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Otology & Neurotology

00:00Y00 2012, Otology & Neurotology, Inc.

Prevalence of Leisure Noise-Induced Tinnitus and the


Attitude Toward Noise in University Students
*Annick Gilles, Dirk De Ridder, Guido Van Hal, Kristien Wouters,
*Andrea Kleine Punte, and *Paul Van de Heyning
*University Department of Otorhinolaryngology and Head and Neck Surgery, and Tinnitus Research Initiative
Centre, BRAI2N, Antwerp University Hospital, Edegem; Department of Epidemiology and Social Medicine,
Medical Sociology and Health Policy, University of Antwerp, Wilrijk; and Department of Medical
Management, Statistical Analysis, Antwerp University Hospital, Edegem, Belgium

Background: Adolescents and young adults often are exposed


to potentially damaging loud music during leisure activities.
As a consequence, more and more young adults suffer from tinnitus, hearing loss, and hyperacusis. The present study provides
prevalence numbers for noise-induced tinnitus (NIT) in this group,
the attitude toward loud music, and the factors influencing the use
of hearing protection (HP).
Method: A questionnaire was undertaken to evaluate the influence of permanent/transient tinnitus after loud music, the attitudes
toward noise, influence of peers, and the ability to manipulate
HP on the use of HP. The questionnaire was completed by 145
university students.
Results: Approximately 89.5% of the students had experienced
transient tinnitus after loud music exposure. The prevalence

of transient NIT was higher in female subjects compared with


male students. Permanent NIT was experienced by 14.8%.
Nevertheless, few respondents were worried, and the degree
of HP use was low (11%). However, the presence of permanent tinnitus was a motivation for HP use. Most respondents
held a neutral to positive attitude (i.e., pronoise) toward loud
music and were not fully aware of the risks of too much noise
exposure.
Conclusion: NIT is a common phenomenon among young adults.
The lack of knowledge in young adults and the underuse of HP
in leisure activities provide useful information to refine preventive measures in the future. Key Words: EpidemiologyVHearing
protectionVNoise-induced tinnitusVYoung adults.
Otol Neurotol 00:00Y00, 2012.

Listening to loud music, whether at concerts, parties,


night clubs, or through personal listening devices (PLDs),
has become a widespread phenomenon among adolescents
and young adults. Many young adults consciously expose
themselves to potentially damaging loud music during
leisure activities. Although industrial regulations state
actions in the form of hearing protection (HP) and compulsory protective actions whenever workers are exposed
to noise more than 85 dB(A) for 8 hours a day (1), the
mean sound levels of PLDs, night clubs, concerts, and
festivals are much higher (2). A Swiss study on the thoughts
toward electronically amplified music of young people
aged 16 to 25 found that 79% of the adolescents regularly

visited night clubs, of which, a quarter spent 8 hours or


more in a discotheque (3). As discotheque sound levels
range from 104 to 112 dB(A) (4), permanent hearing
damage can be established within seconds (3). In addition, sound levels in night clubs increase during the night
by 2 dB(A) per hour (5). Another study determined that
the typical PLD listener sets the volume at a range between 75 and 105 dB(A) (6). In addition, many adolescents regularly attend pop and rock concerts indoors or
at open air festivals where continuously sound levels of
100 to 115 dB(A) have been reported (7).
Because of the evolvement into many leisure activities,
young adults between 16 and 25 years old are more likely
to expose themselves to loud music (4,8). As a consequence,
the prevalence of noise-induced hearing loss (NIHL) in
adolescents and young adults increased tremendously over
the last years. In the Third National Health and Nutrition
Examination Study (NHANES III), conducted from 1988 to
1994, 5,249 US children aged 6 to 19 years received pure
tone audiometry and compliance testing for both ears.
Approximately 12.5% of the children demonstrated a

Address correspondence and reprint requests to Annick Gilles, M.A.,


Department of Otorhinolaryngology, University Hospital Antwerp,
Wilrijkstraat 10, 2650 Edegem, Belgium; E-mail: annick.gilles@UZA.be
This research is financially supported by the Stavros Niarchos Foundation for tinnitus research in adolescents and young adults.
The authors have no conflict of interest and are not financially supported by other organizations than the Stavros Niarchos Foundation.

Copyright 2012 Otology & Neurotology, Inc. Unauthorized reproduction of this article is prohibited.

