Earphones and Hearing Loss: A Study on School Students in Saudi Arabia

This research proposal discusses the risk factors associated with listening to music at a higher volume and the loss of hearing in school students who use earbuds or headphones. The study uses quantitative data collection method and the data is collected from three school students in Jeddah, Saudi Arabia.

Running Head: EARPHONES AND HEARING LOSS
EARPHONES AND HEARING LOSS
Name of the Student
Name of the University
Author Note

1EARPHONES AND HEARING LOSS
Table of Contents
1. Summary....................................................................................................................3
2. Statement of Problem.................................................................................................3
3. Research Hypothesis..................................................................................................4
3.1 Research Questions..............................................................................................5
4. Research Objectives...................................................................................................5
4.1 Overall Objectives................................................................................................5
4.2 Specific Objectives...............................................................................................5
5. Methodology..............................................................................................................6
7.1 Type of Study and General Design......................................................................6
7.2 Population of Study..............................................................................................6
7.3 Sample Selection and Size...................................................................................7
7.4 Unit Analysis and Observation............................................................................7
7.5 Data Collection Procedure and Instruments Used...............................................8
8. Plan for Data Analysis...............................................................................................9
8.1 Methods of Data Analysis....................................................................................9
9. Anticipated Results....................................................................................................9
10. References..............................................................................................................10
11. Appendix................................................................................................................13
11.1 Gantt Chart.......................................................................................................13

2EARPHONES AND HEARING LOSS
11.2 Interview..........................................................................................................13

3EARPHONES AND HEARING LOSS
1. Summary
This research proposal is going to discuss about the various risk factors that are
associated with listening to music at a higher volume. The research proposal aims to discuss
about the association of higher noise and the loss of hearing in the school students who use
ear buds or headphones for most of the time. The study uses quantitative data collection
method and the data is collected from three school students in Jeddah, Saudi Arabia. The data
is analyzed by using the interview results that focus on the various demographic variables
that has been used in the research including age and gender of the participating school
students (Hutchinson et al., 2015). The cross-sectional study is done on the research topic by
the researchers in order to know the relation between the various hearing loss among the
specified population sample and the exposure to high noise. Thus, this is a cross-sectional
study and the methodology used is interview which is a type of qualitative data analysis
method (Keppler, Dhooge & Vinck, 2015). At last the collected data has been analyzed and
the results reveal that there is high prevalence of the symptoms that indicate the loss in
hearing ability among the students who are exposed to loud sound most of the time.
2. Statement of Problem
Across the world, all the school students face a common problem that include the loss
of hearing. Hearing loss can at the radar of every school going student. This is due to the fact
that the students walk to and from the class along with the ear buds and even after the classes
get over the student are seen with ear buds or headphones (Basner et al., 2014; Hutchinson et
al., 2015). The reality is that school students face high ranges of sound are reported to have
regular exposure to high level of noise. A lot of research has been done that shows that the
school students show relation between the personal music player and the decreased level of
hearing status (Stansfeld & Clark, 2015; Mahomed, Swanepoel & Eikelboom, 2016). Thus, it
is very important to conduct regular screening as the students are not aware of the changes
that arise due to hearing loss. Thus, the population that is being highly affected by the
problem are the school students who are regularly exposed to high noise (Keppler, Dhooge &
Vinck, 2015).
Research has shown that the school students in Saudi Arabia (KSA) who are
reportedly exposed to high noise levels show reduced responses due to disability in hearing.
The sensitivity in hearing also affects the ability of understanding the speech. This is due to

