Survey: Awareness of hearing issues among the Australian population

Eric LePage, Sheralyn Shacknofsky (Australian Hearing NSW), Narelle Murray

National Acoustic Laboraotories Annual Report 1996/97 

Background
A survey was conducted because it was felt that people, particularly young people, are loath to take warnings about loud noise and hearing loss seriously. We hypothesised firstly that loud sound, particularly loud music, represents an attractive vibrant lifestyle and secondly that while young people hear warnings that loud sound damages their hearing, this is not borne out by their own experience. They can repeatedly expose themselves to very loud sounds or music for years and they judge that it has no effect. The survey was designed to find out what thoughts, if any, young people had about the causes of hearing loss and what having a hearing loss might be like.

Methods
Questionnaires were designed to ask a series of multiple choice questions which could be fitted on a single page. Fifteen hundred copies were distributed to as many places as could be managed in two weeks. They were designed to be folded in three and included a reply-paid address. Responses were returned from approximately 300 people, predominantly students and young adults, but all ages and many occupations were represented.

Results
People were asked to rate in importance how bad it would be to have one of ten kinds of disability. Loss of vision was regarded as the worst kind, followed in order by loss of mobility (paraplegia), loss of memory, hearing, speech, touch/feeling, writing hand, appearance, smell/taste, other hand. Hearing was thus perceived to be important, but overall rated fourth in the list.

People were asked to rate how likely they thought that they would ever have a hearing loss. Only 6 percent thought it likely whereas the actual incidence is about double that. Forty percent allowed that they might, while the rest rated the chance very low, or had never thought about it.

Does normal hearing mean no ear damage? Only one tenth allowed that damage may prelude actual hearing loss; one third said "yes", one third didn't know and one quarter didn't answer the question. This outcome generally reflected the traditional notion that hearing is fine until a mild hearing loss occurs. The approximately equal number of responses in the negative indicate that few people have ever thought that the common term "hearing damage" can be clearly distinguished into cause, "ear damage", and effect, "hearing disability" or that the effect may be a much-delayed outcome.

The next question was designed to assess how much empathy people feel for others who have a hearing loss since hearing loss has long been described as a hidden disability. Only ten percent thought that someone they knew was seriously disabled by their disability, two thirds sensed some disability, while one fifth were not aware of a problem or didn't answer the question. This outcome rather suggests that people with hearing problems are considered to cope quite well, so the disability cannot be too serious.

To the question, "Which best describes hearing loss?" The answers were almost equally divided between the following diverse manifestations each of which has some factual basis: volume control up; volume control down, no escape from noise, loss of focus, indistinct sounds, loss of clarity, mumbled speech. Two percent answered with loss of direction. Again these answers suggest that the average person really has only a very vague idea of what it is like to have a hearing loss. The responses highlight the fact that hearing loss prevention education programs can be considerably more specific in highlighting loss of the normal ability to select, locate or sort sounds as being responsible for most of the frustration in hearing loss.

The next question was designed to assess the extent to which people are aware how much their ears have been traumatised if they experienced tinnitus subsequent to a loud sound exposure, or how much they were able to ignore the trauma the moment it ceased. Only one fifth thought such trauma might have a permanent effect, nearly half thought the problem was temporary and nearly forty percent gave it no further thought. Overall the responses indicate that people do take their hearing for granted and can readily ignore symptoms since they are not generally associated with pain.

Some years back it was regarded as unmasculine for men to wear ear protection, so the question was designed to obtain current attitudes to the wearing of hearing protection devices: ear muff or ear plugs. "If you were in a very noisy workshop for just 5 minutes and hearing protectors were provided would you use them?" The results were approximately equally divided. Of the 46 percent who would not, two fifths would not because of their need to converse, two fifths wouldn't bother while a fifth still regarded the suggestion as unmasculine.

To gauge what people regard as uncomfortably loud, people were asked to rate a series of public events according to discomfort. There was a clear distinction between the too loud category (rock concerts, discos, motor races and starting guns) compared with fewer people regarding fireworks, cinemas, orchestra concerts, football matches, supermarkets and tennis matches as uncomfortably loud.

Peer pressure is an important factor in fixing and assessing people's response to loud sound. The next three questions were designed to test the level of embarrassment people feel in displaying signs of "weakness". Forty-three percent actually indicated they would ask a party host to turn the music down, thirty percent would do nothing, twenty percent would move away and four percent would use ear plugs.

At a noisy sports venue nearly two thirds would wear no ear protection, but would use their hands when necessary; one third would buy earplugs if available. Three percent would try to use paper tissue as earplugs. These responses clearly indicate that people prefer the discomfort of ear trauma rather than not being able to converse. Those who would use paper tissue admit the need, but show no knowledge that paper tissue provides little attenuation.

Most people own sunglasses to protect their eyes against overstimulation or glare, so the next question was designed to determine whether ears are regarded similarly with caution. Only just over a quarter of respondents indicated they had ever bought a pair of foam earplugs. This may indicate that possessing optical accessories is almost as much a fashion statement as a desire to reduce discomfort. It may also reflect the fact that people are much more reluctant a) to insert objects into their ears and b) to suffer the additional difficulties in verbal communication which result from the wearing of plugs. Certainly those who frequently do wear foam earplugs tend to wear them not fully inserted to trade off protection versus continued ease of communication.

Much attention has been drawn to noise as a cause of hearing loss over the past 100 years. The next question was designed to test people's awareness of other factors. Of the factors suggested, (loud noise, infections, head injury, birth trauma, drugs, cap guns) all scored highly as expected. It was revealing, however, that many fewer people rated their hearing at risk due to solvents and toxins, antibiotics and aerobics.

The second last question was designed to check people's impressions about whether loud music is less damaging overall than noise. One fifth of respondents thought music was less damaging than noise. The question might well have been split to gauge responses to the relative effects of different kinds of music. Our otoacoustic emission evidence is that the way most people use music it can be as damaging as noise.

The last question was designed to test the penetration of the $250,000 Australian Hearing publicity campaign "Noise is murder on your ears" conducted just prior to this survey. One fifth of the respondents said that they had heard of the campaign.

Conclusions
The survey revealed that much of the problem in mounting effective hearing loss prevention strategies stems from the non-impact of hearing issues on general thinking until disability strikes. There appears to be a high level of ignorance which the average person possesses in respect of how their hearing works and that education based upon actual risk may be an important prelude to achieving changes in attitudes and behaviour.

Significance
This investigation is a part of an ongoing evaluation of the reasons for engaging in hearing loss prevention research, the costs to our society for ignoring an apparent rise in leisure-related noise trauma and the strategies for making research and clinical programs more effective.

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