Zivil- und strafrechtliche Aspekte von Gehörschäden durch Silvesterfeuerwerkskörper

Every year several thousand people in Germany experience acute inner ear and middle ear damage due to exposure to New Year's Eve firecrackers.These affect all age groups and both sexes with a clear preponderance of children, teenagers and especially young adult males. In most cases these accidents are caused by an individual other than the patient.While sometimes hearing recovers completely, a large number of children, teenagers and adults will suffer from permanent inner ear damage or tinnitus.Because of the medical, psychological and economic importance of incurable sensorineural hearing loss, it is the task of public health services to promote effective prevention of irreversible damage to the hearing organ.This article reviews legal aspects of acoustic trauma due to New Year's firecrackers, specifically: licensing regulations, the use of firecrackers and its implications for civil and criminal law, and liability issues for import and distribution. The information about the legal status should contribute to effective prevention of irreversible damage to the hearing organ due to this type of leisure noise.     

Noise and hearing loss: a review

BACKGROUND: Noise-induced hearing loss is a major cause of deafness and hearing impairment in the United States. Though genetics and advanced age are major risk factors, temporary and permanent hearing impairments are becoming more common among young adults and children especially with the increased exposure to portable music players. Though treatment options are limited for most people with noise-related hearing loss, several modifiable health behaviors that should begin in childhood might prevent or delay the onset of hearing impairment. The purpose of this article is to review modifiable and non-modifiable risk factors, comorbidity, and the role of health education in the prevention of noise-induced hearing loss. METHODS: Review of current literature in the etiology, prevention, and treatment of noise-induced hearing loss as well as the role of health education. RESULTS: Non-modifiable risk factors related to noise-related hearing loss include increasing age, genetics, male gender, and race. Modifiable risk factors are voluntary exposure to loud noise, nonuse of hearing protection, smoking, lack of exercise, poor diet, tooth loss, and the presence of diabetes and cardiovascular disease. CONCLUSIONS: As hearing impairment among children and teenagers rises due to mostly voluntary exposure to loud noise, there are many implications for health education. Health educators need to address barriers to the use of hearing protection, deliberate exposure to loud music, and other modifiable risk factors, which cause and exacerbate hearing loss among those exposed to loud noise.     

Is Electronically Amplified Music too Loud? What do Young People Think?

Listening to loud music has been associated, in a number of studies, with hearing loss and tinnitus among young people. However an unanswered question is whether or not these same young people want to have their music so loud. In our study 533 young men and 167 young women, in the age group 16 to 25, who were attending a vocational training centre, responded to a questionnaire and volunteered to have their hearing assessed. The questionnaire sought information on listening habits, on the kinds of events attended, on whether the music at these events was too loud or not, and if the respondents considered their hearing had been impaired. Analysis of this data indicated that 79% of the subjects attend discotheques, 52% pop and rock concerts, and 35% techno parties (e.g. raves). A significant number considered the music at these venues was too loud. Some 42% considered this was the case at discos, 35% thought pop and rock concerts too loud, and 39% held a similar view of techno parties. Conversely, fewer than 3% considered sound levels at these events to be too low. On the basis of the response to the questionnaire we estimate that over half the respondents (56.6%) have a sound exposure (L(eq)) from music of over 87 dB(A). It is not surprising therefore that 71% reported that they had suffered tinnitus following attendance at a music event. The hearing capacity of the sample was measured by audiometry. These measurements detected hearing loss in 11% of the 700 individuals tested. However it was not possible to show that the risk of hearing loss increased with increasing exposure to loud music. We conclude that young people neither demand nor require the excessive sound levels typical of most music events.     

Hearing status of French youth aged from 18 to 24 years in 1997: a cross-sectional epidemiological study in the selection centres of the army in Vincennes and Lyon

