ORLI 2021 Volume 51 No.

2: 88-95 The correlation between earphone usage patterns

Research

The correlation between earphone usage patterns with

the incidence rate and severity of tinnitus

Adrian Joshua Velaro, Devira Zahara

Department of Otorhinolaryngology-Head and Neck Surgery
Faculty of Medicine Universitas Sumatera Utara/H.Adam Malik General Hospital, Medan

ABSTRACT
Background: Earphone nowadays is extensively used along with audiovisual technology
development. The increased use of earphone can lead to tinnitus. Around 10- 20% of the adult population
had experienced tinnitus during their life, and 0.5-2.5% affected their quality of life. Tinnitus in medical
students could interfere in the teaching process which could can lead to decreased quality of medical
students. Objective: To observe the correlation between the pattern of using earphone with the incidence
of tinnitus, and to determine the severity of tinnitus among students of the Faculty of Medicine, Universitas
Sumatera Utara, class 2017-2019 who used earphones. Method: This was an analytic study with cross-
sectional design, using consecutive sampling technique. Result: Bivariate analysis between earphone
use patterns and the incidence of tinnitus among the subjects obtained statistically significant results
(p=0.017). Univariate analysis on 148 respondents showed a pattern of risky earphone use (64.2%) and
52 people with tinnitus (35.1%), and tinnitus severity with 52 participants based on Visual Analogue
Scale was mild (55.8%) and based on Tinnitus Handicap Inventory Questionnaire was light (53.9%). In
the pattern of earphone use, the results of the analysis of the frequency of using earphones for 3-4 days
were (40.5%), the volume of earphone use was 60-80% (54.1%), the length of time using earphones
>3 years was (65.5%), and the duration of using earphones <1 hour (38.5%). Conclusion: There was
a correlation between the pattern of earphone use and the incidence of tinnitus among students at the
Faculty of Medicine, Universitas Sumatera Utara, class 2017-2019.

Keywords: earphone, tinnitus, Visual Analog Scale, Tinnitus Handicap Inventory Questionnaire

ABSTRAK
Latar belakang: Earphone saat ini sangat banyak digunakan seiring dengan perkembangan
teknologi audiovisual. Prevalensi pengguna earphone pada remaja sekitar 83,6% dari 436 remaja.
Penggunaan earphone yang berlebihan dapat menyebabkan tinitus. Statistik prevalensi dunia
menunjukkan 30-40% populasi dewasa pernah mengalami tinnitus dalam hidupnya dan 0,5-2,5%
kualitas hidupnya sangat terganggu oleh tinitus. Tinitus merupakan salah satu tanda penurunan
fungsi pendengaran dan mampu menyebabkan penurunan performa kognitif. Tinitus pada mahasiswa
kedokteran dapat mengganggu proses belajar mengajar sehingga dapat menurunkan kualitas mahasiswa
kedokteran. Tujuan: Untuk mengetahui apakah terdapat hubungan pola penggunaan earphone
dengan angka kejadian tinnitus serta tingkat keparahan tinitus pada mahasiswa Fakultas Kedokteran
Universitas Sumatera Utara. Metode: Penelitian analitik dengan desain potong lintang dengan teknik
pengambilan secara consecutive sampling. Pengukuran dilakukan dengan Visual Analog Scale (VAS)
dan Tinitus Handicap Inventory Questionnaire (THI-Q). Hasil: Analisis bivariat antara pola penggunaan
earphone dengan angka kejadian tinnitus pada mahasiswa Fakultas Kedokteran Universitas Sumatera
Utara diperoleh hasil (p=0,017). Analisis univariat pada 148 responden menunjukkan pola penggunaan
earphone berisiko sebanyak (64,2%) dan yang mengidap tinitus sebanyak 52 orang (35,1%), dan tingkat
keparahan tinitus dengan jumlah responden 52 orang berdasarkan VAS adalah ringan (55,8%) dan
berdasarkan THI-Q adalah ringan (53,9%). Pada pola penggunaan earphone diperoleh hasil analisis
frekuensi penggunaan earphone 3-4 hari sebanyak (40,5%), volume penggunaan earphone 60-80%
sebanyak (54,1%), lama penggunaan earphone >3 tahun sebanyak (65,5%), dan durasi penggunaan

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ORLI 2021 Volume 51 No.2 The correlation between earphone usage patterns

earphone <1 jam sebanyak (38,5%). Kesimpulan: Terdapat hubungan antara pola penggunaan
earphone dengan angka kejadian tinitus pada mahasiswa Fakultas Kedokteran Universitas Sumatera
Utara angkatan 2017-2019.

