In Germany, studies at public schools are not permissible unless official approval has been obtained. According to regulations, our research has been conducted with the consent of the German Aufsichts- und Dienstleistungsdirektion, the Commissioner for Data Protection in Rhineland-Palatinate, and the Ministries of Education of the four participating federal states.
Teachers could freely decide whether to participate or not. Their participation might be canceled at any time without further explanation or drawbacks. Participants were informed that their data were anonymized and used only for the purpose of the authorized study. Table 1 shows prevalence and comorbidity of the specific HD as reported by the participants.
All analyses refer to the questionnaire results of the total group of teachers. The data show that most teachers suffered from two HD. The smallest group consisted of teachers suffering from only one HD. In the whole sample of teachers with HD, the majority Diagram 1 illustrates the distribution of gender in the seven HD groups. The distribution of age for the seven groups is presented in Table 1. As can be seen from Table 1 , the highest mean ages were found whenever hearing loss was associated with another hearing impairment.
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For the investigation of annoyance and the impact of comorbid HD, teachers were asked to express their HD-related distress on a scale ranging from 0 no distress to 10 strongest distress. Data across the four concerned HD groups are considerably different. Additionally, teachers were asked to describe the perceived loudness of their tinnitus.
With regard to the classification as proposed by Klockhoff and Lindblom[ 36 ] and the German version of the Structured Tinnitus Interview,[ 43 , 44 ] tinnitus loudness should be evaluated in three different ambient noise settings. Results show that The Mini-TQ was included in the online questionnaire to find out about the tinnitus-related annoyance of teachers. The complete range of the Mini-TQ score covers values from 0 to 24, and data can be assigned to four gradient degrees of annoyance Scores: The test scores are listed in Table 1. The results of the Mini-TQ appear to be split into two segments: To sum up, an essential difference is observed between HD groups including and excluding hyperacusis.
However, in both cases, the differences are not significant. When compared with teachers suffering from all three HD, the H group shows no significant difference. No other group comparison reaches a level of significance, either. Table 1 presents a closely spaced range of subjectively rated hearing loss-related distress on medium level for teachers of all concerned HD groups. To investigate group differences within subjectively rated hearing loss-related distress, a Brown-Forsythe test was conducted, followed by a Tamhane-T2 test. This change in method followed the Levene test result, which disproved homogeneity of variance.
Keeping in mind the closely-ranged distress-values, it is not surprising that no significant differences are found in the ratings of hearing loss-related distress between any of the HD groups. In order to identify risk factors for teachers of getting concerned with auditory impairment, Pearson correlation coefficients were calculated for several personal, job-related, and HD-related aspects. The results are presented in Table 2. The same applies to the period of occupation, duration of tinnitus on the right ear, and duration of hyperacusis, though at a slightly lower level of significance.
Significant correlations with hyperacusis-related distress are detected only for weekly working hours and hyperacusis duration, though at rather a low level of significance. Table 2 shows that the highest correlations exist between the chosen variables in the left column and the distress caused by hearing loss in teachers, though still at a rather low level. Further positive and significant correlation with hearing loss-related distress is found for the duration of comorbid hyperacusis.
However, it is only slightly pronounced. Correlations with the number of daily and weekly working hours appear only marginally, not reaching a level of significance.
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Regarding evaluation of the correlations between the results of the Mini-TQ and the chosen variables, an interesting pattern appears: First, age, period of occupation, and daily working hours correlate positively but not significantly on a very low level with the Mini-TQ data. The number of weekly working hours, as well, is correlated positively on a low level with the Mini-TQ data, reaching a medium level of significance.
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Second, all variables covering the duration of HD correlate negatively on a slightly higher level, revealing medium values of significance in cases of tinnitus in both ears and hearing loss in the right ear. Aside from spatial aspects, the interview inquired about situations at school that are difficult to handle for teachers with HD. Additionally, the kind of manifestation of HD-related impairment was described.
