title: The Effect of Earplugs in Preventing Hearing Loss From Recreational Noise Exposure: A Systematic Review.
abstract: OBJECTIVE
  The prevalence of hearing loss among children and adolescents is rising dramatically, caused mainly by increased exposure to recreational noise.
  
  
  OBJECTIVE
  To present a systematic overview of the effectiveness of wearing earplugs to music venues, such as nightclubs and concert halls, to prevent hearing loss and tinnitus directly after exposure.
  
  
  METHODS
  PubMed, EMBASE, and the Cochrane Library databases were searched for articles from database inception to June 22, 2015, using the keywords music and earplugs and all synonyms. Titles, abstracts, and full text of retrieved articles were screened for eligible articles. The directness of evidence (relevance of the assessed articles) and risk of bias of eligible articles were assessed. For the included articles, the study characteristics and data on our outcomes of interest (hearing loss and tinnitus) were extracted. Data analysis occurred from June 22 to July 3, 2015.
  
  
  RESULTS
  Of 228 articles screened, 4 were eligible for critical appraisal. After critical appraisal, 2 studies with a high directness of evidence and low or moderate risk of bias remained for data extraction. Only 1 of these articles was a randomized clinical trial, which found significantly lower postconcert differences in thresholds and a lower proportion of threshold shifts in the group using earplugs compared with the unprotected group. In the other study, only 3 individuals wore earplugs, and no significant differences were found between the 2 groups.
  
  
  CONCLUSIONS
  The available evidence on the effectiveness of earplugs in preventing hearing damage directly after recreational music exposure is scarce. Only 1 well-conducted randomized clinical trial was found, which showed that wearing earplugs to concerts is effective in reducing postconcert threshold shifts. There is a need for further research on this topic to strengthen the level of evidence. Physicians should promote awareness on the risks of recreational noise and recommend the use of earplugs among their patients who visit music venues.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands2Brain Center Rudolf Magnus University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Véronique J C
authors.initials: VJ
authors.lastname: Kraaijenga
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands2Brain Center Rudolf Magnus University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Geerte G J
authors.initials: GG
authors.lastname: Ramakers
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands2Brain Center Rudolf Magnus University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Wilko
authors.initials: W
authors.lastname: Grolman
mesh_terms: D004430:Ear Protective Devices; D006309:Hearing / Q000502:physiology*; D006317:Hearing Loss, Noise-Induced / Q000503:physiopathology / Q000517:prevention & control*; D006320:Hearing Tests; D006801:Humans; D009622:Noise / Q000009:adverse effects*