BACKGROUND: It is currently thought that young adults are at increasing risk of exposure to deleterious sources of noise. To test this possibility we have assessed hearing status of young French men aged between 18 and 24 years in 1997 and study risk factors of deafness in a cross-sectional epidemiological study at selection centres for aptitudes to National Service. METHODS: During the time of the study, 1208 subjects were examined. For each subject, data of an interview, an otoscopy and audiograms were collected. We compared hearing thresholds between subjects with different noise exposures and we determined risk factors of deafness in this population. RESULTS: The prevalence of hearing loss was 9% at medium frequencies (0.5-2 kHz) and 15% at high frequencies (4-8 kHz).We found that 60% of the subjects were regularly exposed to at least one source of loud noise. Acoustic trauma (6%) mostly explained hearing losses. Repeated episodes of otitis media in childhood (17%) also emerged as an important risk factor apparently due to increased sensitivity to noise. In subjects with antecedent of otitis media, hearing impairments were significant in personal stereo users (>1 hour per day) (p<0.001), in those who went to discos and rock concerts (>2 times per month) (p=0.01) and in those who worked in noisy places (p=0.01). In contrast, in subjects without antecedent of otitis, we found no difference in hearing thresholds between noise exposed and non noise exposed subjects. CONCLUSIONS: Loud sound exposure is a true risk factor of early deafness in subjects that had had repeated episodes of otitis media in childhood. This study stresses the need for both prevention policies and information of health professionals and practitioners.     

H?rst du noch oder pfeift es schon?

Alarming reports have been published about hearing loss in adolescents, and increasing leisure time noise exposure has been blamed. If the exposure limits from the Noise at Work Regulations are applied, discotheque music as well as music from portable music players are associated with the risk of hearing loss. The empirical evidence for this association, however, is not sufficient. Not even an increase in the prevalence of noise-induced hearing loss among adolescents can be documented. OHRKAN is a prospective cohort study aimed to produce information on the prevalence of hearing loss as well as its risk factors in adolescents. Currently, a total of 2,240 pupils in grade 9?at schools in the city of Regensburg, Germany, have been recruited. Data on noise exposure were collected using standardized questionnaires. In addition, hearing status was assessed by medical examination including tympanometry, audiometry, and distortion-product otoacoustic emissions. Developments in noise exposure as well as hearing status will be assessed in follow-up data collections. Independent of this empirical assessment preventive measures are already needed now to reduce the risk of hearing loss in adolescents and young adults.     

Does health promotion work in relation to noise?

Noise is a health risk. The only scientifically established adverse health effect of noise is noise-induced hearing loss (NIHL). Besides noise may affect quality of life and cause annoyance and sleep disturbance. The present scientific evidence of potential non-auditory effects of noise on health is quite weak. Whether health promotion works in relation to noise may be reflected by permanent hearing threshold shift development in population studies. Hearing impairment continues to be the most prevalent disability in Western societies. The National Institute of Occupational Safety and Health (NIOSH) still rates noise induced hearing loss among the top ten work-related problems. Recent studies report that employees continue to develop noise induced hearing loss although to a lesser extent than before, in spite of occupational hearing conservation programmes. Besides socio-acusis and leisure noise seem to be an increasing hazard to hearing, also in young children and adolescents. This seems partly related to acute leisure noise exposure (e.g. toy pistols, amplified music). However, population studies increasingly find non-normal high-frequency hearing including the characteristic NIHL-"notch" around 6 kHz also in subjects who do not report noise exposure incidents or activities. Today 12.5% of US children 6-19 years show a noise-"notch" in one or both ears (n= 5249, Niskar et al 2001). A Norwegian county audiometry survey on adults >/= 20 years n=51.975) showed mean unscreened thresholds +10 dB at 6 kHz for both genders even or the youngest age group 20-24 years (Borchgrevink et al 2001). Accordingly, the present health promotion initiatives seem insufficient in relation to noise and noise-induced hearing loss.     

A study on the effects of discotheque noise on the hearing of young patrons

This study aims to find out whether discotheque music affects hearing by exposing 48 young volunteers to discotheque music in discotheque sessions at two discotheques and evaluating their degree of auditory fatigue after exposure. Questionnaire interviews revealed that the majority of them visit discotheques regularly. A higher proportion of those attending the louder discotheque found the music too loud. The prevalence of tinnitus is also higher in those attending the noisier discotheque. The degree of threshold shifts, however, does not appear to be related to the volume of music or auditory fatigue. The noise level exposure was estimated to be 91 dBA to 98 dBA for weekly exposure and 85 dBA to 92 dBA for monthly exposure. To avoid hearing loss, patrons should avoid loud discotheques, or cut down their frequency of visits if they choose to continue patronising them.     

