Objective: This article presents a comprehensive literature review of past works addressing Hearing Protection Devices (HPD) comfort and to put them into perspective regarding a proposed holistic multidimensional construct of HPD comfort.Design: Literature review.Study samples: Documents were hand searched and Internet searched using "PubMed", "Web of Science", "Google Scholar", "ProQuest Dissertations and Theses Professional", "Scopus" or "Google" search engines. While comfort constructs and measurement methods are reviewed for both earplugs and earmuff types, results and analyses are provided for the earplug type only.Results: This article proposed a multidimensional construct of HPD comfort based on four dimensions: physical, functional, acoustical and psychological. Seen through the prism of the proposed holistic construct of HPD comfort, the main comfort attributes of earplugs have been identified for each comfort dimension.Conclusions: The observed lack of consensus on the definition of HPD comfort in the scientific community makes it difficult to prioritise the importance of comfort attributes yet necessary for future design of comfortable earplugs.

Objective: This paper proposes a comprehensive literature review of past works addressing Hearing Protection Devices (HPDs) comfort with the aim of identifying the main sources of variability in comfort evaluation. Design: Literature review. Study samples: Documents were hand searched and Internet searched using ‘PubMed’, ‘Web of Science’, ‘Google Scholar’, ‘ProQuest Dissertations and Theses Professional’, ‘Scopus’ or ‘Google’ search engines. While comfort constructs and measurement methods are reviewed for both earplugs and earmuff HPD types, results and analyses are provided for earplugs only. Results: The literature shows that the multiple sources of the perceived comfort measurement variability are related to the complexity of the concept of comfort and to the various physical and psychosocial characteristics of the triad ‘Environment/Person/Earplug’ which differ from one study to the other. Conclusions: Considering the current state of knowledge and in order to decrease comfort measurements variability, it is advised to (i) use a multidimensional construct of comfort and derive a comfort index for each comfort dimensions, (ii) use exhaustive and valid questionnaires, (iii) quantify as much as triad characteristics as possible and use them as independent or control variables, and (iv) assess the quality of the earplug fitting and the attenuation efficiency.

Offering hearing protection devices (HPDs) to workers exposed to hazardous noise is a noise control strategy often used to prevent noise-induced hearing loss (NIHL). However, HPDs are used incorrectly and inconsistently, which explains their limited efficiency. Numerous models based on social cognition theories identify the significant factors associated with inconsistent HPD use and aim to improve HPD training programs and to increase HPD use. However, these models do not detail (dis)comfort aspects originating from complex interactions between characteristics of the triad “environment/person/HPD” while these aspects are known to largely influence HPD (mis)use. This paper proposes a holistic model explaining HPD (mis)use, based on the integration of a comfort model adapted to HPDs into an existing behavioral model already developed for HPDs. The model also takes into account the temporal dimension, which makes it possible to capture the scope of change in HPD-related health behaviors. This holistic description of HPD use could be used as a tool for stakeholders involved in HPD use to effectively prevent NIHL among workers.

The occlusion effect (OE) occurs when the earcanal becomes occluded by an in-ear device, sometimes leading to discomforts experienced by the users due to the augmented perception of physiological noises, or to a distorted perception of one's own voice. The OE can be assessed objectively by measuring the amplification of the low-frequency sound pressure level (SPL) in the earcanal using in-ear microphones. However, as revealed by methodological discrepancies found in past studies, the measurement of this objective occlusion effect (OEobj) is not standardized. With the goal of proposing a robust yet simple methodology adapted for field assessment, three experimental aspects are investigated: (i) stimulation source and the stimulus's characteristics to induce the phenomenon, (ii) measurement method of the SPL in earcanal, (iii) indicator to quantify the OEobj. To do so, OEobj is measured on human participants in laboratory conditions. Results obtained with a specific insert device suggest using the participant's own voice combined with simultaneous measurements of the SPLs based on the noise reduction method and using a single value indicator leads to a simple yet robust methodology to assess OEobj. Further research is necessary to validate the results with other devices and to generalize the methodology for field assessment.

Earplugs are a common form of protection for workers exposed to hazardous noise levels. Their comfort directly impacts the effective protection by influencing their consistent and correct use. Nevertheless, comfort definition may vary according to the studies. Thus, a previous review of the literature has shown that to improve our understanding of perceived comfort and to reduce measurement variability, it is advisable to consider comfort through a multidimensional construct (physical, acoustical, functional and psychological). On this basis, the COPROD (COnfort des PROtections auDitives/COmfort of hearing PROtection Devices) questionnaire was developed. It is intended for people working in noisy environments. Nine earplug models were evaluated by 118 participants over a six-week period. This paper presents the successive analyses that were used to validate the structure of the questionnaire and confirm the relevance of the proposed dimensions and of the addressed items. First results suggest a preference for custom moulded earplugs. Practitioner Summary: Earplugs comfort conditions the hearing protection of the users. As the definition of comfort can vary between studies, the COPROD questionnaire was developed to jointly evaluate all its dimensions. Nine earplugs models were evaluated by 118 participants during six weeks. This paper presents the validation process of the questionnaire. Abbreviations: COPROD: COnfort des PROtections auDitives/COmfort of hearing PROtection Devices; HPD: hearing protection devices; SEM: structural equation modeling; CFA: confirmatory factor analysis; GOF: goodness of fit; RMSEA: root mean square error of approximation; CFI: comparison fit index; SRMR: standardised root mean square residual