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CME / ABIM MOC / CE

How Loud Is Too Loud? Unsafe Listening in Teens and Young Adults

  • Authors: WebMD News Author: Lisa O’Mary; CME Author: Laurie Barclay, MD
  • CME / ABIM MOC / CE Released: 12/30/2022
  • Valid for credit through: 12/30/2023
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  • Credits Available

    Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 0.25 ABIM MOC points

    Nurses - 0.25 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)

    Physician Assistant - 0.25 AAPA hour(s) of Category I credit

    IPCE - 0.25 Interprofessional Continuing Education (IPCE) credit

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for pediatricians, family medicine/primary care clinicians, internists, public health and prevention officials, nurses, physician assistants, and other members of the health care team for adolescents and young adults who may be at risk for hearing loss from unsafe listening practices.

The goal of this activity is for learners to be better able to describe the prevalence of unsafe listening practices from exposure to personal listening devices and loud entertainment venues in individuals aged 12 to 34 years, and estimated worldwide prevalence among young people of risk for hearing loss from unsafe listening.

Upon completion of this activity, participants will:

  • Assess the prevalence of unsafe listening practices from exposure to personal listening devices and loud entertainment venues and estimated worldwide prevalence of risk for hearing loss from unsafe listening among young people, based on a systematic review and meta-analysis
  • Evaluate the clinical and public health implications of the prevalence of unsafe listening practices from exposure to personal listening devices and loud entertainment venues and estimated worldwide prevalence of risk for hearing loss from unsafe listening among young people, based on a systematic review and meta-analysis
  • Outline implications for the healthcare team


Disclosures

Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.


WebMD News Author

  • Lisa O’Mary

    Disclosures

    Lisa O’Mary has no relevant financial relationships.

CME Author

  • Laurie Barclay, MD

    Freelance writer and reviewer
    Medscape, LLC

    Disclosures

    Laurie Barclay, MD, has the following relevant financial relationships:
    Formerly owned stocks in: AbbVie Inc.

Editor/Nurse Planner

  • Leigh Schmidt, MSN, RN, CNE, CHCP

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Leigh Schmidt, MSN, RN, CNE, CHCP, has no relevant financial relationships.

Compliance Reviewer

  • Amanda Jett, PharmD, BCACP

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Amanda Jett, PharmD, BCACP, has no relevant financial relationships.


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In support of improving patient care, Medscape, LLC is jointly accredited with commendation by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

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    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.25 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

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CME / ABIM MOC / CE

How Loud Is Too Loud? Unsafe Listening in Teens and Young Adults

Authors: WebMD News Author: Lisa O’Mary; CME Author: Laurie Barclay, MDFaculty and Disclosures

CME / ABIM MOC / CE Released: 12/30/2022

Valid for credit through: 12/30/2023

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Clinical Context

Hearing loss is a public health concern meriting global recognition and prioritization. Voluntary recreational noise exposure, or unsafe listening, is a modifiable risk factor for hearing loss in young people and may increase the risk for hearing loss in aging. Recurrent or even single instances of unsafe listening may cause physiological damage to the auditory system.

The World Health Organization estimates that more than 430 million people worldwide have disabling hearing loss and that prevalence may nearly double without effective hearing loss prevention strategies. Unsafe listening practices, largely attributable to personal listening device use and/or attendance at loud entertainment venues, are likely to be modifiable with implementation of existing policy recommendations and known public health practices.

Study Synopsis and Perspective

As many as 1.35 billion young people worldwide are at risk for hearing loss because of “unsafe listening,” a new study shows.

The study found that as many as 1 in 4 people ages 12 to 34 years are exposed to dangerous noise levels via “personal listening devices,” such as high volume settings on smartphones, and nearly half of people those ages experience damaging noise levels at entertainment venues.

“To our knowledge, this review is the first published article to estimate the prevalence of exposure to unsafe listening practices in adolescents and young adults and its global burden,” the authors write. “These estimates are needed to communicate the urgency of prioritising hearing loss prevention to governments, industries and other stakeholders responsible for implementing policy.”

Published this month in BMJ Global Health, the researchers evaluated data combined from 33 studies of “unsafe listening” among people ages 12 to 34 years. Unsafe listening was defined in the study as exposure to greater than 80 decibels for at least 40 hours a week. (For context, city traffic is about 80 decibels, according to a list of sounds that can cause hearing loss from the Centers for Disease Control and Prevention [CDC].)

Research has shown that both single instances and repeated exposure to high volumes can damage hearing, potentially permanently, and the effects can build up during a person’s lifetime. Hearing loss is associated with poor academic performance, reduced economic mobility, and health problems, the study authors said. 

They encouraged more be done to educate people on how to prevent hearing loss and for policy makers to take action. The CDC suggests turning down the volume or taking listening breaks, using hearing protection such as earplugs, and keeping children away from loud music or equipment at home, among other tips to protect from hearing loss.