4EARPHONES AND HEARING LOSS
the exposure of the students to high noise on a regular basis (Båsjö et al., 2016). There are
some students that also suffer from hidden loss of hearing that is different from the regular
hearing disability. The regular hearing loss is a type of loss in hearing that is often related to
the age or exposure to loud noise. It is typically due to the damage to the sensory nerve cells.
These sensory nerve cells that are responsible for the conversion of sound into electrical
impulses (Sudan et al., 2013; Keppler, Dhooge & Vinck, 2015). On the other hand, hidden
hearing loss is due to the damage of the connections between the auditory and the sensory
nerve cells. Researchers had told that the loss in hearing due to high noise exposure is
completely preventable. For this the school students should apply the 60/60 thumb rule to
protect their long-term hearing (World Health Organization, 2015). According to the law
everyone should listen to 60 percent of the maximum volume for not more than 60 minutes.
Hearing loss is not just a problem in the Saudi Arabia but all across the globe and according
to the World Health Organization, 1.1 billion teens and adults are at higher risk of hearing
loss due to unsafe levels of noise (Swanepoel, 2017). Reports have suggested that the
students who do not use protection on their ears while working in noisy environments suffer
from the loss in hearing. Around 75% of the students were aware of the fact that exposure to
loud sounds can cause loss in hearing. 46% of the students do not use the hearing protection
devices as they felt that hearing loss can occur to them only at older age (Gupta et al., 2018;
Swanepoel, 2017). Thus, the solution that can be used to solve the problem involves the use
of the hearing protection devices and also to follow the 60/60 rule.
This research proposal thus, focuses on the loss of hearing abilities in the school
students of Saudi Arabia (KSA). The main cause that is related to the loss of hearing is the
extensive use of headphones and ear buds among the school students so that they can listen to
music anytime (Ansari et al., 2014; Gupta et al., 2018). The research proposal then discusses
the problems that can be caused to the ears if the students are not careful and finally the
proposal analyses the result that highlights the outcome of the research and also provides
certain recommendations (Mahomed & Eikelboom, 2016; Mahomed, Swanepoel &
Eikelboom, 2016).
3. Research Hypothesis
The research hypothesis are stated as follows:
H0: The risk of high noise is affecting the school students and that is linearly related to the
loss of hearing ability in them.

5EARPHONES AND HEARING LOSS
H1: The young adults who do not have sufficient knowledge about the safety level of hearing
and the consequences faced by them
3.1 Research Questions
The research questions are as follows:
1. What are the various reasons due to which the school students face hearing loss?
2. What is the role of safety level knowledge in protecting the loss of hearing ability?
3. What are the probable ways in which the school students can easily figure out the
challenges faced in hearing and the ways in which they can combat the problems?
4. Research Objectives
4.1 Overall Objectives
The overall objectives are:
1. To understand the cause of hearing loss in school students
2. To find out the various ways in which the hearing loss can be minimized in the school
students
3. To suggest some means in which the hearing loss can be controlled in the young
adults that will directly result in improving their hearing ability.
4.2 Specific Objectives
The specific objectives are:
1. The use of cross sectional study that can be used to measure the prevalence of students
who had developed early signs of hearing loss
2. The involvement of school students specifically in Saudi Arabia that are exposed to high
sound and are facing hearing problem with the hearing protection devices
3. The last objective is to gather and analyze the data to estimate the measure of association
between exposure of the school students to high noise and their linear relation to hearing
problem in school students.

