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BACKGROUND: With advanced virtual reality (VR) technology, its usage in health care is creating an impact on patient outcomes. Patients undergoing knee replacement surgery are already anxious due to the surgery, anaesthesia, and unfamiliar environment of the operation theatre. In addition to that, the unpleasant noise of tools makes it worse. Peri-operative anxiety correlates with increased anaesthesia requirements and prolonged recovery. It causes the release of stress hormones such as cortisol, adrenaline, and norepinephrine, which can lead to difficult intravascular access due to vasoconstriction and heightened cardiovascular responses. Studies on music therapy have shown a reduction in cortisol levels, contributing to anxiety alleviation. VR glasses create immersive environments to distract patients from various stress factors. Investigating the use of VR/music on serum cortisol and adrenocorticotropic hormone (ACTH) levels in knee replacement surgery can improve peri-operative care, improving patient outcomes. AIM: The study was done to investigate the impact of virtual reality glasses and music therapy on serum cortisol and ACTH levels in patients undergoing knee replacement surgery under combined spinal epidural anaesthesia. METHODS: In this prospective randomised control, single-centric study, patients of either sex, aged between 18 and 65 years, undergoing knee replacement surgery under combined spinal and epidural (CSE) anaesthesia, were included. The primary objective was to compare serum cortisol and ACTH levels, while the secondary objective was to compare the State-Trait Anxiety Inventory for State Anxiety (STAI-SA) score and Patient Satisfaction Score (PSS) in the peri-operative period. A total of 100 patients were assessed for eligibility, and 66 patients met the inclusion and exclusion criteria and were finally randomised and equally assigned to group M-VR (music-virtual reality) and group C (control). Three blood samples were collected for serum cortisol and serum ACTH levels one hour before surgery (T1), one hour after skin incision (T2), and two hours after the completion of surgery (T3). STAI-SA was measured one hour before surgery (T1) and two hours after the completion of surgery (T2), while PSS was recorded two hours after the completion of surgery. Hemodynamic parameters were noted during the entire peri-operative period. RESULTS: The demographic and anthropometric parameters were comparable in both groups. Hemodynamic parameters (heart rate [HR], mean arterial pressure [MAP]) were found to be comparable in the pre-operative period, while significant differences (p > 0.05) were noted after 30 minutes of surgery and continued till the end of surgery. Serum cortisol and serum ACTH levels were comparable in the pre-operative period but showed significantly lower variations in group M-VR in comparison to group C in the intra-operative period. PSS was significantly higher in group M-VR in comparison to group C. CONCLUSION: This study substantiates the role of virtual reality and music therapy (VR/music) on anxiety reduction, improved satisfaction scores, and lesser ACTH/cortisol level variations in knee replacement surgery. It further emphasises larger randomised controlled studies in various other surgical populations, along with long-term follow-up and outcome assessment.

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INTRODUCTION: This study tests the utilization of Bluetooth noise-canceling headphones in improving the quality of eye exams in patients with hearing loss. This prospective study was approved on ethical standards by the University of Texas Medical Branch (UTMB) Institutional Review Board (Approval No. 22-0079) and registered with the National Institutes of Health (NCT05420038). METHODS: UTMB patients above 55 years of age were screened for hearing loss using soundcheck audiometry. Twenty-nine subjects answered pre-recorded ophthalmic exam questions that solicited precise responses. As controls, subjects were randomly administered half of the questions via headphones and half via a smartphone at normal speech volume (60 decibels). Points were awarded for responses demonstrating comprehension, and a post-exam survey was collected. RESULTS: Collectively, the mean score was 1.79 with headphones versus 0.96 with control on the Amsler grid segment and 1.90 with headphones versus 0.97 with control on education questions (p=0.001). Between red zone and yellow zone hearing loss patients, the more severe red zone group answered significantly better in both Amsler (1.78 versus 0.50; p=0.0003) and education questions (1.88 versus 0.44; p<0.0001) with headphones. The yellow zone group answered better with headphones overall but failed to reach significance. Post-exam survey indicated that 28 of 29 patients (97%) preferred the headphones during ophthalmic exams. CONCLUSION: Patients with hearing loss demonstrated better comprehension with Bluetooth headphones. These low-cost devices show great promise at improving effective, compassionate communication between providers and hearing loss patients.

