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BACKGROUND: Noise-induced hearing loss (NIHL) is a prevalent and preventable health issue globally. This study aims to evaluate the symptoms, knowledge, beliefs, and preventive practices regarding NIHL among the general population of the southern region of Saudi Arabia. MATERIALS & METHODS: A cross-sectional study was conducted from May to July 2024, using a self-administered, validated electronic questionnaire distributed in Arabic via social media platforms. The questionnaire assessed socio-demographic data, NIHL awareness, attitudes toward prevention, and personal practices regarding noise exposure. The sample included 400 participants analyzed using SPSS version 23 (IBM Corp., Armonk, NY), with associations measured through the chi-square and Fisher's exact tests. RESULTS: Most participants were Saudi nationals (97%) and females (81.3%). Symptoms of NIHL, such as tinnitus and the need to increase TV or radio volume, were prevalent among participants. Most participants (88.5%) were aware that high sound levels affect hearing, yet only 9.5% correctly identified the minimum duration of exposure that could harm hearing. Social media was the primary source of information (51.3%). Positive preventive practices were noted, with 66% lowering device volumes and 55.3% recommending sound restrictions on tablets. Significant associations were found between better preventive practices and higher income as well as marital status. CONCLUSION: The study highlights the high basic awareness of NIHL but identifies critical knowledge gaps regarding the minimum sound level and duration that affect hearing negatively. Enhanced public health education and technological interventions are needed to improve prevention practices. Future research should include longitudinal studies and diverse populations to better understand and address NIHL.

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Introduction Occupational noise-induced hearing loss (NIHL) continues to be a significant public health issue globally, with Malaysia being no exception. In Malaysia, the majority of NIHL cases are reported from the manufacturing sector, with Selangor among the states with the highest number of confirmed cases. This study aimed to assess the prevalence of and factors associated with occupational NIHL among palm oil mill workers in Selangor, Malaysia. Methods A cross-sectional study was conducted to analyze the data from the data collection form, noise risk assessment reports, and audiometric test results done between 2021 and 2022 with a comparable baseline audiometric test. Results A total of 143 participants from three palm oil mills joined this study. The prevalence of NIHL was 42.7% (n = 61). Following the logistic regression model, NIHL was significantly associated with a duration of employment of 10 years and above, a history of occupational noise exposure at the previous workplace, and the use of personal hearing protectors at the current workplace with an adjusted OR of 2.41 (95% CI (1.14, 5.07)), 5.89 (95% CI (2.38, 14.53)), and 0.36 (95% CI (0.16, 0.83)), respectively. Conclusion The prevalence of NIHL among the study participants was high, and the associated factors are modifiable factors that can be prevented with a comprehensive hearing conservation program in the palm oil mills.

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Sensorineural hearing loss (SNHL), characterized by damage to the inner ear or auditory nerve, is a prevalent auditory disorder. This study explores the potential of Castanopsis echinocarpa (CAE) as a therapeutic agent for SNHL. In vivo experiments were conducted using zebrafish and mouse models. Zebrafish with neomycin-induced ototoxicity were treated with CAE, resulting in otic hair cell protection with an EC50 of 0.49 µg/mL and a therapeutic index of 1020. CAE treatment improved auditory function and protected cochlear sensory cells in a mouse model after noise-induced hearing loss (NIHL). RNA sequencing of NIHL mouse cochleae revealed that CAE up-regulates genes involved in neurotransmitter synthesis, secretion, transport, and neuronal survival. Real-time qPCR validation showed that NIHL decreased the mRNA expression of genes related to neuronal function, such as Gabra1, Gad1, Slc32a1, CaMK2b, CaMKIV, and Slc17a7, while the CAE treatment significantly elevated these levels. In conclusion, our findings provide strong evidence that CAE protects against hearing loss by promoting sensory cell protection and enhancing the expression of genes critical for neuronal function and survival.

