Duration-Dependent Changes in Extended High-Frequency Audiometry and Distortion Product Otoacoustic Emissions for Moderate-Level Personal Listening Device Exposures
-
Kruthika Shankar
,
Sandra Nandakumar
,
Kamalakannan Karupaiah
,
Bhuvaneswari Kumaar
,
Sundaresan Ramachandran
,
Prashanth Prabhu
Abstract
Background and Aim: Excessive sound exposure can damage the auditory system and, if left undetected, can progress to permanent noise-induced hearing loss. Extended High-Frequency Audiometry (EHFA) and Distortion Product Otoacoustic Emissions (DPOAEs) can detect subtle cochlear changes earlier than conventional audiological measures. This study examined the effect of short-term personal listening device (PLD) use duration on hearing sensitivity using EHFA and DPOAEs.
Methods: One hundred female college students (18–25 years) were grouped based on daily PLD use into 5 categories (1–2, 2–3, 3–4, 4–5, and 5–6 hours). Participants had no history of otological disorders or industrial noise exposure. EHFA and DPOAE assessments were performed. Exposure group differences were analyzed using the Kruskal–Wallis test with post hoc comparisons.
Results: PLD use duration significantly affected extended high-frequency thresholds and DPOAE amplitudes. Post hoc analysis showed threshold elevations of 16–40 dB HL at 9–16 kHz in the right ear after 1–2 hours of daily use and 16–25 dB HL at 8–16 kHz in the left ear after 4–5 hours (medium-to-large effect sizes). DPOAE amplitudes differed across durations from 356–5645 Hz (right ear) and 498–5645 Hz (left ear), with a few high-frequency reductions of <6 dB SPL after 3–4 hours of exposure.
Conclusion: Prolonged PLD use adversely affects extended high-frequency hearing sensitivity, whereas DPOAEs show limited sensitivity to early cochlear alterations. EHFA may be a valuable tool for detecting early recreational noise-induced auditory changes.
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17. Elmazoska I, Mäki-Torkko E, Granberg S, Widén S. Associations Between Recreational Noise Exposure and Hearing Function in Adolescents and Young Adults: A Systematic Review. J Speech Lang Hear Res. 2024;67(2):688-710. [DOI:10.1044/2023_JSLHR-23-00397]
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19. Alkharabsheh A, Alshurafa S, Alhanbali S, Garadat S. Personal Listening device (PLD) usage among University Students and their audiometric profile during the shift to online learning post COVID-19. PLoS One. 2025;20(3):e0319665. [DOI:10.1371/journal.pone.0319665]
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21. Dillard LK, Arunda MO, Lopez-Perez L, Martinez RX, Jiménez L, Chadha S. Prevalence and global estimates of unsafe listening practices in adolescents and young adults: a systematic review and meta-analysis. BMJ Glob Health. 2022;7(11):e010501. [DOI:10.1136/bmjgh-2022-010501]
22. American National Standards Institute. Maximum permissible ambient noise for audiometric test rooms (ANSI S3.1-1999). New York: American National Standards Institute; 1999.
23. Johnson TA, Cooper S, Stamper GC, Chertoff M. Noise Exposure Questionnaire: A Tool for Quantifying Annual Noise Exposure. J Am Acad Audiol. 2017;28(1):14-35. [DOI:10.3766/jaaa.15070]
24. Veale JF. Edinburgh Handedness Inventory - Short Form: a revised version based on confirmatory factor analysis. Laterality. 2014;19(2):164-77. [DOI:10.1080/1357650X.2013.783045]
25. Carhart R, Jerger JF. Preferred method for clinical determination of pure-tone thresholds. Journal of Speech And Hearing Disorders. 1959;24(4):330-45. [DOI:10.1044/jshd.2404.330]
26. ISO 389-8:2004(en); Acoustics—Reference Zero for the Calibration of Audiometric Equipment—Part 8: Reference Equivalent Threshold Sound Pressure Levels for Pure Tones and Circumaural Earphones. ISO: Geneva, Switzerland, 2004. Available online: https://www.iso.org/obp/ui/#iso:std:iso:389:-8:ed-1:v1:en (accessed on 12 April 2023).
