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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 24  |  Issue : 1  |  Page : 27-34

Ear-related problems among headphone users in the Kingdom of Saudi Arabia


1 Department of Otolaryngology, Prince Mansour Military Hospital, Taif, KSA
2 Department of Otolaryngology, Taif University, Taif, KSA

Date of Submission22-Dec-2021
Date of Decision12-Jan-2022
Date of Acceptance31-Jan-2022
Date of Web Publication30-Mar-2022

Correspondence Address:
Dr. Hazem Khairan Althobaiti
Taif University, Taif
KSA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjoh.sjoh_50_21

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  Abstract 


Background and Objectives: The middle ear cleft and the tympanum inflammation are defined as otitis media. The patient's use of headphones has been linked to aural hygiene issues and ear canal infections. Interestingly, there are not enough studies discussing the hazardous effects of prolonged use of headphones. This study aims to estimate the prevalence of ear infection among headphone users. Materials and Methodology: A cross-sectional study was conducted between February 2021 and December 2021 among 435 Saudi participants through a pretested questionnaire that was published using an online-based (electronic) form. The questionnaire included items related to pattern of hearing devices used among them and ear-related problems. This study includes all persons using earphones in the Kingdom of Saudi Arabia whose native language is Arabic. Results: Experiencing ear-related problems is statistically significantly correlated with ear infection (P = 0.000), using both ears (P = 0.000), female gender (P = 0.009), being a student (P = 0.003), using the hearing device >120 min/day (P = 0.015); however, it is not statistically correlated with age, type of residency, or the type of device being used (P > 0.05). Conclusion: Increased usage of hearing devices and prolonged time of use can have detrimental effects on ear problems. These possible effects are statistically significantly correlated with young age, female gender, being a student, using the device for more than 120 min/day, using the device for more than 4 years, or having chronic diseases in the past.

Keywords: Ear buds, earphones, headphones, otitis media


How to cite this article:
Aljuaid M S, Althobaiti HK, Alotaibi S H, Sarriyah AF, Alsuwat MA, Alfaqih H E, Almnjwami RF. Ear-related problems among headphone users in the Kingdom of Saudi Arabia. Saudi J Otorhinolaryngol Head Neck Surg 2022;24:27-34

How to cite this URL:
Aljuaid M S, Althobaiti HK, Alotaibi S H, Sarriyah AF, Alsuwat MA, Alfaqih H E, Almnjwami RF. Ear-related problems among headphone users in the Kingdom of Saudi Arabia. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2022 [cited 2022 May 16];24:27-34. Available from: https://www.sjohns.org/text.asp?2022/24/1/27/341366




  Introduction Top


Otitis media (OM) is known as the inflammation of the middle ear cleft and the tympanum with or without otorrhea lasting from 2 weeks to more than 3 months, with permanent perforation; OM is caused by bacteria.[1],[2] Ear infection can be of two types, i.e., acute or chronic purulent type.[3] OM is a crucial medical issue that is prevalent in all countries.[4] It results in a significant health and financial burden mainly in high-prevalence countries in Africa and other developing countries, which showed an elevated percentage of the disease reaching up to 11%.[5] The World Health Organization (WHO) reports state that Ethiopia is one of the countries with high ear infection burden.[5] This disease occurs equally in both infants, young children, and adults.[6] It may start in childhood or as a result of poorly treated acute suppurative OM or may be chronic.[4] The microorganisms may reenter the middle ear through a long-standing perforation. Young people are more susceptible to develop ear infections than adults owing to the structure of their  Eustachian tube More Details, which allows organisms easier access through the nasopharynx, with males showing higher predominance than females.[4],[7] In developed countries, e.g., the United States of America (USA) and in Europe, the prevalence of this disease is decreasing owing to awareness; however, in developing countries, it is rising.[1] Untreated OM in developing countries leads to purulent otitis, often with perforation, and further complications such as frequent acute OM, continuity of middle ear effusion requiring the insertion of a drainage tube leading to hearing decline, mastoiditis, meningitis, chronic OM, brain abscess, and sepsis.[7] The pattern of ear infection is highly variable worldwide.[3],[8] According to previous studies, organisms responsible for ear infection include Pseudomonas aeruginosa, Staphylococcus aureus, Proteus mirabilis, Klebsiella pneumoniae, and  Escherichia More Details coli, which have been isolated from cases of ear infection.[9],[10] The use of headphones is correlated with aural hygiene issues and ear canal infections. Headphone users frequently express a concern regarding the device's potential to develop noise-induced diminution of hearing. However, side effects of prolonged use of headphones are rarely mentioned in the published articles. Telephonists and radio DJs are among the long-term users of headphones.[11] A cross-sectional study was performed in December 2020 on the awareness and attitudes of parents toward OM, which included 703 parents; the study showed that the third most common cause of OM was the use of headphones after swimming (approximate 30%). The most frequently mentioned symptoms were ear pain, fever, and dizziness. The study noted that most parents had inadequate knowledge about OM.[12] In 2019, an observational study explored the association of bacterial flora with earphone use by students at Saveetha Medical College and Hospital in Chennai. The study included 60 participants and stated that bacterial transfer increased with prolonged use of earphones, sharing, or improper hygiene. The study determined that the frequent and constant use of earphones increased bacterial growth in the ear.[13] In 2019, an observational study was published on risk factors of infection between swimmers, cotton bud and headphone users, which included 243 males and 75 females, and the average age of individuals was 36 years old. The study revealed that headphones were used by 178 participants; the study concluded that the ear infection, itching and hearing loss were significantly associated with headphone use.[14] In 2018, a cross-sectional study was published on the health effects of earphones and headphones among students living in Chandigarh. A total of 100 participants from Chandigarh admitted using ear hearing devices for more than 5 years; the study showed that approximately half of the students were unaware of dangers of sharing unclean earphones.[15] In 2010, a study evaluated 136 customer service representatives from Malaysia who used headphones on prolonged basis; the study showed correlation between ear canal infection and other ear-related problems.[16]

