Back to Basics | August 2022 Hearing Review
An insightful study of environmental noise and its potential impacts on health
By Marshall Chasin, AuD
This paper is an overview of the findings in the literature for the subject area of the non-auditory effects due to lower level environmental noise. Regular reviews have appeared in the literature since the early 1990s,1,2 with the most recent one being Van Kamp et al.3 Over the past decade, the World Health Organization (WHO) has sponsored several excellent reviews on the effects pertaining to stress and cardiovascular effects,4-6 sleep disruption patterns,7 cognition,8 adverse birth outcomes issues,9 and general annoyance,10 and have come out with several general recommendations that communities and jurisdictions should consider in their environment and building planning processes (WHO, 2019).11
This paper will serve to present a summary of the relevant references and their findings while attempting to delineate many of the inherent difficulties in performing such research. This, in turn, may provide insight into conclusions stemming from the WHO (2018) general recommendations’ paper.
Indeed, in a recent paper, where only high-quality and controlled research was reviewed, it was argued that the WHO (2018) general recommendations’ paper, may need to be revisited and updated due to the possibility of confounding variables in previously reviewed studies, as well as the inclusion of other environmental noise sources such as wind turbine noise and rail traffic noise.12
While it is well-established that prolonged exposure to sound levels at 85 dBA and higher can cause a measurable permanent sensorineural hearing loss,12,13 there are few reliable measures of systemic dysfunction for levels below 80 dBA. (There are data showing that there may be a slight measurable hearing loss for a sufficiently long exposure of sound levels between 80 dBA and 84 dBA). Reports of non-auditory effects of noise exposure are abundant in the literature with ramifications that can increase stress, disrupt sleep, and can be implicated as a factor in language and reading development for elementary-age students in schools.
Some of the literature is contradictory, some reports demonstrate slight issues, and yet other reports fail to find any systemic effects. Part of the problem is the lack of reliable measures or measures that have only a loose correlation with a systemic pathology. For example, serum cholesterol measures may show a slight elevation in the presence of long-term noise exposure, but this should not be taken as an indicator of eventual cardiac pathology. Another example is that environmental noise that creates the greatest disruption of sleep may have the lowest annoyance when compared to other noise stimuli.14
Only publications that have gone through a rigorous peer academic review will be included. However, despite research appearing in a peer-reviewed publication, there can still be serious methodological problems that call the results, or lack thereof, into question. Many historical studies have been summarized in the 1991 book Noise and Health (Thomas H. Fay, Ed, 1991)1 and a review article by Abel.2 Davies and Van Kamp15 also performed an enlightening review, and the results were similar to earlier publications. For a historical review, these references should be consulted. Following is a summary of the more recent research which is delineated under four general headings: “Annoyance,” “Stress and cardiovascular effects of noise,” “Sleep disruptions due to noise,” and “Cognitive/educational issues due to noise.”
An inherent problem with examining the relationship between the effects of low levels (below 85 dBA) of environmental noise and non-auditory sequelae, is that the line between academic integrity and advocacy may be crossed. While it is true that environmental noise exposure may cause some issues in some people, it cannot necessarily be concluded that this would have long-term detrimental consequences. There are no “smoking gun” reports in the literature that environmental noise levels below 85 dBA will cause permanent issues, and this is true of sleep disruption, increased stress leading to cardiac involvement, or long-term educational/language problems. It may be true that some people are more susceptible to environmental noise, and it may be true that the exposure is “dose-dependent,” whereby higher level and/or longer exposure to environmental noise may result in greater annoyance that may have long-term effects, but eventual systemic problems such as cardiac issues may also be related to a host of other factors. Low-level environmental noise is just one of many factors that can contribute to annoyance and possible long-term health issues.
This review will not concern itself with non-human reactions to environmental noise such as that concerning marine life and other wildlife (see Guan et al for a review).16 Many acoustical associations such as the Acoustical Society of America (ASA) and the Canadian Acoustical Association have had long-standing committees to investigate the effect of marine and environmental noise on migration patterns, reproductive patterns, and even vocalization changes in animals.
