noise and hearing loss: a review

GEN E R A L A R T I C L E

Noise and Hearing Loss: A Review

EILEEN DANIEL, DEdABSTRACT

BACKGROUND: Noise-induced hearing loss is a major cause of deafness and hear-

ing 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 nonmodifiable 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: Nonmodifiable 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.

Keywords: noise-induced hearing loss; hearing protection; hearing conservation;

tinnitus.

Citation: Daniel E. Noise and hearing loss: a review. J Sch Health. 2007; 77: 225-231.

Professor, ([email protected]), Department of Health Science, SUNY College at Brockport, Brockport, NY 14420.

Address correspondence to: Eileen Daniel, Professor, ([email protected]), Department of Health Science, SUNY College at Brockport, Brockport, NY 14420.

Journal of School Health d May 2007, Vol. 77, No. 5 d ª 2007, American School Health Association d 225

While noise-induced hearing loss is most preva-

lent among individuals over the age of 65 and

the incidence is expected to rise as the population

ages, the number of children and young adults with

hearing loss is increasing.1,2 This appears to be corre-

lated to the increase in the amounts of hazardous

levels of noise exposure from infancy through early

adulthood.

Approximately 28 million Americans have im-

paired hearing and about half of these cases are at

least partly related to damage from short-term or

chronic exposure to loud noise.1 The National Insti-

tute of Occupational Safety and Health (NIOSH)

reports that approximately 30 million Americans are

exposed to daily noise levels that will likely lead to

hearing loss. Adults are going deaf at earlier ages

than in the past while 1 in 8 children and teenagers

between the ages of 6 and 19 already have some

level of hearing loss.2 Hearing loss, whatever the

cause, can give rise to a number of handicaps. Stud-

ies have shown that children and adults with

impaired hearing have a poorer quality of life related

to reduced social interactions, isolation, a sense of

exclusion, depression, and possibly impaired cogni-

tive function.3

The mechanism of noise-induced hearing loss

involves the destruction of hair cells in the Organ of

Corti within the cochlea of the inner ear. Chronic

exposure to loud noise initially damages the hair

cells, which are responsible for high-frequency

sounds. Over time, continued contact with excessive

noise may lead to impaired transmission of both

low- and high-frequency sounds to the brain. While

the average person is born with approximately

16,000 hair cells, up to 30-50% can be damaged or

destroyed before any measurable level of hearing

loss is detected.4 There is, unfortunately, limited

ability to detect the beginning stages of noise-

induced hearing loss. By the time a sufficient num-

ber of hair cells are destroyed to be noticeable, the

damage has been done. Hearing loss related to hair

cell destruction is not reversible and cannot typically

be restored by the use of a hearing aid.

Sound intensity is measured in decibels (dB),

which is used to indicate how humans hear a given

sound. A dB of 0 is considered the point at which

a person starts to hear sound while a whisper at 3

feet is equal to 30 dB and an average rock concert

can measure up to 140 dB (Table 1). NIOSH defines

hazardous noise as sound that exceeds 85 dB over

a typical 8-hour day1. The agency’s data also indicate

that prolonged exposure to noise over 85 dB can

change the structure of hair cells, resulting in often

irreversible hearing loss. It can also cause tinnitus,

a ringing or buzzing in the ears, which affects an esti-

mated 12 million Americans, many of them are chil-

dren and teenagers.4 Of those, at least 1 million

experience tinnitus to the extent that it interferes

with their daily lives. While constant exposure to

loud noise exacerbates the risk of hearing loss, single

exposures can also cause auditory changes. A recent

study determined that children and teenagers exposed

to a single intense sound event experienced both

hearing loss and tinnitus.5 These individuals, who

ranged from 1 to 16 years, maintained a slight hear-

ing loss and a hypersensitivity to sound after 1 year.

Loud noise has other effects on the body unrelated

to hearing. Nonauditory effects may include elevated

blood pressure, loss of sleep, changes in brain chemis-

try, and increased heart rate.6 Other effects include

impaired early development and learning disabilities

among children. Noisy homes and environments may

impede cognitive and language development and psy-

chomotor tasks. There are many studies demonstrat-

ing that children living and attending schools near

areas of loud noise such as airports have lower read-

ing scores.4 To perform well academically, students

need quiet places to learn and study.