A. GILLES ET AL.

noise-induced threshold shift, identified by a noise notch


configuration on the audiogram (9). Subsequently, the
NHANES 2005Y2006 revealed an increase of noiseinduced threshold shifts among female youths compared
with the previous study. Similar findings were found by
Berg and Serpanos (2011) (10). Besides hearing loss, other
symptoms such as ear pain, noise sensitivity, and tinnitus
have been mentioned as a result of excessive noise exposure (8,11Y13). Widen and Erlandsson (2004) (8) found
a prevalence of 8.7% of noise-induced permanent tinnitus
in high-school students aged 13 to 19 years. Other researchers reported that the majority of young adults have
experienced transient tinnitus after attending concerts and
clubs. The prevalence of tinnitus, in the absence of other
complaints, after loud music exposure in young people is
reported by several studies and ranges from 60% to 85%
(3,7,8,14Y19). However, tinnitus in the absence of hearing loss (HL) often is accompanied by cochlear and/or
neural damage, which is not always perceived by the individual nor measurable by a classical audiogram (20). The
experience of transient tinnitus after loud music may thus
be a relevant precursor for future symptoms such as HL,
permanent tinnitus, or hyperacusis (20Y22).
Despite the fact that tinnitus after loud music is a result
of overexposure, adolescents do not always take tinnitus
into account as a warning sign. As a consequence, many
lack the motivation to wear HP in noisy environments
(8,15,16,23Y25). In addition, most adolescents are heedless of hearing symptoms after loud music. In a study of
Widen and Erlandsson (2004) (8), nearly 25.9% of youngsters experiencing tinnitus after loud music reported to be
worried about noise levels in discotheques and at concerts.
When experiencing a combination of tinnitus and hyperacusis, half of the respondents reported to be worried in these
conditions, and 7.9% of participants with no such symptoms
reported to be worried about it (8).
It is unclear whether making adolescents more aware
of the risks of loud music is sufficient for them to take
precautions in the future (such as the use of HP). However, a hearing education campaign does not seem to
prompt high school students to display hearing-protective
behavior when attending a discotheque (26) or change
their noise exposure in general (27). Evaluating the attitude of young people toward loud music is obligatory
to understand their behavior in noisy situations. Therefore,
the Youth Attitude Toward Noise Scale (YANS) was developed (8). This is a 19-item validated scale dealing with
different types of common sounds in adolescents environments. All items are formulated in the form of statements and are measured on a five degree Likert Scale,
where 1 means totally disagree, and 5 means totally
agree (8,28). Higher scores on the scale imply a pronoise attitude, which means noise is regarded as something positive where lower scores imply a more antinoise
attitude where noise is regarded as something negative. It
is assumed that adolescents experiencing hearing symptoms, such as tinnitus, therefore develop more antinoise
attitudes because loud music or environmental sounds are
experienced as unpleasant. A possible effect is that their

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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PREVALENCE OF LEISURE NOISE-INDUCED TINNITUS


TABLE 1.

Questions concerning hearing protection

Intentions to wear HP in the future


- I will use hearing protection in the future.
Influence of peers
- My friends never wear hearing protection.
- My friends think it is a good idea to wear hearing protection.
Behavior toward HP
- Hearing protection puts too much pressure on my ears.
- I know how to use hearing protection.
- Wearing hearing protection is uncomfortable.
- I am not sure when hearing protection needs to be replaced.
- I know in which situations I should use hearing protection.
- Hearing protection reduces my ability to communicate with others.
- Wearing hearing protection is annoying.
Knowledge about the consequences of loud music
- Exposure to loud music can damage my hearing

Participants and Procedure


The questionnaire was distributed to 160 university students
completing a Bachelor or Master degree in medicine at the
University of Antwerp. Fifteen students did not return or complete the questionnaire and, thus, were considered as internal
dropouts (response rate, 90.6%). The group was composed of
44 male students and 101 female students. The age of the
students ranged from 19 to 26 with a mean age of 20.77 (T1.54)
years. The questionnaires were administered at a lecture and
completed immediately. It was instructed that the classroom
remained silent while completing the questionnaire.