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5. Methodology
The research study uses quantitative research method in order to analyze the relation
between the prevalence of students in Saudi Arabia who are exposed to high noise and are at
the verge of developing hearing loss (Mahomed, Swanepoel & Eikelboom, 2016).
Demographic variables are used in the research study that includes age, gender of the
students and the year in which they were in school. These values will be reported in a
quantitative manner as they have a numerical value (McCreery et al., 2014). Demographic
variables is a variable that is generally collected by the researchers to demonstrate the nature
and distribution of the sample used in the research. These variables are described using
inferential and descriptive statistics (Sulaiman, Seluakumaran & Husain, 2013).
7.1 Type of Study and General Design
The type of study that is being used in the analysis of the relation between hearing
loss among the school students in Saudi Arabia is the cross-sectional study (Dehnert et al.,
2015; Mahomed, Swanepoel & Eikelboom, 2016). The cross-sectional is a form of
quantitative research methodology that is used to examine a theory and is thus, deductive in
nature. This methodology is used as it is much more structured and give a defined objective
approach to the research topic by generating inferences on a population level (Naik & Pai,
2014; McCreery et al., 2014). Cross-sectional study is a type of observational study that is
involved with the analysis of data collected from the population that is representing the
sample population of the research. It helps to measure the exposure and the outcome of the
interest simultaneously (Hutchinson et al., 2015). Thus, it is useful to analyze the research
study using cross-sectional study for establishing the odds ratio and also to calculate the
relative risk for developing hearing disability based on exposure to high noise (Herrera et al.,
2016).
7.2 Population of Study
The population of the study involves the school students who are seen with
headphones or ear buds. The sample population belong to the school of Saudi Arabia and thus
the data collection will be done in the school campus. The sampling method used involves
probability sampling that includes the sampling of all the eligible individuals that can be
selected to collect the sample. However, it is very much important that the selected sample
represents the entire population (Mahomed, Swanepoel & Eikelboom, 2016).

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The research methodology will be using systematic probability sampling in which the
school students will be selected at a regular intervals from the entire sample frame (Gallun et
al., 2013). To avoid any kind of biasness in the collection of the data age and gender of the
students are also importance so that the data represents uniformity and the results can actually
link the relation between the loss of hearing in school students and the exposure to high
sound (Jiang et al., 2013; Mahomed, Swanepoel & Eikelboom, 2016).
7.3 Sample Selection and Size
The sample size is 1200 students from 3 different schools in Saudi Arabia which
means that each 400 students are interviewed from each school. The students are selected
between the age group of 18-25 years from the school campus and the sample will also
contain equal number of male and female students. The male and female students will be
selected on the basis of using headphones and during the interview all the cellphones and
headphones will be confiscated from the students (Suhag et al., 2016; Herrera et al., 2016).
The data will be collected anonymously which means that the data collection method will be
entirely confidential. The interview will be done on the campus between the research staff
and the participants in a one to one basis (Lee et al., 2015).
7.4 Unit Analysis and Observation
The data collected will be analyzed by the researcher to find out the probable cause of
hearing disability among the school students. The participants will be subjected to noise at
higher volumes to identify the volume level at which they will face hearing problems
(McCreery et al., 2014). After that the responses of the participants who were interviewed
will be analyzed by the use of a follow-up questionnaire that will help in the detection of the
early signs of hearing loss in the school students (Dehnert et al., 2015; Herrera et al., 2016).
The most commonly observed signs of hearing loss involves ringing, buzzing, hissing noise
in the ears. The other symptoms are difficulty in understanding words, especially when there
is a background noise or when the participants are in a crowd. The difficulty in hearing can
also be due to hearing of television or radio at a higher volume in the past (Jiang et al., 2013;
Lee et al., 2015).
The analysis will include a 2 by 2 table that is shown below
■ OR-high = a/b OR-low = c/d
■ OR-Prevalence = a*d/c*d

8EARPHONES AND HEARING LOSS
Table-1: Data Analysis
(Source: As created by author)
It is generally observed that the school students who are exposed to music that exceeds 85
decibels for a longer period of time (Naik & Pai, 2014). Decibel is used to describe or
measure the intensity of sound, and thus, 85 decibels is equal to heavy noise. It is also
observed that the music devices are the leading cause for the loss of hearing among school
students. The frequent use of these devices to watch videos or to listen music typically needs
the use of headphones that also increases the risk of music-induced hearing loss (Herrera et
al., 2016; Lee et al., 2015).
Researchers have measured the knowledge of school students on the proper use of listening
devices and the effects of listening to music at high volumes. It was seen that the prolonged
use of the ear buds or headphones along with loud music or noise is higher in males than in
females (Hutchinson et al., 2015). The males are also less aware of the safe listening habits
and are found to exceed the daily recommended limit. It is also observed that the females are
much more conscious of the limits are have more knowledge regarding the maximum
listening levels per day when compared to the male counterparts. Moreover, the younger
students also had less knowledge about the safe hearing level in comparison to the older
students (Gallun et al., 2013; Huh, Choi & Moon, 2016).
7.5 Data Collection Procedure and Instruments Used
The data collection method used an interview among the school students in a one to
one basis. The procedure for conducting the interview will involve the use of a detailed
questionnaire from which the interviewer will ask the questions to each and every
participating students. The questions will be asked by the researchers and thus, complete
anonymity will be maintained. This will prevent any biasedness in the data collection process
(Huh, Choi & Moon, 2016).