BMJ Glob Health. 2022;7(11):e010501.

Study Highlights

  • This systematic review and meta-analysis included peer-reviewed articles that were published between 2000 and 2021 and reported unsafe listening practices in individuals aged 12 to 34 years.
  • Search of 3 databases identified 33 such studies (data from 35 records and 19,046 individuals); 17 records focused on personal listening device use and 18 on loud entertainment venues.
  • Pooled prevalence estimate of exposure to unsafe listening from personal listening devices was 23.81% (95% CI, 18.99%-29.42%), calculated using random effects models or ascertained from the systematic review.
  • Prevalence estimates were similar among age groups (adults: 23.10% [95% CI, 8.90%-48.03%]; minors: 27.10% [95% CI, 21.25%-33.88%]; mixed: 21.55% [95% CI, 14.65%-30.53%]) and income groups (high: 24.51% [95% CI, 19.35%-30.53%]; middle: 22.12% [95% CI, 7.15%-51.17%]), with substantial variability in the middle-income group.
  • As the pooled prevalence estimate for loud entertainment venues was of limited certainty (P>.50), the researchers fitted a model as a function of intensity thresholds and exposure duration to identify the prevalence estimate as 48.20% for an intensity threshold of 80 dB and duration threshold of 40 hours/week.
  • The global estimated number of young people who could be at risk for hearing loss from exposure to unsafe listening practices ranged from 0.67 to 1.35 billion.
  • The I 2 statistics for studies on personal listening device use and loud entertainment venues were 96.2 and 98.8, respectively, indicating a high degree of heterogeneity among studies, but funnel plots did not suggest publication bias.
  • The investigators concluded that unsafe listening practices are highly prevalent worldwide and may expose more than 1 billion young people to risk for hearing loss.
  • Although the potential dose-response relationship of recreational noise exposure and associated hearing loss is not understood, increased exposure to unsafe listening practices may be one cause of increasing prevalence of hearing loss in children.
  • Damage from unsafe listening can accumulate over the course of the lifespan, and noise exposure in early life may increase risk for age-related hearing loss.
  • Untreated hearing loss carries estimated economic costs of nearly $1 trillion annually and seriously affects individuals and families.
  • Hearing loss and/or noise exposure in children has been linked to poorer school performance and decreased motivation and concentration, which may limit economic mobility later in life.
  • In adults, hearing loss has been linked to poorer psychosocial function, lower income, cognitive impairment, and other comorbidity.
  • Tinnitus also affects health and well-being and reduces quality of life.
  • Despite some inconsistent research on associations of recreational noise exposure and permanent changes to hearing in adolescence, animal and human studies have offered strong evidence for the biological plausibility of these associations through the physiological impacts of loud noise exposure on the auditory system.
  • Repeated or even single instances of loud noise exposure may cause physiological damage presenting as temporary hearing loss resolving within several hours or days, or acute tinnitus, both of which may predict permanent hearing damage.
  • Repeated or single exposures have also been linked to “hidden hearing loss,” or cochlear synaptopathy, defined as damage to or loss of synaptic contacts between cochlear hair cells and auditory nerve fibers that can exist without permanent changes to audiometric thresholds.
  • Temporary threshold shifts and hidden hearing loss are likely predictors for irreversible permanent hearing loss and may present as difficulties hearing in challenging listening environments, such as in background noise.
  • Mechanisms of noise-induced hearing loss include damaged synapses, sensory cell destruction in the cochlea, and intense cellular metabolic activity raising levels of cochlear free radicals, eventually causing programmed and/or necrotic cell death.
  • These physiological changes may cause progressive, incremental, and permanent changes to hearing thresholds and/or onset of tinnitus.
  • Governments, industry, and civil society urgently need to prioritize global hearing loss prevention by promoting safe listening practices.
  • WHO offers comprehensive materials, including global standards, recommendations, and toolkits, to facilitate development and implementation of such policies.
  • Study limitations include a high degree of heterogeneity among studies and the inability to stratify findings by sex, rurality, or other demographic factors.
  • Well-designed epidemiological studies are needed to assess the impact of early life recreational noise exposure on hearing throughout the life course and to identify relevant risk factors associated with unsafe listening practices.
  • These studies should use internationally standardized definitions of excessive recreational noise exposure and measure sound exposure, using standardized methodology.

Clinical Implications

  • A systematic review and meta-analysis showed that unsafe listening practices are highly prevalent worldwide and may expose more than 1 billion young people to risk for hearing loss.
  • Governments, industry, and civil society urgently need to prioritize global hearing loss prevention by promoting safe listening practices.
  • Implications for the Health Care Team: Repeated or even single instances of loud noise exposure may cause physiological damage presenting as temporary hearing loss resolving within several hours or days, or acute tinnitus, both of which may predict permanent hearing damage. Members of the healthcare team should provide patient education on strategies to reduce exposure to loud noise.

 

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