Noise and Health

Exposure to loud sounds is a common cause and exacerbater of tinnitus - a troubling auditory symptom that affects millions of people worldwide. Clinical research at the National Center for Rehabilitative Auditory Research has resulted in a clinical model of tinnitus management referred to as Progressive Audiologic Tinnitus Management (PATM). The model involves five hierarchical levels of management: Triage, Audiologic Evaluation, Group Education, Tinnitus Evaluation, and Individualized Management. Counseling by audiologists and, as needed, mental health providers, is a key component of PATM. This style of counseling focuses less on didactic informational counseling; instead, counseling is used for facilitating patients' learning to adjust to the disturbing auditory symptom by successfully employing tools from two powerful skillsets for self-management of chronic tinnitus - the therapeutic uses of sound and techniques from cognitive-behavioral psychology. This article provides an overview of the methods of counseling used with PATM and provides details concerning the overarching principles of collaborative adult learning that are believed to be most important in facilitating self-management by patients who complain of tinnitus.

Environmental inner ear insults often lead to hair cell injury and loss. Therapeutic measures for the prevention of hair cell loss are currently limited. Several reports have demonstrated the applicability of growth factors for hair cell protection. The goal of the experiments presented here was to assess the protective capability of the human GDNF transgene against noise trauma in the guinea pig cochlea. The left ears of guinea pigs were inoculated with a recombinant adenovirus with a human GDNF insert (Ad.GDNF). Four days later, animals were exposed to noise trauma. One week later, animals were sacrificed and hair cells counted in the left (inoculated) and right (non-inoculated) ears. Auditory brainstem thresholds were measured before the inoculation and just prior to sacrifice. Control groups included inoculation with a reporter gene vector (Ad.lacZ) and Ad.GDNF in normal ears with no noise exposure. The results show that intracochlear inoculation with adenovirus into normal ears does not compromise hair cell counts and ABR thresholds. Both Ad.GDNF and Ad.lacZ vectors can protect the cochlear hair cells and hearing from the noise insult. The difference between the protection afforded by Ad.GDNF and that of the Ad.lacZ vector is not statistically significant. The mechanism of Ad.lacZ protection needs to be elucidated. The data demonstrate the general feasibility of gene therapy for over-expression of neurotrophic factors against noise trauma, and emphasize the complexity of the technique and the problems of variability between subjects.

A human factors experiment employed a hemi-anechoic sound field in which listeners were required to localize a vehicular backup alarm warning signal (both a standard and a frequency-augmented alarm) in 360-degrees azimuth in pink noise of 60 dBA and 90 dBA. Measures of localization performance included: (1) percentage correct localization, (2) percentage of right--left localization errors, (3) percentage of front-rear localization errors, and (4) localization absolute deviation in degrees from the alarm's actual location. In summary, the data demonstrated that, with some exceptions, normal hearing listeners' ability to localize the backup alarm in 360-degrees azimuth did not improve when wearing augmented hearing protectors (including dichotic sound transmission earmuffs, flat attenuation earplugs, and level-dependent earplugs) as compared to when wearing conventional passive earmuffs or earplugs of the foam or flanged types. Exceptions were that in the 90 dBA pink noise, the flat attenuation earplug yielded significantly better accuracy than the polyurethane foam earplug and both the dichotic and the custom-made diotic electronic sound transmission earmuffs. However, the flat attenuation earplug showed no benefit over the standard pre-molded earplug, the arc earplug, and the passive earmuff. Confusions of front-rear alarm directions were most significant in the 90 dBA noise condition, wherein two types of triple-flanged earplugs exhibited significantly fewer front-rear confusions than either of the electronic muffs. On all measures, the diotic sound transmission earmuff resulted in the poorest localization of any of the protectors due to the fact that its single-microphone design did not enable interaural cues to be heard. Localization was consistently more degraded in the 90 dBA pink noise as compared with the relatively quiet condition of the 60 dBA pink noise. A frequency-augmented backup alarm, which incorporated 400 Hz and 4000 Hz components to exploit the benefits of interaural phase and intensity cues respectively, slightly but significantly improved localization compared with the standard, more narrow-bandwidth backup alarm, and these results have implications for the updating of backup alarm standards.

Noise is pervasive in everyday life and induces both auditory and non-auditory health effects. Systematic research of the effects of noise on the cardiovascular system has been carried out for more than 50 decades. Noise is a stressor that affects the autonomic nervous system and the endocrine system. Animal experiments, laboratory and field studies carried out on humans provide evidence that persistent exposure to environmental noise affects physiological endpoints, which in turn are adversely associated with cardiovascular diseases. These include hypertension, coronary heart disease, and stroke. New endpoints have been studied, including clinical states of metabolic syndrome such as diabetes mellitus. Chronic sleep disturbance is considered as an important mediator of the effects. Public health policies rely on quantitative risk assessment to set environmental quality standards and to regulate the noise exposure that is generated by environmental noise sources in the communities. Meta-analyses were carried out to derive exposure-response relationships between noise and cardiovascular health. Most of the epidemiological studies refer to road traffic and aircraft noise. No biologically determined threshold values can be determined. Cardiovascular effects due to noise and traffic-related air pollutants are largely independent of one another due to different biological mechanisms.

To determine if aircraft noise exposure causes an increased incidence of hypertension among residents near airports. We conducted a meta-analysis of observational studies to evaluate the association between aircraft noise exposure and the incidence of hypertension. PubMed, Embase, Web of Science, the Cochrane Library, and the Chinese Biomedical Literature Database were searched without any restrictions. Odds ratios (ORs) with 95% confidence intervals (CIs) were extracted. The pooled ORs were calculated using both the fixed effects model and random effects model. All analyses were performed using STATA version 12.0 software (Stata Corporation, College Station, TX, USA). We examined five studies, comprising a total of 16,784 residents. The overall OR for hypertension in residents with aircraft noise exposure was 1.63 (95% CI, 1.14-2.33), and one of our included studies showed that there was no evidence that aircraft noise is a risk factor for hypertension in women. According to our subgroup analysis, the summary OR for the incidence was 1.31 (95% CI, 0.85-2.02) with I2 of 80.7% in women and 1.36 (95% CI, 1.15-1.60) with moderate heterogeneity in men. The pooled OR for the incidence of hypertension in residents aged over 55 years and under 55 years was 1.66 (95% CI, 1.21-2.27) with no heterogeneity and 1.78 (95% CI, 1.33-2.39) with I2 of 29.4%, respectively. The present meta-analysis suggests that aircraft noise could contribute to the prevalence of hypertension, but the evidence for a relationship between aircraft noise exposure and hypertension is still inconclusive because of limitations in study populations, exposure characterization, and adjustment for important confounders.