27. Luengrungrus K, Thanawirattananit P, Teeramatwanich W. Normative Data of Extended High Frequency Audiometry in Normal Hearing Subjects with Different Aged Groups. Audiol Res. 2024;14(6):1084-92. [DOI:10.3390/audiolres14060089]
28. Sharma Y, Mishra G, Mahida DA. Effect on hearing due to amplified music exposure. An International Journal of Otorhinolaryngology Clinics. 2022;14(1):22-5.
29. Peng JH, Tao ZZ, Huang ZW. Risk of damage to hearing from personal listening devices in young adults. J Otolaryngol. 2007;36(3):181-5.
30. Barros SM, Frota S, Atherino CC, Osterne F. The efficiency of otoacoustic emissions and pure-tone audiometry in the detection of temporary auditory changes after exposure to high sound pressure levels. Braz J Otorhinolaryngol. 2007;73(5):592-8. [DOI:10.1016/s1808-8694(15)30118-x]
31. Narahari PG, Bhat J, Nambi A, Arora A. Impact of usage of personal music systems on oto-acoustic emissions among medical students. Noise Health. 2017;19(90):222-6. [DOI:10.4103/nah.NAH_75_16]
32. Poling GL, Siegel JH, Lee J, Dhar S. The influence of self-reported noise exposure on 2ƒ1-ƒ2 distortion product otoacoustic emission level, fine structure, and components in a normal-hearing population. J Acoust Soc Am. 2022;151(4):2391. [DOI:10.1121/10.0010105]
33. Trzaskowski B, Jędrzejczak WW, Piłka E, Cieślicka M, Skarżyński H. Otoacoustic emissions before and after listening to music on a personal player. Med Sci Monit. 2014;20:1426-31. [DOI:10.12659/MSM.890747]
34. Kumar A, Mathew K, Alexander SA, Kiran C. Output sound pressure levels of personal music systems and their effect on hearing. Noise Health. 2009;11(44):132-40. [DOI:10.4103/1463-1741.53357]
35. Sliwinska-Kowalska M, Davis A. Noise-induced hearing loss. Noise and Health. 2012;14(61):274-80. [DOI:10.4103/1463-1741.104893]
2. World Health Organization. Deafness and hearing loss. World Health Organization. Geneva: World Health Organization;. 2025. Available from: https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss
3. Chen F, Xue H, Wang M, Cai Z, Zhu S. Hearing Care: Safe Listening Method and System for Personal Listening Devices. Int J Environ Res Public Health. 2023;20(3):2161. [DOI:10.3390/ijerph20032161]
4. Sharma S, Shah P, Patel D, Tadvi P, Sharma P. Personal Listening Devices (PLD): A Boon or Bane? Perceptions among the Urban Indian Population. Indian J Otolaryngol Head Neck Surg. 2025;77:3541-7.