Kata kunci: earphone, tinitus, Visual Analog Scale, Tinnitus Handicap Inventory Questionnaire

Correspondence address: Adrian Joshua Velaro. Department of OtoRhinoLaryngology-Head and Neck

Surgery, Faculty of Medicine Universitas Sumatera Utara. E-mail: ajoshuav@gmail.com.

INTRODUCTION measured by Visual Analog Scale which is

then divided into 5 degrees: no pain, mild
Current improvements in audiovisual
pain, moderate pain, severe pain, and very
technology have had a major impact on
severe pain. Then, the tinnitus severity level
innovations in music players and hearing
can be measured using the Tinnitus Handicap
devices for listening to music from music
Inventory Questionnaire which can classify
players and other audio devices. Numerous
tinnitus into 5 grades of severitybased on the
types of hearing devices have been produced
negative impact of tinnitus in the patient’s life,
with various capacities and functions of
very mild or no disability, mild, moderate,
sound output, such as earphones, headsets,
severe and very severe.11
headphones, and others.1
The phenomenon of the widespread
One study reported that as many as
use of earphones in adolescents in Indonesia
88.2% out of 1407 children used a personal
stimulated the researchers to find out the
music player known as MP3, and 27.4% of
patterns of earphone use in young population
them listened to music at maximum volume
and their correlation with the incidence of
for a long time without pause. In another
tinnitus. Also, this study was considered
study, it was also stated that out of the 490
very important because tinnitus is a sign of
study subjects, 94.3% of them used personal
decreased hearing function and could cause
music players and almost all of them used the
a decrease in cognitive performance. If a
tool for 1-3 hours every day for three years.
medical student is found to have decreased
While the hearing device that is most widely
hearing function or a decrease in cognitive
used is the type of earphone.This shows how
performance, the teaching and learning
widespread the use of earphones in society,
process could be disrupted which can lead
especially adolescents.2,3
to a decline inthe quality of medical students
Excessive use of earphones and for long who are the successors of Indonesian medical
periods of time can lead to chronic noise personnel in the future.
exposure which can lead to decreased hearing
In this study, the researchers wanted to
sensitivity and the appearance of tinnitus.4,5
find out the pattern of earphone use and its
Tinnitus can have a significant negative correlation with the tinnitus incidence rate
impact on the quality of life of the sufferer.6,7 and tinnitus severity as measured by the
The severity of tinnitus can be affected due Visual Analog Scale and Tinnitus Handicap
to the use of earphones. Excessive patterns Inventory Questionnaire among students of
of earphone use can increase the severity the Faculty of Medicine, University of North
of tinnitus felt by tinnitus sufferers. This is Sumatra, class 2017-2019 using a cross-
due to the increased noise exposure received sectional design.
by tinnitus sufferers.8-10 The pain level due
to tinnitus noise felt by the patient can be

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ORLI 2021 Volume 51 No.2 The correlation between earphone usage patterns

METHOD form by displaying the frequency distribution,

This was an analytical study using across- so that a descriptive picture of all the variables
sectional design. The population in this study contained in the study could be seen. The
was all students of the Faculty of Medicine, bivariate analysis used was Chi-Square.
University of North Sumatra, class 2017-2019 Based on the results of statistical calculations,
who used earphones. Total research sample it could be seen the significance correlation
were 160 participants, but thosewho met the between variables based on probability. The
inclusion and exclusion criteria through a significance of 0.05 has a chance of being
questionnaire using a consecutive sampling correct by 95% and for being wrong by 5%.
technique were 148 participants. If the significance level is 0.05, the confidence
level is 95%.
The research was conducted for 3 months
which was divided into two stages, namely,
the first stage was filling out the Earphone RESULT
Usage Pattern Questionnaire and the Tinnitus
In this study, it was found that the
Questionnaire, then the results of the Tinnitus
respondents who used earphones with a length
Questionnaire were examined and all research
of use 0-3 years were 51 participants (34.5%),
subjects suspected of having tinnitus were
while respondents with a length of use >3 years
re-recorded.
were 97 participants (65.5%). Respondents
In the second stage, research subjects who used earphones with a duration of use
who were suspected of having tinnitus and <1 hour totaled 57 participants (38.5%),
had previously recorded data were asked to duration of use 1-2 hours totaled 55
continue filling out the Tinnitus Handicap participants (37.2%), and duration of use
Inventory Questionnaire and Visual Analog 2-4 hours totaled 36 participants (24.3 %).
Scale Questionnaires, then analyzed the Respondents who used earphones with a
univariate and bivariate data. Univariate frequency of use 1-2 days were 35 participants
analysis was presented in tabular form by (23.6%), the frequency of use for 3-4 days
displaying the frequency distribution so was 60 participants (40.5%), the frequency of
that a descriptive picture of all the variables use for 5-6 days was 27 participants (18.2 %),
contained in the study could be seen. The and the frequency of use every day amounted
bivariate analysis used was Chi-Square. to 26 persons (17.6%). Respondents who used
Based on the results of statistical calculations, earphones with a volume of use <60% were
it can be seen the significance in the second 53 participants (35.8%), a volume of use of
stage, research subjects who were suspected 60-80% was 80 participants (54.1%), and a
of having tinnitus and had previously recorded volume of use>80% was 15 persons (10.1%).
data were asked to continue filling out the
Respondents with a pattern of using
Tinnitus Handicap Inventory Questionnaire
earphones with no risk were 53 participants
and Visual Analog Scale Questionnaires, then
(35.8%) and respondents with a pattern of
analyzed the univariate and bivariate data.
using earphones at risk were 95 participants
Univariate analysis is presented in tabular
(64.2%).