This retrospective cross-sectional study of median hearing threshold levels of males employed in two specific occupations shows that the trend with decreasing noise-induced hearing loss in Sweden during the 1970s and 1980s continues into the 1990s. In the occupational categories mechanical work and wood processing men in age groups 30-39, 40-49 and 50-59 years old examined during the time period 1971-76, 1981-86 and 1991-96 were compared. Possible explanations to the improvement might be a wider use of hearing protectors at work and less exposure to noise during military service. The results show that the awareness of noise-induced occupational hearing loss has improved but the hearing conservation programs are still necessary as hearing threshold levels in these occupational groups continue to be poorer than expected in relation to age.

This article reviews the literature about the effects of specific non-traffic-related ambient noise sources on sleep that appeared in the last two decades. Although everybody is faced with noise of non-traffic and non-industry origin (e.g. sounds made by neighbors, talk, laughter, music, slamming doors, structural equipment, ventilation, heat pumps, noise from animals, barking dogs, outdoor events etc.), little scientific knowledge exists about its effects on sleep. The findings of the present extensive literature search and review are as follows: Only a small number of surveys, laboratory and field studies about mainly neighborhood, leisure and animal noise have been carried out. Most of them indicate that ambient noise has some effect on human sleep. However, a quantitative meta-analysis and comparison is not possible due to the small number of studies available and at times large differences in quality.

This article reviews the literature on research conducted during the last two decades on traffic noise impacts in India. Road traffic noise studies in India are fewer and restricted only to the metropolitan areas. The studies over the years have also focused on the monitoring, recording, analysis, modeling, and to some extent mapping related themes. Negligible studies are observed in areas of physiological and sleep research exposure-effect context. Most impact studies have been associated with annoyance and attitudinal surveys only. Little scientific literature exists related to effects of traffic noise on human physiology in the Indian context. The findings of this review search and analysis observe that very little studies are available relating to traffic noise and health impacts. All of them are subjective response studies and only a small portion of them quantify the exposure-effect chain and model the noise index with annoyance. The review of papers showed that road traffic noise is a cause for annoyance to a variety of degree among the respondents. A generalization of impacts and meta-analysis was not possible due to variability of the study designs and outputs preferred.

As supplement to a general health screening examination (HUNT-II), we conducted a puretone audiometry study in 1996-98 on adults (>20 years) in 17 of 23 municipalities in Nord-Trøndelag, Norway, including questionnaires on occupational and leisure noise exposure, medical history, and symptoms of hearing impairment. The study aims to contribute to updated normative hearing thresholds for age and gender, while evaluating the effects of noise exposure, medical history, and familial or genetic influences on hearing. This paper presents the unscreened hearing threshold data and prevalence of hearing impairment for different age groups and by gender. Valid audiometric data were collected from 62% (n=50,723) of 82,141 unscreened invited subjects (age-range 20-101 years, mean=50.2 years, SD=17.0 years). Two ambulant audiometric teams each conducted 5 parallel self-administered, pure-tone hearing threshold examinations with the standard test frequencies 0.25-0.5-1-2-3-4-6-8 kHz (manual procedure when needed). Tracking audiometers were used in dismountable booths with in-booth noise levels well within ISO criteria, except being at the criterion around 200 Hz. The data were electronically transferred to a personal computer. Test-retest correlations for 99 randomly drawn subjects examined twice were high. The mean thresholds recorded were some dB elevated from "audiometric zero" even for age group 20-24 years. As also found in other studies, this might indicate too restrictive audiometric reference thresholds. Males had slightly better hearing < or =0.5 kHz for all age groups. Mean thresholds were poorer in males > or = 30 years from > or =2 kHz, with maximal gender differences of approximately 20 dB at 3-4 kHz for subjects aged 55-74 years. Weighted prevalence data averaged over 0.5-1-2-4 kHz showed hearing impairment >25 dB hearing threshold level of 18.8% (better ear) and 27.2% (worse ear) for the total population--for males 22.2% and 32.0%, for females 15.9% and 23.0%, respectively. Mean hearing loss > or =10 dB at 6 kHz registered for both genders even in age groups 20-24 years may be partly due to calibration artefacts, but might possibly also reflect noise-related socio-acusis.

Hearing loss is the most common sensory impairment in older people, and may have social and psychological consequences, such as social isolation, frustration and depression. Noise-induced hearing loss (NIHL) is an interaction of both genetic and environmental factors. Some studies have led to the identification of possible NIHL susceptibility genes. The aim of the present study was to investigate whether the polymorphism of the interleukin (IL)-1β gene at position + 3954 was associated with complaints of hearing loss due to occupational exposure. The sample was composed of elderly people with hearing loss (age ≥ 60 years) divided into two groups: 99 with occupational exposure to noise and 193 without exposure. Information on occupational exposure to noise was obtained through interviews using a semi-structured questionnaire. Hearing acuity was measured from 500 to 6000 Hz and the IL-1β genotype was obtained by the polymerase chain reaction- restriction fragment length polymorphism technique. Differences in allelic and genotypic frequencies, and the association between genotypic frequencies and complaints of hearing loss due to occupational exposure, were analyzed by the Chi-square test at the 5% significance level. Fifty-one percent of the elderly were homozygous for the ancestral allele (C), 17.2% were homozygous for the polymorphic allele (T) and 31.8% were heterozygous. The frequency was found to be 67-33% C to allele T. There was no significant association between polymorphism in gene IL-1β and hearing loss associated with occupational exposure (χ2 = 0.538; P = 0.676). No association was found with the polymorphism of the IL-1β +3954 C/T gene and hearing loss associated with the occupational noise exposure history.

ICBEN Team 9, Noise Policy and Economics, provides an update on international progress on noise mitigation policies and strategies, best practices, and guidelines for environmental noise management for each ICBEN Congress. As described in this brief paper and in more detail in the associated paper prepared for the ICBEN 2011 Congress in London, there were a considerable amount of new relevant documents in many countries on these topics since the last ICBEN Congress in 2008. As before, much of this progress was made in the European Union, although other areas of the world demonstrated a continuing commitment to improvement on these issues, especially in Asia and North America. The Team 9 topics are particularly important because they embody the implementation of the results of the work of the other ICBEN International Noise Teams on the effects of noise exposure and, in addition, address the evolving and vital area of economics. The latter focus area includes topics such as cost-benefit analysis, which is crucial for governments to implement adequate and affordable noise mitigation policies. The ICBEN Team 9 review was prepared through inputs for the authors and through inputs by various Team 9 members. Interested readers are encouraged to read the more extensive Team 9 review paper available in the Proceedings of the ICBEN 2011 Congress.