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.

of the total study group. No significant sex differences


in prevalence of permanent tinnitus were found. Most students experiencing permanent tinnitus scored their tinnitus
loudness low on the VAS as the mean score was 1.86
(T1.25) as a consequence of 17 of 21 students rating their
tinnitus as 1 (very silent, just detectable). Four respondents rated their tinnitus loudness 3 or more including
1 individual scoring 6 on the VAS. Transient tinnitus
was experienced by 89.5% for at least once after being
exposed to loud music. Transient tinnitus was significantly
more prevalent in female students opposed to male students, with respective prevalence numbers of 92.9% and
81.8%. Female respondents also scored significantly
higher on the VAS for transient tinnitus compared with
male students with mean VAS scores, respectively, 3.78
(T2.18) and 2.98 (T2.34).
Most university students frequently visit night clubs or
parties. The prevalence of discotheque visits on yearly,
monthly, weekly, and daily basis were 33.1%, 26.2%,
9.7%, and 27.6%, respectively. The remaining 3.4%
ticked the not applicable answer. The attitude toward
loud music was evaluated by the YANS; 25.9% of all
students showed a pronoise attitude, whereas 27.3%
showed an antinoise attitude. The remaining students
(46.8%) had a neutral attitude toward noise, meaning they
were neither positive nor negative. There was no correlation between the score of the entire YANS and the
presence of neither permanent nor temporary tinnitus.
Furthermore, the results of the YANS were analyzed by
sex. Mean scores of the factors separately and the entire
YANS are presented in Table 2, by sex and for the total
group. No sex differences were present except for factor
3 where female students scored significantly lower than
the male subjects (p = 0.013; > = 0.05). In addition, female
subjects scored significantly (p = 0.016) lower on the first
item (I think that the sound level at discos, dances, rock
concerts and sporting events, in general, is too loud).
One hundred students corresponding with 68.5% of the
respondents judged the statement Exposure to loud
music can damage my hearing as totally agree. This

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

F1: attitudes toward noise associated with elements of youth culture


F2: Attitudes toward the ability to concentrate in noisy environments
F3: attitudes to daily noises
F4: attitudes toward influencing the sound environment
Entire Youth Attitude Toward Noise Scale score

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

NS indicates not significant.


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4
TABLE 3.

A. GILLES ET AL.
Reported hearing decrement and fear of permanent tinnitus

After having spent 30 minutes


in loud music I I

Never
(%)

Sometimes
(%)

Often
(%)

Always
(%)

think my hearing is decreased


am afraid the tinnitus will not
disappear

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.

Cumulative logit model


95% Wald confidence interval

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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PREVALENCE OF LEISURE NOISE-INDUCED TINNITUS


Azjens theory of planned behavior (TPB) (33) is one
of the most influential models for the prediction of human
social behavior (34). The TBP states that ones attitude
toward performing a specific behavior is a predictor of an
intention (33). Intention is influenced by attitudes, subjective norms, and perceived behavioral control toward
the behavior. Attitudes are regarded as beliefs about the
outcome determined by positive or negative evaluation
of self-performance of the particular behavior. A subjective norm is the extent to which an individuals perception about the particular behavior is influenced by
significant others (parents, peers, teachers, etc.) weighted by the compliance with such influence. Such a subjective norm might be the advice of peers to wear HP in
noisy situations. Perceived behavioral control is an individuals belief about the presence of factors that facilitate
or impede the performance of the health-related behavior
(35). The analysis performed in the present study can be
placed in the vision of the TPB where attitudes were
evaluated through the YANS, subjective norms by the
items concerning peers influence and the perceived
behavioral control by the items scoring behavior toward
HP. Analyses of the YANS showed that most students
had a neutral-to-positive attitude toward noise. Students
with an antinoise attitude, where loud music is regarded
as something dangerous, showed a significantly higher
degree of HP use compared with the positive group.
Therefore, the multinomial logit model, performed in the
present article, confirms the influence of attitudes on HP
use. However, the p value was not so strong (p = 0.054).
This in contrast to earlier research implementing the TPB
constructs where attitudes toward a certain health-related
behavior had the strongest effect on intentions (33,36).
This might be due to the fact that young adults are still
quite unaware of the consequences of loud music. Although
most respondents claimed loud music can cause damage to
their hearing, the degree of worrying about tinnitus and
decreased hearing after loud music is low, suggesting that
young adults are not so well informed after all. Therefore,
the lack of attitude change might be a result of inadequate
knowledge. As being well informed is a prerequisite for
effective action to produce desired outcomes (37), this
opens perspectives for future educational programs concerning this theme.
The finding that most students are quite neutral toward
noise-induced symptoms is confirmed by earlier research
of Quintanilla-Dieck et al. (14) who analyzed a total of
2500 surveys completed by visitors of the MTV web site.
In this survey, several health issues that involve young
people (drug/alcohol use, cigarette smoking, sexuality,
nutrition/weight loss, depression, acne, and sports-related
injuries) were believed to be a more important concern
compared with hearing loss. Moreover, all categories were
rated to be more of a concern to the general population than
as a personal threat. Another study found that merely 8%
of the respondents defined hearing loss as a big problem
compared with other health issues (15). During the past few
years, there has been a lot of media attention to the problem
of NIHL and other ear-related symptoms such as tinnitus

in an attempt to increase the awareness among adolescents.


