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 Table of Contents  
Year : 2020  |  Volume : 29  |  Issue : 3  |  Page : 407-414

Awareness of noise-induced hearing loss among residents in a metropolitan city in South-south Nigeria

1 Department of Otorhinolaryngology, University of Calabar, Calabar, Nigeria
2 Department of Public Health, University of Calabar, Calabar, Nigeria
3 Department of Special Education, University of Calabar, Calabar, Nigeria

Date of Submission27-Apr-2020
Date of Decision17-May-2020
Date of Acceptance13-Jun-2020
Date of Web Publication18-Sep-2020

Correspondence Address:
Dr. Abiola Grace Adekanye
Department of Otorhinolaryngology, University of Calabar, Calabar
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/NJM.NJM_40_20

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Background: Exposure to loud noise and its attendant health and social effects is a public health problem. Its significance has not been adequately determined in developing countries. Noise-induced hearing loss is permanent and can be acquired at home, schools, concerts, churches, mosques, sporting events, and at workplaces. The objective of this study is to assess respondents' awareness of noise-induced hearing loss, experiential symptoms and sources of noise pollution in a Metropolitan City in South-South, Nigeria. Methods: A cross-sectional descriptive study using interviewee questionnaire was employed. The respondents comprising of secondary school pupils, undergraduates, tricycle riders, and staff of the tertiary institution who participated at awareness campaign programs on World Hearing Day, World Family Day, and at a religious crusade ground in a tertiary institutions. Data were analyzed using IBM statistical product and service solution version 26.0. Results: There were 274 respondents, age range from 10 to 74 years, 73.7% (n = 202) were male and 26.3% (n = 72) female, male:female = 2.8:1. The overall level of noise-induced hearing loss (NIHL) awareness was 69.34% (n = 190). The greater proportion of respondents 236 (86.13%) knew that excessive noise could cause hearing loss. The common symptoms experienced by the respondents were 147 (53.6%) hyperacusis and tinnitus 142 (51.8%). Conclusion/Recommendation: Awareness it NIHL was greater among male, undergraduates between the ages of 20 and 29 years. Children's toys were poorly reported as a source of noise. There was poor awareness of the incurable nature of NIHL. A continuous public health education on sources and prevention of NIHL is advocated for early evaluation and intervention.

Keywords: Awareness, hearing loss, noise-induced, sources, symptoms

How to cite this article:
Adekanye AG, Nja GM, Ojo MO, Mgbe RB, Offiong ME, Umana AN. Awareness of noise-induced hearing loss among residents in a metropolitan city in South-south Nigeria. Niger J Med 2020;29:407-14

How to cite this URL:
Adekanye AG, Nja GM, Ojo MO, Mgbe RB, Offiong ME, Umana AN. Awareness of noise-induced hearing loss among residents in a metropolitan city in South-south Nigeria. Niger J Med [serial online] 2020 [cited 2020 Oct 24];29:407-14. Available from: http://www.njmonline.org/text.asp?2020/29/3/407/295295

  Introduction Top

Hearing loss is a common chronic medical condition that can affect the quality of life and the ability to function in all ages. It is reported to be the third most common chronic physical condition in the United States and twice as prevalent as diabetes or cancer.[1] Noise-induced hearing loss (NIHL) is a permanent sensorineural hearing loss (SNHL). It results from prolonged exposure to loud noise or short-time exposure to extremely loud sounds such as gunshots or explosions. NIHL is often said to be an occupational disease among copper workers, blacksmiths, shipbuilders, miners, wood product manufacturers, construction builders, real estate and rental leasers.[2] However, it can result from nonoccupational exposure to noise in places such as recreational centers, playing in a band; attending loud concerts or by listening to MP3 players at high volume through ear buds or headphones. Lawnmowers, leaf blowers and woodworking tools have also being implicated.[3] In the United States, the prevalence of NIHL among noise-exposed workers, is 23% and 7% in those not exposed to noise at the workplaces.[2] Hearing loss is more prevalent among men than women probably due to increase number of men that work in a noisy environment.[2]

Twelve percent or more of the global population is at risk for hearing loss from noise.[3] The World Health Organization (WHO) estimated that one-third of all the cases of hearing loss was attributed to NIHL.[4] It is the most common modifiable environmental cause of SNHL among young- and middle-aged adults and most common self-reported cause of hearing among men.[5] The WHO estimated in 2015 that 1.1 billion young people are at risk for hearing loss caused by unsafe listening practices.[6] The prevalence of hearing loss among teenagers (12–19 year) between 1994 and 2006, rose from 3.5% to 5.3% based on the analysis of data from National Health and Nutrition Examination Survey in the United States.[7] The individuals listening to music through headphones and earphones increased by 75% between 1990 and 2005, according to another study done in the USA.[8] The European Commission reported in 2008 an increasing proportion of the population using personal audio devices; from 2004 to 2007, unit sales within the European Union were estimated to have been between 184 and 246 million.[9]