The association between noise and cardiovascular disease has been studied for several decades and the weight of evidence clearly supports a causal link. Nevertheless, many questions remain, such as the magnitude and threshold level for adverse effects of noise, how noise and other cardio-toxic pollutants (such as particulate matter) may interact in disease causation, identification of vulnerable populations, of exposure modifiers (i.e., location of bedrooms) and of other effect-modifiers (i.e., gender), and how epidemiologic methodology can be improved. This review describes contributions to literature over the past 3 years in the area of noise and CVD in general, with particular focus on these questions.

Hearing loss, most specifically noise-induced hearing loss (NIHL) due to exposure to vuvuzela noise, received extended media coverage before and during the 2010 Federation Internationale de Football Association (FIFA) soccer world cup tournament. This study aimed to evaluate the impact that this media coverage had on raising awareness about NIHL due to exposure to vuvuzela noise at soccer matches among South African soccer spectators. A descriptive survey study, using a 24-item, self-administered questionnaire was used for this study. One hundred and forty seven (147) soccer spectators were surveyed before (N1 =73) and after (N2 =74) the tournament. Systematic sampling strategy was used to select the participants. Participants completed the questionnaire before the start of matches. Sixteen percent of the participants surveyed reported having had some media exposure about NIHL due to exposure to vuvuzela noise during soccer matches before the tournament in comparison to 26% of the participants after the tournament. This increase in the level of awareness was not statistically significant. Further, most participants were still not aware of the risk of NIHL to them from exposure to excessive noise during matches and did not consider hearing loss from noise exposure during soccer matches a serious concern both before and after the tournament. The results of this study therefore seem to suggest that vuvuzela media coverage during the 2010 FIFA soccer world cup tournament did not significantly raise the level of awareness about NIHL due to exposure to excessive noise during matches among the spectators surveyed.

European noise research and policy-making overall not so effective thus far is considered from a behavioural science perspective. First, an overview is given of a recent strategy paper by the EU's CALM network1, focused on perception-related and emission-related research. After a summary of noise effects on human well-being, environmental noise problems are discussed as socio-technical problems where the social part is just as important as the technical part. The behavioural and social components of noise emission, transmission, exposure and effect are explicated. Environmental stress is considered as a double-sided phenomenon involving subjects' threat appraisal and their coping appraisal, each comprising specific underlying variables. From the wider perspective explained, several comments are given on the research strategy CALM is proposing. It is argued that: increasing motorisation undermines noise abatement; dose-response relationships reflect only part of the problem; more attention is needed for the causative behaviour of noisy actors; technical noise-reduction measures are necessary but insufficient; and that noise as a daily stressor should be treated in the context of people's overall quality of life. Specific suggestions are listed for EU noise research and policy-making. One conclusion is that more effective and visionary European noise policies may well be started tomorrow and need not depend on 15 years more research as envisaged in the CALM strategy paper.

This retrospective study presents the findings of inner ear damage documented in 53 children exposed to impulsive sound emitted by toy weapons and firecrackers. There were 49 boys and four girls aged between four and fourteen years. Thirty-nine children were affected unilaterally while fourteen had bilateral hearing loss (total of 67 ears). Most of the hearing loss (>70%) was sensorineural high frequency hearing loss, while only nine out of the 67 injured ears had sensorineural mid frequency hearing loss. Seven children sustained a traumatic ear drum perforation. Dizziness or tinnitus was reported by twenty children, with pathological ENG findings in four of them. This paper re-emphasizes the possibility of inner ear damage in children from exposure to noisy toys.

Night-time wake-up thresholds at noise levels of 60 dB(A) are frequently employed in Germany to establish "noise polluted areas". The criterion is, however, based on an incorrect processing of statistical data gathered from an evaluation of literature performed by Griefahn et al. (1976). This finding has emerged from an extensive revision of the study. Using appropriate statistical methods, maximum levels of under 48 dB(A) are assessed as waking-up thresholds at ear level in sleeping persons, in contrast to maximum levels of 60 dB(A) calculated by Griefahn et al. in 1976. The linear dose-response relationship, which in the course of the revision could be derived from the early publications, agrees with the results of more recent literature evaluations. The present contribution is not intended to give rise to the question whether in the interest of medical prevention it is reasonable to develop night-time protective policies merely founded on noise levels marking the "statistical" onset of nocturnal wake-up reactions. In this context, emphasis is laid on the deformation of the biological rhythm of sleep.

A total of twenty-five subjects were cloistered for a period of 70 hours, five at a time, in a hyperbaric chamber modified to simulate the conditions aboard the International Space Station (ISS). A recording of 72 dBA background noise from the ISS service module was used to simulate noise conditions on the ISS. Two groups experienced the background noise throughout the experiment, two other groups experienced the noise only during the day, and one control group was cloistered in a quiet environment. All subjects completed a battery of cognitive tests nine times throughout the experiment. The data showed little or no effect of noise on reasoning, perceptual decision-making, memory, vigilance, mood, or subjective indices of fatigue. Our results suggest that the level of noise on the space station should not affect cognitive performance, at least over a period of several days.

High airflow hand dryers are found in many public restrooms today. These dryers offer quick and clean hand drying, and are seen as being an environment-friendly alternative to paper towels. However, many new hand dryers are loud, exposing individuals using the facilities as well as those employees who clean the facilities to potentially dangerous noise. Prolonged exposure to high levels of occupational noise can cause damage to hair cells in the cochlea, resulting in varying degrees of noise-induced hearing loss. This study examined the intensity (in dBA) of the noise produced by the air dryers in campus restrooms. Hand dryer peak and average noise was measured with a sound level meter at 2.5 ft, 5 ft, and 10 ft from the dryer. Noise measurements did not decrease as predicted by the inverse-square law, probably because of the reverberative surfaces found in the restrooms. The small sample of hand dryers tested was mostly found to be producing more noise than the manufacturer claimed they would; indeed, none of the dryers would be safe for an 8-h workday exposure. While hand dryers do reduce paper trash, they pose as a different sort of hazard to our environment and population.