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OBJECTIVE: This cross-sectional website analysis aimed to determine the readability and quality of English and Spanish websites pertaining to the prevention of noise-induced hearing loss. STUDY DESIGN: Cross-sectional website analysis. SETTING: Various online search engines. METHODS: We queried four popular search engines using the term "noise-induced hearing loss prevention" to reveal the top 50 English and top 50 Spanish websites for data collection. Websites meeting inclusion criteria were stratified based on the presence of a Health on the Net Code certificate (independent assessment of honesty, reliability, and quality). Websites were then independently reviewed by experts using the DISCERN criteria in order to assess information quality. Readability was calculated using the Flesch reading ease score for English and the Fernandez-Huerta formula for Spanish websites. RESULTS: Thirty-six English websites and 32 Spanish websites met the inclusion criteria. English websites had significantly lower readability (average = 56.34, SD = 11.17) compared to Spanish websites (average = 61.88, SD = 5.33) (P < .05). Spanish websites (average = 37, SD = 8.47) were also of significantly higher quality than English websites (average = 25.13, SD = 10.11). CONCLUSION: This study emphasizes the importance of providing quality and readable materials to patients seeking information about noise-induced hearing loss prevention. All of the English and Spanish websites reviewed were written at a level higher than the American Medical Association-recommended sixth-grade reading level. The study also highlights the need for evidence-based information online provided by experts in our field.

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Noise-induced hearing loss (NIHL) is a significant and urgent global public health concern, arising from prolonged exposure to elevated levels of noise. This auditory impairment harms delicate inner ear structures, particularly the essential hair cells transmitting auditory signals to the brain. Recognized by the World Health Organization as a major contributor to worldwide hearing loss, NIHL requires a comprehensive examination of its molecular and cellular mechanisms. Animal models emerge as indispensable tools for unraveling these intricacies, allowing researchers to simulate and study the impact of noise exposure on auditory structures, shedding light on the interplay of oxidative stress, inflammation and immune responses-crucial factors in NIHL progression. The present review focuses on elucidating the molecular mechanisms of NIHL, with a specific emphasis on findings derived from animal models, alongside the exploration of thorough preventive strategies, including protective measures and probing potential interventions. Understanding the molecular underpinnings not only provides insight into targeted treatment approaches, but also unlocks pathways for exploring and implementing preventive actions. This approach not only deepens the current comprehension of NIHL, but also has the potential to influence the shaping of public health policies, offering a nuanced perspective on this prevalent auditory disorder.

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Hearing loss is a health crisis that affects more than 60 million Americans. Currently, sodium thiosulfate is the only drug approved by the Food and Drug Administration (FDA) to counter hearing loss. Sirtuins were proposed as therapeutic targets in the search for new compounds or drugs to prevent or cure age-, noise-, or drug-induced hearing loss. Sirtuins are proteins involved in metabolic regulation with the potential to ameliorate sensorineural hearing loss. The mammalian sirtuin family includes seven members, SIRT1-7. This paper is a literature review on the sirtuins and their protective roles in sensorineural hearing loss. Literature search on the NCBI PubMed database and NUsearch included the keywords 'sirtuin' and 'hearing'. Studies on sirtuins without relevance to hearing and studies on hearing without relevance to sirtuins were excluded. Only primary research articles with data on sirtuin expression and physiologic auditory tests were considered. The literature review identified 183 records on sirtuins and hearing. After removing duplicates, eighty-one records remained. After screening for eligibility criteria, there were forty-eight primary research articles with statistically significant data relevant to sirtuins and hearing. Overall, SIRT1 (n = 29) was the most studied sirtuin paralog. Over the last two decades, research on sirtuins and hearing has largely focused on age-, noise-, and drug-induced hearing loss. Past and current studies highlight the role of sirtuins as a mediator of redox homeostasis. However, more studies need to be conducted on the involvement of SIRT2 and SIRT4-7 in hearing protection.

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Background: Occupational hearing loss of workers exposed to impulse noise and workers exposed to steady noise for a long time may have different clinical characteristics. Methods: As of May 2019, all 92 servicemen working in a weapon experimental field exposed to impulse noise for over 1 year were collected as the impulse noise group. As of Dec 2019, all 78 servicemen working in an engine working experimental field exposed to steady noise for over 1 year were collected as the steady noise group. The propensity score matching (PSM) model was used to eliminate the imbalance of age and working time between the two groups of subjects. After propensity score matching, 51 subjects in each group were finally included in the study. The machine learning model is constructed according to pure tone auditory threshold, and the performance of the machine learning model is evaluated by accuracy, sensitivity, specificity, and AUC. Results: Subjects in the impulse noise group and the steady noise group had significant hearing loss at high frequencies. The hearing of the steady noise group was worse than that of the impulse noise group at speech frequency especially at the frequency of 1 kHz. Among machine learning models, XGBoost has the best prediction and classification performance. Conclusion: The pure tone auditory threshold of subjects in both groups decreased and at high frequency. The hearing of the steady noise group at 1 kHz was significantly worse than that of the impulse noise group. XGBoost is the best model to predict the classification of our two groups. Our research can guide the prevention of damage caused by different types of noises.

