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ORIGINAL ARTICLE
Department of Otorhinolaryngology,
Universiti Kebangsaan Malaysia Hospital.
The use of headphone has been thought to cause infection in the ear canal and
contribute to hearing loss. In this study, we examined 136 Customer Service
Representative from Celcom (Malaysia) Sdn. Bhd. who use headphone throughout
their working hours. The purpose of this study was to determine the prevalence of
ear canal infection and other related diseases of the ear, nose and throat. Their
hearing thresholds were also determined using the Amplaid 309 Clinical
Audiometer. We found no incidence of infection of the external ear canal amongst
the subjects. There were 4 cases of chronic middle ear infection and 4 cases of
impacted wax. Hearing impairment was found in 25 subjects (21.2%). However,
there was no significant association between hearing loss and the exposure to sound
from headphone usage because the high frequencies were not predominantly
affected. There was also no association between hearing loss and duration of service.
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R. Mazlan, L. Saim, et. al
Table 1: Sex Distribution among the subjects Table III: Disease of the Ear, Nose and Throat
Sex No. of subjects (n) %
Ear findings No. of subjects (n)
Male 40 33.9
Female 78 66.1
Impacted wax 4
Total 118 100.0
Active CSOM 2
Lumpur offices were included in this study from
Chronic Inactive OM 2
August 1999 to September 1999. The age of the
subjects ranged from 18 years to 35 years. Nose findings No. of subjects (n)
5 9
Results
6 4
Demographic Data
7 1
A total of 136 customer service
8 3
representatives were analyzed from Celcom Call
Total 118 Centre. They worked on shift duty with an average
duration of 8 hours per shift with one hour break.
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EAR INFECTION AND HEARING LOSS AMONGST HEADPHONE USERS
Table IV : Number of subjects with normal and Diseases of the Ear, Nose and Throat
impaired hearing
A total of 11 subjects were found to have
Hearing Status No. of subjects (n) %
diseases of ear, nose and throat, as shown in Table
3.
Normal hearing 93 78.8 Four subjects were found have impacted wax.
Another 4 subjects were found to have chronic otitis
Impaired hearing 25 21.2 media. In 2 of them, there were active diseases and
the other 2 were inactive. All of these subjects had
perforated eardrum.
The headphone was used on one ear only that is the
There was one case each of chronic
preferred ear by the subjects, over 7 hours
rhinosinusitis, allergic rhinitis and chronic tonsilitis.
continuously.
Hearing Impairment
Sex Distribution
The total number of subjects with normal and
Table 1 shows the sex distribution of the
impaired hearing is shown in Table 4.
subjects. The majority of subjects were females
There were 93 (78.8%) subjects with normal
(66.1%).
hearing in both ears. Only 25 subjects (21.2%) were
found to have hearing impairment in either one or
Race Distribution
both ears.
The 25 subjects with hearing impairment were
Figure 1 shows the race distribution among
further analyzed. The number of subjects according
the subjects. Majority (91.1%) of them were Malays.
to ears with hearing impairment in low, mid and high
frequencies are shown in Table 5.
Duration of Service
The numbers of subjects with hearing
impairment in the low, mid and high frequencies
The duration of service among the subjects is
were almost equal in the left and right ear.
shown in Table 2. Majority of the subjects (47%)
have been working between 2-3 years with Celcom.
Duration of Service among the Hearing Impaired
The longest duration of service was 8 years in 3
subjects. However, in 18 subjects the duration of
Figure 2 shows the duration of service among
service could not be determined. Therefore, the 18
the hearing impaired subjects. The majority of
subjects were excluded from the research.
Table V : Number of ear (left and right) with hearing impairment according tofrequency
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R. Mazlan, L. Saim, et. al
India
1%
Malay
91%
subjects with hearing impairment were in the early randomly divided into three groups; one wearing
years of service (2-3 years). premould earplugs, the second using foam earplugs
washed after each used, and (2) the third using
Discussion earplugs washed only once per week (1). The study
lasted 8 weeks and included examinations by
Documented instances in which headphones medical officer as well as skin scrapping for bacterial
used by telephonists have been shown to create aural culture and fungal examinations. The results
hygiene problems or are the cause for infections of indicated no fungal infection or clinically significant
the ear canal are rarely described in the literature. bacterial infections and no differences in positive
Nevertheless it is not uncommon for telephonists bacterial cultures across the three groups of users.