Aim of this work

This study aimed to explore the prevalence of ear canal infection and all ENT-related problems in users of hearing devices.


  Materials and Methodology Top


A cross-sectional observational study was conducted between February 2021 and December 2021 among 435 Saudi participants (both genders, living in Saudi Arabia) through a self-administrated questionnaire that was published using an online-based (electronic) form. The questionnaire included items related to pattern of hearing devices used and ear-related problems. All participants had the right to withdraw from the study at any time if they wished to do so. The questionnaire is composed of two parts. The first section includes demographic descriptive information (age, gender, profession, residency location, residency type, smoking and chronic diseases). The second section describes the type of hearing device used, all necessary information about the device (type, duration in years, duration in minutes, purpose of use, where they use it, in which ear and awareness about the decibel feature), questions about having any ear-related problems (dizziness, pressure, fullness and plugged feeling in the ear, sudden drop in hearing in one or both ears, presence of more than one symptom, or persistent discharge from either ear, pus or blood from the ear, increase ear wax, change in hearing, head cold or sinus problem, dizziness, persistent or recurring headache, recurring fever, night sweats, chills, existence of more than one symptom combined, none of the above mentioning the exact problem) and if they occurred in the last 3 months or immediately after using the hearing device.

All participants met the following inclusion criteria:

Inclusion criteria

people who met the following inclusion criteria:

  1. People using earphones
  2. People who agreed to participate
  3. People whose native language is Arabic
  4. People who live in the Kingdom of Saudi Arabia.


Exclusion criteria

  1. All participants who do not use earphones were excluded.


Statistical analysis

The means and standard deviations for continuous data, frequencies, and percentages for categorical data are analyzed to present patient characteristics. Univariate analyses and univariate logistic regression analyses or Chi-square tests for the categorical variables were used to study the correlations between factors and hearing devices used. For dichotomized outcomes in any questions, responses were counted as (Yes and No) as a nominal variable. Predictors or risk factors for having an ear-related problem were calculated using univariate logistic regression analysis. All data were collected and coded; statistical analysis was conducted using the SPSS version 21 (SPSS Inc., Armonk, NY: IBM Corp, USA); a 2-sided test with P < 0.05 was set as the cut-off value for statistical significance at 95% confidence interval [CI].