While involuntary contact with loud noise puts

children and adults at risk for hearing loss and other

noise-induced health problems, much noise expo-

sure is voluntary. Loud music, particularly portable

music players, can expose listeners to potentially

harmful sound for many hours of the day. Portable

music players can store thousands of songs and can

play for hours. Industrial regulations require

employers to take action whenever their workers are

exposed to noise over 85 dB for 8 hours a day.

Table 1. Decibel Chart*

Decibel Level (dB) SourceTypical Physical

Response

0 Softest sound thatcan be heard

10 Normal breathing Barely audible30 Whisper Very quiet50-65 Normal conversation Quiet80-85 City traffic noise Annoying95-110 Motorcycle Very annoying100 School dance,

boom boxVery annoying

110 Busy video arcade Very annoying120 Nightclub Can damage hearing

after 15 minutesexposure per day

110-125 Stereo, personalmusic player

Can damage hearingafter 15 minutesexposure per day

110-140 Rock concerts Noise may cause painand brief exposurecan injure ears

150 Firecracker Noise may cause painand brief exposurecan injure ears

*American Tinnitus Association, http://www.ata.org/about_tinnitus/consumer/healthy_

hearing1.htm

226 d Journal of School Health d May 2007, Vol. 77, No. 5 d ª 2007, American School Health Association

Either ear protection has to be provided or the noise

must somehow be reduced. Listeners using portable

music players can expose themselves to the same

level of loudness in 15 minutes of music at 100 dB

that an industrial worker gets in an 8-hour day at

85 dB. The typical listener has the volume at a range

between 75 and 105 dB.7

In addition to portable music players, there are

other recreational exposures that can negatively

affect hearing. Playing with loud toys and games and

attending rock concerts can contribute to sounds

high enough to negatively affect hearing or cause

tinnitus. A recent study found that in a typical

nightclub, the sound intensity ranged from 104 to

112 dB.2 Researchers determined that exposure to

loud leisure noise is correlated with hearing loss

and tinnitus and the risk rises as noise exposure

increases.5 Whatever the source, unlike workers

who may have limited choice regarding noise expo-

sure, young people often choose to expose them-

selves to loud sounds.

Mercier and Hohmann studied over 700 teenagers

and young adults and determined that the majority

regularly attended discotheques and rock concerts.

The researchers found that while the subjects typi-

cally were exposed to sounds exceeding 87 dB,

approximately 60% did not consider the noise to be

too loud.8 While these individuals did not perceive

the music as too loud, 71% suffered from tinnitus

and 11% had hearing loss following attendance at

a music event.

Takayuki Kageyama identified several psychologi-

cal characteristics of young people who keep their

volume high while listening to music with portable

headphones.7 These included anxiety and sensation-

seeking tendencies. Overall, those who turned up

the volume the highest were males regardless of the

type of music though rock and heavy metal was

played the loudest by both males and females.

Recent studies have shown prevention measures,

including consistently using hearing protection, can

minimize the negative effects of exposure to loud

noise. Avoiding tobacco, getting regular exercise,

and eating a healthy diet and/or nutritional supple-

ment use may also decrease an individual’s risk of

developing noise-induced hearing loss or delay its

onset even if exposed to consistent levels of noise

loud enough to damage hearing. The presence of

diabetes, heart disease, and tooth loss may increase

the risk of deafness following noise exposure. Under-

standing the risk factors is especially important, as

there are limited effective treatments or cure for

most sufferers once a noise-induced hearing loss

occurs. The purpose of this article is to review modi-

fiable and nonmodifiable risk factors, comorbidity,

and the role of health education in the prevention

of noise-induced hearing loss.

NONMODIFIABLE RISK FACTORS

Nonmodifiable risk factors for noise-induced hear-

ing loss include age, genetics, gender, and race. Of

these factors, age plays the most significant role. The

risk of developing noise-induced hearing loss typi-

cally increases with advancing years. Among individ-

uals between the ages of 65 and 75, approximately

23% suffer from partial or full loss of hearing. Over

age 75, about 40% are hearing impaired or deaf.1

However, studies have shown that increasing numbers

of children and teens are showing signs of tinnitus,

temporary threshold shift, and hearing impairment.