From the latter part of the 19th century, when New York City trains began to operate, until the present time, New York City's Transit Authority has received train noise complaints from riders and residents living near its transit system. The growing body of literature demonstrating the adverse effects of noise on physical and mental health raises the question as to whether transit noise is hazardous to the health of New York City's transit riders and residents living near the transit system. Several studies have examined the impacts of the noise of New York's transit system on hearing, health and learning. Despite the Transit Authority's efforts to remedy transit noise in response to complaints, the noise problem has not yet been satisfactorily ameliorated. This paper will suggest how the Transit Authority could employ techniques that could lower the noise levels of its system and benefit the health and welfare of New Yorkers. The recommendations in this paper could also apply to other cities with major transit systems where noise abatement has not been treated seriously.

Recent findings that glial cell line-derived neurotrophic factor (GDNF), neurotrophin-3 (NT-3), and transforming growth factor a can protect the auditory hair cells from acoustic trauma or aminoglycoside ototoxicity in vivo raise the question of whether other neurotrophic factors can also protect the hair cells in vivo. Fibroblast growth factor-2 (FGF-2) can protect hair cells from neomycin ototoxicity in vitro, and in vivo study has shown upregulation of FGF receptor-3 in the cochlea following noise exposure, suggesting that some FGF family members might play a role in protection or repair of the cochlea from damage. We therefore examined if FGF-1 and FGF-2 chronically delivered to the cochlea prior to noise overstimulation can attenuate noise-induced hair cell damage in vivo under conditions in which GDNF and NT-3 were effective. Pigmented female guinea pigs underwent left scala tympani implantation of a microcannula attached to an osmotic pump filled with artificial perilymph only or containing FGFs (10 or 1 mg/ml FGF-1 or 10 mg/ml FGF-2). They were exposed to noise (4 kHz octave band, 115 dB SPL, 5 hr) 4 days after surgery. Threshold shifts 10 days postexposure were essentially equivalent at all frequencies tested across different treatment groups. No significant difference in threshold shifts was observed between the treated and untreated ears in any of the groups. The extent of hair cell damage was also comparable among the different treatment groups. These findings indicate that exogenous FGF-1 or FGF-2 does not influence noise-induced hair cell damage under the experimental conditions used in this study, suggesting that these FGFs are not good candidates as auditory hair cell protectors in vivo.

Self-reported noise exposure is on the rise in Denmark. Little is known, however, about the social consequences, including sickness absence, of noise exposure. The aim of this paper was to investigate the association between self-reported noise exposure and long-term sickness absence. The association was investigated using the Cox proportional hazards model to analyze outcomes in Danish register data on the basis of Danish survey data (5357 employees aged 18-69 in 2000). The analyses showed that self-reported noise exposure was significantly associated with long-term sickness absence for both men and women when adjusting for demographic factors and health behavior. After further adjustment for physical workload at work the association between noise exposure and sickness absence disappeared for women, but not for men. Men that reported to be exposed to loud noise between one-quarter and three-quarters of their time at work had an increased risk of 43% (CI: 10-85%) for sickness absence of two weeks or longer compared to men that reported never to be exposed to loud noise. Men that reported to be little/rarely exposed to loud noise had an increased risk of 37% (CI: 7-76%). Men that reported to be exposed to loud noise more than three-quarters of their time at work did not have an increased risk of sickness absence. This latter result might be due a healthy worker effect and/or more frequent use of hearing protection in this group. Along with evidence from previous studies these results provide further support for an association between occupational noise exposure and sickness absence.

Otoacoustic emissions and contra-lateral sound activated efferent suppression of emissions were examined to determine whether they provide any early indication of auditory damage from exposure to noise. Three groups were studied: noise exposed workers (n=50, mean age 42 years), patients with Meniere's disease (n=24, mean age 48 years) and normal subjects (n=24, mean age 41 years). All subjects underwent routine pure tone audiometry, tympanometry and otoacoustic emission testing. As a number of studies have shown that with hearing threshold better than 30 dB HL, emissions are almost always present and are generally absent with hearing loss greater than 30 dB HL, subjects in this study were sub grouped into these two categories in order to examine the incidence of emissions. Absence of emissions in subjects with mean hearing thresholds better than 30 dB HL varied from 0% in normal controls, 8% in patients with Meniere's disease and a significantly high 56% in noise exposed workers despite similar mean hearing thresholds for all groups. The mean transient emission levels for the noise exposed workers was significantly lower than the controls and Meniere's groups. This study clearly indicates that in the noise-exposed group there is sub clinical and sub audiometric damage to the outer hair cells responsible for generation of otoacoustic emissions. Of those with normal otoacoustic emissions, the efferent suppression was absent in 60% of noise exposed workers but in only 3.8% of control subjects implying that the efferent control may also be affected in a significant proportion despite normal hearing thresholds and emissions.

Prior to this study, it was not clear how familiar orchestral musicians were with the various insertable models of hearing protectors. The present study focuses on musicians and entertainers and proposes the maintenance of a noise exposure limit through the use of a hearing protector. This study was conducted by distributing a questionnaire to musicians ( n = 429) in nine orchestras in order to obtain information on the use of hearing protection and the musicians' hearing sensitivity. Hearing protectors were found to be seldom used by orchestral musicians. During orchestral rehearsals, < 1/6 of the test persons used Type 1 (individually fitted) hearing protectors although> 80% of the respondents indicated that they knew about them. A gap emerged between what seemed most important to musicians in hearing protectors and what was provided by the manufacturers. The subject of hearing protection in orchestral musicians should be investigated with a multidimensional approach which considers the following in equal measure: legal regulations, the requirements and limits of the music sector and the individual characteristics of the musicians involved.

Noise is the most common agent of occupational exposure. It may induce both auditory and extraauditory dysfunction and increase the risk of work accidents. The purpose of this study was to estimate the fraction of accidents attributable to noise occupational exposure in a mid-size city located in southeastern Brazil. In this population case-control study, which included 108 cases and 324 controls, the incidence rate ratio of work accidents controlled for several covariables was obtained by classifying occupational noise exposure into three levels, as well as determining the prevalence in each level. Based on these data, the attributable fraction was estimated as 0.6391 (95% CI = 0.2341-0.3676), i.e., 63% of the work accidents that took place in the study site were statistically associated with occupational noise exposure. The causes of this association as well as its implications in the prevention of work accidents are discussed.