The negative consequences of NIHL among all age groups can be socially and psychologically devastating, leading to decreased self-esteem, anxiety, depressions, shame, annoyance, tinnitus, hyperacusis, and loneliness,[10],[11],[12] with attendant social isolation, with subsequent deterioration of quality of life.[13],[14],[15],[16] Apart from interpersonal and social loss, hearing loss can also lead to an inability to enjoy nature such as birds chirping and water which have a positive effect on an individual's ability to recover after being stressed or increase cognitive focus.[17],[18] Worldwide, studies have been conducted on awareness of NIHL, but results vary from one country to another.[19] The study done in Limpopo province, South Africa by Joubert et al. reported 89% of participants' awareness about NHIL[16],[20] Chung et al. conducted studies on awareness of hearing loss using a web-based survey and 8% of participants considered hearing loss to be a big problem.[21] They conducted another study 5 years later and the percentage of participants who viewed hearing loss as a big problem increase to 30%. They concluded that education on hearing loss could lead to increased opportunities for protecting the hearing of adults.[22]

In recent times, with the advent of smartphones in developed countries, many people make use of earbuds and headphones to receive phone calls and listen to music at high volume for long hours. Many people also get exposed to loud noise in music concerts, night club and worship centers such as churches and mosques. Sound levels differ from one source to another; 120 dB–dB have been reported in rock concerts[23] and average noise levels >100 dB in nightclubs and pop concerts.[24] While there are laws that regulate noise exposure at workplaces, these regulations and guidelines are either lacking or not enforced in nonoccupational conditions.[19]

There is a paucity of data on awareness of NIHL in our region. Our study aimed to evaluate the respondent' awareness of NIHL, sources of noise, and symptoms-related noise exposure. Therefore, data generated from this study will serve as a baseline for community awareness on NIHL and public health education on the dangers associated with it.

  Methods Top

The study was conducted in Calabar, the capital of Cross River state in South-South, Nigeria. It is a large metropolis with several towns, with a population of 317,022 as of 2006 census. Administratively the city is divided into Calabar municipality and Calabar South Local Government Area.

This study was a cross-sectional descriptive study using interviewee questionnaire. The respondents were recruited at three different awareness programs in a metropolitan city. The consented respondents' include secondary school pupils, undergraduates, and staff of teaching hospital that were invited to awareness program at University teaching hospital conference hall for World Hearing Day, tricycle riders that attended awareness rally during World Family Week at a district in urban city and congregations at a crusade ground in a tertiary institution. The total of 400 interviewee questionnaires was distributed. Three hundred and sixteen consenting participants' returned their questionnaire but only 274 correctly completed the questionnaire and hence they were included in this study. Interviewee questionnaire was developed to assess respondents' demographic data, lifestyle or social history, awareness of NIHL, knowledge of sources of unsafe noise, experiential symptoms of NIHL and risk factors for NIHL. Quantitative data were analyzed using IBM statistical product and service solution version 26, Chi-square at 5% significance level was used to test for association between respondents' demographic data and level of awareness on NIHL, its sources and experiential symptoms.

  Results Top

A total of 316 copies of the interviewee questionnaire out of 400 were recalled from participants during awareness programs in a Metropolitan city, but only 274 copies were correctly completed and therefore included in this study, giving a response rate of 86.7%.

The greater proportion of respondents 223 (81.38%) were single; majority, 202 (73.7%) were male, while 72 (26.3%) were female (male:female = 2.8:1). Most, 190 (69.34%) were aged between 20 and 29 years [Table 1].
Table 1: The association between respondents' sociodemographic data and awareness of noise-induced hearing loss

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The respondents were of varying educational background; 226 (82.5%) had tertiary, 35 (12.8%) secondary, and 13 (4.7%) primary education [Table 2].
Table 2: Association between education, occupation, and awareness of noise-induced hearing loss

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The overall level of NIHL awareness was 69.34% (n = 190) based on the answer to the question on sources of noise, nature of noise, and experiential symptoms of the respondents. A total of 236 (86.13%) were aware that repeated and prolonged exposure to noise could cause hearing loss; 238 (86.86%) reported that individuals across all age brackets could be affected by NIHL. Whereas 223 (81.39%) respondents were aware that NIHL is preventable, only 175 (63.87%) were aware that noise exposure could lead to permanent hearing loss [Appendix 1]. Data analysis showed that undergraduate students; 143 (75.26%) among all of the respondents, had good level of awareness on NIHL.

