I am a co-author of a new study, along with lead author Julie Cullen, on the impact of digital technologies on health and wellbeing of children and adolescents. Our study highlights the risk of harm to the health and wellbeing of young people from frequent and extended screen time, with negative impacts from 2 to 6 hours of daily usage. Risks include vision, hearing (when earbuds/headphones are used during screen time), obesity, pain, sleep, cognition, mental health, and emotional/social impacts. The impacts don’t really change based on whether a child is playing games, using social media, or doing schoolwork.
These findings are troubling with screen time increasing as devices are more commonly used at school. Our paper includes recommendations for minimizing risks to health and wellbeing while maximizing learning benefits that screen-based digital tools can offer in educational settings. Recommendations include interventions to reduce risks such as taking eye breaks, blinking exercises, regular vision and hearing testing, advice on safer use of headphones and earbuds, and ergonomic guidance.
To prevent noise-induced hearing loss, recommendations include:
- Restrict or limit screen time and headphone/earbud use to purposeful and time-limited tasks.
- Encourage children and teens to use the lowest functional personal listening volume or softest loudness setting needed to hear/understand the audio or audiovisual content when using headphones/earbuds.
- The less time spent using headphones/earbuds during screen time, the lower the risk of noise-induced hearing health damage.
Here are some Frequently Asked Questions related to hearing loss risk from headphone/earbud use during screen time.
- How do you find the lowest functional personal listening volume?
- What personal listening volumes are most unsafe?
- Are some devices safer than others?
- Are some headphones or earbuds safer than others?
- Why are earbuds safer for older children and teens?
- Is it okay to share headphones or earbuds?
- What are the early warning signs of noise damage to hearing health?
- Related Posts
How do you find the lowest functional personal listening volume?
The lowest functional personal listening volume is the softest loudness needed for a child or teen to hear/understand the audio or audiovisual content when using headphones/earbuds. It depends on the individual; for example, the functional volume will be higher or louder for a child with hearing loss.
The lowest functional personal listening volume also depends on the content. Individuals typically use louder or less safe volume settings when using headphones or earbuds for music and gaming compared to other audio or audiovisual sources.
Children/teens can find their lowest functional personal listening volume for different audio sources, e.g. audiobook, video, gaming, music. The child or teen should start at zero or the lowest loudness possible, and slowly turn the volume up. Stop once they reach the lowest personal listening volume they can comfortably hear and understand the audio source.
What personal listening volumes are most unsafe?
Children and teens should be encouraged to avoid loud listening through headphones/earbuds given the high risk of noise-induced hearing health damage.
It is well established that 60% to full-on volumes carry the highest risk of noise-induced hearing loss for children, teens, and adults. There is also likely risk of noise-induced hidden hearing loss at exposures from 50% to full on volumes. Hidden hearing loss reflects noise-induced damage not identified by a standard hearing test or audiogram.
Hidden hearing loss can happen when hearing thresholds are still within the normal range, and may include tinnitus (ringing in the ears), impaired speech understanding especially in background noise, and decreased sound tolerance like hyperacusis where sound input is painful or uncomfortable. For example, research has found 11 year olds using headphones at around 50% volume for about an hour daily had higher rates of tinnitus than children who didn’t use headphones.
Assuming normal hearing, children and teens should use the lowest functional personal listening volume, as low as possible below 50% volume, to best protect their hearing health.
Are some devices safer than others?
Compared to other devices, cell/mobile phones have the highest sound output levels even at lower volume settings. Children and teens using cell phones for personal listening are likely at higher risk of noise damage to hearing health than if using other devices.
Most devices can be made safer by using built-in output limits and safer listening features, typically found under settings for audio and/or headphones. Turn down any output limits and safer listening features to the softest or lowest decibels possible. Consider locking settings under parental controls.
Are some headphones or earbuds safer than others?
Loose or poorly fitting headphones/earbuds are less safe, because users tend to turn the volume up to hear/understand audio content over background noise. It is safer when headphones/earbuds fit well or snugly.
Safer headphone/earbud features include noise canceling or sound isolating technology and volume or output limits, if available. However, too many headphones advertising volume limits fail to limit sound levels on independent testing (wirecutter.com), and fail to limit output to decibel levels that are safer for children and teens, e.g. below public health recommended 70 dB (Leq,24-hour) daily average exposure limit to prevent noise-induced hearing loss.
Why are earbuds safer for older children and teens?
While headphone styles are okay for all ages, it is usually best to wait until children are older to consider using earbuds.
There are several reasons why earbuds are not generally recommended for children 12 years old and younger. Earbud styles are less safe for children because of looser fit since sizing is generally for mature or adult ears, and there is higher risk of ear infections.
Is it okay to share headphones or earbuds?
It’s most hygienic if children and teens have their own individual headphones/earbuds to use for school work, and not share with others unless safely cleaned/sanitized between users.
What are the early warning signs of noise damage to hearing health?
Noise damage to hearing health is usually painless and invisible. Early warning signs can include tinnitus or ringing in ears, muffled hearing after loud listening, not responding to instructions, difficulty hearing or understanding in background noise, speech difficulties, and increases in the lowest functional personal listening volume needed.
If a child or teen suffers from ear infections or hearing problems, needing louder personal listening volumes to hear can be a helpful sign for parents to seek medical attention or follow-up with a hearing healthcare provider, e.g. audiologist.
Regular hearing testing, including school-based hearing screening programs, are important to identify hearing problems early for appropriate interventions, regardless of the cause.
For more information, please check out my blog: Teaching Children and Teens about Safer Personal Listening. If you still have questions about hearing health risks of screen/headphone use in schools, feel free to contact me.
References
- Cullen, J., Müntz, A., Marsh, S., Simmonds, L., Mayes, J., O’Neill, K., & Duncan, S. (2024). Impact of digital technologies on health and wellbeing of children and adolescents: A narrative review. New Zealand Journal of Physiotherapy, 52(1), 62–xxx. https://doi.org/10.15619/nzjp.v52i1.364
- Mayes, J. & Fink, D. (2021). Unsafe at any sound: Hearing loss and tinnitus in personal audio system users. Proceedings of Meetings on Acoustics. 43, 040003. https://doi.org/10.1121/2.0001452
- Tordrup, D., Smith, R., Kamenov, K., Bertram, M., Green, N., Chadra, S. & WHO HEAR Group. (2022). Global return on investment and cost-effectiveness of WHO’s HEAR interventions for hearing loss: a modelling study. The Lancet. 10(1), e52-e62. https://doi.org/10.1016/S2214-109X(21)00447-2
Jan L. Mayes 