Noise represents one of the most common occupational health hazards. A Healthy People 2020 objective aims to reduce hearing loss in the noise-exposed public. The purpose of this study was to describe and compare perceived and measured hearing, and to determine the prevalence of hearing loss among a group of factory workers. Data collected as part of an intervention study promoting hearing protector use among workers at an automotive factory in the Midwest were used. Plant employees (n=2691) provided information regarding their perceived hearing ability, work role, and other demographics. The relationships among audiograms, a single-item measure of perceived hearing ability, and demographic data were explored using chi-square, McNemar's test, Mann-Whitney U-test, sensitivity, and specificity. The prevalence of hearing loss among noise-exposed factory workers was 42% (where hearing loss was defined as >25 dB loss at the OSHA-recommended frequencies of 2, 3, and 4 kHz in either ear). However, 76% of workers reported their hearing ability as excellent or good. The difference in perceived hearing ability was significant at each tested frequency between those with and without measured hearing loss. Self-reported hearing ability was poorly related to results of audiometry. Although this group of workers was employed in a regulated environment and served by a hearing conservation program, hearing loss was highly prevalent. These findings, together with national prevalence estimates, support the need for evaluation of hearing conservation programs and increased attention to the national goal of reducing adult hearing loss.

Both the antioxidant, N-l-acetyl cysteine (NAC), and the Src inhibitor, KX1-004, have been used to protect the cochlea from hazardous noise. In order to extend our previous work on KX1-004 with noise exposure, the current studies were undertaken with two goals: (1) to test the effectiveness of NAC and KX1-004 in combination with one another when given in a protection paradigm, and (2) to test the NAC+KX1-004 combination in a postexposure rescue paradigm. The noise exposure for the first experiment consisted of a 4-kHz octave band of noise at 107 dB SPL for 2 hours. The combination of NAC and KX1-004 were administered either prior to the noise exposure or post exposure (rescue). The second experiment was undertaken to extend the findings of the first experiment's rescue paradigm. The 4 kHz octave band noise was delivered at 112 dB SPL for 1 hour, with the experimental drugs delivered only in a rescue paradigm. In Experiment 1, animals treated before the 2-hour noise exposure with the combination of NAC and KX1-004 had from 12 to 17 dB less permanent threshold shift when compared to control saline treated animals. Treatment in the rescue paradigm did not produce any reductions in threshold shift from the 2-hour exposure. In the second experiment, with the 1-hour noise, rescue with KX1-004 or KX1-004 plus NAC yielded small, but significant, reductions in threshold shift. There was no additional benefit from the combination of NAC and KX1-004 over KX1-004 by itself.

In military outdoor shooting training, with safety measures enforced, the risk of a permanent, noise-induced hearing loss is very small. But urban warfare training performed indoors, with reflections from walls, might increase the risk. A question is whether antioxidants can reduce the negative effects of noise on human hearing as it does on research animals. Hearing tests were performed on a control group of 23 military officers before and after a shooting session in a bunker-like room. The experiments were repeated on another group of 11 officers with peroral adminstration of N-acetyl-cysteine (NAC), directly after the shooting. The measurements performed were tone thresholds; transient-evoked otoacoustic emissions, with and without contralateral noise; and psycho-acoustical modulation transfer function (PMTF), thresholds for brief tones in modulated noise. Effects from shooting on hearing thresholds were small, but threshold behavior supports use of NAC treatment. On the PMTF, shooting without NAC gave strong effects. Those effects were like those from continuous noise, which means that strict safety measures should be enforced. The most striking finding was that the non-linearity of the cochlea, that was strongly reduced in the group without NAC, as manifested by the PMTF-results, was practically unchanged in the NAC-group throughout the study. NAC treatment directly after shooting in a bunkerlike room seems to give some protection of the cochlea.

The efficacy of three different doses of sodium salicylate (SAL) in combination with one dose of N-acetylcysteine (NAC) to prevent noise-induced hearing loss was studied in chinchillas. After obtaining baseline-hearing thresholds, the chinchillas were randomly assigned to one of four treatment groups: three sets were injected intraperitoneally with 325 mg/kg NAC combined with 25, 50, or 75 mg/kg SAL, and a separate control group was injected with an equal volume of saline. Animals were injected twice daily for 2 days prior to and 1 hour before the noise exposure (6 hours to a 105-dB Standard Pressure Level octave band noise centered at 4 kHz). Immediate post-noise hearing thresholds were obtained followed by post-noise treatments at 1 hour then twice-daily for 2 days. Hearing tests continued at 1, 2, and 3 weeks post-noise, and immediately after the last hearing test, animals' cochleae were stained for hair cell counts. All the groups showed hearing improvement until week 2. However, at week 3, saline treated animals demonstrated a 17-33 dB SPL permanent threshold shift (PTS) across the test frequencies. Hearing loss was lowest in the 50 SAL/325 NAC mg/kg group (all frequencies, P < 0.001), and although PTS was reduced in the 25 and 75 mg/kg SAL dosage groups compared to the saline group, only the 75 mg/kg SAL group was significantly different at all but 2 kHz frequency. Coupled with the hearing loss, outer hair cell (OHC) loss was maximal in the 4-8 kHz cochlear region of saline treated animals. However, there was a substantial reduction in the mean OHC loss of the NAC plus 50 or 75 mg/kg (but not the 25 mg/kg) SAL groups. These findings suggest that SAL in combination with NAC is effective in reducing noise damage to the cochlea, but SAL has a relatively narrow therapeutic dosing window.

The neonatal intensive care unit (NICU) is an environment that provides premature and fragile infants with health provisions needed to make a complete recovery. Premature infants are often born before their auditory systems have had an opportunity to fully mature. Research has shown that the ambient acoustic environment in the NICU exceeds the maximum noise level recommended by the American Academy of Pediatrics, even after measures have been taken to decrease noise levels. The purpose of this study is to evaluate noise levels inside an Ohmeda Medical Giraffe™ OmniBed™, the natural attenuation of the incubator, and the effects of modifications on attenuation and reverberation within the Giraffe TM OmniBed™. The normal operation of the Giraffe™ OmniBed™ is 41.7 dBA which indicates a lower noise of operation than previous studies. The Giraffe™ OmniBed™ naturally attenuates 12 dBA. Leaving an access latch or portal door open causes a statistically significant (P=.001) increase in sound within the bassinet. All modifications in the no-noise and the noise conditions showed a statistically significant (P=.001) drop in L(eq) when compared to baseline.