As data were collected via multiple answer-set, the percentage values relate to the total number of replies. For 12 of the participants This situation is quoted by 22 participants and represents The aim of the present study was to explore the prevalence of HD among German teachers, focusing particularly on tinnitus, hyperacusis, and hearing loss. Exceeding previous research on HD in teachers,[ 2 , 14 , 32 ] insight into characteristic differences dependent on varied HD combinations was provided.
The main topic was whether the prevalence of particular HD influences the perception of further auditory impairment. In the present study, a remarkable total of teachers with HD participated. However, as the school principles forwarded study information and address of the online-questionnaires to the teachers, not all participants had been contacted individually. Thus, no evidence regarding returning or prevalence rates can be provided. Teachers with HD suffered most frequently from tinnitus, followed by hyperacusis and hearing loss.
Thus, most participants were afflicted with two HD, while the fewest reported only one HD. It is notable that being concerned solely with tinnitus seems to have taken on a special position. Accordingly, tinnitus was more strongly represented than the combination of tinnitus and hearing loss and was nearly equal to hyperacusis and hearing loss. In the present study, the largest of the seven HD groups was the one combining tinnitus, hyperacusis, and hearing loss. It might be assumed that teachers suffering from three HD will be interested in a study such as our present one, rather than colleagues affected by only one HD.
In this context, findings from a representative survey of the German Tinnitus League must be considered. The highest mean ages were observed in teachers suffering from hearing loss only or in combination with further hearing impairment. Similar effects have been detected in previous studies,[ 47 ] and they appear to corroborate this finding, as hearing loss constitutes a verifiable symptom of older age. In contrast, hypersensitivity to sound is perceived as being more intense if no other HD is present.
These results are contrary to the findings of Kellerhals and Zogg They reported that members of the Swiss Tinnitus League rated their hypersensitivity to sound as being more burdensome when they suffered from hyperacusis in addition to tinnitus. Different characteristics of particular HD might be the basis for different observations regarding the evaluation of HD intensities.
Processes of implicit comparison and evaluation of the present HD could possibly influence the reported distress ratings. Participants suffering from tinnitus and hyperacusis may experience that the adverse effects of hyperacusis can be avoided when retreating into silent surroundings. This constitutes an internally controllable solution, though accessible only intermittently.
A comparable, promptly effective strategy in case of tinnitus is hard to find, on the contrary. Moreover, clinical manifestations of tinnitus and hyperacusis differ considerably in quality. While hyperacusis causes bodily pain, induced by mostly inescapable sounds of everyday life, tinnitus bears a huge potential of annoyance through the persistency of the disturbing ear noise.
Moreover, hearing loss is known as a contingent precondition for the development of hyperacusis. Thus, the ensuing hyperacusis might be seen as a late or side effect and, in consequence, perceived as less intense or annoying. This might be due to the fact, that hyperacusis is experienced as more susceptible than tinnitus and hearing loss. The objective measuring of tinnitus-related affection using the Mini-TQ discloses a considerably smaller degree of annoyance than the distress scale does. Thus, it can be hypothesized that the teachers affected with tinnitus overestimate their tinnitus-related distress when asked to rate it abstractly.
It is also conceivable that teachers rate the tinnitus-related distress relatively high but do not feel equally annoyed by the ear sound-related distress. In this respect, the works of Hiller and Goebel must be considered, who emphasize that the perceived tinnitus-related distress must not be implicitly equated with tinnitus-induced annoyance. Moreover, the perception of comorbid HD interacts and might influence specifications in both the distress scales and the Mini-TQ. Teachers affected by tinnitus seem to be split into two subcategories: One category comprising the single HD groups including hyperacusis, the other category comprising those HD groups excluding hyperacusis.
Accordingly, teachers suffering from tinnitus alone and from tinnitus combined with hearing loss show a significantly lower Mini-TQ outcome than colleagues suffering from tinnitus combined with hyperacusis or hyperacusis and hearing loss. Again, the findings of Kellerhals and Zogg[ 33 ] should be kept in mind, as the increased subjective perception of hyperacusis might foster biased responses in the Mini-TQ.