The most common sources of noise pollution as reported by the respondents were generator 234 (85.4%), music 231 (84.3%), and music concerts 210 (76.6%). Furthermore, 144 (52.55%) and 162 (59.12%) identified sport events and fitness activity respectively as sources of noise pollution. Only 95 (34.7%) respondents identified children toys as source of noise pollution. [Table 3] and [Table 4], [Figure 1], and [Appendix 2] show data on sources of noise pollution.
Table 3: Awareness of sources of noise pollution

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Table 4: Association between age and awareness of sources of noise pollution

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Figure 1: Awareness of sources of noise pollution

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Of the respondents, 172 (62.8%) experienced muffled familiar sound, 186 (67.9%) had difficulty understanding sound in noisy environments, 178 (64.9%) ask others to speak out and 181 (66.1%) turned up the volume of radio or television, 142 (51.8%) and 147 (53.6%) experienced tinnitus and hyperacusis respectively. [Figure 2] and [Appendix 3] illustrate experiential symptoms of NIH.
Figure 2: Frequency of the experiential symptoms of noise-induced hearing loss

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  Discussion Top

Our survey revealed that about 80% of respondents were aware that repeated and prolonged exposure to loud noise could cause hearing loss. This study corroborates the work done by DelGiacco and Serpanos who reported that 96% of their respondents knew that repeated and prolonged exposure to loud noise could result in irreversible hearing loss.[25] Alzahrani et al.[26] and Crandell et al.[27] in their studies reported that 85% and 19% of respondents knew that there is no cure for NIHL, respectively; however, in our study, 63.87% acknowledged that NIHL could be permanent.

The greater proportion; 139 (73.16%) of our respondents were male and had more awareness of NIHL, this is probably because there were more males than females in our tertiary institutions, and also more males engaged in occupations that predispose to unsafe noise exposure. This is in line with the study of Le TN et al. that stated that hearing loss is more prevalent among men than women probably due to an increased number of men that work in a noisy environment.[2]

Adults and children alike are being affected by negative consequences of NIHL.[10],[11] A significant number of respondents 86.86% acknowledged that NIHL could affect all age groups. This in line with the findings in the study by Crandell et al.[27] who reported 95% but contrary to the study by Alzahrani et al.[26] reported 53%. The National Institute for Deaf and Other Communication Disorders reported about 15% of adult Americans with NIHL, and one in eight children presented with NIHL as documented by the American Academy of Audiology.[28],[29] In this study, the age bracket of 20–29 years formed the greater percentage; 154 (81.05%) of respondents that knew noise exposure and its consequences.

Our study respondents were exposed to both recreational and occupational sources of noise. Tricycle riders 16.42%, geologists 2%, and music producers 2% were exposed to noise at the work places. The most common nonoccupational sources of noise pollution identified in our study were generator 234 (85.4%), musical appliance 231 (84.3%), and music concerts 210 (76.6%). Our finding was similar to the work of Alzahrani who reported 13% in the military and motorcycles riders each. Another study reported road traffic (73%) as source of noise follow by music and home noise (26%).[30]

In this survey, only 144 (52.55%) and 162 (59.12%) identified sports events and fitness activity respectively as sources of noise pollution. It is likely that many will engage in these activities without preventive measures. Furthermore, 95 (34.7%) respondents identified children toys as a source of unsafe noise, thereby exposing children to unsafe noise and future hearing impairment.

  Conclusion Top

Although most respondents were aware that repeated and prolonged exposure to loud noise could cause hearing loss, however, the greater percentage of them lacked satisfactory awareness about NIHL. The majority of respondents that showed a high level of awareness were 20–29 years old, male and undergraduate students. This is probably because they have access to the Internet to seek information. There was ignorance that NIHL is permanent and cannot be cured, and children's toys may pose a danger to hearing. This knowledge gap may lead to continuous exposure to unsafe noise with a consequent higher prevalence of NIHL and future consequences. There is, therefore, the need for Public awareness campaign on the dangers of exposure to loud noise. Continuous public health education on prevention of NIHL is advocated because early evaluation, intervention and prevention are best achieved when individuals' level of awareness of risk factors is high.

The limitations of this study include small sample size and majority of the respondents were undergraduate students, because the study field was mainly in a tertiary institution rather than the main city.


  1. Otorhinolaryngologists and public health scientists should organize regular advocacy campaigns and public health education to create awareness on the adverse effects and of exposure to unsafe occupational and nonoccupational noise
  2. Policy makers at the educational sector should review and update the syllabus at all levels of learning to incorporate ear, nose, and throat health and hygiene practices among school children
  3. Future studies on assessment of hearing threshold of the general public are necessary for early identification and treatment of NIHL.


The authors would like to acknowledge the otorhinolaryngology resident doctors who assisted in data collection.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Figure 1], [Figure 2]

  [Table 1], [Table 2], [Table 3], [Table 4]


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