In the United Kingdom, before the introduction of the various town and country planning acts and associated regulations, landowners were free to use their land in any way they wished, subject only to limitations imposed by lease or covenant and the avoidance of nuisance or trespass against neighbours. Any disputes arising would be resolved by negotiation or via a court of law. Under current planning laws and regulations, local authorities are empowered to impose special conditions or even to refuse development to prevent excessive nuisance, but the resulting noise management solutions are not always optimum from either the noise maker's or the noise exposed's points of view. In addition, the planning system has almost no effect on existing noise. Public inquiries provide a useful mechanism for the investigation of appeals against local authority decisions, or where the government has decided that issues of strategic or national importance need to be fully explored in a public forum. In practice, and largely because of individual disagreement, public inquiries can result in excessive delays while all interested parties are allowed to have their say. There seems to be an increasing consensus that the general inadequacy of existing methods of assessing noise impact is at least partly to blame. The new European Environmental Noise Directive represents a step change towards the imposition of one-size-fits-all regulatory or administrative procedures which should eventually contribute towards the reduction of public inquiry delays, but on the other hand, any weakening of the general principle of basing decisions on 'informed flexibility' will probably have significant negative consequences over the longer term.

A poor acoustic environment in a school is known to negatively affect pupils' learning and achievement. This paper presents the design and findings of an online questionnaire survey of 11-16 year olds' impressions of their school's acoustic environment. A total of 2588 English secondary school pupils responded to the questionnaire. Factor analysis was used to identify variables which best characterized pupils' impressions of their school's acoustic environment. Four factors, corresponding to ease of hearing in school spaces, sensitivity to noise, the consequences of noise in the classroom, and annoyance to intermittent noise, accounted for 43% of the total variance in pupils' responses to the questionnaire. Analysis of the responses on these factors showed that pupils who reported additional learning needs such as hearing impairment, speaking English as an additional language or receiving learning support reported being significantly more affected by poor school acoustics than pupils reporting no additional learning needs. Older pupils were significantly more sensitive to noise annoyance and to the consequences of poor acoustical conditions on their learning and behaviour than younger pupils. Pupils attending suburban schools featuring cellular classrooms that were not exposed to a nearby noise sources were more positive about their school acoustics than pupils at schools with open plan classroom designs or attending schools that were exposed to external noise sources. The study demonstrates that adolescents are reliable judges of their school's acoustic environment, and have insight into the disruption to teaching and learning caused by poor listening conditions. Furthermore, pupils with additional learning needs are more at risk from the negative effects of poor school acoustics.

The patients in the Intensive Care Units are often exposed to excessive levels of noise and activities. They can suffer from sleep disturbance, especially at night, but they are often too ill to cope with the poor environment. This article investigates the acoustic environment of typical intensive care wards in the UK, based on long period nocturnal measurements, and examines the differences between singlebed and multibed wards, using statistical analysis. It has been shown that the acoustic environment differs significantly every night. There are also significant differences between the noise levels in the singlebed and multibed wards, where acoustic ceilings are present. Despite the similar background noises in both ward types, more intrusive noises tend to originate from the multibed wards, while more extreme sounds are likely to occur in the single wards. The sound levels in the measured wards for each night are in excess of the World Health Organization's (WHO) guide levels by at least 20 dBA, dominantly at the middle frequencies. Although the sound level at night varies less than that in the daytime, the nocturnal acoustic environment is not dependant on any specific time, thus neither the noisiest nor quietest period can be determined. It is expected that the statistical analysis of the collected data will provide essential information for the development of relevant guidelines and noise reduction strategies.

Acute acoustic traumas are caused by exposure to extremely high noise levels ranging from milliseconds to several hours' duration. In pure tone audiometry they range from the C5 dip to basomediocochlear sensorineural hearing loss. Their pathogenesis is assumed to consist of micromechanical-traumatic and biochemical-metabolic damage to the outer hair cells. In order to establish the changes to the DPOAE (distortion products of otoacoustic emissions), 17 patients were examined after sustaining acute acoustic trauma. The causes included firework explosions, anti-tank rocket launchers, vehicle tyre bursting, rock concerts, hand-gun shots, sub-machine gun fire, hand grenade explosion, exploding car battery. The pure tone audiogram, tympanogram, tinnitus maskability and DPOAE (both DP-gram and growth rate in various frequencies) were determined in all patients. If the event had occurred some time ago, measurements were taken only once; in acute cases measurements were repeated at different times. In nine patients with persistent hearing impairment, clear DPs were found in the unaffected frequencies but were completely absent in the affected frequency range. Four of these patients were unilaterally and two patients were bilaterally affected; three patients had a different (not noise-induced) hearing loss on the opposite side. In eight patients with regressive hearing loss, DPs were by contrast detectable throughout the entire frequency range, their amplitudes only rising slightly as hearing recovered. Of these eight patients, three were unilaterally and five bilaterally affected. DPOAE seem to indicate the likelihood of recovery of hearing threshold after an acute acoustic trauma. In cases with DPs completely absent in the affected frequency range, the prognosis seems to be much worse than in cases with present DPs in the frequency range of hearing.

A supportive environment should take care of health. It is an environment that provides complete physical, mental and social well-being. It is not suffiently characterized by infirmity or the absence of disease. It should trigger good feelings and safety (WHO, 2000). Interdisciplinary procedures are needed that include acoustics, physics, psychology, and sociology when a survey on perception of acoustic environments is carried out under the aspect of comfort. It is necessary to combine methods with different sensibilities in order to measure the subjective perception of noise in such an environment. The context, the focus of attention, and the knowledge of past experiences must be taken into account. (Ipsen, 2001) These three conditions are required to implement an adequate measurement. Subject-centred methodological procedures should be used to develop a suitable measurement procedure. Such procedures will be presented with the aim to improve social surveys that especially address the meaning of annoyance in an acoustic environment and the contribution of a soundscape.

Non-acoustic factors in environmental noise can be broadly defined as all those factors other than noise level alone which contribute to noise annoyance and similar effects. Noise levels such as LAeq provide a good indication of the amount of physical noise present, and changes in physical noise level can be expected to correlate with changes in resident's perception, at least to some degree. On the other hand, a flexible approach to noise management based on wide consultation and communication can be extremely important. At Heathrow Airport over the last 20 to 30 years, overall aircraft noise levels have reduced because of the phasing out of the older noisier Chapter 2 aircraft types, but there are also other strategies in place which are clearly regarded as being effective both by airport management and by local community representatives and which are not as easily quantified in terms of noise level alone. This paper describes the background to noise management at Heathrow in some detail and draws a general conclusion that taking non-acoustic factors into account in addition to physical noise levels alone has been of considerable benefit over the years.