  Results Top


This cross-sectional study included 435 participants (Saudi citizens, living in KSA mainly in Taif City, 15–>35 years old); 53.5% of the participants were females, and 46.5% were males. Our analysis showed that 76% of them used different hearing devices, mainly earphones (wireless and wired). All demographic analyses are shown in [Table 1]. Variables regarding the use of hearing devices are shown in [Table 2]; it is confirmed that 40% of our cases have been using these devices for more than 4 years; the daily average time of use is 30–60 min/day; the favourite place to use these devices is mainly at home (for >50% of the participants), followed by school and college. More than half of the participants (51%) experienced ear-related problems in some form [Figure 1]. A total of 36.9% of earphones users admit to having ear infection in both ears; most of them are aware of the sound decibel feature in the hearing device that would protect or avoid noisy situations, and 56% of them use it. [Table 3] shows cross-tabulation between the most common types of hearing devices and different variables and shows a statistically significant correlation (based on the Chi square test) for the duration of use, place, purpose and age (P < 0.05). Experiencing ear-related problems is statistically significantly correlated with ear infection (P = 0.000), using both ears (P = 0.000), female gender (P = 0.009), being a student (P = 0.003), using the hearing device >120 min/day (P = 0.015); however, it is not statistically correlated with age, type of residency or the type of device being used (P > 0.05), based on the Pearson Chi square test [Table 4]. [Table 5] shows positive association between knowing about the decibel feature and using it. A statistically significant correlation was found between having more than one symptom in the past 3 months and age range of 20-24 years old (P = 0.000), using the device for more than 4 years and >120 min/day (P = 0.010 and 0.000, respectively), having chronic diseases in the past (P = 0.000), being nonsmoker (P = 0.009), using both ears (P = 0.000); however, there was no statistically significant correlation with type of residency or type of hearing device [Table 6]. Binary logistic regression was performed to show risk factors for having ear-related problems with usage of hearing devices, and statistically significant correlation was proven for female gender (odds ratio of 0.61, 95% CI of 0.415–0.901, P = 0.013), being a student/medical student (odds ratio of 1.22, 95% CI of 1.032–1.445, P = 0.020), daily usage time >120 min (odds ratio of 0.785, 95% CI of 0.658–0.935, P = 0.007), symptoms lasting for 10 min soon after using the hearing device (odds ratio of 1.31, 95% CI of 1.190–1.460, P = 0.000) [Table 7].
Figure 1: Ear-related problems

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Table 1: Descriptive demographic analysis for participants

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Table 2: Hearing devices

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Table 3: Cross-tabulation between most frequently used hearing device and different variables using Chi-Square test

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Table 4: Have you ever experienced any ear-related problems such as tinnitus, ear pain, ringing, roaring, cricket like sounds, decrease in hearing in one or both ears?

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Table 5: Awareness of the sound decibel feature in the hearing device

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Table 6: Factors affecting having the following symptoms in the past 3 months

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Table 7: Binary logistic regression of Risk factors of having ear related problems with usage of hearing devices

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However, the analysis did not show any significance with residency type, smoking, age, any chronic disease or type of device being used.

Ear related problems

Experiencing ear related problems is statistically significant correlated with ear infection (P = 0.000), using both ears (P = 0.000), female gender type (P = 0.009), being a student (P = 0.003), using the hearing device >120 min/daily with (P = 0.015), however, it is not statistically correlated with age, type of residency, neither the type of device being used (P > 0.05) using Pearson Chi-square test.

A highly statistically significant correlation was proven between both variables using Chi-square (P = 0.000)

III-Factors affecting having the following symptoms in the past 3 months (persistent discharge from either ear, pus or blood from the ear, increase ear wax, change in hearing, head cold or sinus problem, dizziness, persistent or recurring headache, recurring fever, night sweats, chills, more than one symptom combined, none of the above.

A statistically significant correlation was found between having more than one symptom combined in the past 3 months and age range (20–24 years old) P = 0.000, using the device for more than 4 years, and more than 120 min/daily with P value (0.010, 0.000), [Figure 2] and [Figure 3] having chronic diseases in the past P = 0.000, being nonsmoker P value (0.009), using both ears P value (0.000), however there is no statistically significant correlation with type of residency, type of hearing device.
Figure 2: Daily average use of headphone and related ear problem

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Figure 3: Duration of using and most frequently used hearing device

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IV: Binary logistic regression

Binary logistic regression was done to show risk factors for having ear related problems with usage of hearing devices and proved the statistically significant correlation with female gender (odds ratio 0.61, 95% CI [0.415–0.901], P = 0.013), being a student/medical student (odds ratio 1.22, 95% CI [1.032–1.445], P = 0.020), daily time > 120 min (odds ratio 0.785, 95% CI [0.658–0.935], P = 0.007), symptoms lasting for 10 min soon after using the hearing device (odds ratio 1.31, 95% CI [1.190–1.460], P = 0.000).

However, it didn't show any significance with residency type, smoking, age, any chronic disease or type of the device being used.