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8. Plan for Data Analysis
8.1 Methods of Data Analysis
The data generated after the interview process will be analyzed by a data analyst who
will organizing the entire data and will be assigning codes in order to describe the data. Then
after that the entire data will be conceptualized and classified into various themes that can
correlate and connect the interrelated data. The data generated will be analyzed by using the
above table that clearly shows the signs of the relation between high and low exposure of the
students and the probable results (Suhag et al., 2016).
9. Anticipated Results
The results that can be summarized from the data that shows that the prevalence early
signs of hearing loss is relatively high among the students who are exposed to high volume of
sound which is approximately more than 60% of the total volume. As the use of in-ear
headphones or ear buds are very common among the students thus, they are relatively at
higher risk of developing hearing loss (Gallun et al., 2013; Huh, Choi & Moon, 2016). The
headphone users tend to increase the volume of the music if they cannot block the
environmental noise that increases the risk of hearing loss among the individuals. This loss
can be reverted by using headphones at a lower volume and investing in better quality of
headphones that can reduce the risk of hearing disability (Huh, Choi & Moon, 2016).

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10. References
Ansari, H., Mohammadpoorasl, A., Rostami, F., Maleki, A., Sahebihagh, M. H., & Naieni, K.
H. (2014). Pattern of use of earphone and music player devices among Iranian
adolescents. International journal of preventive medicine, 5(6), 776.
Båsjö, S., Möller, C., Widén, S., Jutengren, G., & Kähäri, K. (2016). Hearing thresholds,
tinnitus, and headphone listening habits in nine-year-old children. International
journal of audiology, 55(10), 587-596.
Basner, M., Babisch, W., Davis, A., Brink, M., Clark, C., Janssen, S., & Stansfeld, S. (2014).
Auditory and non-auditory effects of noise on health. The lancet, 383(9925), 1325-
1332.
Dehnert, K., Raab, U., Perez-Alvarez, C., Steffens, T., Bolte, G., Fromme, H., & Twardella,
D. (2015). Total leisure noise exposure and its association with hearing loss among
adolescents. International journal of audiology, 54(10), 665-673.
Gallun, F. J., Diedesch, A. C., Kampel, S. D., & Jakien, K. M. (2013). Independent impacts
of age and hearing loss on spatial release in a complex auditory
environment. Frontiers in neuroscience, 7, 252.
Gupta, A., Gupta, A., Jain, K., & Gupta, S. (2018). Noise pollution and impact on children
health. The Indian Journal of Pediatrics, 85(4), 300-306.
Herrera, S., de Lacerda, A. B. M., Lurdes, D., Alcaras, P. A., & Ribeiro, L. H. (2016).
Amplified music with headphones and its implications on hearing health in teens. The
international tinnitus journal, 20(1), 42-47.
Huh, D. A., Choi, Y. H., & Moon, K. W. (2016). The effects of earphone use and
environmental lead exposure on hearing loss in the Korean population: data analysis
of the Korea National Health and Nutrition Examination Survey (KNHANES), 2010–
2013. PloS one, 11(12), e0168718.
Hutchinson Marron, K., Marchiondo, K., Stephenson, S., Wagner, S., Cramer, I., Wharton,
T., ... & Alessio, H. (2015). College students’ personal listening device usage and
knowledge. International journal of audiology, 54(6), 384-390.