Annoyance is primarily a subjective attribute of a sound or vibration. Annoyance can be related to the uniqueness of a sound; its physical, spectral, and temporal characteristics; and even whether a person has control over the sound.17 Miller18 stated that noise “has its base in the unpleasant nature of some sounds, in the activities that are disturbed or disrupted by noise, in the physiological reactions to noise, and in the response to the meaning or messages carried by the noise.”
Traditionally “annoyance” has resisted a formal definition since it appears to be the result of many intrinsic and extrinsic factors, can be dose-dependent, and can be highly variable among different groups and ages.
Nevertheless, annoyance can be related to some objective measures. This was the basis of much research in the 1950s, 1960s, and 1970s, where the unit “noys” was suggested as a possible measure of annoyance. Spectrally, annoyance appears to be similar to a dBA-weighted noise except that higher frequency sounds above 1,000 Hz contribute more to a sense of annoyance than lower frequencies and can be shown to correlate with the D-weighted filter on sound level meters.19 Despite this pioneering work, annoyance (and its various measures) remains a highly variable phenomenon with sometimes poor correlations, such as where noise that creates the greatest disruption in sleep may have a low level of annoyance.14
Fields20 examined several personal and situational variables that could potentially be an issue when trying to predict noise annoyance in residential settings. “The balance of the evidence from 464 findings drawn from 136 surveys suggests that annoyance is not affected to an important extent by ambient noise levels, the amount of time residents are at home, the type of interviewing method, or any of the nine demographic variables (age, sex, social status, income, education, home ownership, type of dwelling, length of residence, or receipt of benefits from the noise source.” (p. 2,753). However, he found that annoyance is related to the amount of isolation from sound at home and to five attitudes: fear of danger from the noise source; noise prevention beliefs; general noise sensitivity; beliefs about the importance of the noise source, and annoyance with non-noise impacts of the noise source. This author also noted that there was a small percentage of people who were very annoyed even by low environmental noise levels.
Miedema and Voss21 examined several previous studies where the number of responders ranged from 15,000 to 42,000 people. They examined demographic variables including sex, age, education level, occupational status, size of household, homeownership, dependency on the noise source, and use of the noise source. They also looked at two attitudinal variables: noise sensitivity and fear of the noise source. It was found that fear and noise sensitivity have a large impact on the annoyance, but that demographic factors are much less important. Noise annoyance is not significantly related to gender but is related to age. The effects of the other demographic factors on noise annoyance are “very small.” Van Gerven et al,22 in examining the effects of self-reported annoyance from environmental noise across a lifespan, found that out of almost 63,000 people between the ages of 15 and 102, there was an age-dependent response. The results revealed an inverted “U” pattern with the youngest and the oldest responders reporting the lowest levels of annoyance and those around 45 years of age, reporting the greatest annoyance. The authors suggested that a linear relationship over the age span would not be useful in modeling annoyance and could explain the variable results of some earlier studies.
In studying the effects of longitudinal effects of changes in road traffic noise, Ohrstrom23 used questionnaires and measures of annoyance, activity disturbances, and psycho-social well-being. Adverse effects of long-term exposure to a high volume of road traffic were studied in socio-acoustic surveys over a two-year period where traffic had been decreased by 90% from 25,000 cars/day to about 2,400 cars/day. This resulted not only in a large decrease in annoyance and activity disturbances, but also in better general well-being. “To be able to use the outdoor environment and to have the possibility to keep windows open is essential for general well-being and daily behavior, which implies that access both to quiet indoor and outdoor sections of the residency is of importance for the achievement of a healthy sound environment.” (p. 719). As a fitting last entry in this section, Ohrstrom went on to say that “future studies should focus more on ‘softer’ health outcomes and well-being…and preferably be performed in connection with traffic abatement measures.”