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In recent years, headphones have become increasingly popular worldwide. There are numerous models on the market today, varying in technical characteristics and offering different listening experiences. This article presents an application for simulating the sound response of specific headphone models by physically wearing others. In the future, for example, this application could help to guide people who already own a pair of headphones during the decision-making process of purchasing a new headphone model. However, the potential fields of application are much broader. An in-depth study of digital signal processing was carried out with the implementation of a computational model. Prior to this, an analysis was performed on impulse response measurements of specific headphones, which allowed for a better understanding of the behavior of each set of headphones. Finally, an evaluation of the entire system was conducted through a listening test. The analysis of the results showed that the software works reasonably well in replicating the target headphones. We hope that this work will stimulate further efforts in the same direction.

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It is unclear whether the brain handles auditory cues similarly to visual cues for balance. We investigated the influence of headphones and loudspeaker reproduction of sounds on dynamic balance performance when an individual is facing a cognitive challenge. Twenty participants (16 females, aged 19-36) were asked to avoid a ball according to a specific visual rule. Visuals were projected from the HTC Vive head-mounted display in an acoustically controlled space. We varied the environment by adding congruent sounds (sounds coincide with the visual rule) or incongruent sounds (sounds may or may not coincide with the visual rule) as well as creating a multimodal (visual and congruent sounds) vs. unimodal (visual or congruent sounds only) display of stimuli. Sounds were played over headphones or loudspeakers. We quantified reaction time (RT) and accuracy (choosing the correct direction to move) by capturing the head movement. We found that in the absence of sounds, RT was slower with headphones compared to loudspeakers, but the introduction of either congruent or incongruent sounds resulted in faster movements with headphones such that RT was no longer different between apparatus. Participants used congruent sounds to improve accuracy but disregarded incongruent sounds. This suggests that selective attention may explain how sounds are incorporated into dynamic balance performance in healthy young adults. Participants leveraged sounds played over loudspeakers, but not over headphones, to enhance accuracy in a unimodal dark environment. This may be explained by the natural listening conditions created by loudspeakers where sounds may be perceived as externalized.

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PURPOSE: To identify factors that influence vocal habits during online meetings (OMs). METHODS: A prospective trial of forty participants without any known hearing or vocal cord disorders. Subjects participated in an OM divided into six randomly ordered sections, with alterations in audio/speaking equipment and language: the computer's speaker-microphone, a single earbud, two-earbuds or headphones; with/without video, native-language-speaking (Hebrew) versus second language-speaking (English). Each section included free speech, sustained phonation, and a standardized passage. Participants ranked their vocal-effort for each section. Three blinded raters independently scored the voice using the GRBAS scale, and acoustic analyses were performed. RESULTS: No significant difference in self-reported vocal effort was demonstrated between sections. Second-language speaking resulted in significantly increased intensity (p < 0.0001), frequency (p = 0.015), GRBAS (p = 0.008), and strain (p < 0.0001) scores. Using the computer's speaker/microphone resulted in significantly higher strain (p < 0.0001). Using headphones, single or two earbuds resulted in lower intensity and a lower strain score. No differences were detected between OMs with or without video. CONCLUSIONS: Using the computer's microphone/speaker or speaking in a second language during OMs, may result in vocal habits associated with vocal trauma.

