Tinnitus among Serbian secondary school students in relation to their behavior and habits Zoran Marmut1, Goran Belojevic1, Dusan Backovic1, Jelena Ilic Zivojinovic1, Milena Tomanic1, Ema Hadzic2 Institute of Hygiene and Medical Ecology, Faculty of Medicine, 2Student of the Faculty of Medicine, University of Belgrade, Belgrade, Serbia

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Abstract Although tinnitus is a very common symptom, risk factors related to behavior and habits have not been sufficiently investigated. As no investigation on this problem has been performed in Serbia, the aim of our study was to establish the prevalence of tinnitus among Serbian adolescents and to investigate the relationship between their behavior and habits and tinnitus. This investigation was designed as a cross-sectional interview study among secondary school students in Belgrade, Serbia (277 boys and 494 girls). An anonymous questionnaire was selfadministered at classes. The investigated variables were: The presence of tinnitus, sources of noise, night outs at noisy places, use of personal music players, smoking, second hand smoke (SHS), substance abuse, coffee and alcohol consumption. Spearman’s rank-order correlations and multiple logistic regressions were performed with variables related to behavior and habits as independent ones and tinnitus as a dichotomized dependent variable. Tinnitus was reported by 99 students (12.8%), more frequently among girls compared with boys (P = 0.009). Multivariate logistic regression analysis in boys revealed a significant independent effect of a regular drug abuse on the onset of tinnitus. The chances of tinnitus were 13 times higher among drug addicts compared with nondrug users (odds ratio [OR] and 95% confidence interval [CI] for tinnitus = 13.072; 1.335-127.946). In girls, the significant independent effect on tinnitus was found for daily duration of exposure to SHS (OR and 95% CI for tinnitus = 1.328; 1.073-1.644 /per 2 hours of exposure/). Keywords: Adolescent, drug abuse, noise, second hand smoke, smoking, tinnitus

Introduction Tinnitus is the perception of sound or noise in the absence of an external or internal sound source. It is a common complaint, which is mainly resistant to treatment.[1,2] About 10-15% of the adult population is affected by tinnitus.[3] There are about 50 million US adults reported having any tinnitus and 16 million US adults reported having frequent tinnitus in the previous year.[4] In a large cross-sectional study in the United States tinnitus was reported by 7.5% of 3520 individuals aged 12-19 years.[5] About 1-2% of the general population experience significant impairments in their quality-of-life due to tinnitus.[6] The National Study of Hearing in England showed that the prevalence of tinnitus Access this article online Quick Response Code:

Website: www.noiseandhealth.org DOI: 10.4103/1463-1741.132080 PubMed ID: ***

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among adults was 10.1% and in 0.5% of respondents tinnitus severely affected the ability to lead a normal life.[7] There are different perceptions and many degrees of distress among people who experience tinnitus. For someone, it can be just a simple awareness, but it can also be so loud that a person has difficulty in hearing. Severe tinnitus can provoke heterogeneity of psychological symptoms like tension, frustration, impaired concentration, depression and disrupted sleep.[8,9] The studies show that the odds ratio of tinnitus is raised by about 3%, with each year of age and that there is a higher risk of tinnitus for men compared with women.[10] Etiology of tinnitus is diverse and it includes: hearing loss caused by: Infection, loud noise, cerumen impaction, presbycusis, mercury or lead poisoning, Ménière’s disease, lyme disease, ototoxic drugs (aspirin, non-steroidal antiinflammatory drugs, antibiotics, diuretics, antidepressants, biostatics); depression and anxiety, multiple sclerosis, head injury, iron deficiency anemia, hypercholesteremia, thyroid disease, vitamin B12 deficiency, migraine, benzodiazepine withdrawal, nasal congestion, hypertension and head or neck tumors.[11] Noise & Health, March-April 2014, Volume 16:69, 73-78

Marmut, et al.: Tinnitus and behavior and habits

Although tinnitus is a very common symptom, just a few risk factors related to behavior and habits have been proved.

average age of participants was 17.6 ± 1.1 years, ranging from 14 to 20 years.

The prevalence of tinnitus may increase as a consequence of exposure to environmental factors, for example exposure to loud noise during leisure time activities and especially in young people. Even 17% of teens may have hearing problems probably due to non-professional noise exposure; it is so called socioacusis.[12] It has been estimated that 85% of tinnitus cases are accompanied by hearing loss and that occupational and leisure noise are the major factors causing cochlear damage.[13] The most of young adults are mainly exposed to excessively loud music from personal music players (PMP) and during attendance at music concerts and nightclubs.[14]

Investigation instrument

Smoking and second hand smoke (SHS) are of great public health concern and these factors have also been related to tinnitus in two recent investigations. In a study on adult smokers from both genders between 20 and 31 years of age, there were more cases of cochlear dysfunction and tinnitus than in non-smokers.[15] In a recent US study on subjects aged 12-19 years, a multivariable-adjusted analysis revealed that tinnitus was associated with passive smoking and female gender.[5] The association between use of various illicit drugs and hearing impairment or damage was described in several clinical and epidemiological studies.[16-20] Sudden sensorineural hearing loss, presumably of cochlear origin, may be a rare complication of incident drug abuse,[21,22] whereas chronic tinnitus is connected with the duration of inhalant and hallucinogen drug dependence.[20] Alcohol consumption among adolescents may also be associated with tinnitus.[23] In general, there is a lack of studies on behavior and habits and tinnitus. Of special public health concern are recently published two studies, mentioning the relation of smoking and SHS to tinnitus.[15,5] Investigations on this problem from different world regions are needed to re-evaluate the obtained results from previous studies. The aim of this first study of a kind in Serbia is to establish the prevalence of tinnitus among Serbian adolescents and the relationship between their behavior and habits and tinnitus.