Cardiovascular Effects of Noise
This title is not only apropos for this section but also the name of a chapter by Lawrence Raymond in Noise & Health edited by Thomas H. Fay for the New York Academy of Medicine (1991).2,24 In summarizing some of the limited generalizations that potentially could be made, he stated (p. 28):
“1. Abnormal blood pressure levels can be induced by high noise levels in some animal species, and in humans under some laboratory conditions. The effects in animals have been long lasting in some studies.
2. The relevance of these findings to human subjects is unclear….it is not known whether controlling noise to levels that do not usually cause hearing loss…leaves any residual risk of causing hypertension…
3. … the intensity-duration relationship has not been studied.”
Richard Sloan,25 in summarizing the potential cardiovascular effects due to noise exposure, went on to write that despite many inconsistencies in the literature, the exposure to noise suggests that (1) “exposure to noise is associated with elevations in blood pressure, primarily diastolic blood pressure, and (2) that, in general, this effect appears not to habituate over time.” (p. 23). Sloan related these findings to the potential explanation of noise-induced vasoconstriction and its effects on the central blood system.
Some of the methodological and research issues that plagued earlier research (as far back as 1946) have still not been adequately resolved. High levels of subject variability, individual susceptibilities with both psychological and possibly genetic differences, and lack of physical objective measures that possess a high correlation with long-term cardiovascular sequalae remain problematic. Following is a brief overview of some of the approaches, but perhaps only the molecular analysis study of Munzel et al 6 shows any real promise of demonstrating any relationship between low-level environmental noise and potential cardiovascular effects.
Basner and McGuire1 attempted to describe, in a review paper, the physiological basis for the effects of lower levels of noise on the body. They describe a generalized stress model whereby contributions are made by both conscious stresses brought about by an emotional response due to perceived discomfort (“indirect pathway”), and non-conscious physiological responses between the central auditory pathway and different portions of the central nervous system (“direct pathway”). In this model, long-term chronic exposure can create an allostatic load altering a person’s homeostatic conditions. This, in turn, can affect the metabolism and the cardiovascular system. (Allostatic load refers to the cumulative burden of chronic stress and life events. When environmental stress exceeds a person’s ability to cope then allostatic load ensues). This “stress response” is well-known in the literature and can be implicated in people who report tinnitus, and generalized fear of loud sounds such as misophonia.26
Walker et al27 sought to examine 10 male subjects on multiple visits over 41 days in a well-controlled laboratory environment. The subjects were exposed to noise levels (below 85 dBA) and the noise was either centered in the 31.5-125 Hz region or the 500-2000 Hz region. Ambulatory ECG, various blood pressure measures, and saliva-based cortisol measures were assessed before and after exposure. Of all the measures, only Heart Rate Variability (HRV) was found to show a statistically significant change, but only for the lower frequency (31.5-125 Hz) stimulus. There was no statistical evidence for the blood pressure and saliva cortisol measure differences. Although they postulated an allostatic load issue and a generalized stress response, these mechanisms were only hypothetical, and no direct data was supplied to support this conclusion.
Michaud et al28 assessed stress reactions associated with wind turbine noise exposure using self-reported and objective measures. Over 1,200 participants, between the ages of 18-79 who lived between 0.25 km and 11.22 km from wind turbines and had exposures of up to 46 dBA outdoor levels of wind turbine-related noise exposure, were assessed. Regression modeling was only able to account for 21-33% of the variance and many of their measures did not achieve statistical significance. These included measures of the Perceived Stress Scale, hair cortisol concentrations, resting blood pressure levels, and heart rate. Of these measures, only the subjective Perceived Stress Scale scores were positively, but weakly, related to cortisol concentrations and resting heart rate. Regardless of the measured outdoor noise levels from the wind turbines, diastolic blood pressure appeared to be only slightly higher among participants who were highly annoyed by the blinking lights on turbines. “Collectively, the findings do not support an association between exposure to wind turbine noise up to 46 dBA and elevated self-reported, and objectively defined measures of stress.” (p. 1,467).
