Does Earphone Type Affect Risk for Recreational Noise-induced Hearing Loss?
Brian J. Fligor, Sc.D., CCC-A Director of Diagnostic Audiology, Children's Hospital Boston Instructor in Otology and Laryngology, Harvard Medical School LO-367 300 Longwood Ave Boston, MA 02115
Discussion and Summary While in-the-ear earphones can produce higher sound levels than over-the-ear earphones, they are not necessarily used at higher levels. Factors that affected chosen listening level were gender and the amount of background noise in the listening environment. Conversely, the amount of sound isolation provided by the earphones in noisy listening environments allowed subjects to choose music levels that were lower. If a chosen listening level of 85 dBA is deemed the cut-off constituting “risky” behavior, then roughly 6% of subjects listening in a quiet setting are “risky listeners.” What about the loud environment? We tested subjects in a common environment for using headphones (a “simulated” airplane cabin), and 80% of subjects using the Koss over-the-ear and iPod earbud earphones exceeded 85 dBA; these earphones provide essentially no sound isolation. When an ER-6i inthe- ear earphone was used (average of 25 dB sound isolation), only 20% exceeded 85 dBA. This study estimates the number of people who listen in excess of “safe” levels, and the factors that influence a person to choose high sound levels. As well, it specifically describes the effect of sound isolating earphones in mitigating behaviors of listening to excessively high music levels. Findings from this study will provide consumers and healthcare providers with specific recommendations to reduce risk for music-induced hearing loss in users of mp3 players.
Maximum Listening
Time Per Day
% of Volume Control
Time Limit Before Potential
Damage Occurs
up to 50 % No Limit
60%
18 hours
70%
4.6 hours
80%
1.2 hours
90%
18 minutes
100%
5 minutes
source: University of Colorado
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Newborn Screening Techniques Screening procedures for newborns and infants can detect permanent or fluctuating, bilateral or unilateral, and sensory or conductive hearing loss, averaging 30 to 40 dB or more.
The screening of newborns and infants involves use of non-invasive, objective physiologic measures that include otoacoustic emissions (OAEs) and/or auditory brainstem response (ABR). Both procedures can be done painlessly while the infant is resting quietly.
OAEs are inaudible sounds from the cochlea when audible sound stimulates the cochlea. The outer hair cells of the cochlea vibrate, and the vibration produces an inaudible sound that echoes back into the middle ear. This sound can be measured with a small probe inserted into the ear canal. Persons with normal hearing produce emissions. Those with hearing loss greater than 25-30 dB do not. OAEs can detect blockage in the outer ear canal, middle ear fluid, and damage to the outer hair cells in the cochlea.
ABR is an auditory evoked potential that originates from the auditory nerve. It is often used with babies. Electrodes are placed on the head, and brain wave activity in response to sound is recorded. ABR can detect damage to the cochlea, the auditory nerve and the auditory pathways in the stem of the brain. ASHA-certified audiologists (and state licensed where applicable) should be designated as the manager of these screening programs.
What happens if an infant does not pass the screening? Infants who do not pass a screening are often given a second screening to confirm findings and then referred for follow-up audiological and medical evaluations that should occur no later than 3 months of age. These evaluations confirm the presence of hearing loss ; determine the type, nature, and (whenever possible) the cause of the hearing loss; and help identify options for treatment.
Even if the infant passes screening, certain conditions do not produce immediate hearing loss. Rather, the hearing loss occurs later in the child's development. An infant with any of the following indicators for progressive or delayed-onset hearing loss should receive audiologic monitoring every six months until age 3 years: Parental or caregiver concern regarding hearing, speech, language, and/or developmental delay. Family history of permanent childhood hearing loss.
Characteristics or other findings associated with a syndrome known to include a sensorineural and/or conductive hearing loss. Postnatal infections associated with sensorineural hearing loss including bacterial meningitis. In utero infections such as cytomegalovirus, herpes, rubella, syphilis, and toxoplasmosis.
