INTRODUCTION:

Personal listening through earphones has become nearly universal among medical students.

Medical students now almost always use earphones for personal listening when studying, traveling, and having fun. Although extended use of personal listening devices is frequently linked to auditory complaints including tinnitus or ear pain, there is conflicting information about whether preferred volume level or total listening time is the main cause. Knowledge risk patterns and developing useful hearing-health recommendations in medical education contexts require a clearer knowledge of the relative importance of these factors.

Personal listening devices are now embedded in university life, with earphones widely used for study, leisure, and communication; among medical students, they also support learning through recorded lectures, podcasts, and clinical simulations^1,2. Public-health guidance has long cautioned that auditory risk reflects both sound level and duration of exposure, and global estimates suggest that unsafe listening is common among adolescents and young adults^3,4. Cross-sectional studies in student populations repeatedly link frequent earphone/headphone use with tinnitus, ear pain, and other hearing-related complaints, and some report associations with anxiety or depressive symptoms^5,6.However, several gaps remain: many investigations are single-institution snapshots; few parse the relative roles of listening time versus self-reported volume level; communication-focused outcomes (e.g., straining to follow conversations) are less often modelled; and evidence from Southeast Asian medical schools is limited^1,2. To address these gaps, this study quantifies the prevalence and patterns of earphone use among clinical-year MBBS students at a Malaysian medical college and examines how sociodemographic factors and specific listening behaviors relate to auditory symptoms and communication difficulties using multivariable analyses^3,5,6.

METHOD:

This descriptive cross-sectional study was carried out from September 2024 to May 2025 among Year 3–5 MBBS students at a medical university in Ipoh, Malaysia who reported using earphones; students with diagnosed hearing impairment were excluded. From a clinical student population of 438, a minimum sample of 205 was estimated at 95% confidence using the OpenEpi calculator, and 208 students ultimately participated via convenience sampling through an online questionnaire. Data were collected using a validated, structured Google Forms instrument adapted from prior studies, capturing (i) sociodemographic characteristics (year, gender, age, ethnicity), (ii) earphone-use patterns (device type, daily duration, typical volume, purpose), (iii) self-reported auditory symptoms (tinnitus, ear pain, dizziness, hearing difficulty, aural fullness, and communication strain), and (iv) knowledge and perceptions regarding earphone-related complications.

Data analysis. Data were coded and analysed in SPSS (N = 207). Descriptive statistics are presented as frequencies and percentages; for key proportions (e.g., any hearing symptom and high impact) binomial 95% confidence intervals were calculated. Bivariate associations used chi-square tests for categorical predictors (year of study, sex, ethnicity, device class, dominant side) and Spearman rank tests for ordered exposures (daily use time: <30, 30–60, 60–120, >120 minutes; volume level: 20%–100%). Statistical significance was set at p < 0.05 (two-sided). For multivariable inference, modified Poisson regression with standard errors estimated adjusted prevalence ratios (PRs) for binary outcomes (any hearing symptom; high impact), adjusting for year, sex, ethnicity, device class, dominant side, daily use time, and volume level. For the ordered communication outcome (strain to understand conversation, Never→Always), ordinal logistic regression (proportional odds) estimated adjusted common odds ratios (ORs). Effect sizes are reported with 95% confidence intervals and exact p-values.

ETHIC APPROVAL:

Participation was voluntary and anonymous. Informed consent was obtained. The study was conducted for educational purposes with institutional approval.

RESULTS:

Among 207 students, Year 4 formed the largest group (98, 47.3%), followed by Year 5 (56, 27.1%) and Year 3 (53, 25.6%). Females comprised two-thirds of the cohort (137, 66.2%). Most participants were Malay (201, 97.0%).

The most common device was wired earphones (121, 58.5%), followed by wireless earphones (51, 24.6%), wired headphones (26, 12.6%), and wireless headphones (9, 4.3%). Most students predominantly used the right ear (179, 86.5%), with 9.7% the left and 3.9% both sides.