In a large, national population-based study, re-

searchers estimated that approximately 12% of 6- to

12-year-old children had experienced noise-induced

threshold shifts.9 Chung et al10 determined that

a majority of teenagers and young adults in their

study suffered from tinnitus and impaired hearing

after exposure to loud music.

Although age is correlated with hearing loss,

genetics and gender also have been linked. Studies

have shown that there are considerable differences

in susceptibility to noise damage between individu-

als, between the left and the right ear, and at differ-

ent times of day within the same person, indicating

the possibility of genetic variability to response to

noise exposure.11 Dogru et al12 determined that

there may be a correlation between blood group and

noise-induced hearing loss. The researchers found

that noise-induced hearing loss was significantly more

frequent among subjects with blood group O who

may be more prone to noise-related hearing impair-

ments. A recent National Health and Nutrition Study

III indicated that boys were more likely to show

signs of early hearing loss than girls, possibly due to

the kinds of activities in which they engage.9 Finally,

researchers found a positive association between

hearing loss and short stature.13 While genetics or

other variables may play a role, they theorized that

mechanisms linked to prenatal growth retardation

during fetal life may have caused both the short

stature and the damage to the development of the

cochlea.

A racial difference in hearing loss when exposed

to loud noise has been observed in the workplace.

Researchers determined that non-whites suffered

a greater degree of hearing loss after adjusting for

years of employment.14 Helzner et al15 found that

other variables were better predictors than race and

included concomitant high blood pressure, diabetes,

and smoking.

MODIFIABLE RISK FACTORS

Several modifiable risk factors relate to noise-

induced hearing loss. These include the nonuse of


hearing protection, cigarette smoking, lack of exer-

cise, low dietary intake of foods rich in antioxidant

vitamins and minerals, the presence of diabetes or

heart disease, and poor oral health.

Nonuse of Hearing ProtectionWhile ear protection has been found to reduce

the risks associated with loud noise, many people do

not wear them, especially teenagers. Several studies

have shown that even when individuals are aware

of the risks of noise exposure, they are reluctant to

use hearing protection.16,17 Reasons include discom-

fort, safety concerns, design, lack of knowledge

related to noise-induced hearing loss, and peer pres-

sure. These barriers exist even when individuals per-

ceive themselves to be at risk for hearing loss.16

Olsen and Erlandsson17 found that teenagers with

a high socioeconomic status were more likely to use

hearing protection and were more concerned about

hearing loss related to exposure to loud noise.

Peters18 determined that most people were not suffi-

ciently aware of the dangers of noise, which contrib-

uted to their not using hearing protection. A Web

site survey conducted by Chung et al10 found that

most teens responding to questions about general

health did not consider hearing loss a major con-

cern. This was despite the fact that about 60% had

experienced temporary hearing loss or tinnitus while

attending loud concerts or clubs. Many of these re-

spondents claimed they might consider hearing

protection if they believed they were at risk for

permanent as opposed to temporary hearing loss

(66%). Peters18 found that individuals who expose

themselves to loud noise during their leisure time

were unlikely to consider the need for hearing

protection.

SmokingCigarette smoking is a major risk factor for many

health problems, including hearing loss. Smoking

exposes smokers to distinct toxic substances in

mainstream smoke, which may synergistically affect

hearing when combined with loud noises. Non-

smokers exposed to both noise and secondhand

smoke are also more likely to have hearing loss.

Researchers tested the hearing of over 3700 adults

who began smoking in their teens and found they

were more likely to have hearing loss than non-

smokers. Nonsmokers who were exposed to second-

hand smoke were also more likely to experience loss

of hearing.19

A study involving steel workers found that smok-

ing was associated with increased odds of having

high-frequency hearing loss. Researchers determined

that there was a synergistic effect on hearing with

exposure to smoking and industrial noise.20 Investi-

gators found similar results in a study involving male

metal factory workers. They determined that there

was a synergistic effect of smoking and noise expo-

sure on hearing loss.21

Exercise and NutritionA limited number of studies were identified,

which linked physical fitness and prevention of

hearing loss. Cristell et al22 found that after 2

months of fitness training, teens and young adults

improved both their level of cardiovascular fitness

and their hearing. Kolkhorst et al23 determined that

there was an association between physical fitness

and diminished temporary hearing loss experienced

after noise exposure. The researchers theorized that

exercise training causes the inner ear to receive

more oxygen-rich blood, which enhances hearing.