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BACKGROUND: Calcitriol (Cal) is the most active metabolite of vitamin D and has antioxidant and anti-inflammatory properties. The aim of this study was to investigate the role of Cal in noise-induced hearing loss (NIHL) to further elucidate the mechanism of noise-induced oxidative stress in the mouse cochlea. METHODS: C57BL/6 J mice were given six intraperitoneal injections of Cal (500 ng/kg/d). After 14 days of noise exposure, auditory brainstem response (ABR) thresholds, and the cochlear outer hair cell loss rate were analysed to evaluate auditory function. Real-time fluorescence quantitative PCR, immunofluorescence and western blotting were performed in vitro after the treatment of cochlear explants with 100 µM tert-butyl hydroperoxide (TBHP) for 2.5 h and HEI-OC1 cells with 250 µM TBHP for 1.5 h. RESULTS: In vivo experiments confirmed that Cal pretreatment mitigated NIHL and outer hair cell death. The in vitro results demonstrated that Cal significantly reduced TBHP-induced cochlear auditory nerve fibre degradation and spiral ganglion neuron damage. Moreover, treatment with Cal inhibited the expression of oxidative stress-related factors (3-NT and 4-HNE) and DNA damage-related factors (γ-H2A.X) and attenuated TBHP-induced apoptosis in cochlear explants and HEI-OC1 cells. A total of 1479 upregulated genes and 1443 downregulated genes were screened in cochlear tissue 1 h after noise exposure. The level of transcription factor 3 (ATF3) was significantly elevated in HEI-OC1 cells after TBHP stimulation. Gene Transcription Regulation Database （GTRD）and Cistrome database analyses revealed that the downstream target gene of ATF3 is dual specificity phosphatase 1 (DUSP1). Cistrome DB Toolkit database results showed that the transcription factor of DUSP1 was ATF3. In addition, the ChIP-PCR results indicated that ATF3 might be a direct transcription factor of DUSP1. CONCLUSION: The results of our study suggest that Cal attenuates NIHL and inhibits noise-induced apoptosis by regulating the ATF3/DUSP1 signalling pathway.

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To assess the Knowledge, Attitude, and Practice on Noise Induced Hearing Loss(NIHL) caused by using Personal Listening Devices (PLD). To assess the usage pattern of PLD among undergraduate medical students studying at a tertiary health center in South India. A descriptive study was conducted by the Department of ENT over a three-month duration on undergraduate medical students who volunteered to fill in an electronic questionnaire form that they received via WhatsApp. A convenient sampling technique was used. NIHL questionnaire consisted of three sets of electronic questionnaires: Q1, Q2, and Q3. In Q1 total score of more than 75% was taken as good knowledge, 50-75% as fair knowledge, and less than 50% as poor knowledge. Q2 score of more than 50% was taken as a good attitude and less than 50% as a need to improve upon attitude. A total of 224(94.5%) participants had consented, out of the 224 students, 132(58.9%) were males and 92(41.1%) were females. 195(87.1%) of the 224 participants are regular users of PLD and the most common PLD used was earbuds (76.8%). The mean total knowledge on NIHL is less than 75%. Medical students have fair knowledge (54.5%). The weaker areas of knowledge were about the nature of the disease believing that NIHL is a reversible condition. Their overall attitude score is good (61.8%). Students more than 18 years of age had a positive attitude score (3.42 +/- 0.856) as compared with students less than 18 years of age (2.69 +/- 0.800). Most participants preferred a volume level of 6.26 +/- 1.517 on a scale of 1 to 10 for PLD, indicating that students prefer to set the volume at higher level. The participants showed fair knowledge and a good attitude concerning NIHL. The present study highlights a concerning lack of practice about NIHL and the prevalence of unsafe PLD among medical students. This underscores the importance of educational interventions to increase awareness among this population.