Physical activity patterns of kindergarten children in comparison to teenagers and young adults

BACKGROUND: Due to the increasing occurrence of obesity and low physical activity (PA) reported in school children there is a need to investigate PA patterns of preschool children. Our aim was to identify the PA of preschool children in comparison to the PA of teenagers and young adults. METHODS: PA of 104 Czech preschool children (aged 5-7 years), 1174 teenagers (aged 12-17 years) and 787 young adults (aged 18-24 years) was determined using Caltrac accelerometery. PA was evaluated on the basis of activity energy expenditure (AEE--kcal kg(-1) day(-1)). Subjects were monitored over 7 days to include a weekend. RESULTS: The AEE in preschool children was significantly higher in comparison to all age groups of teenagers and young adults during both weekdays and at the weekend (P<0.0001). On weekdays during leisure time, preschoolers were considerably more physically active than all categories of teenagers and young adults (P<0.001). Preschoolers show similarities in PA level between weekdays and weekends, unlike the older age groups. CONCLUSION: It seems to appear that organized daily PA (2x20 min of exercising on carpet, 50-70 min of walking outdoors) in preschool children along with enough space for spontaneous PA establishes prerequisites for their further healthy development.     

Beyond music: auditory temporary threshold shift in rock musicians after a heavy metal concert.

Audiometry was undertaken before and within half an hour following a heavy metal concert to assess evidence of noise damage. Of the four members tested, one member wore an ear defender in his right ear during the period of noise exposure. All unprotected ears showed a temporary threshold shift which was maximum in the lower frequencies. There was some evidence that early noise damage had occurred with a dip at 6 kHz. The role of music as noise and its potential to damage the cochlea are discussed.     

Exposure to loud noise and risk of acoustic neuroma

Exposure to occupational loud noise has been previously identified as a possible risk factor for acoustic neuroma in only one relatively small (n = 86 cases) case-control study of men. The goal of the present study was to further examine the role of loud noise in acoustic neuroma etiology. In their population-based case-control study of both sexes conducted from 1999 to 2002 in Sweden, the authors compared reports on type and duration of occupational and nonoccupational loud noise exposure of 146 acoustic neuroma cases and 564 controls. Controls were randomly selected from the study base and were frequency matched on age, sex, and residential area. The authors found that individuals reporting loud noise exposure from any source were at increased risk for acoustic neuroma (odds ratio (OR) = 1.55, 95% confidence interval (CI): 1.04, 2.30). Exposure to loud noise from machines, power tools, and/or construction increased the risk for acoustic neuroma (OR = 1.79, 95% CI: 1.11, 2.89), as did exposure to loud music (OR = 2.25, 95% CI: 1.20, 4.23). The odds ratio for a latency period of 13 or more years since the first loud noise exposure from any source was 2.12 (95% CI: 1.40, 3.20). The findings of an increased risk of acoustic neuroma with loud noise exposure support previous research.     

Risk behaviour and noise exposure among adolescents

Adolescents in Western society often expose themselves to high levels of sound in gyms, rock concerts, discotheques etc. As these behaviours are as threatening to young people's health as more traditional risk behaviours are, our aim in the present study was to analyze the relationship between self-exposure to noise, risk behaviours and risk judgements among 310 Swedish adolescents aged 15-20 (167 men; 143 women). Adolescents' behaviour in different traditional risk situations correlated with behaviour in noisy environments, while judgements about traditional risks correlated with judgements regarding noise exposure. It is an interesting finding that although young women judge risk situations as generally more dangerous than young men do, they nevertheless behave in the same way. We suggest that this difference is a social and cultural phenomenon which underscores the importance of adopting a gender perspective in the analysis of risk factors. Adolescents reporting permanent tinnitus judged loud music as more risky than adolescents with no symptoms and they did not listen to loud music as often as those with occasional tinnitus. Research on hearing prevention for young people needs to acknowledge and make use of theories on risk behaviour, especially due to the existence of a relationship between adolescents' risk-taking in noisy environments and other types of risk-taking. Similarly, theories on risk behaviour should acknowledge noise as a risk factor.     

The role of hearing protectors in leisure noise

Ear muffs and ear plugs are widely used in the workplace to provide hearing protection for employees exposed to high levels of noise. Through an examination of the use of ear protectors in the workplace this paper explores the extent to which these devices can play a similar role in protecting members of the public from hearing damage arising from exposure to high levels of noise from leisure activities. It is concluded that the major limitation to the effective use of ear protectors for leisure use is likely to be the lack of easily accessible information, advice and guidance on the nature of the hearing protection risk from noisy leisure activities, and on the availability, selection and use of protectors, and of the need for regular hearing checks.     

