International Journal of Community Medicine and Public Health

Das JJ Int J Community Med Public Health. 2020 Oct;7(10):3924-3930

http://www.ijcmph.com pISSN 2394-6032 | eISSN 2394-6040

DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20204355
Original Research Article

Assessment of knowledge regarding the consequences

of using earphones among higher secondary and
non-medical postgraduate students
Jiban Jyoti Das*

Centre for Pollution Control and Environment Engineering, Pondicherry University, Puducherry, India

Received: 11 July 2020

Revised: 19 August 2020
Accepted: 26 August 2020

*Correspondence:
Jiban Jyoti Das,
E-mail: [email protected]

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Due to the incremental scope of using earphones, in today’s world youngsters are susceptible to loud
sounds or prolong sounds that may cause negative consequences to them in the later run. Aim of the study was to assess
the knowledge regarding the consequences of the use of earphones in terms of basic level and advanced levels of
awareness among some high secondary students and non-medical postgraduate students.
Methods: A structure questionnaire-based study was done by distributing it among the students of Pondicherry central
university, Puducherry, India, and Delhi Public School, Digboi Assam. 18 students from different departments of the
Pondicherry central university and 19 students from the high secondary of Delhi Public School, Digboi were selected
randomly for the study. A structured questionnaire consisting of questions related to the consequences of using
earphones was used as a study tool for observation. Sets of questions related to the awareness were categorized into
basic level, advanced level-1, and advanced level-2.
Results: Knowledge scores for basic level awareness showed very good results. Knowledge scores for advanced level
1 and 2 awareness showed poor results for both the groups.
Conclusions: The study highlights the requirement of developing awareness programs regarding health hazards
associated with the use of earphones in terms of parameters like the feeling of ringing like sounds through the ears, ear
wax, ear stress, ear pain, and tinnitus. Such awareness needs to be incorporated in textbooks of the school level.

Keywords: Tinnitus, Earphones, Volume, Ears, Ear stress

INTRODUCTION

In this modern era of technology, it is common to see According to a large-scale survey and study by Gilliver et
adolescents and young adults exposing themselves to loud al of personal listening device users based on hearing
noise or music through the use of earphones for a long health indicators suggested that several high-risk users
period of time However the risky patterns of exposure if may be experiencing early warning signs of hearing
are not being monitored by themselves to the proper extent damage.3
may lead to noised induced hearing loss in the latter part of
their life.1 Noise-induced hearing loss is caused by long- In another study by Sulaiman et al suggested that excessive
term exposure to sounds that are either too loud or last too exposure to music among personal listening device users
long. This kind of noise exposure can damage the sensory may lead to initial effects on their hearing at very high
hair cells in the ear that allow us to hear.2 frequencies.4

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The scope of using earphones was less a few years ago, development of programs of building awareness regarding
however, nowadays the scope of such use has increased to health hazards associated with the use of earphones beyond
a great extent. Earphones are not only used for listening to the scope of the basic awareness commonly known by the
recreational music, but also to hear audio-books, online students and make them aware of the body indications and
videos, and online educational programs. early symptoms of damage in ears.

According to study by Siddiqua et al. about earphone METHODS

usages among peoples of age 15 and 24, risky patterns of
using earphones everyday were observed.5 Listening The study site was selected using the convenience
through earphones was found to be common for a longer sampling method. Study site included Pondicherry Central
duration of time also during sleep or during the study, University, Puducherry and Delhi Public School, Digboi.
neglecting the fact that prolonged use can result in ear The study was conducted in between March 2018 to June
canal infection and damage hearing. 2018.