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Advancements in portable neuroimaging technologies open up new opportunities to gain insight into the neural dynamics and cognitive processes underlying day-to-day behaviors. In this study, we evaluated the relevance of a headphone- mounted electroencephalogram (EEG) system for monitoring mental workload. The participants (N = 12) were instructed to pay attention to auditory alarms presented sporadically while performing the Multi-Attribute Task Battery (MATB) whose difficulty was staged across three conditions to manipulate mental workload. The P300 Event-Related Potentials (ERP) elicited by the presentation of auditory alarms were used as probes of attentional resources available. The amplitude and latency of P300 ERPs were compared across experimental conditions. Our findings indicate that the P300 ERP component can be captured using a headphone-mounted EEG system. Moreover, neural responses to alarm could be used to classify mental workload with high accuracy (over 80%) at a single-trial level. Our analyses indicated that the signal-to-noise ratio acquired by the sponge-based sensors remained stable throughout the recordings. These results highlight the potential of portable neuroimaging technology for the development of neuroassistive applications while underscoring the current limitations and challenges associated with the integration of EEG sensors in everyday-life wearable technologies. Overall, our study contributes to the growing body of research exploring the feasibility and validity of wearable neuroimaging technologies for the study of human cognition and behavior in real-world settings.

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OBJECTIVE: To determine ETSPLs for the Oscilla H210A circumaural audiometric headphones. DESIGN: ETSPL measurements were performed for 11 audiometric frequencies with the ISO 8253-1 (2010) bracketing procedure. STUDY SAMPLE: The study was based on 25 otologically normal test subjects. RESULTS: ETSPLs are provided for an ear simulator according to IEC 60318-1 (2009) along with a detailed measurement uncertainty budget. CONCLUSIONS: ETSPLs for the Oscilla H210A headphones may be used to update ISO 389-8 (2004), the reference ETSPL standard for circumaural audiometric headphones.

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Background: Hearing disability in preschool children can delay or impact oral communication and social skills. Provision of hearing screening tests by standard audiometry in low- to middle-income countries is problematic due to a lack of pediatric audiologists, standard hearing equipment, and standard soundproof rooms. Therefore, an innovative hearing screening tool that is easily accessible and inexpensive such as a mobile app should be considered. Headphones have been a crucial part of hearing screenings. Audiometric headphones, which serve as the reference standard, have been used in most studies. However, since audiometric headphones are not accessible in rural areas, we hypothesized that generic headphones can also be used in hearing screenings. Objective: This study aimed to determine the sensitivity, specificity, κ coefficiency, and time consumption of the PASS-Pro (Preschool Audiometry Screening System-Pro) app when using TDH39 headphones, Beyerdynamic DT 770 PRO headphones, and generic earmuff headphones compared to standard conditioned play audiometry. Methods: We recruited preschool children aged 4 to 5 years to participate in this study. The children received 3 PASS-Pro screening tests using different types of headphones in a quiet room and 1 standard conditioned play audiometry in a soundproof room. All tests were administered in random order. The agreement coefficient, sensitivity, specificity, and mean test duration were determined. Results: A total of 44 children participated in this study. For mild hearing loss screening, the κ coefficients between standard conditioned play audiometry and the PASS-Pro app using TDH39 headphones, Beyerdynamic DT 770 PRO headphones, and generic earmuff headphones were 0.195, 0.290, and 0.261 (P=.02, P=.002, and P=.004), respectively. The sensitivity for all headphones was 50% and the specificity was more than 88%. For moderate hearing loss screening, the κ coefficients were 0.206, 0.272, and 0.235 (all Ps=.001), respectively. The sensitivity for all headphones was 100% and the specificity was more than 92%. There were no statistical differences in sensitivity and specificity between the reference headphone (TDH39), Beyerdynamic DT 770 PRO headphone, and generic earmuff headphones (all Ps >.05). The PASS-Pro app used significantly less time to carry out hearing tests than conditioned play audiometry (P<.001). Conclusions: The PASS-Pro app, used with generic headphones, is effective for conducting hearing screening tests in preschool children with high sensitivity and specificity.

