLDs) were investigated using generalised estimating equations (GEEs). Up to 73% of students exceeded noise levels of 85 dB(A) at some timepoint. The noise exposure and importance of different leisure activities changed with increasing age. Risky exposure to TLN and PLDs was associated with lower education, single parent households and being male. Risky PLD exposure was additionally associated with a migrant background. Current prevention measures for leisure noise exposure must be extended to at-risk groups. Besides enhancing campaigns in lower education schools, acoustical insulation in sports halls, noise warnings on tools or in videogames could address especially men. Migrants need education about healthy PLD use in their native language if necessary.

Usage of personal music players in adolescents and its association with noise-induced hearing loss: A cross-sectional analysis of Ohrkan cohort study data.

OBJECTIVE: To describe personal music player (PMP) usage among adolescents, sociodemographic determinants and association with audiometric notches. DESIGN: Audiometric evaluation to assess hearing status, and standardized questionnaires to evaluate PMP listening behaviors, leisure noise exposures and self-reported hearing loss symptoms. Sociodemographic information was collected using a parent questionnaire. Noise exposure by PMP usage equivalent for a 40 h week was estimated based on self-reported volume and duration of use. STUDY SAMPLE: A total of 2143 students (54% females) attending 9th grade in Regensburg, Germany, during 2009 to 2011. RESULTS: Overall, 85% of the students reported using PMPs. Exposure level exceeded 80 dB(A) in approximately one third, and 85 dB(A) in one quarter, of those who used PMP. An audiometric notch was found in 2.3% of participants, but was not significantly associated with higher PMP exposure. CONCLUSIONS: PMP exposure above the occupational limits of 80 and 85 dB(A) set by the Directive 2003/10/EC may be a risk factor for developing noise-induced hearing loss. Educational measures to ameliorate high risk behaviors in PMP usage are needed, particularly for socially disadvantaged groups.

Audiometric notch and extended high-frequency hearing threshold shift in relation to total leisure noise exposure: An exploratory analysis.

BACKGROUND: Studies investigating leisure noise effect on extended high frequency hearing are insufficient and they have inconsistent results. The aim of this study was to investigate if extended high-frequency hearing threshold shift is related to audiometric notch, and if total leisure noise exposure is associated with extended high-frequency hearing threshold shift. MATERIALS AND METHODS: A questionnaire of the Ohrkan cohort study was used to collect information on demographics and leisure time activities. Conventional and extended high-frequency audiometry was performed. We did logistic regression between extended high-frequency hearing threshold shift and audiometric notch as well as between total leisure noise exposure and extended high-frequency hearing threshold shift. Potential confounders (sex, school type, and firecrackers) were included. RESULTS: Data from 278 participants (aged 18-23 years, 53.2% female) were analyzed. Associations between hearing threshold shift at 10, 11.2, 12.5, and 14 kHz with audiometric notch were observed with a higher prevalence of threshold shift at the four frequencies, compared to the notch. However, we found no associations between total leisure noise exposure and hearing threshold shift at any extended high frequency. CONCLUSION: This exploratory analysis suggests that while extended high-frequency hearing threshold shifts are not related to total leisure noise exposure, they are strongly associated with audiometric notch. This leads us to further explore the hypothesis that extended high-frequency threshold shift might be indicative of the appearance of audiometric notch at a later time point, which can be investigated in the future follow-ups of the Ohrkan cohort.

Total leisure noise exposure and its association with hearing loss among adolescents.

OBJECTIVE: To investigate total leisure noise exposure among adolescents and to assess its association with hearing. DESIGN: Based on self-reported time spent on 19 leisure activities and associated mean sound pressure levels reported in the literature, total leisure noise exposure was evaluated and compared to noise at work limits (> 85 dB(A) = hazardous) in a cross-sectional survey. Tympanometry and pure-tone audiometry was performed in sound isolated rooms. STUDY SAMPLE: The study sample consists of 2143 pupils attending grade nine in any school in a German city 2009-2011 (mean age: 15.4 years; range: 13-19 years). Audiometric data were available for 1837 (85.8%) pupils (53.9% girls). RESULTS: 41.9% of the 2143 adolescents who had provided self-reported data on leisure activities associated with noise exposure were estimated to be hazardously exposed to leisure time noise. The interaction of gender with total leisure time noise exposure was not significant. No association between leisure time noise exposure and audiometric notches could be detected. CONCLUSION: While hearing loss seems seldom in this age group, a high proportion of adolescents aged 15-16 years are exposed to noise levels during leisure time bearing long-term risks of hearing loss.

The prevalence of audiometric notches in adolescents in Germany: The Ohrkan-study.

Although there is concern about increasing hearing loss in adolescents caused by leisure noise exposure, prevalence data are scarce. In an US study, about 16-17% of adolescents were affected by audiometric notches. To estimate the prevalence of audiometric notches in adolescents in Germany, baseline data of the cohort study Ohrkan, recruitment during the school years 2009/2010 and 2010/2011 were analyzed. All students in grade 9 visiting any school in the city of Regensburg were eligible for participation. Data was collected via standardized questionnaires from students and their parents. In addition, students were asked to visit the University Clinics of Regensburg for ear examination including a tympanogram and the determination of hearing thresholds in air conduction audiometry. The prevalence of audiometric notches was determined in students with normal tympanogram in both ears and complete audiometry data. Audiometric notches were defined according to criteria used to analyse US data. Overall, 2149 students (1158 girls, 991 boys mainly aged 15-16 years) of the 3846 eligible adolescents (56%) participated. Among the 1843 adolescents with complete audiometry and tympanometry data, the prevalence of audiometric notches was 2.4% (95% confidence interval 1.7-3.1%). We could not confirm the high prevalence of audiometric notches as reported in National Health and Nutrition Examination Surveys for adolescents in the US. Differences in prevalence might be at least partly due to methodical differences in audiometry. Even if empirical evidence is presently ambiguous, it is reasonable to educate young people about the potential risks of high leisure noise exposure.

Chondrocytes suspended in modified fibrin glue for vocal fold augmentation: An in vitro study in a porcine larynx model.

BACKGROUND: Injection laryngoplasty is an option for treatment of dysphonia following vocal fold paralysis. Modified fibrin glue with suspended chondrocytes might be a favorable cell-based material for permanent vocal fold medialization. METHODS: We compared fibrin glue with suspended chondrocytes to collagen and hyaluronic acid gels concerning alteration of vocal fold vibration and correct intralaryngeal placement after intralaryngeal injection into porcine larynges. Viscoelastic properties of the materials were analyzed by means of a parallel plate rheometer. RESULTS: Fibrin glue with cells was comparable to collagen and hyaluronic acid with respect to amplitudes, symmetry, and periodicity of vocal fold vibration. Application and positioning of fibrin glue with suspended chondrocytes were technically undemanding and comparable with controls. Complex stress modulus of fibrin glue with suspended cells was comparable to that of collagen gel. CONCLUSIONS: Fibrin glue with suspended chondrocytes seems suitable for the indication of injection laryngoplasty and holds promise for permanent vocal fold medialization.