In addition to exercise, diet may also play a role

in mitigating the effects of noise exposure. Research-

ers believe that exposure to loud noise can damage

inner ear hair cells via processes related to free radi-

cals, unstable oxygen compounds, which can attack

or react with healthy body cells. Antioxidants such

as vitamins A, C, and E and the mineral selenium

protect the body against damage caused by free radi-

cals.24 Kopke et al25 similarly found that antioxi-

dants helped reduce hearing damage after exposure

to loud noises. The mineral magnesium has also

been shown to lessen the damaging effects of noise

exposure. Two studies have demonstrated the pro-

phylactic effects of magnesium on noise-related

hearing damage in humans.26,27

In addition to magnesium, the mineral zinc and

two B vitamins may also play a role in lessening the

impact of noise exposure and resulting hearing loss.

Vitamins B9 (folate) and B12 have been studied in

relationship to hearing loss. Data indicate that while

further studies are needed, there may be some ther-

apeutic value in the use of these two vitamins.28

ComorbidityThere is a well-established relationship between

hearing loss and tooth loss, diabetes, and heart dis-

ease.6,29 Lawrence et al29 observed nearly twice as

much hearing loss among patients shifting from

greater than 17 to less than 17 teeth. Schell et al30

found that hearing loss was more pronounced

among those with the highest number of teeth lost.

The authors suggested that tooth loss causes hearing

impairment because of a lack of muscle activity of

the palate on the auditory tube.

Among individuals with diabetes, there appears to

be an increased risk of hearing loss and loss of hear-

ing at an earlier age. High blood sugar may cause

blood vessels in the inner ear to narrow, which dis-

rupts the normal transmission of sound.31,32 Diabetes


is of particular concern since its incidence has

been increasing significantly among young children

and teens.31 Similarly, cardiovascular disease can

also increase the risk of hearing loss. People with

cardiovascular-induced circulatory problems are

more likely to suffer hearing loss due to diminished

circulation and narrowing of the blood vessels in the

inner ear.33

IMPLICATIONS FOR HEALTH EDUCATION

While age and hearing loss is linked, there

appears to be a rise in hearing impairment among

children and teenagers, usually related to recrea-

tional noise exposure. Unlike industrial contact,

many young people voluntarily expose themselves

to loud noise via headphones, car sound systems,

loud concerts, and nightclubs. The most effective

way to lower the incidence of noise-induced hearing

loss among this population is to reduce the exposure

to loud noise by having them turn down the vol-

ume, avoid the source of the loud noise, or the con-

sistent use of hearing protection. Unfortunately,

many listeners who deliberately expose themselves

to loud noise appear unwilling to do any of these. It

has been determined that many young people be-

lieve music is enhanced when played very loudly.8

There also appear to be barriers to the use of

hearing protection. Major limitations to the consis-

tent and effective use is discomfort, the lack of easily

accessible health information, advice and guidance

on the risk from loud noise during leisure activities,

lack of knowledge of the function of the ear, the

need for regular hearing assessments, and lack of

hearing conservation programs.18 Hearing conserva-

tion programs focusing on the prevention of hearing

loss have traditionally been offered in the workplace

but are also offered in some school districts.34 School-

based hearing conservation programs are designed

for children and teens to emphasize consequences of

hearing loss and the types of noise that are most

likely to cause temporary and permanent impair-

ment. Numerous studies have evaluated the efficacy

of hearing conservation programs and determined

that they significantly improve knowledge and have

measurable, positive effects on behavior.10,34 While

the benefits of hearing conservation programs are

clear, there are too few school districts including

them in their curricula.35 That may be related to

lack of public awareness about how excessive sound

exposure damages hearing and the impact of hearing

loss. Both children and parents should be educated

on the various means to prevent noise-induced

hearing loss at home, school, and during recreational

activities.