  Discussion Top


Our study confirmed the high percentage of using earbuds, earphones, and headphones (76% of our participants) and documented the incidence of ear infections from different ear hearing devices. Regular and overuse are on the rise for work, learning or playing purposes. According to the American Osteopathic Association, it is allowed to use MP3 devices at levels up to 60% of maximum volume for a maximum of 1 h per day; the higher is the volume, the shorter must be the duration.[16] Wearing hearing devices is likely the culprit of a rising number of ear infections because people wear them more frequently and do not follow proper hygiene regulations

Recently, earbuds have become more popular among all age groups. In our study, 46.4% of the participants use earphones wireless (earbuds), 45% use wired earphones, and 8% use headphones. This agrees with another cross-sectional study performed in the eastern province in KSA, where most participants (92.7%) use earbuds, while only 7.3% use headphones.[17]

According to Pandey et al., in 2015, 32.5% of the respondents used earbuds.[18] This differs from our results, which showed that 76% of our participants used different hearing devices. An observational cross-sectional study, which calculated the frequency of headphone usage among medical undergraduates while driving, showed that the prevalence of regular headphone usage in transportation/car or while driving was 20.8%[17] versus 9.2% in our study.

In another study, the prevalence of wearing personal listening devices during studying was relatively higher (83.1%)[19] compared to our results, which showed 16% usage at school and college and 52% at home.

Our study shows that 40% of our participants have been using various hearing devices for more than 4 years, with the highest percentage of use at home, by females and students. Our results showed that 30% of study participants used hearing devices for 30–60 min/day compared to another study, which stated that approximately half of the respondents used earbuds for 1-2 h/day.[17] Awad et al. determined that the participants of their study used headphones and earphones for more than 4 h/day.[17] Another paper published in India reported that many students were using headphones for a duration of 2–4 h/day (35%) or 4–6 h/day (27%), which was higher than the findings in our study.[20] However, most students (77.7%) in a Nigerian study indicated 1 h/day use of earphones, which agrees with our study results.[21]

More than half of our participants (51%) experienced hearing-related problems; 37% of them got ear infections, and 14% experienced more than one symptom within 10 min of using the hearing device, i.e., either dizziness, decrease in hearing, plugged ear, pressure in the ears or fullness.

Experiencing hearing-related problems is statistically significantly correlated with ear infection, using both ears, female students, using the hearing device >120 min/day. However, it is not statistically associated with age, type of residency, type of device being used (P > 0.05), based on the Pearson Chi-square test.

A statistically significant association was found between having more than one single symptom in the past 3 months and age range of 20-24 years old, using the device for more than 4 years, having chronic diseases, being a nonsmoker and using both ears; these findings were confirmed by binary logistic regression analysis.

It was determined that young teens who used earphones for a period of more than 80 min daily in a noisy background had a 4.7 folds higher risk of hearing decline than those who used them <80 min per day.[22] This finding was confirmed by another study, which explained that using earphones for more than 60 min daily on average could lead to hearing loss in Korean university students.[22],[23]

Overuse of earbuds can lead to complications. Sunny et al.[21] reported the prevalence rate of earbud use among the students, and subjective tinnitus accounted for 95.6%.

The total period of using earbuds that are inserted directly into the external ear canal and the level of temperature changes or humidity inside in addition to the hygienic practice determines canal occlusion and possibility of ear-related issues.[17]

Owing to frequent and constant use of earphones, otitis externa was present in a large percentage (56%–92%) of swabs of the ear or earphone swabs in one of the studies, which found an increase in bacterial growth in the ear, and the prevalence increased by sharing the earpiece.[24]

Zia et al. showed that headphones were used by 55.97% of their study participants and confirmed that ear infection (P = 0.002) was significantly associated with headphone use.[25]


  Conclusion Top


Increased usage of hearing devices, as well as prolonged time of use, can have detrimental effects on ear-related problems. These possible effects are statistically significantly associated with young age, being female, being a student, using the device for more than 120 min per day, using the device for more than 4 years, or having chronic diseases in the past.

More in-depth multicentric prospective studies with large samples are needed to confirm or dismiss the association or causal effect of hearing devices on the incidence of OM, hearing loss or various ear-related problems to ensure a safe and proper evidence-based exposure.

Ethical approval

The study was approved by Research Ethics Committee Of Armed Forced Hospital Western Region (Approval number: 2021-573).

Acknowledgement

The authors would like to thank Falcon Scientific Editing (https://falconediting. com) for proofreading the English language in this paper.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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