Several organizations have developed initiatives to promote safe listening habits. The National Institute on Deafness and Other Communication Disorders (NIDCD) has guidelines aimed at the pre-adolescent population (9–13 years) for safely listening to personal music players.[22]​ The Dangerous Decibels program promotes the use of mannequins to measure the production of PASPs as an educational tool to raise awareness about overexposure to sound through personal listening.[23]​ This type of mannequin is simple and inexpensive. to build and is often a demand for attention in schools, health talks, waiting rooms in clinics, etc.

The National Acoustic Laboratories (NAL), a division of Hearing Australia, developed Know Your Noise, funded by the Australian Government Department of Health.[24]​ The Know your Noise website has a Noise Risk Calculator that easily identifies and understands noise exposure levels (at work and play), and potential hearing risks. Users can also perform online pre-audiometry to see how well they hear in background noise. The WHO launched the Make Listening Safe initiative as part of the celebration of World Hearing Day on March 3, 2015.[25]​[19]​ The main goal of the initiative is to ensure that people of all ages can enjoy listening to music and other audio media in a way that does not create a risk to hearing. Noise-induced loss, hyperacusis, tinnitus and tinnitus, have been associated with the frequent use at high volume of devices such as headphones and certain technologies called True Wireless Stereo.[18]​[20]​[26]​[27]​.

The goals of Make Listening Safe are:

In 2019 the World Health Organization published a toolkit for safe listening devices and systems that provides guidance on proposed strategies, identifying actions that governments, industry and civil society can justify.[29]​.

One of the approaches taken by Make Listening Safe is to promote the development of features in personal sound amplification products (PASPs), to increase user awareness of risky listening practices. In this context, WHO partnered with the International Telecommunication Union (ITU) to develop appropriate exposure limits included in the voluntary safety standards H.870 on "Guidelines for safe listening systems/devices."[30] Experts in the fields of audiology, otology, public health, epidemiology, acoustics, and sound engineering, as well as professional organizations, standardization organizations, manufacturers, and users are collaborating in this effort. common.[31]​.

The Make Listening Safe initiative also covers entertainment venues. Average sound pressure levels (NPS) in nightclubs, discotheques, bars, gyms and sports venues with live audiences can reach 112 dBA (weighted); Sound levels at pop concerts can be even higher.[32]​[33]​[34]​[35]​[36]​[37]​[38]​ Frequent exposure or brief exposure to very high sound pressure levels like these can be harmful. The WHO reviewed existing noise regulations for several entertainment venues, including clubs, bars, concert halls and sports stadiums, as a first step in developing a regulatory framework that would ensure safe listening in such spaces.[25]​ It published a global standard for safe listening venues and events as part of World Hearing Day 2022. Also released in 2022 were an mSafeListening manual, on how to create an mHealth safe listening program and a toolkit of media for journalists that contains key information and how to talk about safe listening.

In Spain, the Federation of Associations of Cochlear Implants of Spain (AICE) carries out a project called “Soundless Laboratory” with a virtual proposal accessible to communication that teaches educational content on Hearing Health through a web space and carries out a pre-audiometric test at the end of the session that allows us to know in a simple way the hearing capacity of the students and recommends going to professionals if the results are not favorable. The project is part of the WHO Make Listening Safe initiative.

Personal Listening Systems (PES)

Personal listening systems are portable devices – usually an electronic player attached to headphones or earphones – which are designed to listen to various media, such as music or video games. The sound output of such systems varies widely. Maximum output levels vary depending on individual devices and regional regulatory requirements.[39]​ Typically, SPE users can choose to limit the volume between 75 and 105 dB NPS.[18]​ The ITU and WHO recommend that PLS be programmed with a function to monitor a weekly sound exposure limit and provide alerts when users consume their weekly sound time. If users recognize the alert, they can choose whether to reduce the volume or not. But if the user does not acknowledge the alert, the device will automatically reduce the volume to a predetermined level (based on the selected mode, for example 80 or 75 dBA). By conveying information about the exhibition in a way that end users can easily understand, this recommendation aims to make it easier for listeners to manage their exhibitions and avoid any negative effects. The health app on iPhones, Apple watches, and iPads has already incorporated these recommendations since 2019.[40] These feature the added option of the Apple Hearing Study, part of the Search app that is being conducted in collaboration with the University of Michigan School of Public Health. The data is being shared with the WHO safe listening initiative. Preliminary results released in March 2021, after one year of study, indicated that 25% of participants experienced ringing in their ears a few times a week or more, 20% of participants had hearing loss, and 10% have typical features of cases of noise hearing loss.[41] Nearly 50% of participants reported that they had not had their hearing checked in the past 10 years. While 25% of the participants experienced high exposures to environmental sounds.