11EARPHONES AND HEARING LOSS
Jiang, W., Zhao, F., Guderley, N., & Manchaiah, V. (2016). Daily music exposure dose and
hearing problems using personal listening devices in adolescents and young adults: A
systematic review. International Journal of Audiology, 55(4), 197-205.
Keppler, H., Dhooge, I., & Vinck, B. (2015). Hearing in young adults. Part II: The effects of
recreational noise exposure. Noise & health, 17(78), 245.
Lee, J. S., Choi, H. G., Jang, J. H., Sim, S., Hong, S. K., Lee, H. J., ... & Kim, H. J. (2015).
Analysis of predisposing factors for hearing loss in adults. Journal of Korean medical
science, 30(8), 1175-1182.
Mahomed-Asmail, F., & Eikelboom, R. H. (2016). Hearing loss in urban South African
school children (grade 1 to 3). International journal of pediatric
otorhinolaryngology, 84, 27-31.
Mahomed-Asmail, F., Swanepoel, D. W., & Eikelboom, R. H. (2016). Diagnostic hearing
assessment in schools: validity and time efficiency of automated audiometry. Journal
of the American Academy of Audiology, 27(1), 42-48.
McCreery, R. W., Alexander, J., Brennan, M. A., Hoover, B., Kopun, J., & Stelmachowicz,
P. G. (2014). The influence of audibility on speech recognition with nonlinear
frequency compression for children and adults with hearing loss. Ear and
hearing, 35(4), 440.
Naik, K., & Pai, S. (2014). High frequency hearing loss in students used to ear phone music:
A randomized trial of 1,000 students. Indian Journal of Otology, 20(1), 29.
Stansfeld, S., & Clark, C. (2015). Health effects of noise exposure in children. Current
environmental health reports, 2(2), 171-178.
Sudan, M., Kheifets, L., Arah, O. A., & Olsen, J. (2013). Cell phone exposures and hearing
loss in children in the Danish National Birth Cohort. Paediatric and perinatal
epidemiology, 27(3), 247-257.
Suhag, A. K., Larik, R. S., Mangi, G. Z., Khan, M., Abbasi, S. K., & Madiha, H. (2016).
Impact of excessive mobile phone usage on human. J Comput Sci Syst Biol, 9, 173-
177.

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Sulaiman, A. H., Seluakumaran, K., & Husain, R. (2013). Hearing risk associated with the
usage of personal listening devices among urban high school students in
Malaysia. public health, 127(8), 710-715.
Swanepoel, D. W. (2017). Enhancing ear and hearing health access for children with
technology and connectivity. American Journal of Audiology, 26(3S), 426-429.
World Health Organization. (2015). Hearing loss due to recreational exposure to loud
sounds: a review (No. 9789241508513). World Health Organization.

13EARPHONES AND HEARING LOSS
11. Appendix
11.1 Gantt Chart
Activities 1st
to 3rd
Week
4th
to 10th
week
11th
to 13th
Week
14th
to 17th
Week
18th
to 21st
Week
22nd
to 23rd
Week
24th
Week
Selection of the topic 
Data collection from
secondary sources
 
Creating layout 
Literature review   
Analysis and
interpretation of
collected data
  
Findings of the data  
Conclusion of the
study

Formation of draft  
Submission of final
work

Fig: Gantt Chart
(Source: As created by the author)
11.2 Interview
The following are the questions that will be used to conduct the interview
1. What is your age? How frequently do you listen to music?
2. Do you use headphones or not?
3. How frequently do you use headphones while at campus?

14EARPHONES AND HEARING LOSS
4. Do you use headphones even at home?
5. Do you use hearing aid?
6. Do you increase the volume of the music to block the environmental noise?
7. Do you feel uncomfortable when the volume increases suddenly?
8. Do you hear a buzzing or hissing sound in the ear?
9. Can you understand the words said by other people in presence of surrounding
noise or background noise?
10. What do you know about the safety levels of sound?