To examine potential changes at the molecular level, specifically looking at Reactive Oxygen Species (ROS), Munzel et al6 demonstrated that aircraft noise exposure during nighttime can “induce endothelial dysfunction in healthy subjects and is even more pronounced in coronary artery disease patients. Importantly, impaired endothelial function was ameliorated by acute oral treatment with the antioxidant vitamin C, suggesting that excessive production of ROS contributes to this phenomenon.” (p. 873). They also describe an animal model of aircraft noise exposure characterizing the underlying molecular mechanisms leading to noise-dependent adverse oxidative stress-related effects on the vasculature.
Van Kempen et al,5 in looking at a review of available data, concluded that, “The results of the current review show that, at this moment, not enough studies of good quality are available that investigated the impact of noise on the cardiovascular and metabolic system. The plausibility of an association calls for further efforts with improved research methodology. In order to improve the quality of the existing evidence, more studies with a cohort or case-control design are needed….We also recommend that more well-designed studies on health effects in relation to exposure to wind turbines and rail traffic noise are set up and carried out.” (pp. 12-13).
Sleep Disruptions Due to Noise
Like the studies concerning the interaction between environmental noise and cardiovascular/stress relationships, the study of sleep disruptions due to low-level environmental noise can be highly problematic. Low-level environmental exposure can be viewed as more problematic with some groups of people, and indeed, during some hours of the day with the 6-9 PM time surprisingly being the most bothersome.29 And many of the studies that have been reported in the literature do not touch on the effects of more recent wind turbine noise exposure, which may turn out to be problematic in some conditions and with some population groups.
Jurriens30 performed the “1,000-night joint European field study of noise effects” and found that, indeed, subjectively the sleep quality was affected negatively after noisy nights, but that the results were highly variable. They did find slight decreases in REM (Rapid Eye Movement) sleep during noisy nights, but only by about 6.5 minutes. There were, however, no clear implications for long-term systemic implications.
Historically, the study of sleep disruptions was based on subjective reports as well as changes in REM vs. non-REM sleep fractions as well as alterations in the subjects’ EEG activity, and overall EEG power. However, caution should be exercised when interpreting “overall” or “complete sleep time” measures since there can be many transient changes that affect the final number. In laboratory settings, many studies used white noise that may not be appropriate for generalization where actual environmental noise may be intermittent or restricted to certain frequency regions. To further complicate things, environmental noise that creates the greatest disruption of sleep may have the lowest annoyance when compared to other noise stimuli.14
It is also not clear from the research whether the data can be extrapolated equally to all groups in society. For example, increased age is correlated with increased arousal from sleep due to low-level environmental noise, as is shift work, especially if alcohol and tobacco are consumed. In an insightful study, Elmenhorst et al14 examined three environmental noise sources that they considered to significantly contribute to general annoyance: air, road, and railway traffic noise. However, these findings may not be transferable to physiological reactions during sleep, which is considered to decrease nighttime recovery and might mediate long-term negative health effects. They found that measures of annoyance and studies on sleep awakenings were not always correlated. For example, studies on awakenings from sleep indicate that railway noise, while having the least impact on annoyance, may have the most disturbing properties on sleep compared to aircraft noise. The impact of over 100,000 noise events on assessed awakenings was analyzed in 237 subjects. Results showed that the probability to wake up from equal maximum sound pressure levels (SPL) increased in the following order: aircraft < road = railway noise. That is, while the probability of wakening from road and railway noise exposure was roughly equal, aircraft noise at 70 dB SPL was 7% less likely to disrupt sleep as compared with the other two noise sources. They concluded that the three major traffic noise sources differ in their impact on sleep. The order with which their impact increased was opposite to what was compared to that found in annoyance surveys. They state that “It is thus important to choose the correct concept for noise legislation, ie, physiological sleep metrics in addition to noise annoyance for nighttime noise protection.” (p. 10).
