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A. GILLES ET AL.
self-image may alter, so they perceive themselves as vulnerable to noise. As a consequence, they would start using
HP, as opposed to individuals who have no hearing symptoms experiences and, therefore, do not feel the need to
protect themselves (29). Factor analysis showed that the
YANS has 4 dimensions: 1) attitudes toward noise associated with youth culture, for example, loud music at
concerts or discotheques; 2) attitudes toward the ability to
concentrate in a noisy environment; 3) attitudes toward
daily noises, for example, traffic noise; and 4) attitudes
toward influencing the sound environment (8).
The increase of NIHL in the last 20 years (12) and the
finding that more and more young adults find their way
to the hospital after acoustic trauma with symptoms of
hearing loss, tinnitus, and hyperacusis raise questions
whether young people are well enough informed concerning the risks of loud music exposure. Our main goal
was to assess the prevalence of noise-induced tinnitus
(NIT) in a young population as a parameter for overexposure to noise. In addition, the effect of the attitudes
toward noise and HP on the intention to protect their
hearing was assessed. The increase in hearing problems
in this age group might be explained by understanding
certain elements such as the attitude of young people
toward noise and HP, which should be taken into account
in the attempt to make young adults more aware of the risks
of loud music.
METHODS
A survey by questionnaire was undertaken at the otorhinolaryngology (ORL) department of the University Hospital Antwerp
and the University of Antwerp in March 2011. Demographic data,
such as sex and age, were collected. The study was approved by
the University Hospital Antwerp institutional review board.
Questionnaire
The survey contained questions about the occurrence of temporary tinnitus after loud music and the duration of tinnitus. The
loudness of tinnitus was evaluated by a Visual Analogue Scale
(VAS) going from 0 (no tinnitus) to 10 (extremely loud, unbearable tinnitus). The presence of permanent tinnitus was evaluated
by a yes-no question: Do you permanently experience tinnitus?
Two questions assessed tinnitus and hearing problems: After I
spent minimum 30 minutes in a noisy environment (e.g., discotheque, party, iPod etc.)I: 1) I have the feeling my hearing
decreased. 2) Im afraid the tinnitus will not disappear. Answer
possibilities were always, often, sometimes, and
never. Frequency of discotheque attendance was evaluated by
asking whether one visits a discotheque daily, weekly, monthly,
or yearly. A possibility of not applicable was included for
those who never attend night clubs. To evaluate the thoughts and
attitudes of young people toward loud music, a Dutch adapted
validated version of the Youth Attitude to Noise Scale (8,30)
was included in this study. All 19 items of the YANS were
scored on a 5-point Likert scale going from totally agree to
totally disagree.
The intention to wear HP in the future, the influence of peers
and the behavior toward HP was evaluated by the items given
in Table 1. All items presented were scored, analogous to the
YANS scoring, on a 5-point Likert scale going from totally
agree to totally disagree.
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Statistical Analysis
For the statistical analysis a Statistical Software package
(SPSS 17.0, Inc., Chicago, IL, USA) was used to perform
descriptive statistics and Spearman correlations. In addition, a
cumulative logit model was used to verify the relationship
between the different parts (YANS, influence of peers, behavior
toward HP, and knowledge) of the survey and the intention to
wear HP. Values were considered significant when p e 0.05.
RESULTS
The experience of permanent tinnitus in 1 or both ears
was reported by 21 respondents, corresponding to 14.8%
TABLE 2.
Mean scores for the entire Youth Attitude Toward Noise Scale and the 4 factors separately for male and female students,
including indications whether the difference between male and female scores were significant
Total
Men
Women
Total
Men
Women
Total
Men
Women
Total
Men
Women
Total
Men
Women
Mean
Standard deviation
2.60
2.67
2.58
3.05
3.11
3.05
2.79
2.73
2.81
2.19
2.44
2.09
2.61
2.70
2.58
0.48
0.48
0.47
0.99
1.00
0.97
0.64
0.80
0.56
0.60
0.60
0.56
0.33
0.30
0.32
p value
NS
NS
NS
0.002
NS
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4
TABLE 3.
A. GILLES ET AL.
Reported hearing decrement and fear of permanent tinnitus
Never
(%)
Sometimes
(%)
Often
(%)
Always
(%)
33.6
66.4
43.8
24.0
15.8
3.4
6.2
2.7
means that one would expect that young adults are well
aware of the risks of loud music, and there is sufficient
knowledge of the risks concerning loud music. Table 3
reports on the answers to the questions after having spent
at least 30 minutes in loud music I I 1) have the feeling
my hearing decreased; 2) fear that the tinnitus will not
disappear. Approximately 66.2% of the students report
to experience decreased hearing after loud music sometimes, often, or always. Nevertheless, 66.4% never fears
for permanent tinnitus. Table 4 shows the results of the
cumulative logit model with intention to wear HP as
dependent variable and attitudes (YANS), items questioning the influence of peers, behavior toward HP, and
knowledge as covariates (predictors). The items of behavioral toward HP and peers influence had a significant
influence; the attitudes were almost significant, and knowledge was not significant. The model suggests that peers
influence and behavior toward HP have the most influence
on the intentions to wear HP.
DISCUSSION
The percentage of young adults with permanent tinnitus is rather high. However, other studies also found a
relatively high prevalence of tinnitus in a young population. Figure 1 illustrates the results of the present study
compared with previous research (3,7,8,14,15,17,19,31).