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OBJECTIVE: To examine risky leisure noise exposure from listening to music via headphones and to identify potential determinants with special focus on portable listening devices (PLDs) among adolescents over a period of 7.5-years. DESIGN: Data were collected by questionnaires at four equidistant time points (O1-O4). Music exposure via headphones was calculated based on self-reported volume setting and listening duration. Exceeding 85 dB(A) equivalent for a 40-hour working week was defined as risky noise exposure. Determinants of risky headphone and PLD exposure were investigated using generalised estimating equations and accounting for missing data by multiple imputation. STUDY SAMPLE: Closed cohort of 2148 students attending 9th grade of any secondary school type in Regensburg (Germany), during 2009 to 2011. RESULTS: Risky noise exposure from headphone usage was almost twice as high in wave O1 and O2 (at age 15 or 18) compared with 20-23-year-olds in O3 and O4. Risky exposure to headphones and PLDs were associated with younger age, low and medium education, single-parent household and smoking, whereas good self-rated hearing showed a protective effect. Additionally, not being born in Germany was associated with risky PLD exposure. CONCLUSION: Before harmful behaviours become entrenched, starting preventive efforts at a young age is essential.

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OBJECTIVES: The aim of the present study was to determine whether the use of headphones to eliminate audible static during Doppler ultrasonic sphygmomanometry affects blood pressure (BP) measurement in conscious young adult (aged 1-6 years) and mature adult/senior (aged ⩾7 years) cats. METHODS: A randomized crossover study was conducted. Healthy client-owned cats (>1 year) were enrolled. Blood pressure measurements were obtained twice, 14 days apart, with or without the use of headphones worn by a veterinarian. A fear, anxiety and stress (FAS) score (0 = relaxed; 4 = severe signs) was recorded. A linear mixed-effects model was used to compare the effect of wearing headphones on BP measurement. RESULTS: In total, 18 young adult and 14 mature adult and senior cats with a median age of 5 years (range 1-14 years) were enrolled. Of the cats, 47% (15/32) had an average BP measurement that was at least 10 mmHg higher when using headphones compared with when not using headphones, of which a majority (11/15, 73%) were young adult cats. The average BP measurement was not different when using headphones compared with when not using headphones (mean difference -7 mmHg; 95% confidence interval -14 to 0.6; P = 0.07). When compared within age groups, the average BP measurement taken when using headphones (125 ± 15 mmHg) was lower compared with the measurement taken when not using headphones (137 ± 17 mmHg) in young adult cats (P = 0.02). CONCLUSIONS AND RELEVANCE: The reduction in the average BP measurement with the use of headphones suggests this method may be helpful in reducing situational hypertension, particularly in young adult cats. Our findings also highlight the importance of consistent use of headphones when comparing serial measurements in a cat.

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According to the World Health Organization (WHO), around 55 million people worldwide have dementia, and Alzheimer's Disease International (2019) estimates that by 2050 this number is expected to rise to 152 million. With no available cure (WHO, 2021), non-pharmacological interventions have become a popular alternative in the treatment of the cognitive, behavioral, and psychological symptoms of dementia (Dementia Australia, 2020). A widely adopted option that come in different forms is music interventions and while the basic means remains music, some choose a more personalized approach and even less deliver music through over-ear headphones. A number of studies regarding the latter approach report positive outcomes; however, solid evidence on its benefits is scarce.The aim of this literature review was to locate the organizations and initiatives around the world that use the specific approach, explore the different methodologies, search for existing evidence on the interventions' efficacy and the symptoms they address, and look for any ongoing research on the subject. Furthermore, we aimed at investigating if there are any relevant initiatives in Greece.We systematically searched 16 databases and from 276 eligible records, we located 18 relevant studies that met our inclusion criteria and 1 literature review on music interventions for people with dementia. Our examination and analysis of those studies suggested that music interventions utilizing personalized music playlists and headphones result in positive outcomes, including mood improvement and a significant decrease of behavioral and psychological symptoms of dementia. However, our analysis also pointed the need for further and more focused research.