and other wearers of hearing protective devices to In another study, Cooper reported a study on 587
express concern regarding the potential for the employees at five mid-western (United State of
headphones to cause ear infection. America) industrial facilities using otoscopy. The
Our study did not show any evidence of subjects were divided into premould earplug users,
infection of the external ear canal amongst the 118 foam earplugs users and those who did not wear any
customer service representatives examined by the device. The prevalence of external ear canal
ENT Surgeons. Observable signs of infection that infections was less than 0.5% across all groups, with
were looked for in the ear canal include swelling no statistically significant differences among the
and reddening of the ear canal, discharge and foul groups. Cooper also reported data on the presence
odour of the ear canal. Symptoms included itching, of cerumen. The prevalence of partial cerumen
pain and tenderness upon manipulation of the pinna blockage was 5.0% and total cerumen blockage was
and a feeling of fullness in the ear. None of the 5.1% (3).
subjects had any of the above signs and symptoms. Wearing headphones or earplugs has been
However amongst these subjects, 4 were noted to suggested as a possible predisposing factor for
have impacted wax. Since this is a cross-sectional external ear canal infection since their use can
study with no control group, it is not possible to increase the temperature and humidity of the canal,
attribute the occurrence of impacted wax due to the create the potential for skin abrasion and provide a
use of headphones. This low percentage may vehicle for the introduction of organisms into the
represent the prevalence of impacted wax in normal canal skin (4). However, as discussed above, our
population. Reports of external ear infection or study does not substantiate concern regarding the
impacted wax resulting directly from wearing potential for headphones to increase the likelihood
headphones are exceedingly rare. Forshaw and of developing an external ear infection.
Cruchley reported on a study of 60 long range patrol- We found 4 cases of chronic middle ear
aircraft crew members wearing earplugs, who were infection with perforation of the tympanic
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EAR INFECTION AND HEARING LOSS AMONGST HEADPHONE USERS
0
1 2 3 4 5 6 7 8
Duration of service (years)
membranes. There were 2 active disease and 2 one or both eras were further analyzed to determine
inactive diseases. These were incidental findings. It if the hearing impairment was due to noise exposure
was most unlikely that the headphone is the cause from prolonged use of the earphone. As one knows,
of the middle ear infection without any external ear noise induced hearing loss affects the 4 kHz
canal infection. However, in the 2 subjects with frequency first before further affecting the other
active chronic middle ear infection, they claimed frequencies (7). This study did not show higher
that prolonged use of the headphone on the affected incidence of hearing impairment in the 4 kHz or
ear may cause itchiness and increased discharge other frequencies. In fact the number of subjects with
from the ear. This was expected since it has been hearing impairment in the low, mid and high
our experience that the use of ear mould for hearing frequencies were almost equal. Therefore, it was
aids in-patients with chronic middle ear infection most unlikely that the use of headphone for a period
would cause such complications. This finding has of 8 hours per shift by these customer service
also been reported in other studies (5). representatives would have any effect on the hearing.
There was also concern amongst these users This was further strengthened by our findings when
of headphones that prolonged use of the device may comparing the association between hearing loss and
cause hearing loss. In this study, we examined the duration of service. The majority of the subjects with
incidence of hearing impairment in the left and right hearing impairment were in fact in the early years
ear separately by performing pure tone audiometry. (2-3 years). Thus, the longer the service and therefore
A strict criteria for hearing impairment is used. more prolonged usage of the headphone does not
Hearing impairment was defined as having hearing predispose one to hearing impairment. This finding
threshold of more than 20 dB HL in at least one was expected since the sounds from these
tested frequency. Twenty-five subjects (21.2%) were headphones are of low intensity. The average
found to have hearing impairment in either one or measurement of sound intensity from the headphone
both ears. This prevalence was comparable to the was found to be 58 dB HL. It was generally below
prevalence of hearing loss in normal subjects used 85 dB Hl, which was the threshold above which
as controls in other studies (6). prolonged exposure of 8 hours or more which may
The 25 subjects with hearing impairment in caused a permanent hearing loss.
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R. Mazlan, L. Saim, et. al
Conclusion Correspondence:
We would like to thank Puan Puteri Suraya 7. Noise and Hearing Loss. NIH Consensus Statement
Jan 22-24, 1990 ; 8(1):1-24.
Binti Megat Harun and Encik Nuri of Celcom
(Malaysia) Sdn. Bhd. for their fullest cooperation
in conducting this study.
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