Average daily usage clustered at 30–60 minutes (28.5%) and <30 minutes (27.5%); 24.2% reported 60–120 minutes and 19.8% >120 minutes. Typical volume settings were 60% (44.0%), 40% (37.2%), 80% (12.6%), 20% (5.8%), and 100% (0.5%).

For stated purposes (multiple response), selections were Leisure (46.7%), Educational (20.1%), Talk through phone (18.5%), Sleeping (11.1%), and Style (3.6%). Percentages sum to 100% of all purpose selections (total selections = 422; ≈2.0 purposes per respondent).

Table 1: shows demographic data of the study population

Variable	Category	n	%
Year of study	Year 3	53	25.6
	Year 4	98	47.3
	Year 5	56	27.1
Gender	Male	70	33.8
Gender	Female	137	66.2
Ethnicity	Malay	201	97.0
Ethnicity	Non-Malay	6	3.0
Type of device	Earphone – wired	121	58.5
	Earphone – wireless	51	24.6
	Headphone – wired	26	12.6
	Headphone – wireless	9	4.3
Dominant side	Right	179	86.5
	Left	20	9.7
	Both sides	8	3.9
Avg. daily use	<30 min	57	27.5
	30–60 min	59	28.5
	60–120 min	50	24.2
	>120 min	41	19.8
Typical volume	20%	12	5.8
	40%	77	37.2
	60%	91	44.0
	80%	26	12.6
	100%	1	0.5
Purpose of use*	Leisure time	197	46.7
	Educational purpose	85	20.1
	Talk through phone	78	18.5
	Sleeping	47	11.1
	Style	15	3.6

*Multiple-response item; percentages reflect the share of all selections (not participants).

Experience with Hearing Problems

About one-third reported tinnitus (70, 33.8%), ear pain was more common (93, 44.9%), while dizziness (31, 15.0%) and difficulty hearing (37, 17.9%) were less frequent.

Communication-related difficulties were mostly intermittent. Over half sometimes had to strain to understand conversations (116, 56.0%), with 3.9% usually and 1.4% always experiencing this; 38.6% never experienced it. Similarly, needing higher TV volume was sometimes for 30.4% and usually/always for 6.3%, though most never did (63.3%). Speaking too loudly was sometimes for 38.6% and usually/always for 6.2% (55.1% never). Asking people to repeat was sometimes for 61.8% and usually/always for 19.8% (18.4% never). Responding inappropriately occurred sometimes for 54.1% and usually/always for 9.1% (36.7% never).

Knowledge of hearing-problem indicators was generally high: difficulty hearing (90.3%), tinnitus (87.4%), ear pain (87.4%), fullness sensation (69.1%), and dizziness (56.0%). Overall perceived impact was low for most participants: Low impact (0–10) in 196 (94.7%) and High impact (11–20) in 11 (5.3%).

Table 2: Table depicts Experience in Hearing Problems of the study subjects

Domain	Item / Category	n	%
Symptoms (experience)	Tinnitus — Yes	70	33.8
	Ear pain — Yes	93	44.9
	Dizziness — Yes	31	15.0
	Difficulty in hearing — Yes	37	17.9
Strain understanding conversation	Never	80	38.6
	Sometimes	116	56.0
	Usually	8	3.9
	Always	3	1.4
High TV volume	Never	131	63.3
	Sometimes	63	30.4
	Usually	12	5.8
	Always	1	0.5
Talk too loud	Never	114	55.1
	Sometimes	80	38.6
	Usually	10	4.8
	Always	3	1.4
Asking people to repeat	Never	38	18.4
	Sometimes	128	61.8
	Usually	33	15.9
	Always	8	3.9
Respond inappropriately	Never	76	36.7
	Sometimes	112	54.1
	Usually	15	7.2
	Always	4	1.9
Knowledge (signs of hearing problems)	Tinnitus — Yes	181	87.4
	Ear pain — Yes	181	87.4
	Dizziness — Yes	116	56.0
	Difficulty in hearing -Yes	187	90.3
	Fullness sensation — Yes	143	69.1
Perceived impact	Low impact (0–10)	196	94.7
Perceived impact	High impact (11–20)	11	5.3

Using inferential statistics, this study examined which listening habits were linked with hearing problems in 207 students. Longer daily earphone use showed a clear, dose–response association with any hearing symptom: each step up in time (<30 → 30–60 → 60–120 → >120 minutes) increased prevalence by about 20% (adjusted PR 1.20, 95% CI 1.10–1.32, p<0.001), and this trend was also evident in a rank test (Spearman ρ=0.27, p<0.001).