Identifying education strategies to prevent or

delay onset of noise-induced hearing loss will have

important effects on the numbers of Americans who

develop noise-induced hearing loss. These strategies

may include the integration of hearing conservation

into existing health education and science classes,

raising awareness of the relationship between other

modifiable risk factors and hearing loss, and mandat-

ing hearing conservation instruction during elemen-

tary and secondary schools.

Though knowledge of the relationship between

noise and hearing loss is an important component of

health education, it does not always facilitate change.

For over half a century, the Health Belief Model

(HBM) has been used to better understand health

behavior and factors related to compliance and non-

compliance with recommended health behaviors.36

The model offers guidelines for the development of

programs, which address compliance issues. For

instance, this model suggests that young people vol-

untarily exposed to loud noise are more likely to

take action (ie, use hearing protection or turning

down the volume) if they believe they are suscepti-

ble to permanent hearing loss. In addition, if they

are aware that developing a hearing impairment

could negatively affect their quality of life and may

not be treatable, that would increase their sense of

susceptibility. Next they must perceive the benefits

of taking action (avoiding loud noise or the use of

ear protection) as outweighing the barriers (ie, peer

pressure).

Hearing conservation programs based on the

HBM and administered in school-based settings

could be designed with two components: knowledge

(ear anatomy, relationship between noise and hear-

ing loss, and hearing loss and modifiable risk fac-

tors) and skill building (turning down the volume,

proper use of ear protection, ways to add vitamin

and mineral-rich foods to the diet, exercise programs,

and good oral hygiene). If available, hearing testing,

particularly before and after exposure to loud noise,

could provide a strong illustration of the relation-

ship between noise and temporary hearing loss.

Program evaluation should address knowledge of

ear anatomy, the effects of loud noise on ear cells,

and behaviors (use of hearing protection, turning

down the volume, diet, exercise, and dental care).

Most school-based hearing conservation programs

conclude that compared to pretest responses, stu-

dents’ performance on knowledge and awareness

questionnaires improves significantly as measured

by posttests.34 In addition, several studies have

determined that a significantly larger number of

students used hearing protection following conser-

vation instruction than among control groups.35

This is significant since personal hearing protection

devices are one of the most important behavioral

changes that can be made to prevent noise-induced

hearing loss.18


Offering school-based programs is an opportunity

to reach children and help them develop the knowl-

edge and skills to conserve their hearing. Although

most students are aware of the relationship between

smoking and cancer, information about the correla-

tion with hearing loss is not as well disseminated.

Active and passive smokers are exposed to several

toxic substances that have been linked to hearing

loss.19 In addition, smoking increases the risk of

cardiovascular disease and tooth loss, which are also

correlated to hearing impairment.29,30,33 School-

based smoking prevention and cessation programs

should consider addressing the issue of the relation-

ships between hearing loss, noise, and tobacco use.

Studies examining the role of exercise and nutri-

tion in preventing noise-induced hearing loss indi-

cate that increased consumption of antioxidant

vitamins might help mitigate the effects of exposure

to loud noise. The mineral magnesium and the B

vitamins folate and vitamin B12 may also play a sim-

ilar role. Exercise also appears beneficial since it

enhances the circulation and may improve the avail-

ability of oxygen-rich blood to the ears. Exercise and

a healthy diet rich in antioxidants also decreases the

risk of cardiovascular disease and diabetes, which

have also been linked to hearing loss.25,31,32

Increasing hearing conservation education and

reducing the aforementioned risk factors might pre-

vent or delay the onset of noise-induced hearing

loss. Since hearing loss can lead to a number of dis-

abilities, prevention can enhance the quality of life.37

Although effective treatment is currently limited, pre-

vention offers hope for the future. Information sum-

marized implies that many cases of noise-induced

hearing loss should be preventable. Avoiding and/or

minimizing exposure to loud noise whenever possi-

ble, the use of hearing protection where appropriate,

smoking cessation, dietary changes, exercise, and good

oral hygiene are lifestyle factors that can reduce the

risk of developing this condition. Although it is

hoped an effective early diagnosis and treatment will

be developed for noise-induced hearing impairment,

until that occurs, prevention can and should play

a major role.

REFERENCES

1. Centers for Disease Control and Prevention/NIOSH. Criteria for

a Recommended Standard: Occupational Noise Exposure Revised Cri-

teria. Cincinnati, Ohio: US Department of Health and Human

Services; 1998.