According to study by Ansari et al risky patterns of usages A structured questionnaire was used as a study tool for
of earphones and music player devices among Iranian observation. The questionnaire was designed such that it
adolescents were observed.6 The authors suggested enables to know about the duration of use of earphones,
planning educational programs in this domain for occurrence of symptoms in students like pain in the ears,
adolescents, especially in high schools is necessary. It is and awareness related to the consequences of use of
important to make people, especially the adolescents aware earphones. Assessment of awareness among the groups
of its consequences and also make them aware of the early was done by categorizing knowledge and awareness scores
signs of ear damages. in terms of basic level and advanced level. Advanced level
was further categorized into advance level 1 and advance
One such ear damage is called tinnitus which is incurable level 2.
in nature. One of the symptoms of tinnitus includes the
sensation of noise in the ears, such as buzzing or ringing.7 Participants were selected randomly. 18 students from the
A study was done by Chung et al through a web-based Pondicherry Central University and 19 students of standard
survey among 9393 young adults concluded that a majority 11 from Delhi Public School, Digboi participated in the
of the participants have experienced tinnitus and hearing study. Prior consent was obtained from all participants.
impairment after exposure to loud music.8 Inclusion criteria included students having an electronic
device for playing music and using earphones for it.
According to Foy, an osteopathic pediatrician from Students not having an electronic device capable for
Vallejo, California, listening through headphones at a high playing music or not using earphones were excluded from
volume for extended periods of time can result in lifelong the study.
hearing loss for children and teens and advises that people
should not exceed 60% of maximum volume when Statistical analysis was done using WPS office and through
listening through headphones.9 online tools provided by Graphpad software available at
https://www.graphpad.com.
The study principally tries to highlight the key fact that
students of both groups are aware of the basic awareness RESULTS
related to the consequences of earphone usage. But are not
aware of some other consequences of the use of earphones The average time of earphones used in one day was noted.
like the sensation of buzzing or ringing sound in the ears, The average time of daily earphones use was 1.30 hours
reasons for wax build-up in the ears, ear canal wetness due among postgraduate students and 1.70 hours among higher
to prolong earphone use, and tinnitus. These lacks of secondary students (Table 1).
knowledge are making them use earphones
indiscriminately, even after knowing its potential harm. Table 1: Average hours of daily earphones use.

The study also highlights the average duration of daily use Average time in hours
Group
of earphones and points out common symptoms like (approximately)
feeling pain after listening to music among the students. It Non-medical
also makes an important highlight the fact that most of the postgraduate
1.30
students of non-medical post graduate student group as High school 1.70
well as the higher secondary student group use earphone
more than the 50% of the maximum volume level of their The inputs of the students whether they use earphones at
device. This may make them vulnerable to dangerous the level of more than 50% level of the device was noted
levels of noise making them susceptible to noise-induced and studied. The study has been done considering the fact
hair loss in later life if the patterns of the use of earphones that the students who listen more than the 50% volume
are not monitored properly. Through this study authors level of the device may be susceptible to loud sound if used
want to convey the concerned policy makers in the for a prolonged time. 17 students (94.44 %) out of 18

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students of the postgraduate group and 12 out of 19 earphones in more than 50% level mode. Similarly, from
students of the higher secondary group normally use Table 2, it is observed that 100% of the students of the
earphones with more than 50% level of the volume of the higher secondary graduate group are aware of the same,
device. but still, 63.16% of the students use earphone in more than
50% level mode of the device. This particular observation
From the study, it can be observed that more than 50% of highlights the fact that even having the basic knowledge
the students of both groups use earphones at a volume level student may not be making a conscious decision of using
of more than 50% of the device volume level. earphone at a good level of volume of the device.

The percentage of the student using at this level is seen to Study data of students having pain in ear, especially after
be much higher among the postgraduate student group than listening to music highlighted that out of 18 students of the
among the higher secondary student group. postgraduate students 9 (50%) responded positively for
pain in ears especially after listening to music. Only 4
Assessment of basic level awareness among the students (21.1%) students of the higher secondary group responded
of the two groups was done based upon three questions positively of having some pain in ears. The result shows
mentioned in Table 3. Out of 18 students of the non- that the incidence of pain in the ears, especially after
medical postgraduate group, 16 (88.89%) and all the 19 listening music, is seen more among the postgraduate
students of the higher secondary group responded student’s group. The study highlights the fact that the
positively about the awareness that high volume can incidence of pains may gradually be visible with age as
damage the listening capacity of the ears. students are promoted to higher studies (Table 5).

