The impact of road traffic noise on cognitive performance in attention-based tasks depends on noise level even within moderate-level ranges

Little empirical evidence is available regarding the effects of road traffic noise on cognitive performance in adults, although traffic noise can be heard at many offices and home office workplaces. Our study tested the impact of road traffic noise at different levels (50 dB(A), 60 dB(A), 70 dB(A)) on performance in three tasks that differed with respect to their dependency on attentional and storage functions, as follows: The Stroop task, in which performance relied predominantly on attentional functions (e.g., inhibition of automated responses; Experiment 1: n = 24); a non-automated multistage mental arithmetic task calling for both attentional and storage functions (Exp. 2: n = 18); and verbal serial recall, which placed a burden predominantly on storage functions (Experiment 3: n = 18). Better performance was observed during moderate road traffic noise at 50 dB(A) compared to loud traffic noise at 70 dB(A) in attention-based tasks (Experiments 1-2). This contrasted with the effects of irrelevant speech (60 dB(A)), which was included in the experiments as a well-explored and common noise source in office settings. A disturbance impact of background speech was only given in the two tasks that called for storage functions (Experiments 2-3). In addition to the performance data, subjective annoyance ratings were collected. Consistent with the level effect of road traffic noise found in the performance data, a moderate road traffic noise at 50 dB(A) was perceived as significantly less annoying than a loud road traffic noise at 70 dB(A), which was found, however, independently of the task at hand. Furthermore, the background sound condition with the highest detrimental performance effect in a task was also rated as most annoying in this task, i.e., traffic noise at 70 dB(A) in the Stroop task, and background speech in the mental arithmetic and serial recall tasks.     

Road,rail, and air transportation noise in residential and workplace neighborhoods and blood pressure (RECORD Study)

Associations between road traffic noise and hypertension have been repeatedly documented, whereas associations with rail or total road, rail, and air (RRA) traffic noise have rarely been investigated. Moreover, most studies of noise in the environment have only taken into account the residential neighborhood. Finally, few studies have taken into account individual/neighborhood confounders in the relationship between noise and hypertension. We performed adjusted multilevel regression analyses using data from the 7,290 participants of the RECORD Study to investigate the associations of outdoor road, rail, air, and RRA traffic noise estimated at the place of residence, at the workplace, and in the neighborhoods around the residence and workplace with systolic blood pressure (SBP), diastolic blood pressure (DBP), and hypertension. Associations were documented between higher outdoor RRA and road traffic noise estimated at the workplace and a higher SBP [+1.36 mm of mercury, 95% confidence interval (CI): +0.12, +2.60 for 65-80 dB(A) vs 30-45 dB(A)] and DBP [+1.07 (95% CI: +0.28, +1.86)], after adjustment for individual/neighborhood confounders. These associations remained after adjustment for risk factors of hypertension. Associations were documented neither with rail traffic noise nor for hypertension. Associations between transportation noise at the workplace and blood pressure (BP) may be attributable to the higher levels of road traffic noise at the workplace than at the residence. To better understand why only noise estimated at the workplace was associated with BP, our future work will combine Global Positioning System (GPS) tracking, assessment of noise levels with sensors, and ambulatory monitoring of BP.     