2. Serra M, Biassoni E, Richter U, et al. Recreational noise expo-

sure and its effects on the hearing of adolescents. Int J Audiol.

2005;44(2):65-73.

3. Schmuzigger N, Fostiropoulos K, Probst R. Long-term assess-

ment of auditory changes resulting from a single noise expo-

sure associated with non-occupational activities. Int J Audiol.

2006;45(1):46-54.

4. Bronzaft A. The increase in noise pollution: what are the

health effects? Nutr Health Rev. 1996;78(78):2-7.

5. Holgers KM, Pettersson B. Noise exposure and subjective

hearing symptoms among school children in Sweden. Noise

Health. 2005;7(11):27-37.

6. Lusk SL, Hagerty BM, Gillespie B, Caruso CC. Chronic effects

of workplace noise on blood pressure and heart rate. Arch

Environ Health. 2002;57(4):273-281.

7. Kageyama T. Loudness in listening to music with portable

headphone stereos. Percept Mot Skills. 1999;88(2):423.

8. Mercier V, Hohmann B. Is electronically amplified music too

loud?: what do young people think? Noise Health. 2002;4(1):

47-55.

9. Niskar A, Kieszak SM, Holmes AE, et al. Estimated prevalence

of noise-induced hearing threshold shifts among children 6 to

19 years of age: the Third National Health and Nutrition Exami-

nation Survey, 1988-1994. Pediatrics. 2001;108(1):40-50.

10. Chung JH, Des Roches CM, Meunier J, et al. Evaluation of

noise induced hearing loss in young people using a web-based

survey technique. Pediatrics. 2005;115(4):861-867.

11. Klein BEK, Cruickshanks KJ, Nondahl, et al. Cataract and

hearing loss in a population-based study: the Beaver Dam

Studies. Am J Ophthalmol. 2001;132(1):537-543.

12. Dogru H, Tuz M, Uygur K. Correlation between blood group

and noise-induced hearing loss. Acta Otolaryngol. 2003;123(8):

941-942.

13. Barrenas M, Bratthall A, Dahlgren J. The association between

short stature and sensorineural hearing loss. Hearing Res.

2005;205(2):123-130.

14. Ishii EK, Talbott EO. Race/ethnicity differences in the preva-

lence of noise-induced hearing loss in a group of metal fabri-

cating workers. J Occup Environ Med. 1998;40:661-666.

15. Helzner EP, Cauley JA, Pratt SR, et al. Race and sex differen-

ces in age-related hearing loss: the Health, Aging and Body

Composition Study. J Am Geriatr Soc 2005;53(12):2119-2127.

16. Bogoch II, House RA, Kudla I. Perceptions about hearing pro-

tection and noise-induced hearing loss of attendees of rock

concerts. Can J Public Health. 2005;96(1):69-72.

17. Olsen WSE, Erlandsson SI. The influence of socio-economic

status on adolescent attitude to social noise and hearing pro-

tection. Noise Health. 2004;7(25):59-70.

18. Peters RJ. The role of hearing protectors in leisure noise. Noise

Health. 2003;5(18):47-55.

19. Cruickshanks J, Klein R, Klein BEK, et al. Cigarette smoking

and hearing loss: the Epidemiology of Hearing Loss Study.

JAMA. 1998;279(279):1715-1719.

20. Mizoue T, Miyamoto R, Shimizu T. Combined effect of smok-

ing and occupational exposure to noise on hearing loss in

steel factory workers. J Occup Environ Med. 2003;60(10):56-59.

21. Ferrite S, Sasntana V. Joint effects of smoking, noise exposure

and age on hearing loss. Occup Med. 2005;55(1):48-53.

22. Cristell M, Hutchinson KM, Alessio HM. Effects of exercise

training on hearing ability. Scand Audiol. 1998;27:219-224.

23. Kolkhorst FW, Smaldino JJ, Wolf SC, et al. Influence of fit-

ness on susceptibility to noise-induced temporary threshold

shift. Med Sci Sports Exerc. 1998;30:289-293.

24. Kaygusuza I, Ozturka A, Ustundag B, et al. Role of free oxy-

gen radicals in noise-induced hearing impairment. Hearing

Res. 2001;162(1):43-47.