The result shows that almost all the students of both the Assessment of advanced level-1 awareness of the students
group are aware of the basic fact that high volume can among the groups was done based upon the parameters
damage the hearing capacity of ears. Also, all the students mentioned in Table 6. Out of 18 students of the
of both groups responded positively (100%) about postgraduate student’s group, only 5 (27.78%) and out of
awareness that the overuse of earphones can damage the the 19 students of higher secondary students, only 4
hearing capacity of ears. (21.05%) responded positively to the awareness that
prolonged listening to music using earphones may make
About the awareness that listening to music for longer ear canal wet. The result highlights the fact that, more than
duration may lead to stress in ears 15 (83.33%) students of 50 % of both groups are not aware that prolong music may
non-medical postgraduates and 13 (68.42%) students of make ear canals wet.
the higher secondary group responded positively. The
percentages of awareness about ear stress due to prolong About the awareness of ear wax, only 8 (44.44%)
listening to music are more than 50% for both the groups. responded positively among the postgraduate student
groups which also makes it clear that more than 50 % of
Knowledge scores for basic awareness was studied based the students are not being aware of the awareness about ear
upon the mentioned three parameters by giving an equal wax. However, among higher secondary students, 11
weight of 2 points to each parameter and then calculating (57.89%) responded positively and 8 responded (42.11%)
the average knowledge score for each group. It was found negatively about its awareness. The result highlights that
that for both the groups the percentage of knowledge score between the two groups the percentage of the higher
was more than 89% highlighting a strong and very good secondary students are more aware of the knowledge of ear
level of awareness. wax. However, the percentage is not satisfactory and
highlights the fact that awareness is required among both
Knowledge score data of both the groups was statistically the groups.
checked using two sample independent tests assuming
unequal variances for finding any relation between the Based on the response provided for advance level-1
scores of students among both the groups if it exists. awareness, knowledge score was awarded to every student
by giving an equal weight of 2 points to each parameter
The 18 participants of the postgraduate student group mentioned in Table 7 and the average knowledge score
(M=5.67, SD=0.77) compared to the group of 19 corresponding to the two groups were noted. It was found
participants of the higher secondary level (M=5.37, that in both the groups the percentage of knowledge score
SD=0.96) did not demonstrated significantly at t (35) was below 50% reflecting very bad knowledge score.
=1.0512, p=0.3006. Hence we can conclude that there is no
difference regarding knowledge score among the studied Knowledge score data for advanced level-1 awareness of
post graduate and higher secondary level students. both the groups was statistically checked using two sample
independent test assuming unequal variances for finding
From Table 2 it is observed that 88.89% of the students any relation between the scores of students among both the
from the postgraduate group are aware that high volume groups if it exists.
can damage listening capacity of ears, however, from
Table 3 it can be observed that 94.44% of the students use