Effects of noise and acoustics in schools on vocal health in teachers

Previous studies on the influence of noise and acoustics in the classroom on voice symptoms among teachers have exclusively relied on self-reports. Since self-reported physical conditions may be biased, it is important to determine the role of objective measurements of noise and acoustics in the presence of voice symptoms. To assess the association between objectively measured and self-reported physical conditions at school with the presence of voice symptoms among teachers. In 12 public schools in Bogotá, we conducted a cross-sectional study among 682 Colombian school workers at 377 workplaces. After signed the informed consent, participants filled out a questionnaire on individual and work-related conditions and the nature and severity of voice symptoms in the past month. Short-term environmental measurements of sound levels, temperature, humidity, and reverberation time were conducted during visits at the workplaces, such as classrooms and offices. Logistic regression analysis was used to determine associations between work-related factors and voice symptoms. High noise levels outside schools (odds ratio [OR] = 1.83; 95% confidence interval [CI]: 1.12–2.99) and self-reported poor acoustics at the workplace (OR = 2.44; 95% CI: 1.88–3.53) were associated with voice symptoms. We found poor agreement between the objective measurements and self-reports of physical conditions at the workplace. This study indicates that noise and acoustics may play a role in the occurrence of voice symptoms among teachers. The poor agreement between objective measurements and self-reports of physical conditions indicate that these are different entities, which argue for inclusion of physical measurements of the working environment in studies on the influence of noise and acoustics on vocal health.     

Long-term noise exposure and the risk for type 2 diabetes: A meta-analysis

Diabetes mellitus is one of the leading causes for disability and mortality in modern societies. Apart from personal factors its incidence might be influenced by environmental risks such as air pollution and noise. This paper reports a systematic review and meta-analysis on the risk for type 2 diabetes due to long-term noise exposure. Electronic searches in MEDLINE, EMBASE and the Internet yielded 9 relevant studies (5 for residential and 4 for occupational exposure). They were checked against a predefined list of safeguards against bias producing individual quality scores, which were then fed to MetaXL to conduct a quality effects meta-analysis. People exposed at their homes to roughly L_den > 60 dB had 22% higher risk (95% confidence interval [CI]: 1.09-1.37) for type 2 diabetes in comparison to those exposed to L_den < 64 dB; when studies reporting contentious exposure categories were excluded, there was still 19% risk (95% CI: 1.05-1.35) for L_den = 60-70 dB versus L_den < 60 dB. In occupational environment there was not significant risk (relative risk [RR] = 0.91, 95% CI: 0.78-1.06) for < 85 dB versus >85 dB. There was no heterogeneity in the two groups (I² = 0.00). The results should be interpreted with caution due to methodological discrepancies across the studies; however, they are indicative of the close links that noise pollution might have not only to cardiovascular diseases but to endocrine dysfunction as well.     

Simultaneous effects of noise exposure and smoking on OAEs

Noise is one of the most pervasive hazardous factors in the workplace. Noise-induced hearing loss (NIHL) is the most common disorder related to noise exposure. Smoking is probably associated with hearing loss. The simultaneous effect of noise and smoking on hearing is a recent concern. In this study, we assessed the simultaneous effect of noise and smoking on standard pure tone audiometry (PTA) and distortion product otoacoustic emissions (DP-OAEs). This was an historical cohort study on 224 workers exposed to noise who were divided into two groups: Smokers and nonsmokers. DP-OAE response amplitudes were assessed. Data were analyzed by SPSS software (version 19) using Student''s t-test and Mann-Whitney U test. One hundred and five subjects were smokers (case group) and 119 individuals were nonsmokers (control group). All the subjects were exposed to 91.08 ± 2.29 dBA [time-weighted average (TWA) for an 8 h work shift]. Mean DP-OAE response amplitude at frequencies higher than 1,000 Hz was significantly higher in the smokers than the nonsmokers. This study showed that smoking can aggravate the effect of noise on hearing in DP-OAEs.     

Early-life exposure to noise reduces mPFC astrocyte numbers and T-maze alternation/discrimination task performance in adult male rats

In this experiment, we evaluated the long-term effects of noise by assessing both astrocyte changes in medial prefrontal cortex (mPFC) and mPFC-related alternation/discrimination tasks. Twenty-one-day-old male rats were exposed during a period of 15 days to a standardized rats’ audiogram-fitted adaptation of a human noisy environment. We measured serum corticosterone (CORT) levels at the end of the exposure and periodically registered body weight gain. In order to evaluate the long-term effects of this exposure, we assessed the rats’ performance on the T-maze apparatus 3 months later. Astrocyte numbers and proliferative changes in mPFC were also evaluated at this stage. We found that environmental noise (EN) exposure significantly increased serum CORT levels and negatively affected the body weight gain curve. Accordingly, enduring effects of noise were demonstrated on mPFC. The ability to solve alternation/discrimination tasks was reduced, as well as the number of astroglial cells. We also found reduced cytogenesis among the mPFC areas evaluated. Our results support the idea that early exposure to environmental stressors may have long-lasting consequences affecting complex cognitive processes. These results also suggest that glial changes may become an important element behind the cognitive and morphological alterations accompanying the PFC changes seen in some stress-related pathologies.     