In an older, but nevertheless insightful study, Ando and Hattori31 studied the effect of airport noise on unborn fetuses (Groups 1, 2, and 3) and newborns (Group 4). The environmental noise levels were higher for this study (95 dBA) and there is some question about whether these responses are the result of systemic and metabolic changes from the mother or changes directly in the fetus. The reactions of babies to aircraft noise were studied by means of electroplethysmography (PLG) and electroencephalography (EEG). It was found that the babies whose mothers had moved to the area around the Osaka International Airport before conception (Group 1) or during the first five months of pregnancy (Group 2) showed little or no reaction on PLG and on EEG to aircraft noise. In contrast, babies whose mothers had moved close to the airport during the second half of the pregnancy, or after birth (Groups 3 or 4) and the babies whose mothers lived in a quiet living area (control group), reacted to the same auditory stimuli. The babies in Groups 1 and 2 showed different responses depending on whether the auditory stimuli were aircraft noise or music. “Abnormal PLG and EEG were observed in the majority of babies living in an area where noise levels were over 95 dBA. This suggests that the deep sleep of the babies living in such an area was disturbed, but it is not clear whether there would be any long-term effects from these exposures.” (p. 199).
Amundsen et al32 describe the Norwegian Facade Insulation Study which includes modifications to over 2,500 dwellings that serve to reduce indoor noise levels. In Norway, about 30% of the population lives near main arterial roads with indoor noise levels being on the order of 55 dBA. In an attempt to remediate this situation, a program was implemented in 2004 and 2005 for more than 2,500 dwellings with improved windows, sound-insulation facades, and, in some cases, quieter home ventilation systems. The facade-insulating measures reduced indoor noise levels by 7 dB on average. Before the intervention, 43% of the respondents were highly annoyed by noise. Half a year after the intervention, the proportion of respondents who were highly annoyed by road traffic noise had been significantly reduced to 15%. In a follow-up study two years later, they found that the number of self-reported annoyances from the outdoor noise level remained lower and that the reduction in the respondents’ self-reported sleep disturbances also remained stable from the first to the second post-intervention study. This suggests that there is some statistical support for this type of assessment. In the control group, there were no statistically significant differences in annoyance between the pre-intervention and the two post-intervention studies. This study indicated a reduction from 43% to 15% in annoyance level (on a questionnaire) and was related to a 7 dB noise reduction level.
Smith et al33 evaluated the relative contribution and possible interaction effects of vibration and noise from railways on physiological sleep outcomes. Of importance is the finding that both environmental sequelae of railways are important. “Vibration from railway freight often accompanies airborne noise, yet this data is almost totally absent in the existing literature.” (p. 3262). In an experimental investigation, 23 participants, each sleeping for six nights in the laboratory, were exposed to 36 simulated railway freight pass-bys per night with vibration alone, the noise alone (49.8 dBA), or both vibration and noise simultaneously. A fourth exposure night involved 52 pass-bys with concurrent vibration and noise. Sleep was measured with polysomnography. Cardiac activity was measured with electrocardiography. The probability of awakening was greater following all exposures, including vibration alone, than spontaneous reaction probability (p < 0.05). The effects of vibration exposure and noise exposure on changes in sleep stage and arousals were directly additive. This implies that the effects of vibration and the noise were processed separately in the brain, but the mechanism(s) were not investigated in this study. The findings show that vibration and noise level, are both important when considering the impact of railway freight on sleep.
Rocha et al34 reported on a survey of sleep disruption for people living near the Atlanta International Airport and items included questions about sleep quality, sleep disturbance by noise, noise annoyance, coping behaviors, and health. Approximately 10% of over 3,000 surveys were returned. Some of the responses indicated that the calculated, outdoor, nighttime aircraft noise (“Lnight”) was significantly associated with lower sleep quality (p < 0.05), trouble falling asleep within 30 min ≥1/week (p < 0.01), and trouble sleeping due to awakenings ≥1/week (p < 0.05). The Lnight level was also associated with an increased prevalence of being highly sleep disturbed (p < 0.0001) and highly annoyed (p < 0.0001) by aircraft noise. The Lnight level was associated with several coping behaviors such as often or always closing their windows (p < 0.01), drinking alcohol (p < 0.05), using television (p < 0.05), and using music (p < 0.05) as sleep aids. There was no significant relationship between the Lnight level and self-reported general health or likelihood of self-reported diagnosis of sleep disorders, heart disease, hypertension, or diabetes.