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The 18 participants of the postgraduate student group weight of 3 points to each parameter. It was found that for
(M=2.17, SD=2.01) compared to the group of 19 both groups the percentage of knowledge score was less
participants of the high secondary level (M=2.37, than 50%.
SD=2.14) did not demonstrated significantly at t
(35)=0.2931, p=0.7712. Hence it can be concluded that Knowledge score data for advanced level-2 awareness of
there is no difference regarding knowledge score of both the groups was statistically checked using two sample
advanced level-1 among the studied post graduate and independent test assuming unequal variances for finding
higher secondary level students. any relation between the scores of students among both the
groups if it exists.
Assessment of advanced level 2 awareness was based upon
two parameters mentioned in Table 8. It was observed that The 18 participants of the postgraduate student group
out of 18 students only 2 (11.11%) from the postgraduate (M=1.33, SD=1.85) compared to the group of 19
group and out of 19 students of the higher secondary group participants of the high secondary level (M=2.68,
only 2 (10.52%) students knew about tinnitus. The study SD=1.70) demonstrated significantly at t (35)=2.3076,
clearly reflects a big knowledge gap of the awareness about p=0.0272. Hence it can be concluded that there is
tinnitus among both the groups. The second parameter that difference regarding knowledge score of advanced level-2
was taken for the study was the knowledge of ringing in among the studied post graduate and higher secondary
the ears as it is considered as a sign of tinnitus or other level students.
underlying ear infection.
As mentioned in table 8 that only 6 students from the
It was observed that out of 18 students of the postgraduate postgraduate group and 15 students of the higher
group only 6 (33.33%) students knew about the term of secondary group were aware of the ringing in the ears.
ringing sound that can be heard in the ears. However, the Among these 6 students of postgraduate group 4 students
case was opposite about the higher secondary group as out and among these15 students of higher secondary group 10
of 19 students 15 (78.95%) knew about the ringing in ears. students themselves felt that they can hear buzzing or
ringing sound through their ears. This highlights the fact
The study highlights that there is a huge difference of the that ringing in the ears could be prevalent among the
percentages of awareness about ringing in ears between the students, but ignored due to lack of awareness of
groups. The higher secondary group highlighted better parameters as mentioned in advanced level-1 and level-2
knowledge about it than that by the postgraduate group. of this study. Awareness about the knowledge of the
perception of ringing in the ears and tinnitus therefore is
Knowledge score of advanced level-2 awareness was something which is required at top most priority from the
studied based upon the two parameters by giving an equal lower age level.

Table 2: Distribution of earphone use at more than 50% device level.

Parameter Group Responses Number of participants (Percentage)

Yes 17 (94.44)
Non-medical post graduate
Earphones use in more than No 1 (5.56)
50% level mode Yes 12 (63.16)
Higher secondary
No 7 (36.84)

Table 3: Details of basic awareness.

Parameters Group Responses Number of participants (Percentage)

Non-medical post Yes 16 (88.89)
Awareness that high volume can graduate No 2 (11.11)
damage listening capacity of ears Yes 19(100)
Higher secondary
No 0 (0)
Non-medical post Yes 18 (100)
Awareness that prolong use of graduate No 0 (0)
earphone can damage the listening
Yes 19 (100)
capacity of ears Higher secondary
No 0 (0)
Non-medical post Yes 15 (83.33)
Awareness that listening to music for graduate No 3 (16.67)
longer duration may lead to stress in
Yes 13 (68.42)
ear Higher secondary
No 6 (31.58)

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International Journal of Community Medicine and Public Health
Das JJ Int J Community Med Public Health. 2020 Oct;7(10):3924-3930
http://www.ijcmph.com pISSN 2394-6032 | eISSN 2394-6040

Table 4: Knowledge scores for basic level of awareness.

Group Total knowledge score Average score per student Percentage (%)
Non-medical post graduate 102 out of 108 5.7 out of 6 94.4
Higher secondary 102 of 114 5.36 out of 6 89.3

Table 5: Distribution of student suffering from pain in ear, especially after listening to music.

Parameters Group Responses Number of participants (Percentage)

Pain in ear specially after Non-medical post graduate Yes 9 (50)
listening to music Higher secondary Yes 4 (21.1)

Table 6: Details of advanced level-1 awareness.

Parameters Group Responses Number of participants (Percentage)

Yes 5 (27.78)
Awareness about prolong Non-medical post graduate
No 13 (72.22)
music can make ear canal wet
Yes 4 (21.05)
Higher secondary
No 15 (78.95)
Yes 8 (44.44)
Non-medical post graduate
No 10 (55.56)
Awareness about the reason of
wax build up in ear Yes 11 (57.89)
Higher secondary
No 8 (42.11)

Table 7: Knowledge scores for advanced level-1 awareness.

Group Total knowledge score Average score per student Percentage (%)
Non-medical post graduate 39 out of 108 2.17 out of 6 36.11
Higher secondary 45 out of 114 2.37 out of 6 39.47

Table 8: Details of advanced level-2 awareness.