Inner ear damage in children due to noise exposure from toy cap pistols and firecrackers: a retrospective review of 53 cases

This retrospective study presents the findings of inner ear damage documented in 53 children exposed to impulsive sound emitted by toy weapons and firecrackers. There were 49 boys and four girls aged between four and fourteen years. Thirty-nine children were affected unilaterally while fourteen had bilateral hearing loss (total of 67 ears). Most of the hearing loss (>70%) was sensorineural high frequency hearing loss, while only nine out of the 67 injured ears had sensorineural mid frequency hearing loss. Seven children sustained a traumatic ear drum perforation. Dizziness or tinnitus was reported by twenty children, with pathological ENG findings in four of them. This paper re-emphasizes the possibility of inner ear damage in children from exposure to noisy toys.     

Self-reported tinnitus and noise sensitivity among adolescents in Sweden

It seems to be a common opinion among researchers within the field of audiology that the prevalence of tinnitus will increase as a consequence of environmental factors, for example exposure to loud noise. Young people are exposed to loud sounds, more than any other age group, especially during leisure time activities, i.e. at pop concerts, discotheques and gyms. A crucial factor for the prevention of hearing impairments and hearing-related symptoms in the young population is the use of hearing protection. The focus of the present study is use of hearing protection and self-reported hearing-related symptoms, such as tinnitus and noise sensitivity in a young population of high-school students (N=1285), aged 13 to 19 years. The results show that the prevalence of permanent tinnitus and noise sensitivity, reported in the total group, was 8.7% and 17.1% respectively. Permanent tinnitus was not significantly related to level of socio-economic status, but age-related differences in the prevalence rates of experienced tinnitus and noise sensitivity were found to be significant. Older students reported such symptoms to a greater extent than younger students did. Those who reported tinnitus and other hearing-related symptoms protected their hearing to the highest extent and were the ones most worried.     

Influence of noise on gustatory affective ratings and preference for sweet or salt

Ten adult men were exposed to four different conditions of noise--low noise (70 dB), loud noise (90 dB), loud music (90 dB) and a silence control--while they tasted sweet or salty solutions. In the first experiment, they rated the pleasure/displeasure aroused by ten gustatory stimuli (five sucrose and five sodium chloride from 0.15 to 2.35 M/l). The median affective rating for sucrose was significantly higher in loud noise and with loud music. No change was observed for salt. In the second experiment, the subjects were invited to mix solutions in order to obtain the most pleasant concentration of sucrose or sodium chloride. Subjects' preferred concentrations of sucrose or sodium chloride did not vary with auditory conditions.     

The effects of a hearing education program on recreational noise exposure,attitudes and beliefs toward noise,hearing loss,and hearing protector devices in young adults

Excessive recreational noise exposure in young adults might result in noise-induced hearing loss (NIHL) and tinnitus. Inducing behavioral change in young adults is one of the aims of a hearing conservation program (HCP). The goal of the current study was to evaluate the effect of a hearing education program after 6 months in young adults in relation to knowledge regarding their individual hearing status. The results of a questionnaire regarding the weekly equivalent recreational noise exposure, attitudes and beliefs toward noise, and hearing loss and hearing protector devices (HPDs) were compared between both sessions. Seventy-eight young adults completed the questionnaire concerning recreational noise exposure, youth attitude to noise scale (YANS), and beliefs about hearing protection and hearing loss (BAHPHL). Their hearing status was evaluated based on admittance measures, audiometry, transient-evoked otoacoustic emissions (TEOAEs), and distortion-product otoacoustic emissions (DPOAEs). The main analysis consisted of a mixed model analysis of variance with dependent variables of either the noise exposure or the scores on (subscales of) YANS and BAHPHL. The independent variables were hearing status and session one versus session two. There was a significant decrease in recreational noise exposure and several (sub) scales of YANS and BAHPHL between both the sessions. This behavioral change resulted in a more frequent use of HPDs in 12% of the participants. However, the behavioral change was not completely related to the knowledge of young adults’ individual hearing status. To prevent hearing damage in young people, investing in HCPs is necessary, apart from regulating sound levels and its compliance at various leisure-time activities. Also, the long-term effect of HCPs and their most cost-efficient repetition rates should be further investigated.     