The results of these studies show a lot of resemblances
with the present article as many also found a high prevalence of NIT in a young population, but a few differences should be highlighted. The results of Widen and
Erlandsson (8) show the greatest difference with the present article. This is because of the narrower definition of
temporary tinnitus used by Widen and Erlandsson as tinnitus should persist for more than 24 hours. Approximately
21.6% of the respondents (n = 1285) reported transient
tinnitus under these circumstances, and most hearing
problems and tinnitus were present after concerts and
discotheque visits. In the present study, the duration of
TABLE 4.
Parameter
Youth Attitude Toward Noise Scale
Peers influence
Behavior toward hearing protection
Knowledge risks
FIG. 1. Summary of prevalence numbers of transient and temporary tinnitus in previous research (B to I) compared with the
present article (A).
temporary tinnitus was not defined, so also tinnitus persisting for a few minutes was included. The purpose of this
wide definition was to include those individuals who
clearly have been exposed to loud music, which is not
always objectively measurable (20) but does translate into
subjective temporary tinnitus. Hearing symptoms, such as
tinnitus, are more common among older adolescents than
younger adolescents, probably because of the longer period of noise exposure (8,19). The present study focused on
a group of university students, with a higher mean age
compared with study B, E, F, and G presented in Figure 1,
which might also explain the greater prevalence of permanent and transient tinnitus found in the present study.
A 3-fold increase of tinnitus report in subjects with
significant social noise exposure (Q97 dB NIL) also was
previously reported (32). The discotheque and party attendance in the present study group was rather large.
Therefore, these students are frequently exposed to harmful
noise levels resulting in an increase of permanent and temporary tinnitus. In contrast, students who regularly visit
night clubs or parties rarely wear HP. Nevertheless, discotheque attendance has repeatedly been reported as the
main cause of symptoms such as tinnitus, ear pain, and
hearing loss (8,14,15,17) after loud music exposure. Experiencing otologic symptoms as a cause of loud music
does not seem a determining factor for the use of HP.
Possibly ones personal attitude toward loud music is a
more adequate precursor for the use of HP. Nevertheless,
an individuals behavior is not solely dependent on ones
attitudes toward a particular behavior.
Hypothesis test
Standard error
Lower
Upper
Wald W2
Significance
0.997
0.959
0.911
-0.464
0.5219
0.2093
0.,3208
0.3713
-0.026
0.549
0.283
-1.192
2.020
1.369
1.540
0.263
3.647
20.990
8.073
1.565
0.056
0.000
0.004
0.211
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CONCLUSION
In summary, our findings revealed that a large proportion of young adults experiences NIT, but this does
not result in the use of HP, possibly because of a lack
of knowledge concerning the risks of loud music. The
present article underlines the importance of hearing damage
in young adults. Its novelty is to increase our knowledge
about why HP is not used in individuals regularly exposed
to loud music. The use of the idea of the TPB provides
elucidation of this paradox and helps to identify the factors
associated with performing a certain behavior and, thus,
providing suggestions toward improvement of preventive
campaigns. In the future, campaigns must provide sufficient information concerning the risks of loud music and
Otology & Neurotology, Vol. 00, No. 00, 2012
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A. GILLES ET AL.
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Copyright 2012 Otology & Neurotology, Inc. Unauthorized reproduction of this article is prohibited.
Partly
agree
Neutral
Partly
disagree
Totally
disagree
1. I think that the sound level at discos, dances, rock concerts and sporting events, in
general, is too loud.
2. Listening to music while doing homework helps me concentrate.
3. I am prepared to do something to make the school environment quieter.
4. I consider leaving a disco, rock concert, dance or sporting event if the sound level is
too loud.
5. I can concentrate even if there are many different sounds around me.
6. I think it is unnecessary to use earplugs when I am at a disco, rock concert, dance or
sporting event.
7. It is important for me to make my sound environment more comfortable.
8. I dont like when it is quiet around me.
9. The sound level at discos, dances, rock concerts or sporting events is not a problem.
10. Noise and loud sounds are natural parts of our society.
11. Traffic noise is not disturbing to me.
12. The sound level should be lowered at discos, rock concerts, dances or sporting
events.
13. I think it should be quiet and calm in the classroom.
14. Sounds from fans, refrigerators, computers, etc., do not disturb me.
15. I am prepared to give up activities where the sound level is too loud.
16. The sound level at my school is comfortable.
17. It is easy for me to ignore traffic noise.
18. There should be more rules or regulations for the sound levels in society. (F1-)
19. When I cannot get rid of sounds that bother me, I feel helpless.
Olsen-Widen S.E. & Erlandsson S.I. (2004). Youth Attitude Toward Noise Scale (YANS). In: Olsen S.E (2004). Psychological aspects of
adolescents perceptions and habits in noisy environments. Licentiate dissertation. Department of Psychology, University of Goteborg, Sweden.
Partly agree
Neutral
Partly disagree
Totally disagree
No
Never
Sometimes
Often
Always
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A. GILLES ET AL.
Point out below how loud the tinnitus is after at least 30 minutes of loud music exposure (0 = no tinnitus; 10 = unbearable)
Right ear
g
0
g
1
g
2
g
3
g
4
g
5
g
6
g
7
g
8
g
9
g
10
g
1
g
2
g
3
g
4
g
5
g
6
g
7
g
8
g
9
g
10
Left ear
g
0
How long does the tinnitus persist after loud music exposure?
g
g
g
g
g
g
g
g
g
g
g
daily
weekly
monthly
yearly
not applicable
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