In the past, adolescents have indicated to be willing to use
HP if they would be more aware of the risks of loud music
or advised by a medical professional (14,15). In the present
study, also, 24.7% of the students declared they will use
HP in the future, whereas another 35.6% is considering
doing so. This means that more than half of the students
claim to have the intention to protect their hearing, which
is in extreme contrast to the percentage of those actually
using HP (11%). The analysis showed that the influence
of peers and the behavior toward HP are strong predictors
for the actual use of HP. The authors like to point out that,
although the results of the current questionnaire were
looked upon through the TPB, several disparities with the
TPB construct guidelines were present. First, a TPB assessment is usually performed on a 7-point bipolar adjective scale, whereas in the present study, a 5-point Likert
scale was applied. Second, the TPB states that 5 to 6 items
are required for each construct. This criteria was met for
the evaluation of attitudes (19 items of the YANS) and perceived behavioral control (7 items) but not for subjective
norms(2items).However,inouropinion,itisnotnecessary
to follow the TPB guidelines strictly to identify influencing
factors for a certain social behavior. Other studies have
been performed also not completely following the strict
guidelines of the TPB (36). Nevertheless, the use of the
idea of the TPB is useful for the explanation of the behavior
of young people and the factors influencing HP use.
A limitation of this study was that the sample population
was limited to university undergraduate students and contained (by coincidence) a relatively large proportion of
female students. As only few sex differences were found,
chances are small that this caused biasing. In addition, the
prevalence of permanent tinnitus must be interpreted
with caution. The role of noise is not clear as the presence
of permanent tinnitus was assessed with a yes-no question,
the etiology of the permanent tinnitus was not questioned,
and pre-existing conditions were unknown. The prevalence
of permanent tinnitus is therefore a general prevalence
including all possible causes. In the future, a larger population will be targeted containing also high school students with different backgrounds and educational programs.

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
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A. GILLES ET AL.

focus on tinnitus as a sign of overexposure. Young adults


should consider tinnitus as alarming instead of a natural
consequence of loud music. This is a first step to changing the attitudes toward noise to achieve an increase
of HP use in this population.
Acknowledgments: The authors thank the Stavros Niarchos
Foundation for financial support for tinnitus research in adolescents and young adults. The authors also thank Jasna Peeters
and Berina Ihtijarevic, two master students of Medicine, for
cooperation in the distribution of the questionnaires. Finally,
the authors also thank the 2 reviewers for their useful comments
and advice.

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PREVALENCE OF LEISURE NOISE-INDUCED TINNITUS

APPENDIX: TRANSLATED QUESTIONNAIRE


Youth Attitude Toward Noise Scale (YANS)
Totally
agree

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.

Questions concerning hearing protection


Totally agree

Partly agree

Neutral

Partly disagree

Totally disagree

Intentions to wear HP in the future


- I will use hearing protection in the future
Influence of peers
- My friends never wear hearing protection
- My friends think it is a good idea to wear hearing protection
Behavior toward HP
- Hearing protection puts too much pressure on my ears
- I know how to use hearing protection
- Wearing hearing protection is uncomfortable
- I am not sure when hearing protection needs to be replaced
- I know in which situations I should use hearing protection
- Hearing protection reduces my ability to communicate with others
- Wearing hearing protection is annoying
Knowledge about the consequences of loud music
- Exposure to loud music can damage my hearing

Questions concerning tinnitus


Yes

No

I always experience tinnitus

After having spent 30 minutes in loud music I I

Never

Sometimes

Often

Always

think my hearing decreased


am afraid the tinnitus will not disappear

Otology & Neurotology, Vol. 00, No. 00, 2012

Copyright 2012 Otology & Neurotology, Inc. Unauthorized reproduction of this article is prohibited.

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

Less than 30 minutes


between 30 minutes and 2 hours
between 2 hours and 6 hours
between 6 hours and one day
more than one day
not applicable

How often do you visit a discotheque/ night club?

g
g
g
g
g

daily
weekly
monthly
yearly
not applicable

Otology & Neurotology, Vol. 00, No. 00, 2012

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