Methods Participants This cross-sectional study was conducted in two secondary schools in Belgrade: 13th Gymnasium and Chemical School, during 2005. The sample encountered students from all four classes. The sample consisted of a total of 771 students, 277 boys (35.9%) and 494 girls (64.1%). The response rate was 92% (771 out of 835 distributed questionnaires). An Noise & Health, March-April 2014, Volume 16

A questionnaire with closed questions was used as an investigation instrument. The investigated variables were: Gender, age, major sources of noise in the environment (traffic, construction works, industrial facilities, neighborhood, elevator and installations in the house), five graded verbal noise annoyance scale (“Thinking about the last 12 months, how much does noise bother you, annoys you or disturbs you at home; not at all = 0; a little = 1; moderately = 2; very much = 3; extremely = 4), time of the day when most disturbed by noise (day; night; day and night), night outs at noisy places (never or less than once a month = 0; 1-3 times a month = 1; 1-3 times a week = 2; 4-6 times a week = 3; every day = 4), average duration of stay at noisy places (hours), use of PMP (never or less than once a month = 0; 1-3 times a month = 1; 1-3 times a week = 2; 4-6 times a week = 3; every day = 4) (average daily use in hours) (“How do you usually adjust volume when using PMP? — “low”; “medium”; “high”), the presence of tinnitus (“Do you feel occasional or permanent buzzing or ringing in your ears?”), smoking (smoker; ex-smoker, no) (for smokers — duration/years/ — 1-5; 6-10; 11-15; 16-20; more than 20; number of cigarettes daily - 1-5; 6-10; 11-15; 16-20; more than 20, exposure to SHS (“Are there any smokers at your home”, “What is the average daily time you spend indoors with environmental tobacco smoke — never = 0; 1-2 h = 1; 2-4 h = 2; more than 4 h = 3; coffee consumption (never = 0; rarely = 1; 1-4 cups daily = 2; more than 4 cups daily = 3; and alcohol consumption (never = 1; occasionally without getting drunk = 2; every day without getting drunk = 3; occasionally getting drunk = 4; every day getting drunk = 5; and substance abuse (“Have you ever tried any illicit drug”, “If yes, which one?” “If yes do you still use it ?”). Procedure An anonymous questionnaire was self-administered at classes on 1 day. Analysis In descriptive statistics, we used percentage calculation. Student’s t-test was used to compare means of variables in independent samples (gender) and Chi-square test was used to test differences between categorical variables in relation to gender. Spearman’s rank-order correlations and multiple logistic regressions were performed with variables related to behavior and habits as independent ones and tinnitus as a dichotomized dependent variable. We hypothesized a significant moderating role of gender in behavior-habitstinnitus relation. 74

Marmut, et al.: Tinnitus and behavior and habits

Results

Discussion

Tinnitus was reported by 99 students (12.8%) and was more frequently present among girls compared with boys (75/15.2% and 24/8.7%, respectively; Pearson Chi-square = 6.84, P = 0.009).

We found tinnitus in 13% of adolescents in Belgrade and more frequently present among girls compared with boys. We show that the exposure to SHS and daily duration of it,

Behavioral and habits factors of students in relation to gender are presented in Table 1. Active smoking was reported by every ninth student and was similarly distributed among boys and girls. However, boys smokers smoked longer compared to girls (mean ± standard deviation, 1.3 ± 1.0 and 1.0 ± 0.3 years, respectively; P = 0.029) with a higher daily number of smoked cigarettes (3.5 ± 1.3 and 2.6 ± 1.3, respectively; P = 0.003). Exposure to SHS was reported by every second student and was more frequently present among girls, compared to boys. Drinking more than four cups of coffee was reported by about 2% of students and was more frequent among boys, in comparison to girls. Occasional and regular drinking with getting drunk was reported by 23% students and was more frequent among boys, compared to girls. Experience with drugs was reported by every 12th student and was more present among boys, compared with girls. Regular drug abuse was reported by 2% of students and was similarly distributed among boys and girls. The drugs regularly used were marijuana (65%), heroin or cocaine (20%) and “ecstasy” (15%). There were more boys with four and more night outs per week, in comparison with girls. The average time spent in night outs was 4.1 h and was similar in boys and girls. About 89% of students used PMP and it was more frequent among girls. There were 65% of students who listened to PMP every day for 2.4 h on average and about 50% of them regularly chose the maximum volume and these habits were similar in boys and girls. Using bivariate Spearman’s correlation analysis in boys we found a positive significant relation of tinnitus with smoking, exposure to SHS and daily duration of exposure to SHS, alcohol and coffee consumption and regular drug abuse. In girls, a negative significant relation of tinnitus was found with age while positive significant relation was found with daily time spent indoors with environmental tobacco smoke [Tables 2 and 3]. Multivariate logistic regression analysis in boys revealed a significant independent effect of a regular drug abuse on the onset of tinnitus [Table 4]. The chances of tinnitus were about 13 times higher among drug addicts in comparison with non-drug users. In girls, the significant independent effect on tinnitus was found for daily duration of exposure to SHS [Table 5]. 75

Table 1: Demographic characteristics and behavioral patterns of students Variable

Boys Girls (n = 277) (n = 494) 17.63±1.12 16.58±1.13

Total P (n = 771) 17.60±1.12 0.507*

Age (years; mean±SD) Night outs (n [%]) Never or rarely 52 (18.9) 98 (20.1) 150 (19.7)

Tinnitus among Serbian secondary school students in relation to their behavior and habits.

Although tinnitus is a very common symptom, risk factors related to behavior and habits have not been sufficiently investigated. As no investigation o...
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