Speech warnings and communication systems are increasingly used in noisy, high workload environments. An important decision in the development of such systems is the choice of a male or a female speaker. There is little objective evidence to support this decision, although there are many misconceptions and misunderstandings on this topic. This paper suggests that both acoustic and non-acoustic differences (such as social attributions towards speakers of different sexes) between male and female speakers is negligible, therefore the choice of speaker should depend on the overlap of noise and speech spectra. Female voices do however appear to have an advantage in that they can portray a greater range of urgencies because of their usually higher pitch and pitch range. An experiment is reported showing that knowledge about the sex of a speaker has no effect on judgements of perceived urgency, with acoustic variables accounting for such differences.

Background noise and room acoustics may impede social interactions by interfering with oral communication and other cognitive processes. Accordingly, recent research in school environments has showed that social relationships with peers and teachers are described more negatively in rooms with long reverberation times (RT). The purpose of this study was to investigate how RT and hearing ability (i.e., hearing thresholds [HT] and distortion product oto-acoustic emissions) were associated with schoolteachers' perceptions of the social climate at work and their intentions to stay on the job. Schoolteachers (n = 107) from 10 schools that worked in classrooms classified by acoustical experts as "short RT" (3 schools, mean RT 0.41-0.47 s), "medium RT" (3 schools, mean RT 0.50-0.53 s), and "long RT" (4 schools, mean RT 0.59-0.73 s) were examined. Teachers who worked in classrooms with long RT perceived their social climate to be more competitive, conflict laden, and less relaxed and comfortable. They were more doubtful about staying on the job. Even if the teachers were generally satisfied with their work the results suggest that the comfort at work may have been further improved by acoustical interventions that focus on reducing sound reflections in the classrooms. Yet, due the study design and the novelty of the findings the potential practical significance of our observations remains to be evaluated.

The objective of this research was to study musicians' abilities to estimate the risk to obtain a hearing loss. Twenty-two professional musicians mainly playing classical music wore dosimeters during 2 working weeks. They also wrote a diary describing all their musical activities and tried to judge the percentage of time that every activity was harmful to their hearing. Half of the musicians seemed to be capable to reasonably judge the harmfulness of the music that they were exposed to. They started to judge the levels to be risky at 80 dB(A) and regarded themselves as sligthly more susceptible to noise induced hearing loss than normal.

Occupational hearing loss is one of the most prevalent occupational conditions; yet, there is no acknowledged international metric to allow comparisons of risk between different industries and regions. In order to make recommendations for an international standard of occupational hearing loss, members of an international industry group (the International Aluminium Association) submitted details of different hearing loss metrics currently in use by members. We compared the performance of these metrics using an audiometric data set for over 6000 individuals working in 10 locations of one member company. We calculated rates for each metric at each location from 2002 to 2006. For comparison, we calculated the difference of observed-expected (for age) binaural high-frequency hearing loss (in dB/year) for each location over the same time period. We performed linear regression to determine the correlation between each metric and the observed-expected rate of hearing loss. The different metrics produced discrepant results, with annual rates ranging from 0.0% for a less-sensitive metric to more than 10% for a highly sensitive metric. At least two metrics, a 10dB age-corrected threshold shift from baseline and a 15dB nonage-corrected shift metric, correlated well with the difference of observed-expected high-frequency hearing loss. This study suggests that it is feasible to develop an international standard for tracking occupational hearing loss in industrial working populations.

Connections between thalamic structures of the auditory system and subcortical areas (amygdala, hippocampus, hypothalamus) had been hypothesized to act as a fast reacting "memory chain" establishing and enhancing adverse excitations during noise exposure. Recent studies prove that the lateral amygdala is an important part of a second separate pathway to the telencephalic projections of the auditory system. This fast, monosynaptic thalamo-amygdala tract is responsible for full-blown "fear responses" evoked by auditory stimuli as shown by several conditioning experiments in animals: A fear memory system. The appertaining basic processes of plasticity in the amygdala are reductions of latencies of neuronal excitations and recruiting of more elements with shorter latency, long-term potentiation causing enhancement of auditory-evoked responses by repeated stimulation, as well as sharpening of primary broad tuning curves of elements. Very recently a study using Functional-Magnetic-Resonance-Imaging (fMRI) demonstrated that an amygdalar contribution to conditioned fear learning can be revealed in normal human subjects too. These findings were supported by Positron-Emission-Tomography (PET) studies in depressive persons showing that amygdala metabolic abnormality predicted the cortisol concentration in blood. Using connections via central amygdala, lateral and medial hypothalamus to parts named nuclei paraventriculares and regio arcuata, the sound evoked excitations reach two essential components of endocrine functioning: a) the well-known hypothalamic-pituitary-adrenal (HPA) system with a subsequent rise (via Corticotropin-Releasing Hormone: CRH) in Corticotropin (Adreno-CorticoTropin Hormone: ACTH) and the corticosterone levels; b) the synthesis of ACTH and beta-endorphine-like substances in the arcuate region being axonally transported to extrahypothalamic brain regions. Longer-lasting activation of the HPA-axis, especially abnormally increased or periodically elevated levels of cortisol and the widespread extrahypothalamically distributed CRF/ACTH may lead to disturbed hormonal balance and even to severe diseases.

This is a review of the research into endocrine effects of noise since the early 1980s at the Institute for Water, Soil and Air Hygiene. According to our knowledge, no other group has studied systematically the endocrine effects of acute and chronic noise exposure. Mechanisms of acute noise-induced stress reactions as well as long-term increase of stress hormones in animal and persons under chronic noise exposure were studied. Our theoretical background was Henry's psychophysiological stress model with the two reaction alternatives : (i) The fight-flight reaction, characterised by an increase in adrenalin and noradrenaline (ii) The defeat reaction with increased cortisol. Extremely intense acute noise exposure near the threshold of pain caused an increased release of cortisol from the suprarenal cortex but acute noise exposure with levels between 90 and 100 dB(A) caused an increase of catecholamines. Non-habituated noise increased primarily the release of adrenalin from the suprarenal medulla, whereas habituated noise caused a chronic increase of noradrenaline from the sympathetic synapses under longterm noise exposure at work. Environmental noise exposure (Leq >/= 60 dB(A)) caused catecholamine increase if activities such as conversation, concentration, recreation etc were disturbed through noise. In sleeping persons, traffic noise with only Leq >/= 30 dB (A) and Lmax >/= 55 dB(A) caused significant acute increase of cortisol, which developed into chronic increase if the noise exposure was repeated consistently. Parallel to cortisol, chronic noradrenaline increase was also observed. Based upon the empirical results, a noise stress model was developed which is a first step forward in the theoretical understanding of endocrine noise effects.