Association between polymorphism of interleukin-6 in the region -174G/C and tinnitus in the elderly with a history of occupational noise exposure

Tinnitus is a symptom usually related to cochlear change that may arise from noise exposure and induces expression of proinflammatory cytokines including interleukin-6 (IL6). This study aimed to evaluate the association between the polymorphism of the IL6 gene in the region 174G/C and tinnitus in elderly with history of occupational noise exposure. Settings and Design: This was a cross-sectional study with a sample of 179 independent elderly individuals aged >60 years. Information on exposure to occupational noise was obtained by interviews. Audiological evaluation was performed using pure tone audiometry and genotyped through polymerase chain reaction by restriction fragment length polymorphism (PCR-RFLP). Data were analyzed using the chi-square test and the odds ratio (OR), with the significance level set at 5%. Among the study subjects, 24.6% were homozygous for the G allele, 39.7% were homozygous for the C allele, and 35.8% were heterozygous for IL6 (P > 0.05). Of these, 33.5% reported noise exposure history, with 42.5% having tinnitus. We found significant association between the genotype and allele frequencies of the IL6 −174 gene (rs1800795) and tinnitus among the elderly with history of exposure to occupational noise (P = 0.03). The elderly with the C allele were less likely to have tinnitus associated with history of exposure to occupational noise [OR = 0.167, confidence interval (CI) 95% 0.167-0.749; P = 0.004] when compared to those carrying the G allele. This study suggests that there is an association between polymorphisms in the IL6 gene at region – 174G/C and susceptibility to tinnitus.     

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.     

Effects of pedagogical ideology on the perceived loudness and noise levels in preschools

High activity noise levels that result in detrimental effects on speech communication have been measured in preschools. To find out if different pedagogical ideologies affect the perceived loudness and levels of noise, a questionnaire study inquiring about the experience of loudness and voice symptoms was carried out in Iceland in eight private preschools, called “Hjalli model”, and in six public preschools. Noise levels were also measured in the preschools. Background variables (stress level, age, length of working career, education, smoking, and number of children per teacher) were also analyzed in order to determine how much they contributed toward voice symptoms and the experience of noisiness. Results indicate that pedagogical ideology is a significant factor for predicting noise and its consequences. Teachers in the preschool with tighter pedagogical control of discipline (the “Hjalli model”) experienced lower activity noise loudness than teachers in the preschool with a more relaxed control of behavior (public preschool). Lower noise levels were also measured in the “Hjalli model” preschool and fewer “Hjalli model” teachers reported voice symptoms. Public preschool teachers experienced more stress than “Hjalli model” teachers and the stress level was, indeed, the background variable that best explained the voice symptoms and the teacher''s perception of a noisy environment. Discipline, structure, and organization in the type of activity predicted the activity noise level better than the number of children in the group. Results indicate that pedagogical ideology is a significant factor for predicting self-reported noise and its consequences.     