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OBJECTIVE: To measure noise exposure present on pickleball courts and assess the risk of noise-induced hearing loss (NIHL) per guidelines put forward by the National Institute of Occupational Safety and Health (NIOSH). METHODS: Observational study measuring noise levels at multiple recreational pickleball courts in the Richmond, VA area, documenting LAeq, LASmax, and LCpeak at courtside and waiting areas of pickleball courts. Measurements were completed using the NIOSH SLM application on an iPhone 13 with iMM-6 Calibrated Measurement Microphone (equivalent to IEC 61672-1 Class II) that was calibrated using ND-9 Sound Level Calibrator (IEC942 Class I). RESULTS: Average sound levels recorded at waiting areas adjacent to the courts, measured in LAeq, LASmax, and LCpeak, were 69.1 dBA, 92.0 dBA, and 112.1 dBC, respectively, while courtside measurements were 69.7 dBA, 92.2 dBA, and 115.6 dBC, respectively. These measurements were within NIOSH and OSHA recommendations. CONCLUSION: The data demonstrates that randomly sampled pickleball courts have noise levels that do not increase risk for NIHL for participants or bystanders alike based on NIOSH guidelines. However, prolonged noise exposure and ambient noise pollution may have other health implications and warrant further investigations. LEVEL OF EVIDENCE: Level 2.

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Existing studies have indicated that noise induces apoptosis and necroptosis in cochlear outer hair cells (OHCs). However, the role of the extrinsic cell death pathway, initiated by death ligands in the cochlea, remains unknown. In this study, we hypothesized that noise could induce the NFAT3/FasL axis-mediated extrinsic death pathway in the cochlea. We found that NFAT3/FasL signaling was silent in normal OHCs. Noise exposure induced apoptosis and necroptosis in OHCs with specifically high FasL expression. Multiplex immunofluorescence staining revealed that NFAT3 nuclear translocation and FasL upregulation were colocalized in the apoptotic and necroptotic OHCs following noise trauma. Administration of FK506 or 11R-vivit (an specific NFAT inhibitor) blocked NFAT3 nuclear translocation, inhibited FasL expression, mitigated apoptosis and necroptosis, and protected against noise-induced hearing loss (NIHL). Finally, FasL knockdown by delivering siRNA intratympanically attenuated apoptosis and necroptosis in OHCs and alleviated NIHL, confirming the role of FasL in OHC death. Collectively, our study demonstrates that the NFAT3/FasL axis mediates noise-induced extrinsic death pathway in OHCs, leading to their apoptosis and necroptosis.

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OBJECTIVE: Acute sensorineural hearing loss represents a spectrum of conditions characterized by sudden onset hearing loss. The "Clinical Practice Guidelines for the Diagnosis and Management of Acute Sensorineural Hearing Loss" were issued as the first clinical practice guidelines in Japan outlining the standard diagnosis and treatment. The purpose of this article is to strengthen the guidelines by adding the scientific evidence including a systematic review of the latest publications, and to widely introduce the current treatment options based on the scientific evidence. METHODS: The clinical practice guidelines were completed by 1) retrospective data analysis (using nationwide survey data), 2) systematic literature review, and 3) selected clinical questions (CQs). Additional systematic review of each disease was performed to strengthen the scientific evidence of the diagnosis and treatment in the guidelines. RESULTS: Based on the nationwide survey results and the systematic literature review summary, the standard diagnosis flowchart and treatment options, including the CQs and recommendations, were determined. CONCLUSION: The guidelines present a summary of the standard approaches for the diagnosis and treatment of acute sensorineural hearing loss. We hope that these guidelines will be used in medical practice and that they will initiate further research.

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Noise-induced hearing loss (NIHL) often presents with an insidious onset, resulting from the cumulative effect of chronic, high-level noise exposure regardless of etiology. Stereocilin (STRC) is a protein that supports stereocilia attachment and cochlear hair cell function, 2 common targets of noise trauma. In this study, we explored the relationship between STRC and daily noise exposure in young, healthy adults. We found that higher noise exposure levels were associated with lower serum levels of STRC, as was the case for another inner-ear protein, prestin. There was a statistically significant positive correlation between serum STRC and prestin levels. These results support a biomarker approach for the diagnosis and monitoring of NIHL. The ability to detect and measure STRC in the blood also has implications for targeted gene therapy. STRC mutations are known to be associated with autosomal recessive deafness, a condition that is now amenable to targeted gene therapy.