The International Technical Commission (ITC) published the first European standard IEC 62368–1 on personal audio systems in 2010.[42]​ It defines safe output levels for PLSs at 85 dB or less, while allowing users to increase the volume to a maximum of 100 dBA. Even so, when users raise the volume to the maximum level, the standard specifies that an alert would be output to warn the listener of the potential hearing problem.[31]​.

The 2018 ITU and WHO standard H.870 "Guidelines for safe listening systems/devices" for sound administration devices focuses on weekly exposure doses.[30] This standard was based on the EN 50332-3 standard "Sound system equipment: headphones and earphones associated with personal music players – maximum sound pressure level measurement methodology – Part 3: measurement method for sound dose administration." This standard defines a safe listening limit at a weekly sound dose equivalent to 80 dBA for 40 hours/week.

The frequent use of EPS among children has raised concerns about the potential risks that could be associated with such exposure.[43] There is no agreement on the acceptable risk of hearing loss in children; and adult risk of harm criteria are not appropriate for establishing safe listening levels for children due to differences in physiology and the impact of the more serious development of early hearing loss.[44]​[45]​.

An attempt to identify safe levels assumed that the most appropriate exposure limit for recreational noise exposure in children would aim to protect 99% of children from a change in hearing greater than 5 dB at 4 kHz after 18 years of noise exposure.[44] Using estimates from the International Organization for Standardization (ISO 1999:2013), the authors estimated that 99% of children who are exposed from birth to age 18 8-h median sound levels (LEX) of 82 dBA would have hearing thresholds up to 4.2 dB higher, indicating a change in hearing ability.[46] These authors recommend, to preserve hearing from birth until the age of 18 years, noise exposures limited to 75 dBA over a 24-hour period. Other researchers recommend that the weekly sound dose be limited to the equivalent of 75 dBA for 40 hours/week for children and users who are sensitive to intense sound stimulation.[31]​.

Personal Sound Amplification Products (PASPs)

Personal sound amplification products are sound amplification devices for use by people with normal hearing. The output levels of 27 commercially available PASPs in Europe were analyzed in 2014. All of them had a peak output exceeding 120 dB SPL; 23 (85%) exceeded 125 dB SPL, while 8 (30%) exceeded 130 dB SPL. None of the products analyzed had a volume limiting option.[47]​.

The report prompted the development of a few standards for these devices. The ANSI/CTA standard 2051 on "Performance Criteria for Personal Sound Amplification" was approved in 2017.[48] This specified a maximum production sound pressure of 120 dB at SPL. In 2019, the ITU published the ITU-T H.871 standard titled "Safe Listening Guidelines for Personal Sound Amplifiers."[49]​ This standard recommends that PASPs measure weekly sound dose and comply with a maximum of less than 80 dBA for 40 hours over 7 days. PSAP devices that cannot measure weekly sound dose would have to limit maximum output to 95 dBA by default. It also recommends that PSAPs provide clear alerts in their user guides, packaging, and that advertising should mention the risks of hearing damage that can be triggered when using the device, providing information to avoid these risks.[31]​.

Entertainment venues

In 2019, the WHO published a report summarizing regulations for the control of sound exposure in entertainment venues in Belgium, France, and Switzerland.[50] This case-by-case study was published as an initial step towards the development of a WHO regulatory framework for the control of sound exposure in entertainment venues. In 2020, a couple of reports described exposure scenarios and procedures in use during entertainment events. The safety of the public attending the events was taken into account, as well as those exposed to high-intensity music at work and the sound influence exerted on the surrounding neighborhoods.[51]​[52]​ Technical solutions, forms of sound monitoring on stage, as well as indicators of the problems of applying environmental noise controls in an urban environment were presented, with specific examples from each country.