Tualang honey improves memory performance and decreases depressive-like behavior in rats exposed to loud noise stress

Recent evidence has exhibited dietary influence on the manifestation of different types of behavior induced by stressor tasks. The present study examined the effects of Tualang honey supplement administered with the goal of preventing or attenuating the occurrence of stress-related behaviors in male rats subjected to noise stress. Forty-eight adult male rats were randomly divided into the following four groups: i) nonstressed with vehicle, ii) nonstressed with Tualang honey, iii) stressed with vehicle, and iv) stressed with honey. The supplement was given once daily via oral gavage at 0.2 g/kg body weight. Two types of behavioral tests were performed, namely, the novel object recognition test to evaluate working memory and the forced swimming test to evaluate depressive-like behavior. Data were analyzed by a two-way analysis of variance (ANOVA) using IBM SPSS 18.0. It was observed that the rats subjected to noise stress expressed higher levels of depressive-like behavior and lower memory functions compared to the unexposed control rats. In addition, our results indicated that the supplementation regimen successfully counteracted the effects of noise stress. The forced swimming test indicated that climbing and swimming times were significantly increased and immobility times significantly decreased in honey-supplemented rats, thereby demonstrating an antidepressant-like effect. Furthermore, cognitive function was shown to be intensely affected by noise stress, but the effects were counteracted by the honey supplement. These findings suggest that subchronic exposure to noise stress induces depressive-like behavior and reduces cognitive functions, and that these effects can be attenuated by Tualang honey supplementation. This warrants further studies to examine the role of Tulang honey in mediating such effects.     

不同机械通气方式对新生儿脑血流的影响及临床意义

目的:探讨气管插管机械通气和经鼻CPAP(nCPAP)对新生儿脑血流的影响及临床意义。方法:采用经颅多普勒超声诊断仪监测气管插管机械通气和nCPAP新生儿脑血流变化,并与同期健康足月儿做对照。结果:气管插管机械通气组脑血流参数在第1天和第2天与对照组比较,差异均有统计学意义(P<0.05),而nCPAP组在第1～3天与对照组比较,差异均无统计学意义(P>0.05);气管插管机械通气组在第2天脑血流异常率为20.0%(6/30),明显高于nCPAP组的3.3%(1/30)(P<0.05);机械通气60例新生儿最终经临床诊断有6例脑损伤,其中在第3天4例脑血流异常新生儿均被证实有脑损伤,第2天7例脑血流异常新生儿有5例被证实存在脑损伤。结论:气管插管呼吸机辅助通气对新生儿脑血流有明显影响,应尽量选择鼻塞式CPAP辅助通气,减少脑损伤的发生。     

超声评估性激素治疗对绝经期妇女脑血流的影响

目的:应用超声检测方法观察性激素治疗前后大脑中动脉血流动力学的变化,探讨性激素治疗对绝经期妇女脑血流的影响。方法:自然绝经1年以上,年龄50～60岁,诊断为更年期综合征者60例,使用经颅彩色多普勒超声分别检测HT前及1年后大脑中动脉的峰值流速(Vmax)等血流动力学指标。结果:激素组大脑中动脉的收缩期最大峰值流速、舒张末期血流速度(Vmin)较治疗前明显升高(P0.001)、阻力指数(RI)无明显变化(P0.05);激素组的Vmax、Vmin较对照组升高(P0.05),RI无明显变化(P0.05)。结论:经颅彩色多普勒超声能够显示颅底动脉环的结构并对其血流动力学指标进行评估,激素治疗能改善大脑中动脉的血流动力学状态,增加脑供血,高分辨率彩色多普勒超声可以准确地对其进行评价。     

Hearing in young adults. Part I: The effects of attitudes and beliefs toward noise,hearing loss,and hearing protector devices