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OBJECTIVE: Steroids given systemically, locally, or both are the mainstay of treatment for acute acoustic trauma (AAT). The overall recovery rate (full, partial, and none) is undetermined. STUDY DESIGN: Original case series and systematic literature review. SETTING: Case series of a tertiary referral center and a systematic literature review. METHODS: Cases of AAT between 2012 and 2022 were retrospectively analyzed for demographics, acoustic trauma characteristics, treatment modality and delay and prognosis. This case series was added to the series identified by a systematic literature review. This review included "Medline" via "PubMed", "EMBASE", and "Google scholar". All series were pooled for meta-analysis defining prognosis following steroidal treatment for AAT patients. RESULTS: The pooled analyses included 662 ears, out of which 250 underwent complete recovery of hearing (overall proportion = 0.2809, 95%confidence interval [CI] = 0.1611-0.4178). Any recovery was recorded for 477 ears (overall proportion = 0.7185, 95% CI = 0.5671-0.8493) and no recovery was documented for 185 ears (overall proportion = 0.2815, 95% CI = 0.1507-0.4329). CONCLUSION: The rate of overall recovery for AAT is around 70%, and around 30% for full recovery when steroids are initiated within the first 2 weeks following the insult.

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In the German Ordinance on Occupational Diseases (BKV), there are currently 82 occupational diseases listed, of which 18 partially or completely fall within the field of ENT medicine due to the associated health disorders. Noise-induced hearing loss is usually the focus of attention for the ENT specialist, but it has long since ceased to be the only occupational disease. In order to help uncover possible causalities between occupational noxious substances and diseases, it is important that physicians report their own observations and new scientific findings regarding suspected cases to the German Social Accident Insurance, especially in situations where cancer may be linked to occupational influences.

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The ABCC1 gene belongs to the ATP-binding cassette membrane transporter superfamily, which plays a crucial role in the efflux of various endogenous and exogenous substances. Mutations in ABCC1 can result in autosomal dominant hearing loss. However, the specific roles of ABCC1 in auditory function are not fully understood. Through immunofluorescence, we found that ABCC1 was expressed in microvascular endothelial cells (ECs) of the stria vascularis (StV) in the murine cochlea. Then, an Abcc1 knockout mouse model was established by using CRISPR/Cas9 technology to elucidate the role of ABCC1 in the inner ear. The ABR threshold did not significantly differ between WT and Abcc1-/- mice at any age studied. After noise exposure, the ABR thresholds of the WT and Abcc1-/- mice were significantly elevated. Interestingly, after 14 days of noise exposure, ABR thresholds largely returned to pre-exposure levels in WT mice but not in Abcc1-/- mice. Our subsequent experiments showed that microvascular integrity in the StV was compromised and that the number of outer hair cells and the number of ribbons were significantly decreased in the cochleae of Abcc1-/- mice post-exposure. Besides, the production of ROS and the accumulation of 4-HNE significantly increased. Furthermore, StV microvascular ECs were cultured to elucidate the role of ABCC1 in these cells under glucose oxidase challenge. Notably, 30 U/L glucose oxidase (GO) induced severe oxidative stress damage in Abcc1-/- cells. Compared with WT cells, the ROS and 4-HNE levels and the apoptotic rate were significantly elevated in Abcc1-/- cells. In addition, the reduced GSH/GSSG ratio was significantly decreased in Abcc1-/- cells after GO treatment. Taken together, Abcc1-/- mice are more susceptible to noise-induced hearing loss, possibly because ABCC1 knockdown compromises the GSH antioxidant system of StV ECs. The exogenous antioxidant N-acetylcysteine (NAC) may protect against oxidative damage in Abcc1-/- murine cochleae and ECs.

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Characterising inner ear disorders represents a significant challenge due to a lack of reliable experimental procedures and identified biomarkers. It is also difficult to access the complex microenvironments of the inner ear and investigate specific pathological indicators through conventional techniques. Omics technologies have the potential to play a vital role in revolutionising the diagnosis of ear disorders by providing a comprehensive understanding of biological systems at various molecular levels. These approaches reveal valuable information about biomolecular signatures within the cochlear tissue or fluids such as the perilymphatic and endolymphatic fluid. Proteomics identifies changes in protein abundance, while metabolomics explores metabolic products and pathways, aiding the characterisation and early diagnosis of diseases. Although there are different methods for identifying and quantifying biomolecules, mass spectrometry, as part of proteomics and metabolomics analysis, could be utilised as an effective instrument for understanding different inner ear disorders. This study aims to review the literature on the application of proteomic and metabolomic approaches by specifically focusing on Meniere's disease, ototoxicity, noise-induced hearing loss, and vestibular schwannoma. Determining potential protein and metabolite biomarkers may be helpful for the diagnosis and treatment of inner ear problems.