Several case reports suggest that some individuals are susceptible to hearing loss from opioids. A combination of noise and opium exposure is possible in either occupational setting such as military service or recreational settings. According to the Drug Enforcement Agency of the U.S. Department of Justice, prescriptions for opiate-based drugs have skyrocketed in the past decade. Since both opium and noise independently can cause hearing loss, it is important to know the prevalence of hearing loss among individuals who are exposed to opium or both opium and noise. The purpose of this research was to evaluate auditory sensitivity in individuals with a history of opium abuse and/or occupational or nonoccupational noise exposure. Twenty-three men who reported opiate abuse served as participants in the study. Four of the individuals reported no history of noise exposure, 12 reported hobby-related noise exposure, 7 reported occupational noise exposure including 2 who also reported hobby-related noise exposure. Fifty percent (2/4) of the individuals without any noise exposure had a hearing loss confirming previous reports that some of the population is vulnerable to the ototoxic effects of opioids. The percentage of population with hearing loss increased with hobby-related (58%) and occupational noise exposure (100%). Mixed MANOVA revealed a significant ear, frequency, and noise exposure interaction. Health professionals need to be aware of the possible ototoxic effects of opioids, since early detection of hearing loss from opium abuse may lead to cessation of abuse and further progression of hearing loss. The possibility that opium abuse may interact with noise exposure in determining auditory thresholds needs to be considered in noise exposed individuals who are addicted to opiates. Possible mechanisms of cochlear damage from opium abuse, possible reasons for individual susceptibility, and recommendations for future studies are presented in the article.

Noise in most working environments is an unwanted by-product of the process. In most countries, noise exposure for workers has been controlled by legislation for many years. In the music industry the "noise" is actually the "desired" product, and for a long time the UK entertainment industry was exempt from these regulations. From April 2008, however, it became regulated under the Noise at Work Regulations 2005, meaning that employers from orchestras to nightclubs are legally required to adhere to the same requirements (based on ISO 9612:2009) for controlling noise exposure for their staff that have been applied to other industries for many years. A key question is to what degree, 2 years after implementation, these employers are complying with their legal responsibilities to protect the staff from noise? This study assessed four public music venues where live and/or recorded music is regularly played. Thirty staff members in different roles in the venues were monitored using noise dosimetry to determine noise exposure. Questionnaires were used to determine work patterns, attitudes to noise and hearing loss, and levels of training about noise risk. Results showed that the majority of staff (70%) in all venues exceeded the daily noise exposure limit value in their working shift. Use of hearing protection was rare (<30%) and not enforced by most venues. The understanding of the hazard posed by noise was low, and implementation of the noise regulations was haphazard, with staff regularly exceeding regulatory limits. The implication is that the industry is failing to meet regulatory requirements.

The aims of this study were to evaluate the effects of administration of Vitamins C and E on fertilization capacity in rats exposed to noise stress. 40 adult male rats were randomly divided into 5 equal groups. Group 1 as controls who were not exposed to noise and groups 2-5 exposed to noise with 90-120 dB intensity and 300-350 Hz frequency from 7 pm to 7 am everyday for 50 days. Group 2 exposed to noise and did not receive Vitamins. Group 3 received vitamin C, Group 4 received Vitamin E. Group 5 received Vitamins C and E concomitantly. After 50 days, serum Follicle-stimulating hormone (FSH), Luteinizing hormone (LH) and testosterone were calculated. Then each rat was left with three female rats for mating. Pregnant females were sacrificed on the 19 th day of pregnancy and evaluated for the presence and number of viable, dead and absorbed fetuses. The level of FSH, LH and testosterone significantly decreased in rats exposed to noise (P < 0.05). By administration of Vitamins in groups 3-5 we observed that the level of hormones significantly increased in compared to group 2 (P < 0.05). The fertilization capacity of male rats in groups 3-5 significantly increased in compared to group 2 (P < 0.05). There was significant difference between groups 1 and 2 in case of fertilization capacity (P = 0.001). The data in this study strongly suggests a negative role for noise stress on level of FSH, LH and testosterone level and also fertilization capacity of male rats. To complement the information it is suggested that this research be done on human samples.

Both the antioxidant, n-l-acetyl cysteine (L-NAC) and the Src inhibitor, KX1-004, have been used to protect the cochlea from hazardous noise. To date, KX1-004 has only been used locally on the round window. In the current study, the two drugs were administered systemically. LNAC was delivered intraperitoneally at a dose of 325 mg/kg while KX1-004 was administered subcutaneously at a dose of 50 mg/kg. The noise exposure consisted of a 4 kHz octave band of noise at 100 dB SPL for 6 hours/day for 4 days. The drugs were administered once each day, 30 minutes prior to the onset of the noise exposure. The animals' hearing was estimated using the evoked response records from surgically-implanted chronic electrodes in the inferior colliculi. Animals treated with LNAC and KX1-004 had from 10 to 20 dB less temporary threshold shift at day 1 and an average 10 dB less permanent threshold shift by day 21 when compared to control saline treated animals. There were no significant side effects (i.e.: appetite loss, weight loss, lethargy, etc.) related to either of the drug treatments. KX1-004 produced at least as much protection as L-NAC, but at a significantly lower concentration.

Exposure to loud sound during leisure activities for long periods of time is an important area to implement preventive health education, especially among young people. The aim was to identify the relations among awareness about the damaging effects of loud levels of sounds, previous exposures do loud sounds, preferences-related to sound levels and knowledge about hearing protection with age, gender, and their parent's educational level among children. Prospective cross-sectional. Seven hundred and forty students (5-16 years old) and 610 parents participated in the study. Chi-square test, Fisher exact test and linear regression. About 86.5% of the children consider that loud sounds damage the ears and 53.7% dislike noisy places. Children were previously exposed to parties and concerts with loud music, Mardi Gras, firecrackers and loud music at home or in the car and loud music with earphones. About 18.4% of the younger children could select the volume of the music, versus 65.3% of the older ones. Children have poor information about hearing protection and do not have hearing protection device. Knowledge about the risks related to exposures to loud sounds and about strategies to protect their hearing increases with age, but preference for loud sounds and exposures to it increases too. Gender and parents' instructional level have little influence on the studied variables. Many of the children's recreational activities are noisy. It is possible that the tendency of increasing preference for loud sounds with age might be a result of a learned behavior.