In another study performed by the same group, Bartels et al,35 researchers studied the impact of nighttime (Lnight) road traffic noise, bedroom window orientation, and work-related stress on the subjective sleep quality of almost 4,000 working women. Sleep was assessed using a single question on general sleep quality and four questions on specific sleep problems (poor sleep vs no poor sleep). Work-related stress was assessed by questions pertaining to job strain and effort-reward imbalance. Nighttime exposure to road traffic noise was assessed regarding whether the bedroom window faced onto a quiet, medium-, or high-traffic street noise level (modeled as <45 dBA, 45-50 dBA, or >50 dBA respectively). Poor sleep was associated with job strain and effort-reward imbalance. The prevalence of poor sleep did not increase with increasing Lnight. Bedroom windows that faced on to a quiet street had a protective effect on sleep in each Lnight category. They found a non-significant trend for an additive interaction between bedroom window Lnight exposure and job strain and concluded that noise levels modeled for the most exposed location likely overestimated the actual exposure, and thus may not be a precise predictor of poor sleep. Bedroom window Lnight exposures may be a more relevant factor. Although this did not achieve statistical significance, the authors queried whether potential additive interaction effects between bedroom window orientation and job strain should be considered when interpreting epidemiological study results on noise-induced sleep disturbances.
Cognitive/Educational Issues Due to Noise
Unlike the subject areas of effects of noise on stress and sleep disruptions, the effects of low-level environmental noise on cognition and educational/language issues are more straightforward. While it is true that some “well-controlled” laboratory-based studies of the 1960s showed little or no effect, others showed adverse effect on some tasks (eg, Wyons reported by Bronzaft).36,37 But when switching the research paradigm to a more natural “in-situ” setting, more educational measures have achieved statistical significance, especially when other factors such as psycho-social aspects are controlled for. It has been argued that natural settings correlational studies would be better to draw educational and environmental conclusions from rather than (perhaps limited), but well-controlled laboratory studies.37
As far back as the early-to-mid-1970s, studies in a natural environment started to appear. Two can be metaphorically referred to as “smoking gun” studies that show clear results. There is, however, no evidence that decreased performance on reading or writing assessments will have any long-term effects.
Cohen et al38 were able to show that children who lived on lower floors of apartments, nearer to noisy expressways, performed poorer on school reading tasks than matched children who lived in higher altitude apartments, farther from environmental noise sources.
Bronzaft and McCarthy39 published a study with the telling name “The effect of elevated train noise on reading ability.” The school that was used had half the classrooms facing noisy train tracks while the other side was quieter. The students were matched for socioeconomic and other factors. During a typical school day, 80 trains passed the school with levels of 89 dBA and, when quiet, the classroom noise levels were 59 dBA. Bronzaft37 states that “Students on the noisy side did more poorly on reading achievement tests than did those on the quiet side of the building. The children in the sixth grade who were exposed to the noise were found to be a year behind their counterparts on the quiet side.” (p. 88).
Of interest in this last study, noise abatement measures were performed both by the transit authority (rubber vibration isolator pads were installed on the tracks) and the school (acoustic tiling was installed in the noisiest classrooms adjacent to the train tracks), resulting in a 6-8 dB reduction in noise levels. In a follow-up study, published six years later after the noise abatement measures were undertaken, the reading levels were assessed for children on both sides of the school and found to be comparable.40
In the first of four studies by Dockrell and Shield41 titled “Children’s Perceptions of Their Acoustic Environment at School and at Home,” this group assessed the question regarding whether children could be a good judge of the effects of certain environmental noise levels. Over 2,000 children completed a questionnaire designed to discriminate between different classroom listening conditions, the noise sources heard at home and at school, and their annoyance with these noise sources. Teachers also completed a questionnaire about the classroom noise environment. Indeed, children were able to discriminate between situations with varying amounts and types of noise and their responses accounted for 45% of the variance in the school environment noise sources. External LA max levels were a significant factor in reported annoyance, whereas external LA90 and LA99 levels were a significant factor in determining whether children hear sound sources. This study demonstrates that children can be sensitive judges of their noise environments and that the impact of different aspects of noise needs to be considered.