Several different regulatory approaches have been implemented to address sound levels and minimize the risk of causing hearing damage for music venue workers.[53]​ A report published in 2020 identified 18 controls that consider sound levels in entertainment venues – 12 from Europe and the remainder from cities or states in North and South America. Legislative approaches include: sound level limitations, real-time sound exposure monitoring, mandatory provision of hearing protection devices, signage and warning requirements, loudspeaker placement restrictions, and ensuring that users can access quiet zones or rest areas. The effectiveness of these measures in reducing the risk of hearing damage has not been evaluated, but the adaptation of the measures described above are compatible with the hierarchy of controls used to direct noise exposure in the workplace.[54][55]​.

Users of music venues have indicated a preference for lower sound levels and may be receptive when earplugs are provided or accessible.[56][57][58][59][60][61] This finding may be region or country dependent. In 2018, the US Centers for Disease Control and Prevention released the results of a survey of adults regarding the use of a hearing protection device during exposure to loud sounds at recreational events.[62] Overall, four in five reported that they never or rarely wear hearing protection devices when attending loud sporting or entertainment events. Adults ages 35 and older are significantly more likely to not use hearing protection than young adults ages 18 to 24. Among adults who frequently enjoy sporting events, women were twice as likely as men to never or rarely use hearing protection. College education or having higher income influences adults, who were more likely to wear hearing protection. People with hearing impairments or deaf family members were significantly more likely to use their protective devices.

The challenges in implementing measures to reduce hearing risks in leisure venues are significant, whether through mandatory or voluntary guidelines, with or without sanctions. It requires work from many different professional groups and involvement of both venue managers and users.[54]​[63]​.

While establishing effective public and community health interventions, enacting appropriate laws and regulations, and developing relevant standards for listening and audio systems are all important to establishing a social infrastructure for safe listening; Individuals can take steps to ensure that their personal listening habits minimize their risk of hearing problems.[8]​ Personal safe listening strategies include:[64]​.

We must teach children and young adults about the dangers of overexposure to loud sounds and how good safe listening habits will protect their hearing.

Good modeling of listening habits would encourage young people to improve their hearing health. As part of their health promotion activities, hearing professionals should recommend appropriate protection (e.g. noise-canceling helmets) when necessary and provide information, training and fit testing to ensure that people are adequately protected.[64]​.

Several organizations have developed initiatives to promote safe listening habits. The National Institute on Deafness and Other Communication Disorders (NIDCD) has guidelines aimed at the pre-adolescent population (9–13 years) for safely listening to personal music players.[22]​ The Dangerous Decibels program promotes the use of mannequins to measure the production of PASPs as an educational tool to raise awareness about overexposure to sound through personal listening.[23]​ This type of mannequin is simple and inexpensive. to build and is often a demand for attention in schools, health talks, waiting rooms in clinics, etc.

The National Acoustic Laboratories (NAL), a division of Hearing Australia, developed Know Your Noise, funded by the Australian Government Department of Health.[24]​ The Know your Noise website has a Noise Risk Calculator that easily identifies and understands noise exposure levels (at work and play), and potential hearing risks. Users can also perform online pre-audiometry to see how well they hear in background noise. The WHO launched the Make Listening Safe initiative as part of the celebration of World Hearing Day on March 3, 2015.[25]​[19]​ The main goal of the initiative is to ensure that people of all ages can enjoy listening to music and other audio media in a way that does not create a risk to hearing. Noise-induced loss, hyperacusis, tinnitus and tinnitus, have been associated with the frequent use at high volume of devices such as headphones and certain technologies called True Wireless Stereo.[18]​[20]​[26]​[27]​.

The goals of Make Listening Safe are:

In 2019 the World Health Organization published a toolkit for safe listening devices and systems that provides guidance on proposed strategies, identifying actions that governments, industry and civil society can justify.[29]​.

One of the approaches taken by Make Listening Safe is to promote the development of features in personal sound amplification products (PASPs), to increase user awareness of risky listening practices. In this context, WHO partnered with the International Telecommunication Union (ITU) to develop appropriate exposure limits included in the voluntary safety standards H.870 on "Guidelines for safe listening systems/devices."[30] Experts in the fields of audiology, otology, public health, epidemiology, acoustics, and sound engineering, as well as professional organizations, standardization organizations, manufacturers, and users are collaborating in this effort. common.[31]​.