There is great concern regarding the development of noise-induced hearing loss (NIHL) in youth caused by high sound levels during various leisure activities. Health-orientated behavior of young adults might be linked to the beliefs and attitudes toward noise, hearing loss, and hearing protector devices (HPDs). The objective of the current study was to evaluate the effects of attitudes and beliefs toward noise, hearing loss, and HPDs on young adults’ hearing status. A questionnaire and an audiological test battery were completed by 163 subjects (aged 18-30 years). The questionnaire contained the Youth Attitude to Noise Scale (YANS) and Beliefs about Hearing Protection and Hearing Loss (BAHPHL). A more positive attitude or belief represented an attitude where noise or hearing loss is seen as unproblematic and attitudes and beliefs regarding HPDs is worse. Hearing was evaluated using (high frequency) pure tone audiometry (PTA), transient evoked and distortion product otoacoustic emissions. First, mean differences in hearing between the groups with different attitudes and beliefs were evaluated using one-way analysis of variance (ANOVA). Second, a χ² test was used to examine the usage of HPDs by the different groups with different attitudes and beliefs. Young adults with a positive attitude had significantly more deteriorated hearing and used HPDs less than the other subjects. Hearing conservation programs (HCPs) for young adults should provide information and knowledge regarding noise, hearing loss, and HPDs. Barriers wearing HPDs should especially be discussed. Further, those campaigns should focus on self-experienced hearing related symptoms that might serve as triggers for attitudinal and behavioral changes.     

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.     

Otoneurological symptoms in Brazilian fishermen exposed over a long period to carbon monoxide and noise

Fishing, one of the oldest productive activities, is an important sector of the Brazilian economy as well as the world economy. To evaluate the vestibular behavior in population of fishermen. It was realized as a retrospective and cross-sectional study. Thirty fishermen [mean age 49.5 (±8.5) years] whose age ranged from 33 years to 67 years were submitted to anamnesis, otorhinolaryngological evaluation, and vestibular examination through the electronystagmography (ENG). The most evident otoneurological symptoms were: Tinnitus (66.7%), dizziness (63.3%), and hearing loss (53.3%). The most evident clinical symptoms were: Fatigue (36.7%), anxiety (23.3%), and depression (16.7%). There were alterations in the vestibular examination of 13 (43.3%) fishermen in the caloric test. There was a prevalence of alteration in the peripheral vestibular system and there was a major frequency of the peripheral vestibular irritative syndrome (30.0%). Conclusion: The otoneurological complaints were frequent in the population studied that verifies the importance of allowing labyrinth examinations and the need for adopting preventive measures related to noise exposure to carbon monoxide (CO), since they can cause and/enhance various manifestations of labyrinthine vestibular impairment that can affect the quality of life of these workers.     

Exposure to music and noise-induced hearing loss (NIHL) among professional pop/rock/jazz musicians

Noise-induced hearing loss (NIHL) has been extensively studied in industrial work environments. With the advent of new technologies, loud music has been increasingly affecting listeners outside of the industrial setting. Most research on the effects of music and hearing loss has focused on classical musicians. The purpose of the current study was to examine the relationship between the amount of experience a professional pop/rock/jazz musician has and objective and subjective variables of the musician''s hearing loss. This study also examined professional pop/rock/jazz musicians’ use of hearing protection devices in relation to the extent of their exposure to amplified music. Forty-four pop/rock/jazz musicians were interviewed using the Pop/Rock/Jazz Musician''s Questionnaire (PRJMQ) in order to obtain self-reported symptoms of tinnitus and hyperacusis. Forty-two of the subjects were also tested for air-conduction hearing thresholds in the frequency range of 1-8 kHz. Results show that the extent of professional pop/rock/jazz musicians’ exposure to amplified music was related to both objective and subjective variables of hearing loss: Greater musical experience was positively linked to higher hearing thresholds in the frequency range of 3-6 kHz and to the subjective symptom of tinnitus. Weekly hours playing were found to have a greater effect on hearing loss in comparison to years playing. Use of hearing protection was not linked to the extent of exposure to amplified music. It is recommended that further research be conducted with a larger sample, in order to gain a greater understanding of the detrimental effects of hours playing versus years playing.     