5. Jiang W, Zhao F, Guderley N, Manchaiah V. Daily music exposure dose and hearing problems using personal listening devices in adolescents and young adults: A systematic review. Int J Audiol. 2016;55(4):197-205. [DOI:10.3109/14992027.2015.1122237]
6. How Loud is Too Loud? National Institute on Deafness and other Communication Disorders [Internet]. 2025 [cited 2025 April 28]. Available from: https://www.nidcd.nih.gov/health/how-loud-too-loud
7. Pienkowski M, Munguia R, Eggermont JJ. Effects of passive, moderate-level sound exposure on the mature auditory cortex: spectral edges, spectrotemporal density, and real-world noise. Hear Res. 2013;296:121-30. [DOI:10.1016/j.heares.2012.11.006]
8. Fligor BJ, Cox LC. Output levels of commercially available portable compact disc players and the potential risk to hearing. Ear Hear. 2004;25(6):513-27. [DOI:10.1097/00003446-200412000-00001]
9. You S, Kong TH, Han W. The Effects of Short-Term and Long-term Hearing Changes on Music Exposure: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2020;17(6):2091. [DOI:10.3390/ijerph17062091]
10. AlQahtani AS, Alshammari AN, Khalifah EM, Alnabri AA, Aldarwish HA, Alshammari KF, et al. Awareness about the relation of noise induced hearing loss and use of headphones at Hail region. Ann Med Surg (Lond). 2021;73:103113. [DOI:10.1016/j.amsu.2021.103113]
11. Dhami AK. Studies on cellphone radiation exposure inside a car and near a bluetooth device. Int J Environ Res. 2015;9(3):977-80. [DOI:10.22059/ijer.2015.985]
12. Jayaraju N, Kumar MP, Sreenivasulu G, Prasad TL, Lakshmanna B, Nagalaksmi K, et al. Mobile phone and base stations radiation and its effects on human health and environment: A review. Sustainable Technology and Entrepreneurship. 2023;2(2):100031. [DOI:10.1016/j.stae.2022.100031]
13. Gajendran A, Devi Rajendiran G, Prateep A, Satindra H, Rajendran R. Prevalence of High Frequency Noise-Induced Hearing Loss Among Medical Students Using Personalized Listening Devices. J Clin Med. 2024;14(1):49. [DOI:10.3390/jcm14010049]
14. LePage EL, Murray NM. Latent cochlear damage in personal stereo users: a study based on click-evoked otoacoustic emissions. Med J Aust. 1998;169(11-12):588-92. [DOI:10.5694/j.1326-5377.1998.tb123426.x]
15. Divya AP, Prakash P, Konadath S, Hussain RO, Narne VK, Ravi SK. Electrophysiological Evidence of Early Auditory Dysfunction in Personal Listening Device Users: Insights from ABR with Ipsilateral Masking. Diagnostics (Basel). 2025;15(21):2672. [DOI:10.3390/diagnostics15212672]
16. Shah P, Ms V, Raja K. Awareness About Noise Induced Hearing Loss and the Use of Unsafe Listening Practices Among Medical Students. Indian J Otolaryngol Head Neck Surg. 2024;76(4):3458-64. [DOI:10.1007/s12070-024-04727-3]
17. Elmazoska I, Mäki-Torkko E, Granberg S, Widén S. Associations Between Recreational Noise Exposure and Hearing Function in Adolescents and Young Adults: A Systematic Review. J Speech Lang Hear Res. 2024;67(2):688-710. [DOI:10.1044/2023_JSLHR-23-00397]
18. Sulaiman AH, Husain R, Seluakumaran K. Evaluation of early hearing damage in personal listening device users using extended high-frequency audiometry and otoacoustic emissions. Eur Arch Otorhinolaryngol. 2014;271(6):1463-70. [DOI:10.1007/s00405-013-2612-z]
19. Alkharabsheh A, Alshurafa S, Alhanbali S, Garadat S. Personal Listening device (PLD) usage among University Students and their audiometric profile during the shift to online learning post COVID-19. PLoS One. 2025;20(3):e0319665. [DOI:10.1371/journal.pone.0319665]
20. Škerková M, Mrázková E, Kovalová M, Kocurková L, Gottfriedová N. Extended high-frequency audiometry for detecting early hearing effects of personal listening devices: A narrative review. Eur Ann Otorhinolaryngol Head Neck Dis. 2026;143(3):195-200. [DOI:10.1016/j.anorl.2026.01.011]
21. Dillard LK, Arunda MO, Lopez-Perez L, Martinez RX, Jiménez L, Chadha S. Prevalence and global estimates of unsafe listening practices in adolescents and young adults: a systematic review and meta-analysis. BMJ Glob Health. 2022;7(11):e010501. [DOI:10.1136/bmjgh-2022-010501]
22. American National Standards Institute. Maximum permissible ambient noise for audiometric test rooms (ANSI S3.1-1999). New York: American National Standards Institute; 1999.