The Make Listening Safe initiative also covers entertainment venues. Average sound pressure levels (NPS) in nightclubs, discotheques, bars, gyms and sports venues with live audiences can reach 112 dBA (weighted); Sound levels at pop concerts can be even higher.[32]​[33]​[34]​[35]​[36]​[37]​[38]​ Frequent exposure or brief exposure to very high sound pressure levels like these can be harmful. The WHO reviewed existing noise regulations for several entertainment venues, including clubs, bars, concert halls and sports stadiums, as a first step in developing a regulatory framework that would ensure safe listening in such spaces.[25]​ It published a global standard for safe listening venues and events as part of World Hearing Day 2022. Also released in 2022 were an mSafeListening manual, on how to create an mHealth safe listening program and a toolkit of media for journalists that contains key information and how to talk about safe listening.

In Spain, the Federation of Associations of Cochlear Implants of Spain (AICE) carries out a project called “Soundless Laboratory” with a virtual proposal accessible to communication that teaches educational content on Hearing Health through a web space and carries out a pre-audiometric test at the end of the session that allows us to know in a simple way the hearing capacity of the students and recommends going to professionals if the results are not favorable. The project is part of the WHO Make Listening Safe initiative.

Personal Listening Systems (PES)

Personal listening systems are portable devices – usually an electronic player attached to headphones or earphones – which are designed to listen to various media, such as music or video games. The sound output of such systems varies widely. Maximum output levels vary depending on individual devices and regional regulatory requirements.[39]​ Typically, SPE users can choose to limit the volume between 75 and 105 dB NPS.[18]​ The ITU and WHO recommend that PLS be programmed with a function to monitor a weekly sound exposure limit and provide alerts when users consume their weekly sound time. If users recognize the alert, they can choose whether to reduce the volume or not. But if the user does not acknowledge the alert, the device will automatically reduce the volume to a predetermined level (based on the selected mode, for example 80 or 75 dBA). By conveying information about the exhibition in a way that end users can easily understand, this recommendation aims to make it easier for listeners to manage their exhibitions and avoid any negative effects. The health app on iPhones, Apple watches, and iPads has already incorporated these recommendations since 2019.[40] These feature the added option of the Apple Hearing Study, part of the Search app that is being conducted in collaboration with the University of Michigan School of Public Health. The data is being shared with the WHO safe listening initiative. Preliminary results released in March 2021, after one year of study, indicated that 25% of participants experienced ringing in their ears a few times a week or more, 20% of participants had hearing loss, and 10% have typical features of cases of noise hearing loss.[41] Nearly 50% of participants reported that they had not had their hearing checked in the past 10 years. While 25% of the participants experienced high exposures to environmental sounds.

The International Technical Commission (ITC) published the first European standard IEC 62368–1 on personal audio systems in 2010.[42]​ It defines safe output levels for PLSs at 85 dB or less, while allowing users to increase the volume to a maximum of 100 dBA. Even so, when users raise the volume to the maximum level, the standard specifies that an alert would be output to warn the listener of the potential hearing problem.[31]​.

The 2018 ITU and WHO standard H.870 "Guidelines for safe listening systems/devices" for sound administration devices focuses on weekly exposure doses.[30] This standard was based on the EN 50332-3 standard "Sound system equipment: headphones and earphones associated with personal music players – maximum sound pressure level measurement methodology – Part 3: measurement method for sound dose administration." This standard defines a safe listening limit at a weekly sound dose equivalent to 80 dBA for 40 hours/week.

The frequent use of EPS among children has raised concerns about the potential risks that could be associated with such exposure.[43] There is no agreement on the acceptable risk of hearing loss in children; and adult risk of harm criteria are not appropriate for establishing safe listening levels for children due to differences in physiology and the impact of the more serious development of early hearing loss.[44]​[45]​.

An attempt to identify safe levels assumed that the most appropriate exposure limit for recreational noise exposure in children would aim to protect 99% of children from a change in hearing greater than 5 dB at 4 kHz after 18 years of noise exposure.[44] Using estimates from the International Organization for Standardization (ISO 1999:2013), the authors estimated that 99% of children who are exposed from birth to age 18 8-h median sound levels (LEX) of 82 dBA would have hearing thresholds up to 4.2 dB higher, indicating a change in hearing ability.[46] These authors recommend, to preserve hearing from birth until the age of 18 years, noise exposures limited to 75 dBA over a 24-hour period. Other researchers recommend that the weekly sound dose be limited to the equivalent of 75 dBA for 40 hours/week for children and users who are sensitive to intense sound stimulation.[31]​.