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INTRODUCTION: Aerosol mitigation equipment implemented due to COVID-19 has increased noise levels in the operating room (OR) during otolaryngological procedures. Intraoperative sound levels may potentially place personnel at risk for occupational hearing loss. This study hypothesized that cumulative intraoperative noise exposures with aerosol mitigation equipment exceed recommended occupational noise exposure levels. METHODS: Sound levels generated by the surgical smoke evacuator (SSE) during adenotonsillectomy were measured using a sound level meter and compared to surgery without SSE. RESULTS: Thirteen adenotonsillectomy surgeries were recorded. Mean sound levels with the SSE were greater than the control (72 ± 3 A-weighted decibels (dBA) vs. 68 ± 2 dBA; p=0.015). Maximum noise levels during surgery with SSE reached 82 ± 3 dBA. CONCLUSION: Surgeons performing adenotonsillectomy with aerosol mitigation equipment are exposed to significant noise levels. Intraoperative sound levels exceeded international standards for work requiring concentration. Innovation is needed to reduce cumulative OR noise exposures.

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OBJECTIVE: Operating room (OR) sounds may surpass noise exposure thresholds and induce hearing loss. Noise intensity emitted by various surgical instruments during common pediatric otolaryngologic procedures were compared at the ear-level of the surgeon and patient to evaluate the need for quality improvement measures. STUDY DESIGN: Cross-sectional study. SETTING: Single tertiary care center. METHODS: Noise levels were measured using the RISEPRO Sound Level Meter and SoundMeter X 10.0.4 at the ear level of surgeon and patient every 5 minutes. Operative procedure and instrument type were recorded. Measured noise levels were compared against ambient noise levels and the Apple Watch Noise application. RESULTS: Two hundred forty-two total occasions of noise were recorded across 62 surgical cases. Cochlear implantation surgery produces the loudest case at the ear-level of the patient (91.8 Lq Peak dB; P < .001). The otologic drill was the loudest instrument for the patient (92.1 Lq Peak dB; P < .001), while the powered microdebrider was the loudest instrument for the surgeon (90.7 Lq Peak dB; P = .036). Noise measurements between surgeon and patient were similar (P < .05). Overall agreement between the Noise application and Sound Level Meter was excellent (intraclass correlation coefficient of 0.8, with a 95% confidence interval ranging from 0.32 to 0.92). CONCLUSION: Otolaryngology OR noises can surpass normal safe thresholds. Failure to be aware of this may unwittingly expose providers to noise-related hearing loss. Mitigation strategies should be employed. Quality improvement measures, including attention to surgical instrument volume settings and periodic decibel measurements with sound applications, can promote long-term hearing conservation. DISCUSSION: Otolaryngology OR noises can surpass normal safe thresholds. Failure to be aware of this may unwittingly expose providers to noise-related hearing loss. The duration, frequency of exposure, and volume levels of noise should be studied further. IMPLICATIONS FOR PRACTICE: Mitigation strategies should be employed. Quality improvement measures, including attention to surgical instrument volume settings and periodic decibel measurements with sound applications, can promote long-term hearing conservation.

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As urbanization and population growth escalate, the challenge of noise pollution intensifies, particularly within the aviation industry. This review examines current insights into noise-induced hearing loss (NIHL) in aviation, highlighting the risks to pilots, cabin crew, aircraft maintenance engineers, and ground staff from continuous exposure to high-level noise. It evaluates existing noise management and hearing conservation strategies, identifying key obstacles and exploring new technological solutions. While progress in developing protective devices and noise control technologies is evident, gaps in their widespread implementation persist. The study underscores the need for an integrated strategy combining regulatory compliance, technological advances, and targeted educational efforts. It advocates for global collaboration and policy development to safeguard the auditory health of aviation workers and proposes a strategic framework to enhance hearing conservation practices within the unique challenges of the aviation sector.

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