Neonatal indicators--specifically hyperbilirubinemia at a serum level requiringexchange transfusion, persistent pulmonary hypertension of the newborn associated with mechanical ventilation, and conditions requiring the use of extracorporeal membrane oxygenation (ECMO) Syndromes associated with progressive hearing loss such as neurofibromatosis, osteopetrosis, and Usher' s syndrome Neurodegenerative disorders, such as Hunter’s syndrome, or sensory motor neuropathies, such as Friedreich's ataxia and Charcot-Marie-Tooth syndrome. Head trauma Recurrent or persistent otitis media with effusion for at least 3 months.
Legal Requirements Contact your local school district or your state or local health department to find out how to obtain screenings/evaluations and intervention services through your state' s Early Intervention program.
Older Infants and Toddlers Infants and toddlers (7 months through 2 years) should be screened for hearing loss as needed, requested, mandated, or when conditions place them at risk for hearing disability. Infants not tested as newborns should be screened before three months of age. Other infants should be screened who received neonatal intensive care or special care, or who display other indicators that place them at risk for hearing loss. Older infants and toddlers who have a greater chance of hearing loss because of certain risk factors should also be screened. This screening should be done even if an initial hearing screening is passed because some causes of hearing loss do not take effect until later in the child's development. These children's hearing should be monitored at least every 6 months until 3 years of age, and at regular intervals thereafter dependent upon the risk factor.
Risk Factors Parental, caregiver and/or health care provider concerns regarding hearing, speech, language, and/or developmental delay based on observation and/or standardized developmental screening. Family history of permanent childhood hearing loss. Characteristics or other findings associated with a syndrome known to include a sensorineural and/or conductive hearing loss. Infections associated with sensorineural hearing loss including bacterial meningitis, mumpsIn utero infections such as cytomegalovirus, herpes, rubella, syphilis, and toxoplasmosis. Neonatal indicators - specifically hyperbilirubinemia at a serum level requiring exchange transfusion, persistent pulmonary hypertension of the newborn associated with mechanical ventilation, and conditions requiring the use of extracorporeal membrane oxygenation (ECMO) Syndromes associated with progressive hearing loss such as neurofibromatosis, osteopetrosis, and Usher' s syndrome Neurodegenerative disorders, such as Hunter’s syndrome, or sensory motor neuropathies, such as Friedreich's ataxia and Charcot-Marie-Tooth syndrome. Head trauma Recurrent or persistent otitis media with effusion for at least 3 months. Anatomic disorders that affect eustachian tube function Neurofibromatosis type II or neurodegenerative disorders
Screening Techniques Screening procedures to detect hearing impairment that exceeds 20-30 dB HL are applicable to this age group. Two screening methods are suggested as the most appropriate tools for children who are functioning at a development age of 7 months to 3 years, visual reinforcement audiometry (VRA) and conditioned play audiometry (CPA). Both of these methods are behavioral techniques that require involvement and cooperation of the child.
Visual reinforcement audiometry (VRA) is the method of choice for children between 6 months and 2 years of age. The child is trained to look toward (localize) a sound source. When the child gives a correct response, e.g., looking to a source of sound when it is presented, the child is "rewarded" through a visual reinforcement such as a toy that moves or a flashing light.
Conditioned play audiometry (CPA) can be used as the child matures. It is widely used between 2 and 3 years of age. The child is trained to perform an activity each time a sound is heard. The activity may be putting a block in a box, placing pegs in a hole, putting a ring on a cone, etc. The child is taught to wait, listen, and respond. With both of these methods, sounds of different frequencies are presented at a sound level that children with normal hearing can hear.
It is ideal if the child will allow earphones to be placed on his or her head so that independent information can be obtained for each ear. If the child refuses earphone placement or earphone placement is otherwise not possible, sounds are presented through speakers inside a sound booth. Since sound field screening does not give ear specific information, a unilateral hearing loss (hearing loss in only one ear) may be missed.
Alternative procedures, such as otoacoustic emissions (OAEs) or auditory brainstem response (ABR) may be used if the child is unable to be conditioned. Certified audiologists are the professionals who have the knowledge, skill, and expertise to screen for hearing impairment in this age group.
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