In the same year, these same researchers (Shield and Dockrell)42 published data on external and internal sound levels in a range of schools in the United Kingdom. Of interest is that they were able to delineate several physical changes (such as window glazing) that could ameliorate the noise levels. They examined 142 primary schools that were away from airports or airplane flight paths and found that 86% of these schools had outside environmental levels of 57 dBA. The children reported that they were bothered only while performing quieter activities in the classroom and not while the louder activities were being performed. While they did examine the age of the school and factors such as window glazing, their results were inconclusive.
In the third study of their series in the noise and education analysis of primary schools in the United Kingdom, Shield and Dockrell43 examined the effects of classroom noise on the academic attainments of primary school children. “External noise was found to have a significant negative impact upon performance in measures of literacy, mathematics, and science; the effect being greater for the older children.” (p. 133). The analysis suggested that children are particularly affected by the noise of individual external events. Other factors that significantly affected the children’s test scores were internal classroom noise levels and background levels being significantly related to test results. Even when the data were corrected for social-economic and special needs factors, the negative relationship between performance and noise levels was maintained.
In their fourth and final study in the United Kingdom, this same group studied reading comprehension levels and vocabulary learning tasks in adolescent students (Connolly et al).44 In a study of almost 1,000 English high school pupils (564 aged 11 to 13 years and 412 aged 14 to 16 years) reading tasks on laptop computers were completed while the students were exposed to different levels of classroom noise played through headphones. The number of questions attempted and the number of times taken to read the texts and answer questions, were recorded, as well as correct answers to different types of questions. Two similar experiments were performed with classroom noise at levels of 50 and 70 dB LAeq, and the second at levels of 50 and 64 dB LAeq. The results showed that the performance of all pupils was significantly negatively affected in the 70 dB LAeq condition, for the number of questions attempted and the accuracy of answers to factual and word learning questions. However, while the answer was clearer for the younger group of children and showed statistical significance, it was more difficult to discern whether the effects at 64 dB LAeq, had a detrimental effect on the older pupils.
And finally, because of the COVID-19 pandemic, where UNICEF estimates that 1.6 billion children across the world have had their education impacted, and have attempted to continue their learning at home, the study by Chere and Kirkham45 has some implications for home-based study and environmental noise levels. One hundred and twenty-nine students aged 11–18 took part online after passing an online hearing screening test. The students filled out a sociodemographic questionnaire with questions designed to assess their socioeconomic status and other factors. This was followed by a home environment and noise questionnaire. Three executive function tasks—the Flanker, the Backward Digit Span, and the Wisconsin Card Sorting Test—were completed while listening to either white noise or home-like environmental noise. Participants were then stratified into quieter and noisier homes for statistical analyses of the results. Measures of the home environment significantly correlated with individual perceptions of the noise and the task performance. Students in this age group coming from noisier homes were more likely to report that they studied in a noisy room and that they were annoyed by noise when studying. In terms of noise and task performance, the Flanker task revealed that while the older students in the group were more “efficient” than their younger peers, they appeared to lose that advantage if they lived in noisier homes. Reaction times for younger students from noisier homes were less impacted by accuracy compared to their peers from quieter homes, though there was no difference for the older adolescents. “This evidence suggests that higher in-home noise levels lead to higher rates of annoyance and may be hindering home learning, with both younger and older adolescents being impacted. Furthermore, the long-term effect of in-home noise on adolescent executive function task performance indicates that these findings transcend the pandemic and would influence in-school learning.” (p. 1).