Table 1. Description of the distribution of earphones usage patterns among students of the Faculty of
Medicine, University of North Sumatra, Class of 2017-2019
f %
0-3 year 51 34.5
Length of use
>3 year 97 65.5

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ORLI 2021 Volume 51 No.2 The correlation between earphone usage patterns

<1 hour 57 38.5

Duration of use 1-2 hour 55 37.2
2-4 hour 36 24.3
1-2 day 35 23.6
3-4 day 60 40.5
Frequency of use
5-6 day 27 18.2
Every day 26 17.6
<60% 53 35.8
Volume 60-80% 80 54.1
>80% 15 10.1
Pattern of use No risk 53 35.8
At risk 95 64.2

Table 2. Description of tinnitus distribution among students of the Faculty of Medicine, University of North
Sumatra, Class of 2017-2019
f %

Incidence rate of No 96 64.9

tinnitus
Yes 52 35.1

Table 3. The correlation between earphone usagepatterns and the incidence rate of tinnitus among students
of the Faculty of Medicine, University of North Sumatra, Class of 2017-2019
The pattern of use of Incidence rate of tinnitus
Earphone Total
P-value
No Yes
f % f % f %
No Risk 41 27.8 12 8.1 53 35.9
At Risk 55 37.1 40 27 95 64.1 0.017
Total 96 64.9 52 35.1 148 100

Table 2 showed respondents suspected of tinnitus and the p-value = 0.017 (p <0.05) so
having tinnitus symptoms. The table showed there was a significant relationship between
52 participants (35.1%) from a total of 148 earphone use patterns and the incidence of
respondents. tinnitus.
In this study, it was known that the Based on the Tinnitus Questionnaire,
ratio of the number of respondents who 52 respondents were suspected of having
experienced tinnitus with a pattern of using tinnitus. Respondents suspected of having
earphones at risk (27%) is greater than that of tinnitus then asked to fill in the Visual Analog
respondentswith a pattern of using earphones Scale (VAS) and the Tinnitus Handicap
without risk (8.1%). The results of statistical Inventory Questionnaire (THI-Q).
tests showed that there was a significant
This study obtained the result of
difference between the pattern of using risky
distribution of tinnitus severity as measured
and non-risk earphones with the incidence of
by the Visual Analog Scale (VAS), where

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ORLI 2021 Volume 51 No.2 The correlation between earphone usage patterns

there were no respondents who felt painless, measured by the Tinnitus Handicap Inventory
29 participants felt mild pain (55.8%), 23 Questionnaire at grade 1 (very mild) totaling
participants felt moderate pain (44.2%), and 18 participants (34.6%), at grade 2 (mild)
there were no respondents who felt severe and totaling 28 participants (53.8%), at grade 3
very severe pain. (moderate) totaling 6 (11.5%), and there were
no respondents at grade 4 (severe) and grade
This study also obtained a description
5 (very severe).
of the distribution of tinnitus severity as

Table 4. Tinnitus severity as measured by Visual Analog Scale among students of Faculty of Medicine,
University of North Sumatra, Class of 2017-2019
f %
Score Result Vi- No pain 0 0
sual Analog Scale Mild pain 29 55.8
(VAS)
Moderate pain 23 44.2
Severe pain 0 0
Very severe
pain 0 0

Table 5. Tinnitus severity as measured by Tinnitus Handicap Inventory Questionnaire among students of
the Faculty of Medicine, University of North Sumatra, Class of 2017-2019
f %
Score Result Grade 1 18 34.6
Tinnitus Grade 2 28 53.8
Handicap Grade 3 6 11.5
Inventory Grade 4 0 0
Questionnaire Grade 5 0 0
(THI-Q)

DISCUSSION use <1 hour and average duration of use >4

Previous research conducted by Ilma12 hour. These results indicated the duration of
showed that earphone users with a length of use of earphone at the Faculty of Medicine,
use >3 years were 114 (49.8%) and a length University of North Sumatra was better when
of use 0-3 years were 115 (50.2%) subjects. compared to the earlier study. This could
These results supported the finding that be due to the level of knowledge about the
earphone users at the Faculty of Medicine, harm of using earphones, already concerned
University of North Sumatra with a length of about the harms of using earphones on ear
use >3 years were higher than previous studies health, the understanding that noise induced
report, this was because many teenagers hearing loss noise is irreversible, and levels
nowadays were already using earphones ever of exposure to information about ear health
since junior high school. in medical students.