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Background and Aims: This study aimed to determine the effects of music and active noise cancellation on intraoperative anxiety in patients undergoing lower limb surgeries under spinal anaesthesia. Methods: After obtaining ethical approval, this randomised controlled study was conducted in adult patients (18-50 years of age) of either gender. Patients were randomly allocated to binaural beat music (Group A), noise cancellation (Group B) or no headphones (Group C) group (n = 36 in each group). State-Trait Anxiety Inventory-6 (STAI-6) score and Visual Analogue Score for Satisfaction (VAS-S) were noted preoperatively and at the end of surgery. In addition, Ramsay sedation scores and Likert communication difficulty scores were noted at 30 min intraoperatively. Haemodynamic parameters were noted preoperatively and at different intervals intraoperatively till the end of the surgery. Results: There was a significant decrease in anxiety scores in Group A, Group B and Group C with postoperative STAI-6 scores (mean ± standard deviation) of 7.8 ± 1.7, 11.7 ± 4.2 and 14.7 ± 5.3, respectively. The difference was significant in Groups A and B compared to Group C (P < 0.001). Patient satisfaction scores in Groups A and B were better than in Group C (7.3 ± 1.7 and 6.2 ± 1.6 vs. 5.2 ± 1.3, respectively). Sedation scores and communication difficulty was significantly better in Groups A and B compared to Group C. Systolic blood pressure was significantly better intra- and postoperatively. There were no significant differences in other haemodynamic parameters on most occasions. Conclusion: Music and noise-cancellation headphones can reduce anxiety and improve satisfaction and sedation scores in patients undergoing spinal anaesthesia.

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Encoding and processing sensory information is key to understanding the environment and to guiding behavior accordingly. Characterizing the behavioral and neural correlates of these processes requires the experimenter to have a high degree of control over stimuli presentation. For auditory stimulation in animals with relatively large heads, this can be accomplished by using headphones. However, it has proven more challenging in smaller species, such as rats and mice, and has been only partially solved using closed-field speakers in anesthetized or head-restrained preparations. To overcome the limitations of such preparations and to deliver sound with high precision to freely moving animals, we have developed a set of miniature headphones for rats. The headphones consist of a small, skull-implantable base attached with magnets to a fully adjustable structure that holds the speakers and keeps them in the same position with respect to the ears.

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Background and Objectives: Noise exposure during total knee arthroplasty (TKA) has been demonstrated to exceed thresholds that are deemed as over-exposure by industry noise level standards. With orthopedic surgeons being at risk of suffering from Noise Induced Hearing Loss, the purpose of this pilot study was to evaluate the viability of the use of industry grade active noise cancelling headphones (ANCH) during TKA. Material and Methods: In this prospective pilot study, 10 TKA were performed. In five of these cases, surgeon, assistant, scrub nurse and anesthetist wore ANCH with automatic noise level dependent noise attenuation above 82 dB. A validated 14-item questionnaire was used after each case to evaluate the quality of communication, performance, teamwork and mental load. In seven cases a calibrated sound level meter was used to measure the operating theatre noise. Peak sound level (LApeak), A-weighted continuous sound level (LAeq) and A-weighted noise exposure averaged for an 8-h time-period (LEPd) were calculated. Results: There was no perceived benefit of ANCH for the surgeons (p = 0.648), assistants (p = 0.908) and scrub nurses (p = 0.251). There was an overall improvement observed by anesthetists (p = 0.001). A worse communication while wearing ANCH was reported by surgeons but not by the rest of the team. Average LApeak was 90.6 ± 3.2 dB(C), LAeq was 61.9 ± 1.0 dB(A) and LEPd was 53.2 ± 1.2 dB(A). Conclusions: Industry grade ANCH seem to provide no benefit for surgeons, assistants and scrub nurses during TKA, while anesthesiologists seem to benefit from the use of ANCH during TKA. Due to the limitations of this pilot study, further studies with larger study populations are necessary to adequately investigate the use of ANCH during TKA.