Personal Sound Amplification Products (PASPs)

Personal sound amplification products are sound amplification devices for use by people with normal hearing. The output levels of 27 commercially available PASPs in Europe were analyzed in 2014. All of them had a peak output exceeding 120 dB SPL; 23 (85%) exceeded 125 dB SPL, while 8 (30%) exceeded 130 dB SPL. None of the products analyzed had a volume limiting option.[47]​.

The report prompted the development of a few standards for these devices. The ANSI/CTA standard 2051 on "Performance Criteria for Personal Sound Amplification" was approved in 2017.[48] This specified a maximum production sound pressure of 120 dB at SPL. In 2019, the ITU published the ITU-T H.871 standard titled "Safe Listening Guidelines for Personal Sound Amplifiers."[49]​ This standard recommends that PASPs measure weekly sound dose and comply with a maximum of less than 80 dBA for 40 hours over 7 days. PSAP devices that cannot measure weekly sound dose would have to limit maximum output to 95 dBA by default. It also recommends that PSAPs provide clear alerts in their user guides, packaging, and that advertising should mention the risks of hearing damage that can be triggered when using the device, providing information to avoid these risks.[31]​.

Entertainment venues

In 2019, the WHO published a report summarizing regulations for the control of sound exposure in entertainment venues in Belgium, France, and Switzerland.[50] This case-by-case study was published as an initial step towards the development of a WHO regulatory framework for the control of sound exposure in entertainment venues. In 2020, a couple of reports described exposure scenarios and procedures in use during entertainment events. The safety of the public attending the events was taken into account, as well as those exposed to high-intensity music at work and the sound influence exerted on the surrounding neighborhoods.[51]​[52]​ Technical solutions, forms of sound monitoring on stage, as well as indicators of the problems of applying environmental noise controls in an urban environment were presented, with specific examples from each country.

Several different regulatory approaches have been implemented to address sound levels and minimize the risk of causing hearing damage for music venue workers.[53]​ A report published in 2020 identified 18 controls that consider sound levels in entertainment venues – 12 from Europe and the remainder from cities or states in North and South America. Legislative approaches include: sound level limitations, real-time sound exposure monitoring, mandatory provision of hearing protection devices, signage and warning requirements, loudspeaker placement restrictions, and ensuring that users can access quiet zones or rest areas. The effectiveness of these measures in reducing the risk of hearing damage has not been evaluated, but the adaptation of the measures described above are compatible with the hierarchy of controls used to direct noise exposure in the workplace.[54][55]​.

Users of music venues have indicated a preference for lower sound levels and may be receptive when earplugs are provided or accessible.[56][57][58][59][60][61] This finding may be region or country dependent. In 2018, the US Centers for Disease Control and Prevention released the results of a survey of adults regarding the use of a hearing protection device during exposure to loud sounds at recreational events.[62] Overall, four in five reported that they never or rarely wear hearing protection devices when attending loud sporting or entertainment events. Adults ages 35 and older are significantly more likely to not use hearing protection than young adults ages 18 to 24. Among adults who frequently enjoy sporting events, women were twice as likely as men to never or rarely use hearing protection. College education or having higher income influences adults, who were more likely to wear hearing protection. People with hearing impairments or deaf family members were significantly more likely to use their protective devices.

The challenges in implementing measures to reduce hearing risks in leisure venues are significant, whether through mandatory or voluntary guidelines, with or without sanctions. It requires work from many different professional groups and involvement of both venue managers and users.[54]​[63]​.

While establishing effective public and community health interventions, enacting appropriate laws and regulations, and developing relevant standards for listening and audio systems are all important to establishing a social infrastructure for safe listening; Individuals can take steps to ensure that their personal listening habits minimize their risk of hearing problems.[8]​ Personal safe listening strategies include:[64]​.

We must teach children and young adults about the dangers of overexposure to loud sounds and how good safe listening habits will protect their hearing.

Good modeling of listening habits would encourage young people to improve their hearing health. As part of their health promotion activities, hearing professionals should recommend appropriate protection (e.g. noise-canceling helmets) when necessary and provide information, training and fit testing to ensure that people are adequately protected.[64]​.