Earlier study conducted by Shah et al.13 In a prior study conducted by Fitri

about the duration of use of earphone showed Sakinah14 regarding the frequency of earphone
that only 5% of students had a duration of use, the result was that 78.9% of respondents
used earphones 1-4 days/week and 21.1%

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ORLI 2021 Volume 51 No.2 The correlation between earphone usage patterns

used ear phones >5 days/week. On the other conducted by Silvestre et al.18 in the year 2016
hand, a research conducted by Silvestre at Curitiba, Brazil which stated that there
et al.15 in 2013 showed that 74.43% of was a correlation between earphone usage
respondents used earphones >5 days/ patterns and the incidence rate of tinnitus (p
week. This discrepancy could be caused by <0.05). The habit of using earphones could
using the earphones not for a long period or cause tinnitus, although it occured when a
continuously at a relatively low volume or person use it for more than three years, use it
intensity. Fitri Sakinah14 research, regarding several times a week, use it for a long time in
the volume of earphone used, found that one day, and use it at high volume.
77.3% of respondents used earphones with
The results of measuring tinnitus severity
a dangerous volume. These results were also
using the Visual Analog Scale in this study
supported by other research conducted by
were similar to previous studies conducted by
Levey et al.16 which found that 189 students
Figueiredo et al.11 which found 0% with no
used earphones with an average level of
pain results, 13% mild pain, 32.6% moderate
92.3 dB or equivalent to 60% of the total
pain, 37% severe pain, and 17.4% very severe
volume. The use of high volume earphones
pain. In our study there was no subject that
could occur because earphone users could not
was in severe pain and very severe pain. This
enjoy music in low volume so they chose to
finding could be due to differences in age,
increase the music volume even though they
in line with previous studies where tinnitus
knew about the harm of using high volume
severity was directly proportional to age.9
earphones.
The results of measuring tinnitus severity
In previous research conducted by
using the Tinnitus Handicap Inventory
Putri17 on earphone usage patterns, it was
Questionnaire in this study were likely to be
found that 61.7% of respondents were risky
similar with the result obtained by Al-Swiahb
earphone users. This high-risk pattern of
et al.23 which reported the distribution of very
earphone use was caused by the length of
mild (13,75%), mild (32.5%), and moderate
time using earphones >3 years, the duration
(37.5%). In this study, it could be seen that
of earphone use >1 hour/day, the frequency of
there was a correlation between the VAS and
earphone use >4 days/week, and the volume
THI scores. This result was in accordance
of earphone use >60%.17,18
with the finding of Figueiredo et al.11
These results were higher than previous
Based on the results of this study,
studies conducted by Sunny et al.19 which
to prevent the occurrence of tinnitus the
stated that tinnitus occurred 10.33% in global
researchers suggest that students of the
prevalence. The results obtained in our
Faculty of Medicine, University of North
study were considered higher than those of
Sumatra reduce the duration of earphone use
Nondahl et al.6 and colleagues with the results
to <1 hour/day, the frequency of earphone use
of 10.6% of respondents suffering from
to <5 days/week, and the volume of earphone
tinnitus. A higher number of tinnitus sufferers
use <60% each time using earphones.
compared to earlier studies could occur due
to the prevalence of tinnitus which was high The researchers suggest further research
in adolescents (0.6-49.25%), this increase in tinnitus using audiometric examinations to
could also occur because in adolescents there simultaneously determine whether hearing
are cognitive and hormonal changes that loss is present due to the risky pattern of
could cause tinnitus reactions, and could be earphone use.
accompanied by anxiety or depression.20-22 It is also necessary to do further research
The results of the chi-square statistical on the components of the earphone usage
test in our study were in line with the research pattern, such as the type of earphone used and

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the type of music being listened to. of and risk factors for tinnitus in a young
population. Otol Neurotol. 2014; 35 (7):
Furthermore, the researchers proposed 1218-22.
another research with linear regression
10. Kurniawati SP. Intensitas Kebisingan
method to determine the extent of duration, Terhadap Gangguan Pendengaran dan
frequency and volume of the earphone usage Keluhan Tinnitus pada Pekerja Penggilingan
pattern criteria in relation with the tinnitus Daging di Kabupaten Jember. Epub ahead of
incidence rate. print. 2017. DOI: 10.1242/jcs.150862.
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