23. Johnson TA, Cooper S, Stamper GC, Chertoff M. Noise Exposure Questionnaire: A Tool for Quantifying Annual Noise Exposure. J Am Acad Audiol. 2017;28(1):14-35. [DOI:10.3766/jaaa.15070]
24. Veale JF. Edinburgh Handedness Inventory - Short Form: a revised version based on confirmatory factor analysis. Laterality. 2014;19(2):164-77. [DOI:10.1080/1357650X.2013.783045]
25. Carhart R, Jerger JF. Preferred method for clinical determination of pure-tone thresholds. Journal of Speech And Hearing Disorders. 1959;24(4):330-45. [DOI:10.1044/jshd.2404.330]
26. ISO 389-8:2004(en); Acoustics—Reference Zero for the Calibration of Audiometric Equipment—Part 8: Reference Equivalent Threshold Sound Pressure Levels for Pure Tones and Circumaural Earphones. ISO: Geneva, Switzerland, 2004. Available online: https://www.iso.org/obp/ui/#iso:std:iso:389:-8:ed-1:v1:en (accessed on 12 April 2023).
27. Luengrungrus K, Thanawirattananit P, Teeramatwanich W. Normative Data of Extended High Frequency Audiometry in Normal Hearing Subjects with Different Aged Groups. Audiol Res. 2024;14(6):1084-92. [DOI:10.3390/audiolres14060089]
28. Sharma Y, Mishra G, Mahida DA. Effect on hearing due to amplified music exposure. An International Journal of Otorhinolaryngology Clinics. 2022;14(1):22-5.
29. Peng JH, Tao ZZ, Huang ZW. Risk of damage to hearing from personal listening devices in young adults. J Otolaryngol. 2007;36(3):181-5.
30. Barros SM, Frota S, Atherino CC, Osterne F. The efficiency of otoacoustic emissions and pure-tone audiometry in the detection of temporary auditory changes after exposure to high sound pressure levels. Braz J Otorhinolaryngol. 2007;73(5):592-8. [DOI:10.1016/s1808-8694(15)30118-x]
31. Narahari PG, Bhat J, Nambi A, Arora A. Impact of usage of personal music systems on oto-acoustic emissions among medical students. Noise Health. 2017;19(90):222-6. [DOI:10.4103/nah.NAH_75_16]
32. Poling GL, Siegel JH, Lee J, Dhar S. The influence of self-reported noise exposure on 2ƒ1-ƒ2 distortion product otoacoustic emission level, fine structure, and components in a normal-hearing population. J Acoust Soc Am. 2022;151(4):2391. [DOI:10.1121/10.0010105]
33. Trzaskowski B, Jędrzejczak WW, Piłka E, Cieślicka M, Skarżyński H. Otoacoustic emissions before and after listening to music on a personal player. Med Sci Monit. 2014;20:1426-31. [DOI:10.12659/MSM.890747]
34. Kumar A, Mathew K, Alexander SA, Kiran C. Output sound pressure levels of personal music systems and their effect on hearing. Noise Health. 2009;11(44):132-40. [DOI:10.4103/1463-1741.53357]
35. Sliwinska-Kowalska M, Davis A. Noise-induced hearing loss. Noise and Health. 2012;14(61):274-80. [DOI:10.4103/1463-1741.104893]
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How to Cite
1.
Shankar K, Nandakumar S, Karupaiah K, Kumaar B, Ramachandran S, Prabhu P. Duration-Dependent Changes in Extended High-Frequency Audiometry and Distortion Product Otoacoustic Emissions for Moderate-Level Personal Listening Device Exposures. Aud Vestib Res. 2026;.