Significant positive correlations with tinnitus-related distress were found for age and other duration-related variables, though on a very low level. The upward trend of feeling more stressed with tinnitus in older age and after longer years of living with the disturbing ear sound is worth noting, however. Correlations regarding hyperacusis-related distress were on a very low level, as well. However, the results indicate a clear tendency: The longer teachers suffered from hyperacusis, the more they were afflicted by it.
Thus, the weekly working load fosters the burdensome character of their hypersensitivity to sound. This might be due to an increased stress-induced vulnerability. Correlations with Mini-TQ scores imply that the longer teachers suffered from tinnitus, the less they were burdened by it. This is a substantial finding, as it indicates certain habituation effects.
On the other hand, it is contradictory to the self-rated tinnitus-related distress, which shows significant positive correlations with tinnitus duration. The interviews revealed that teachers are clearly hindered in their practice due to their HD. As understanding, communication, and concentration are considerably affected, they are constantly challenged in their workday routine.
Possible solutions should take different school- and job-related issues for their starting points. The teachers concerned should be shown appreciation and be encouraged to openly deal with their impairment. Some teachers reported that informing their pupils made an important difference in loudness levels during class. In this regard, a sound-signal light to avoid high noise levels could be a useful device, especially when younger children are concerned. Moreover, the configuration of classrooms offers potential for improvement and the facilitation of room insulation.
The priority objective of the present study was to investigate HD in teachers. The results show that most teachers with HD suffer from tinnitus, and the largest group of HD is the one including tinnitus, hyperacusis, and hearing loss. The intensity rating for tinnitus rises with the number of concomitantly present HD and the reverse effect applied to intensity ratings of hyperacusis. National Center for Biotechnology Information , U. Journal List Noise Health v. Meuer and Wolfgang Hiller.
Author information Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Abstract Recent research indicates that a notable number of teachers are concerned with conditions of auditory impairment such as tinnitus, hyperacusis, and hearing loss. Hearing disorders HD , noise prevention , occupational safety , school , teachers. Introduction Today, risk factors for the development of hearing disorders HD such as noise exposure[ 1 , 2 , 3 , 4 , 5 ] and associated annoyance reactions[ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ] in the school environment are well-known and examined to a remarkable extent.
Methods Participants The headmasters of all schools in four German federal states had been informed via email about the study. Data collection Online questionnaire The online questionnaire included four complete tests, 12 single test items, and 16 teachers with HD respectively 11 teachers without HD self-generated questions.
Interview The interview addressing teachers with HD was half-structured and covered relevant issues in about 50 questions the exact number of items varying according to the number of HD the participants suffered from. Ethics In Germany, studies at public schools are not permissible unless official approval has been obtained. Results HD Table 1 shows prevalence and comorbidity of the specific HD as reported by the participants.
Open in a separate window. Gender In the whole sample of teachers with HD, the majority Age The distribution of age for the seven groups is presented in Table 1. Subjective rating of distress For the investigation of annoyance and the impact of comorbid HD, teachers were asked to express their HD-related distress on a scale ranging from 0 no distress to 10 strongest distress. Tinnitus-related distress Data across the four concerned HD groups are considerably different. Mini-Tinnitus questionnaire Mini-TQ [ 37 ] The Mini-TQ was included in the online questionnaire to find out about the tinnitus-related annoyance of teachers.
Hearing loss-related distress Table 1 presents a closely spaced range of subjectively rated hearing loss-related distress on medium level for teachers of all concerned HD groups. Correlations In order to identify risk factors for teachers of getting concerned with auditory impairment, Pearson correlation coefficients were calculated for several personal, job-related, and HD-related aspects. Hyperacusis-related distress Significant correlations with hyperacusis-related distress are detected only for weekly working hours and hyperacusis duration, though at rather a low level of significance.
Hearing loss-related distress Table 2 shows that the highest correlations exist between the chosen variables in the left column and the distress caused by hearing loss in teachers, though still at a rather low level. Mini-TQ[ 37 ] Regarding evaluation of the correlations between the results of the Mini-TQ and the chosen variables, an interesting pattern appears: Additional information from the interviews: A strong personal involvement characterizes our Services, be they a single day assessment or a multi-year program.
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