title: Early indication of noise-induced hearing loss from PMP use in adolescents: A cross-sectional analysis.
abstract: BACKGROUND
  Distortion product otoacoustic emissions (DPOAEs) may indicate preclinical noise-induced hearing loss (NIHL) in adolescents from unsafe personal music player (PMP) use.
  
  
  OBJECTIVE
  The objective, therefore, was to observe preclinical signs of NIHL in 9th grade adolescents with clinically normal hearing by comparing DPOAE signals between different levels of A-weighted equivalent PMP exposure.
  
  
  METHODS
  Subjects were recruited from all secondary-level schools located in the city of Regensburg, Germany during two academic years 2009/2010 and 2010/2011.
  
  
  METHODS
  A-weighted equivalent sound pressure levels (SPLs) for a 40-hour work week (LAeq,40h) were estimated from questionnaire responses on output and duration of PMP use of the previous week. Subjects were then categorized into four levels of exposure: <80, 80-85, >85 to <90, and ≥90 A-weighted Decibel [dB(A)]. DPOAE signals were collected by trained audiological staff, applying a standard optimized protocol, at the Department of Otorhinolaryngology of the University Hospital Regensburg.
  
  
  METHODS
  Mean DPOAE signals were compared between levels by unpaired t test. Novel linear regression models adjusting for other leisure noise exposures and with outcome variables DPoutcome and 4 kilo Hertz (kHz) DPOAEs estimated effects between levels.
  
  
  RESULTS
  A total of 1468 subjects (56% female, mostly aged 15 or 16 years) were available for analysis. Comparison of DPOAE means by PMP exposure typically showed no greater than 1 dB difference between groups. In fact, comparisons between ≥90 dB(A) and <80 dB(A) presented the least differences in magnitude. Both DPoutcome and 4 kHz linear regression models presented a weak association with the 4-level PMP exposure variable. An expected dose-response to PMP exposure was not observed in any analyses.
  
  
  CONCLUSIONS
  DPOAE signal strength alone cannot indicate preclinical NIHL in adolescents.
authors.affiliation: Department of Occupational and Environmental Medicine and Epidemiology, Bavarian Health and Food Safety Authority, Munich; Pettenkofer School of Public Health, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Diana C
authors.initials: DC
authors.lastname: Colon
authors.affiliation: Department of Occupational and Environmental Medicine and Epidemiology, Bavarian Health and Food Safety Authority, Munich, Germany.
authors.forename: Ulla
authors.initials: U
authors.lastname: Verdugo-Raab
authors.affiliation: Department of Otorhinolaryngology, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Carmelo P
authors.initials: CP
authors.lastname: Alvarez
authors.affiliation: Department of Otorhinolaryngology, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Steffens
authors.affiliation: Department of Otorhinolaryngology, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Marcrum
authors.affiliation: Department of Occupational and Environmental Medicine and Epidemiology, Bavarian Health and Food Safety Authority, Munich; Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Clinical Centre of the Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Kolb
authors.affiliation: Department of Occupational and Environmental Medicine and Epidemiology, Bavarian Health and Food Safety Authority, Munich; Pettenkofer School of Public Health, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Caroline
authors.initials: C
authors.lastname: Herr
authors.affiliation: Department of Occupational and Environmental Medicine and Epidemiology, Bavarian Health and Food Safety Authority, Munich, Germany.
authors.forename: Dorothee
authors.initials: D
authors.lastname: Twardella
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001299:Audiometry; D003430:Cross-Sectional Studies; D005260:Female; D006317:Hearing Loss, Noise-Induced / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D008297:Male; D009146:Music; D017084:Otoacoustic Emissions, Spontaneous / Q000502:physiology*; D012307:Risk Factors