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AIM: Cancer remains a disease with a significant impact on morbidity and mortality but also on quality of life. This prospective randomized pilot study investigated the effects of a sound intervention on physical and emotional well-being in outpatients with cancer. METHODS: Two self-applied sound interventions were used for this purpose, either active "music playing" with a body monochord or passive sound intervention with headphones to listen to a given music compilation. Interventions were carried out over a period of 4 weeks for at least 15 min in the evening before bedtime. The following self-assessment questionnaires were completed both at baseline and after 4 weeks to evaluate the response: the Pittsburgh Sleep Quality Index (PSQI), the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30), Visual Analogue Scale (VAS) for pain and fatigue, and the Fear of Progression (FoP) questionnaire. Primary endpoint of this exploratory trial was to describe the rate of patients with improvement in at least one dimension without worsening of any other. RESULTS: 73 patients (29 male, 44 female) were included in the study and randomized to either active (n = 34, 47%) or passive sound intervention (n = 39, 53%). Median age was 52.0 years (range 21-79). Fourteen patients (19%) stated that they were musically active. The sound intervention was carried out on a median of 26 days (range 5-28). A higher percentage of patients in the passive group reached the primary endpoint: n = 15 (39%) versus n = 9 (27%). Response differences in favour of the passive group were seen with the VAS fatigue and with QLQ-30 questionnaires. Overall, an improvement in QLQ-30 questionnaire was seen in 12 patients (31%) in the passive group versus 3 patients (9%). Moreover, sound intervention significantly improved social functioning and shortness of breath in the passive group according to QLQ-C30. Significant improvements were also noticed in the passive group in terms of affective reactions as a domain of the FoP questionnaire. No effects on pain or sleep quality could be observed. CONCLUSION: A 4-week self-administered sound intervention was feasible in outpatients suffering from cancer. Using a panel of 5 questionnaires, passive sound interventions appeared to be more likely to positively influence patient-reported outcomes. In particular, a positive impact was documented in social functioning and fatigue.

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OBJECTIVE: User-operated audiometry faces multiple barriers. One of these is the concern of audiologists that patients (non-experts) placing headphones by themselves results in invalid hearing thresholds due to greater placement variability. DESIGN: Comparative study. Participants took the AMTAS pure-tone air-conduction audiometry under two different conditions, expert and non-expert circumaural headphone placement for five frequencies within the range 250-8000 Hz. Questionnaires were also used to gain insight into the usability of the user-operated audiometry system - as well as the participants' perceived handling of the audiometry headphones. STUDY SAMPLE: Thirty participants (mean age 67.5 years). RESULTS: No statistically significant mean differences in hearing thresholds between the expert and non-expert conditions were found. The mean system usability scale score was 84.5. Handling the headphones was also rated as being easy (30%) or very easy (60%) by most non-experts. CONCLUSION: The conclusion of the study is that non-experts can be trusted to properly equip a pair of circumaural audiometry headphones for the correct conduction of pure-tone audiometry with only a few digital instructions.

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The explosion of headphones is a rare incident, not reported in the literature, and is responsible for serious burns involving functional and aesthetic consequences with a major psychological impact. We report here the case of a young boy in order to raise awareness in the population and draw attention to these risks.

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Perpetuated exposure to higher decibels is one of the leading causes of noise-induced hearing loss (NIHL). The occurrence of NIHL has likewise been expanding in kids and adolescents. NIHL in youngsters and adolescents is connected with personal music players, which need earphones or headphones, and have powerful sound tones. The effects of such leisure activities and their relation to NIHL remains poorly studied. Various studies have been conducted to establish the degree of correlation between audio device usage and hearing disablement; recent studies show more agreeable data about the same. Therefore, the use of earphones and their effects on hearing needs to be well assessed, considering the high prevalence of the problem and the relative lack of literature for the same. The intent of the following review is to gather information regarding the manifestations of impairment in hearing due to audio devices with the objective to assess the correlation between hearing impairment and the use of audio devices. Also, guidelines established by Central Pollution Control Board regarding noise pollution need to be revised as per the present-day setting. The implementation of these guidelines is the responsibility of the companies that design and produce different types of audio devices. These devices should be made ear-safe according to standard safety guidelines related to hearing impairment from loud noise. This review has taken into consideration 23 authentic studies from all around the globe that state a positive or negative result after studying the correlation between NIHL and long-term noise exposure. The findings of this narrative review indicate that leisure activities involving the use of audio devices pose a risk of NIHL, and a need for further research in this domain is seen, given the ubiquitous and ever-increasing nature of their consumption.