Current notions of “hearing impairment,” as reflected in clinical audiological practice, do not acknowledge the needs of individuals who have normal hearing pure tone sensitivity but who experience auditory processing difficulties in everyday life that are indexed by reduced performance in other more sophisticated audiometric tests such as speech audiometry in noise or complex non-speech sound perception. This disorder, defined as “Auditory Processing Disorder” (APD) or “Central Auditory Processing Disorder” is classified in the current tenth version of the International Classification of diseases as H93.25 and in the forthcoming beta eleventh version. APDs may have detrimental effects on the affected individual, with low esteem, anxiety, and depression, and symptoms may remain into adulthood. These disorders may interfere with learning per se and with communication, social, emotional, and academic-work aspects of life. The objective of the present paper is to define a baseline European APD consensus formulated by experienced clinicians and researchers in this specific field of human auditory science. A secondary aim is to identify issues that future research needs to address in order to further clarify the nature of APD and thus assist in optimum diagnosis and evidence-based management. This European consensus presents the main symptoms, conditions, and specific medical history elements that should lead to auditory processing evaluation. Consensus on definition of the disorder, optimum diagnostic pathway, and appropriate management are highlighted alongside a perspective on future research focus.

Objective: To investigate the association between long term residential exposure to road traffic and railway noise and risk of incident dementia. Design: Nationwide prospective register based cohort study. Setting: Denmark. Participants: 1 938 994 adults aged ≥60 years living in Denmark between 1 January 2004 and 31 December 2017. Main outcome measures: Incident cases of all cause dementia and dementia subtypes (Alzheimer’s disease, vascular dementia, and Parkinson’s disease related dementia), identified from national hospital and prescription registries. Results: The study population included 103 500 participants with incident dementia, and of those, 31 219 received a diagnosis of Alzheimer’s disease, 8664 of vascular dementia, and 2192 of Parkinson’s disease related dementia. Using Cox regression models, 10 year mean exposure to road traffic and railway noise at the most (L _den max) and least (L _den min) exposed façades of buildings were associated with a higher risk of all cause dementia. These associations showed a general pattern of higher hazard ratios with higher noise exposure, but with a levelling off or even small declines in risk at higher noise levels. In subtype analyses, both road traffic noise and railway noise were associated with a higher risk of Alzheimer’s disease, with hazard ratios of 1.16 (95% confidence interval 1.11 to 1.22) for road L _den max ≥65 dB compared with <45 dB, 1.27 (1.22 to 1.34) for road L _den min ≥55 dB compared with <40 dB, 1.16 (1.10 to 1.23) for railway L _den max ≥60 dB compared with <40 dB, and 1.24 (1.17 to 1.30) for railway L _den min ≥50 dB compared with <40 dB. Road traffic, but not railway, noise was associated with an increased risk of vascular dementia. Results indicated associations between road traffic L _den min and Parkinson’s disease related dementia. Conclusions: This nationwide cohort study found transportation noise to be associated with a higher risk of all cause dementia and dementia subtypes, especially Alzheimer’s disease.

Background: Assessment of sound exposure by noise dosimetry can be challenging especially when measuring the exposure of classical orchestra musicians where sound originate from many different instruments. A new measurement method of bilateral sound exposure of classical musicians was developed and used to characterize sound exposure of the left and right ear simultaneously in two different symphony orchestras. Objectives: To measure binaural sound exposure of professional classical musicians and to identify possible exposure risk factors of specific musicians. Methods: Sound exposure was measured with microphones mounted on the musician’s ears and recorded digitally. The recorded sound was analysed and the specific sound exposure of the left and the right ear was determined for the musicians. A total of 114 measurements covering 106 h were recorded in two symphony orchestras. Results: Sound exposure depends significantly on the specific instrument and the repertoire played by the exposed musician. Concerts, group rehearsals and individual practice were all significant contributors to the sound exposure. The highest L_Aeq of 86 –98 dB was found among the brass players. High string players were exposed from 82 to 98 dBA and their left ear was exposed 4.6 dB more than the right ear. Percussionists were exposed to high sound peaks >115 dBC but less continuous sound exposure was observed in this group. Musicians were exposed up to L_Aeq8h of 92 dB and a majority of musicians were exposed to sound levels exceeding L_Aeq8h of 85 dB. Conclusions: Binaural recording of the individual sound exposure showed that orchestra musicians could be exposed differently to the left and right ear and that they were primarily exposed from their own instruments. Specific repertoires as well as the specific instrument determine the level of exposure.

Objectives: The objectives of this study were to: (1) estimate the hearing status of classical symphony orchestra musicians and (2) investigate the hypothesis that occupational sound exposure of symphony orchestra musicians leads to elevated hearing thresholds. Design: The study population comprised all the musicians from five symphony orchestras. Questionnaires were filled in by 337 subjects, and 212 subjects performed an audiometric test. For a group of 182 musicians (363 ears) the results of the audiometry was analyzed in relation to the individual exposure, which was estimated on the basis of sound measurements and questionnaire data regarding the exposure time. The mean hearing threshold at the frequencies 3, 4, and 6 kHz, corrected for age and sex, was used as outcome. Results: The musician ears with the highest exposure (29 of 363) had an additional threshold shift of 6.3 dB compared with the 238 ears with lowest exposure. The observed hearing loss of musicians was smaller compared with the noise-induced permanent threshold shift (NIPTS) predicted from ISO1999. A remaining confounding effect of age after ISO7029 age corrections could be observed to explain the difference in observed and predicted NIPTS. However, the observed hearing loss difference between the left and the right ear of musicians was 2.5 dB (95% confidence interval 1.5–3.6), which was similar to the NIPTS predicted from ISO1999. Most of the musicians had better hearing at 3, 4, and 6 kHz for age than expected, however, 29 ears with the highest exposure above 90.4 dBA with a mean exposure time of 41.7 years had significantly elevated hearing thresholds. Trumpet players and the left ear of first violinists had significantly elevated hearing thresholds compared with other musicians. Conclusion: Most of the symphony orchestra musicians had better hearing than expected but they had a work-related risk of developing additional noise-induced hearing loss. The additional NITPS of the left ear compared with the right ear was at the expected level based on the cumulated sound exposure and ISO1999, indicating that performing music may induce hearing loss to the same extent as industrial noise.

To create a user-operated pure-tone audiometry method based on the method of maximum likelihood (MML) and the two-alternative forced-choice (2AFC) paradigm with high test-retest reliability without the need of an external operator and with minimal influence of subjects' fluctuating response criteria. User-operated audiometry was developed as an alternative to traditional audiometry for research purposes among musicians. Test-retest reliability of the user-operated audiometry system was evaluated and the user-operated audiometry system was compared with traditional audiometry. Test-retest reliability of user-operated 2AFC audiometry was tested with 38 naïve listeners. User-operated 2AFC audiometry was compared to traditional audiometry in 41 subjects. The repeatability of user-operated 2AFC audiometry was comparable to traditional audiometry with standard deviation of differences from 3.9 dB to 5.2 dB in the frequency range of 250-8000 Hz. User-operated 2AFC audiometry gave thresholds 1-2 dB lower at most frequencies compared to traditional audiometry. User-operated 2AFC audiometry does not require specific operating skills and the repeatability is acceptable and similar to traditional audiometry. User operated 2AFC audiometry is a reliable alternative to traditional audiometry.