World Health Organization (WHO) Environmental Noise Guidelines for the European Region (2018)
Based on thorough reviews of the available data, the World Health Organization (WHO)5 has listed some environmental noise limits where non-auditory systemic effects may begin to be observed. The 2018 WHO document was based on a more recent review of meta-studies and reviews from other sources, and many of the authors of the previous reports contributed to the WHO document. All nine WHO reports are referenced at the end of this document. The 2018 WHO consensus document was based on 7 systematic studies from 2000 to 2014. Van Kamp et al3 reviewed more recent studies and controlled for confounding and methodological issues from the 2018 review. Among the findings were high-quality studies linking wind turbine noise to sleep alteration patterns, but more study needs to be performed on the long-term effects of environmental noise on cardiovascular dysfunction. Following is a table, adapted from WHO (2018) summarizing some of the health effects of different average outdoor night noise levels (dB Lea):
A review of the non-auditory effects of lower-level environmental noise on several systems has been reviewed. This is admittedly an extremely difficult area of study with a range of many potentially confounding factors and measures that either have poor test-retest reliability or have a poor correlation with sleep disruption, cognitive and educational issues, stress, and general annoyance. For example, noise that may cause the greatest sleep disruptions may be judged as a noise source that is associated with relatively little annoyance.
There are also a range of other either uncontrolled (or unconsidered) phenomena where some people, in some circumstances, and with some types of noise, are more susceptible to its effects than are others. This may be a dose-related effect or even a genetic predisposition, or not; the literature is unclear on this. And, to be fair, this same issue of differential “susceptibility” is observed for some sections of the population, even for high levels of noise and/or music exposure for measurable and permanent hearing loss, where again, the reasons are not well known.
There are no “smoking gun” studies or set of studies, that, when taken together, definitively describe predictable and associated effects of low-level noise exposures. While many studies do demonstrate changes in some measures, there is no clear evidence that these changes will have long-term consequences.
While it would be tempting to say “more research needs to be performed,” given the inherent difficulties in this area of study, it would be unrealistic to conclude that at some point in the near future definitive and predicted results could be obtained. All that can realistically be said, is that for a range of low-level environmental exposures, some people are quite susceptible to its effects, whereas others are not, and these effects can include sleep disruption, potential cognitive and educational issues, and an increase in stress and annoyance.
I would like to acknowledge four external readers who provided constructive comments on the manuscript: Dr Arline Bronzaft, Dr Bob Harrison, Dr Steve Aiken, and Dr Bill Hodgetts.
Citation for this article: Chasin M. Non-auditory effects of environmental noise. Hearing Review. 2022;29(8):8-17.
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- Fay TH. Noise and Health. New York Academy of Medicine; 1991.
- Van Kamp I, Simon S, Notley H, Baliatsas C, van Kempen E. Evidence relating to environmental noise exposure and annoyance, sleep disturbance, cardio-vascular and metabolic health outcomes in the context of IGCB (N): A scoping review of new evidence. International Journal of Environmental Research and Public Health. 2020;17(9):3016.
- Van Kempen EEMM, Casas M, Pershagen G, Foraster M. Cardiovascular and metabolic effects of environmental noise. National Institute for Public Health and the Environment report. Published 2017.
- Van Kempen E, Casas M, Pershagen G, Foraster M. WHO Environmental Noise Guidelines for the European Region: A systematic review on environmental noise and cardiovascular and metabolic effects: A summary. International Journal of Environmental Research and Public Health. 2018;15(2):379.
- Munzel T, Sørensen M, Schmidt F, et al. The adverse effects of environmental noise exposure on oxidative stress and cardiovascular risk. Antioxidants & Redox Signaling. 2018;28(9):873-908.
- Basner M, McGuire S. WHO Environmental Noise Guidelines for the European Region: A systematic review on environmental noise and effects on sleep. International Journal of Environmental Research and Public Health. 2018;15(3):519.
- Clark C, Paunovic K. WHO Environmental Noise Guidelines for the European Region: A systematic review on environmental noise and cognition. International Journal of Environmental Research and Public Health. 2018;15(2):285.
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