25. Kopke R, Bielefeld E, Jianzhong L, et al. Prevention of

impulse noise-induced hearing loss with antioxidants. Acta

Otolaryngol. 2005;125(3):235-243.

26. Attias J, Sapir S, Bresloff I, et al. Reduction in noise-induced

temporary threshold shift in humans following oral magne-

sium intake. Clin Otolaryngol. 2004;29:635-641.

27. Scheibe F, Haupt H, Mazurek B, et al. Therapeutic effect of

magnesium on noise-induced hearing loss. Noise Health. 2001;

3(11):79-84.


28. Houston DK, Johnson MA, Nozza RJ, et al. Age-related hear-

ing loss, vitamin B-12, and folate in elderly women. Am J Clin

Nutr. 1999;69(3):564.

29. Lawrence HP, Garcia RI, Essick GK, et al. A longitudinal study

of the association between tooth loss and age-related hearing

loss. Spec Care Dentist. 2001;21:129.

30. Schell CL, Diehl DL, Holmes AE, et al. An association between

dentate status and hearing acuity. Spec Care Dentist. 1999;19:208.

31. deLeon-Morales, Diaz LV, Jauregui-Renaud K, et al. Auditory

impairment in patients with type 2 diabetes. Arch Med Res.

2005;36(5):507-510.

32. Kakarlapudi V, Sawyer R, Staecker H. The effects of diabetes on

sensoineural hearing loss. Otol Neurotol. 2003;24(3):382-386.

33. Torre P, Cruickshanks KJ, Klein BEK. The association

between cardiovascular disease and cochlear function in older

adults. J Speech Lang Hear Res. 2005;48:473-481.

34. Folmer RL, Griest SE, Martin WH. Hearing conservation edu-

cation for children: a review. J Sch Health. 2002;72(2):51-57.

35. Borchgrevink HM. Does health promotion work in relation to

noise? Noise Health. 2003;5(18):25-30.

36. Strecher VJ, Rosenstock IM. The health belief model. In:

Glanz K, Lewis FM, Rimer BK, eds. Health Behavior and Health

Education: Theory, Research, and Practice. 2nd ed. San Francisco,

Calif: Jossey-Bass; 1997:41-59.

37. Arlinger S. Negative consequences of uncorrected hearing loss:

a review. Int J Audiol. 2003;42(2):17-20.

NOTICE

General Recommendations on ImmunizationRecommendations of the Advisory Committee on Immunization Practices (ACIP)

This report is a revision of General Recommendations on Immunization and updates the 2002

statement by the Advisory Committee on Immunization Practices (ACIP) (CDC. General

recommendations on immunization: recommendations of the Advisory Committee on Immuniza-

tion Practices and the American Academy of Family Physicians. MMWR 2002;51[No. RR-2]). This

report is intended to serve as a general reference on vaccines and immunization. The principal

changes include 1) expansion of the discussion of vaccination spacing and timing; 2) an increased

emphasis on the importance of injection technique/age/body mass in determining appropriate

needle length; 3) expansion of the discussion of storage and handling of vaccines, with a table

defining the appropriate storage temperature range for inactivated and live vaccines; 4) expansion

of the discussion of altered immunocompetence, including new recommendations about use of

live-attenuated vaccines with therapeutic monoclonal antibodies; and 5) minor changes to the

recommendations about vaccination during pregnancy and vaccination of internationally adopted

children, in accordance with new ACIP vaccine-specific recommendations for use of inactivated

influenza vaccine and hepatitis B vaccine. The most recent ACIP recommendations for each

specific vaccine should be consulted for comprehensive discussion. This report, ACIP recommenda-

tions for each vaccine, and other information about vaccination can be accessed at CDC’s National

Center for Immunization and Respiratory Diseases (proposed) (formerly known as the National

Immunization Program) website at http//:www.cdc.gov/nip.

Reference: Kroger AT, Atkinson WL, Marcuse EK, Pickering LK. General Recommendations on

Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP).

MMWR Recommendations and Reports 2006; 55(RR15);1-48. Errata to Table 9, MMWR 2006;

55(48); 1303-1304.


noise and hearing loss: a review

Documents