Parameters Group Responses Number of participants (Percentage)

Yes 6 (33.33)
Non-medical post graduate
Awareness about ringing No 12 (66.67)
sound heard from ears Yes 15 (78.95)
Higher secondary
No 4 (21.05.)
Yes 2 (11.11)
Non-medical post graduate
No 16 (88.89)
Knowledge of definition of
Yes 2 (10.52)
tinnitus Higher secondary
No 17 (89.48)

Table 9: Knowledge scores for advanced level 2 awareness.

Group Total knowledge score Average score per student Percentage (%)
Non-medical post graduate 24 out of 108 1.33 22.2
Higher secondary 51 out of 114 2.68 44.7

Table 10: Distribution of students feeling ringing sound in the ears.

Parameter Group No. of students

Non-medical post graduate 4 out of 6

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 Das JJ Int J Community Med Public Health. 2020 Oct;7(10):3924-3930

Awareness of ringing of ears together with themselves

thinking that they can hear the ringing sound through Higher secondary 10 out of 15
their ears

DISCUSSION It was also observed that the average hours of use of

earphones by the students of both the group were between
With the growing use of earphones, especially among the 1 to 2 hours, which was similar to the observation of a
students has led to an increased risk of the consequences study done by Siddiqua et al where almost all the
of using earphones, especially when used for a longer individuals used earphones daily for at least 1-2 hours per
duration. Although there has been awareness about the day.
basic consequences of using earphones at high volume and
also its prolonged use, certain facts like ear stress, ear
wetness, ringing in the ears, and tinnitus are something
which students may not be aware of. In this study, these The study was concluded as students from the non-medical
facts have been classified as advanced level awareness post graduate group and the higher secondary group have
while those considered to be commonly known facts have poor knowledge regarding health hazards associated with
been classified as basic awareness. Advanced level was the use of earphones in terms of parameters like the feeling
further categorized into level 1 and level 2. of ringing like sounds through the ears, ear wax, ear stress,
ear pain, and tinnitus.
Although there had been many studies regarding the risky
patterns of using earphones observed in students or the risk CONCLUSION
of having ear infection and hearing loss but no study has
been taken to know whether students are actually aware of Requirement of developing awareness programs regarding
certain terms and causes related to consequences of using health hazards associated with the use of earphones in
earphones as mentioned in this study. terms of parameters like the feeling of ringing like sounds
through the ears, ear wax, ear stress, ear pain, and tinnitus.
This study was conducted primarily to investigate the
knowledge scores of awareness of the consequences of Limitation of the study
using earphones among some of the students of non-
medical postgraduates of Pondicherry University and Further research based on this qualitative study may be
higher secondary students of Delhi Public School, Digboi. conducted in terms of higher number of participants
including demographic and other important parameters.
A study done by Vineetha et al regarding knowledge of the
hazards of earphone use among high school students of ACKNOWLEDGEMENTS
Mangaluru concluded that the students had good
knowledge.10 However, in this study, it is observed that The author would like to sincerely thank Er. S. Sudalai,
students of high school groups and non-medical post Assistant Professor and the head of the department Dr.
graduate group, though have very good knowledge about Basant Kumar Tiwary of Centre for Pollution control and
the basic consequences of using earphones, but they do not Environment Engineering, Pondicherry University, India
have good knowledge and awareness if we go little beyond for the support and providing valuable guidance for
the basic awareness towards parameters of advanced level carrying out the survey based study. The author also likes
1 and 2 of this study. Among the parameters of advanced to acknowledge the contribution of the students of
knowledge, the knowledge of tinnitus was the lowest Pondicherry University and Delhi Public School Digboi,
among both the groups. India for participating and contributing this questionnaire-
based study.
A questionnaire based study conducted among the students
of a Dental college done by Reddy et al. highlighted that Funding: No funding sources
60% of the students can feel ringing in the ears due to Conflict of interest: None declared
exposure of the ears to noise for longer duration.11 Ethical approval: Not required
However, in this study, it was observed that though
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