Examination of changes caused by tubal sterilization in ovarian hormone secretion and uterine and ovarian artery blood flow rates

OBJECTIVES: To examine the changes caused by tubal sterilization (TS) in ovarian hormone secretion and uterine and ovarian circulation. DESIGN: Tubal sterilization was performed by minilaparotomy and laparoscopy methods in 36 women. Blood samples were taken for hormonal tests on Preoperative Day 3 (D3) of the menstrual cycle, on Postoperative Days 13-15 (periovulatory period) of the same cycle and on D3 in the 1st and 6th months post-TS. Uterine and ovarian artery blood flow rates of the women were measured on the same days as hormonal tests by transvaginal color Doppler ultrasonography (TVCDUSG). The control group was composed of 15 volunteers in the same age group who preferred the barrier method and who had the same TVCDUSG and hormonal analyses in the same periods. RESULTS: There was a decrease in the uterine and ovarian artery pulsatility index (PI) measurements and an increase in serum luteinizing hormone (LH) and estradiol (E2) values during the periovulatory period as compared with preoperative and postoperative menstrual measurements in all groups. There was no difference between baseline uterine and ovarian artery PI and serum follicle-stimulating hormone, LH and E2 values and those measured on D3 of the menstrual cycle in the 1st and 6th months post-TS. CONCLUSIONS: The 6-month postoperative follow-up of groups that had undergone different TS methods showed no difference in uterine or ovarian artery blood flow rates or ovarian hormone secretion in comparison with baseline values.     

Noise stress changes mRNA expressions of corticotropin-releasing hormone,its receptors in amygdala,and anxiety-related behaviors

Noise is a psychological, environmental stressor that activates limbic sites in the brain. Limbic sites such as the amygdala and the amygdaloid corticotropin-releasing hormone (CRH) system play an important role in integrating stress response. We investigated the association between noise exposures, CRH-related molecules in the amygdala, and behavioral alterations. In total 54 Sprague-Dawley rats were divided into the following three groups: Control (CON), acute noise exposure (ANE), and chronic noise exposure (CNE). The ANE group was exposed to 100 dB white noise only once in 4 h and the CNE group was exposed to the same for 4 h per day for 30 days. Expression profiles of CRH and its receptors CRH-R1 and CRH-R2 were analyzed by quantitative real-time polymerase chain reaction (qPCR). The same stress procedure was applied to the ANE and CNE groups for behavior testing. The anxiety responses of the animals after acute and chronic stress exposure were measured in the defensive withdrawal test. CNE upregulated CRH and CRH-R1 mRNA levels but downregulated CRH-R2 mRNA levels. ANE led to a decrease in both CRH-R1 and CRH-R2 expression. In the defensive withdrawal test, while the ANE increased, CNE reduced anxiety-like behaviors. The present study shows that the exposure of rats to white noise (100 dB) leads to behavioral alterations and molecule-specific changes in the CRH system. Behavioral alterations can be related to these molecular changes in the amygdala.     

Measurement of impulse peak insertion loss from two acoustic test fixtures and four hearing protector conditions with an acoustic shock tube

Impulse peak insertion loss (IPIL) was studied with two acoustic test fixtures and four hearing protector conditions at the E-A-RCAL Laboratory. IPIL is the difference between the maximum estimated pressure for the open-ear condition and the maximum pressure measured when a hearing protector is placed on an acoustic test fixture (ATF). Two models of an ATF manufactured by the French-German Research Institute of Saint-Louis (ISL) were evaluated with high-level acoustic impulses created by an acoustic shock tube at levels of 134 decibels (dB), 150 dB, and 168 dB. The fixtures were identical except that the E-A-RCAL ISL fixture had ear canals that were 3 mm longer than the National Institute for Occupational Safety and Health (NIOSH) ISL fixture. Four hearing protection conditions were tested: Combat Arms earplug with the valve open, ETYPlugs^® earplug, TacticalPro headset, and a dual-protector ETYPlugs earplug with TacticalPro earmuff. The IPILs measured for the E-A-RCAL fixture were 1.4 dB greater than the National Institute for Occupational Safety and Health (NIOSH) ISL ATF. For the E-A-RCAL ISL ATF, the left ear IPIL was 2.0 dB greater than the right ear IPIL. For the NIOSH ATF, the right ear IPIL was 0.3 dB greater than the left ear IPIL.