Effects of loud noise exposure on DNA integrity in rat adrenal gland

Loud noise is generally considered an environmental stressor causing negative effects on acoustic, cardiovascular, nervous, and endocrine systems. In this study, we investigated the effects of noise exposure on DNA integrity in rat adrenal gland evaluated by the comet assay. The exposure to loud noise (100 dBA) for 12 hr caused a significant increase of DNA damage in the adrenal gland. Genetic alterations did not decrease 24 hr after the cessation of the stimulus. We hypothesize that an imbalance of redox cell status is responsible for the induction and persistence of noise-induced cellular damage.     

The influence of socio-economic status on adolescent attitude to social noise and hearing protection

The focus of the present study, of 1285 adolescents, was young people's attitudes towards noise and their use of hearing protection at discos and pop concerts. Comparisons were made between adolescents from different age groups, and with different socio-economic status. Logistic regressions indicated that "worry before attending noisy activities" and "hearing symptoms" such as tinnitus and noise sensitivity could, to some degree, explain the use of hearing protection in noisy environments. Another conclusion to be drawn from this study was that adolescents' attitudes and behaviours regarding hearing protection use differed between levels of socio-economic status. Individuals with high SES expressed more negative attitudes and used ear protection to a greater extent than those with lower SES. This result might indicate differences in the development of future auditory problems among individuals with different levels of socio-economic status. The cause of hearing impairment and tinnitus may not be restricted merely to noise exposure. Psychological aspects, such as attitudes towards noisy environments and the individual's behaviour regarding the use of hearing protection may be considered as important factors in the understanding of why the prevalence of hearing related problems has increased among adolescents.     

ALCOHOL INTOXICATION IN CHILDHOOD AND ADOLESCENCE

Coma and vomiting are the commonest symptoms in young teenagersintoxicated by alcohol. Severe toxicity, manifested as coma,occurs at lower blood alcohol concentrations in young teenagersthan in adults. The effect of ethanol on the state of consciousnessis directly proportional to blood alcohol concentration. Amongchildren under 5 years of age the risk of hypoglycaemia is increased.A significant risk in acute alcohol intoxication is the rapiddevelopment of coma, which in cold environments could lead tofatal hypothermia. Preschool-age children are reported to eliminateethanol twice as fast as adults, whereas young teenagers eliminateit at the adult rate. The biochemical disturbances in children11 to 16 years of age with alcohol intoxication resemble thoseof adults. Mild acidosis of a respiratory or metabolic originand mild hypokalaemia are common findings in young teenagers.Fluid replacement with glucose-containing fluids and follow-upare generally the only treatments needed for complete recovery.Motives leading to alcohol intoxication are a wish to get drunk,experimenting, problems in human relations, and attempted suicide.The underlying problems are often family-related. such as divorce,an alcoholic parent and a lower socioeconomic group.     

Attitudes toward noise,perceived hearing symptoms,and reported use of hearing protection among college students: Influence of youth culture

The purpose of this study was to assess the attitude toward noise, perceived hearing symptoms, noisy activities that were participated in, and factors associated with hearing protection use among college students. A 44-item online survey was completed by 2,151 college students (aged 17 years and above) to assess the attitudes toward noise, perceived hearing symptoms related to noise exposure, and use of hearing protection around noisy activities. Among the participants, 39.6% experienced at least one hearing symptom, with ear pain as the most frequently reported (22.5%). About 80% of the participants were involved in at least one noise activity, out of which 41% reported the use of hearing protection. A large majority of those with ear pain, hearing loss, permanent tinnitus, and noise sensitivity was involved in attending a sporting event, which was the most reported noisy activity. The highest reported hearing protection use was in the use of firearms, and the lowest in discos/ dances. The reported use of hearing protection is associated with having at least one hearing symptom but the relationship is stronger with tinnitus, hearing loss, and ear pain (χ² = 30.5-43.5, P < 0.01) as compared to noise sensitivity (χ² = 3.8, P = 0.03); it is also associated with anti-noise attitudes, particularly in youth social events. Universities and colleges have important roles in protecting young adults’ hearing by integrating hearing conservation topic in the college curriculum, promoting hearing health by student health services, involving student groups in noise-induced hearing loss (NIHL) awareness and prevention, and establishing noise level limitations for all on-campus events.