Typical volume level (20%→100%) was not independently related to symptoms (PR ≈1.00, p=0.96). Compared with Year 3, Year-4 students had a lower prevalence of symptoms (PR 0.78, 95% CI 0.63–0.98, p=0.031), while female sex showed a borderline higher prevalence (PR 1.22, 95% CI 0.98–1.53, p=0.078). For the rarer outcome of high impact (11/207; 5.3%), Year-5 students had a higher adjusted prevalence than Year-3 (PR 6.46, 95% CI 1.01–41.22, p=0.049), but estimates were imprecise due to few cases. In an ordinal model of straining to understand conversation (Never→Always), longer daily use again showed a strong dose–response (common OR 1.72 per time category, 95% CI 1.31–2.26), whereas volume, device type, dominant side, and ethnicity were not significant predictors. After adjustment, time of use was associated with symptoms, whereas volume level was not.

Overall, time of use—not volume level—was the consistent driver of increased symptoms and communication strain after adjusting for year, sex, ethnicity, device class, and side.

Table 3: Single Inferential statistics summary table with overall prevalence (N=207)

Outcome	Predictor (comparison)	Effect metric	Effect	95% CI	p-value	Plain meaning
Any hearing symptom (overall prevalence)	-	Proportion	65.20%	0.585-0.714	-	135/207 students reported ≥1 symptom
Any hearing symptom	Daily use time (per category ↑)	Adjusted PR	1.20	1.10–1.32	<0.001	Each step up in time raised prevalence ≈20%
Any hearing symptom	Volume level (per category ↑)	Adjusted PR	≈1.00	—	0.96	No independent association
Any hearing symptom	Year 4 vs Year 3	Adjusted PR	0.78	0.63–0.98	0.031	Lower prevalence in Year 4
Any hearing symptom	Female vs Male	Adjusted PR	1.22	0.98–1.53	0.078	Borderline higher in females
Any hearing symptom	Trend in time (rank)	Spearman ρ	0.27	—	<0.001	Positive dose–response with time
Any hearing symptom	Trend in volume (rank)	Spearman ρ	0.06	—	0.383	No clear trend with volume
High impact (11–20)	Year 5 vs Year 3	Adjusted PR	6.46	1.01–41.22	0.049	Higher prevalence (imprecise, few cases)
Strain to understand conversation (Never→Always)	Daily use time (per category ↑)	Adjusted OR	1.72	1.31–2.26	<0.001	More time → more frequent strain
Strain to understand conversation (Never→Always)	Volume level (per category ↑)	Adjusted OR	≈1.00	—	NS	Not associated

DISCUSSION

This study of 207 clinical-year medical students highlights a high burden of self-reported auditory symptoms, with roughly two-thirds experiencing at least one symptom, and a small but important minority reporting high impact. Daily time spent using earphones showed a clear dose–response relationship with symptoms and with communication strain, whereas self-reported volume level did not add explanatory value once time of use and other covariates were considered. These patterns suggest that cumulative exposure (minutes per day) may be the more salient driver of perceived auditory problems in this population, aligning with exposure–response concepts in noise epidemiology.

The findings fit within a growing body of literature linking personal listening device use to tinnitus, ear pain, and related complaints among young adults. Studies in university cohorts have consistently reported substantial prevalence of earphone use and hearing-related issues^1,2, and several have associated headphone/earphone behaviors with tinnitus and psychosocial sequelae^5,6. Evidence from student samples in the Middle East likewise indicates a relationship between headphone use and hearing problems⁶. At the policy level, WHO’s Make Listening Safe initiative underscores that unsafe listening is a major, preventable risk for permanent hearing loss in young people and recommends practical exposure controls³. The present results complement those messages by pointing to “time at exposure” as an actionable target for campus health education and behavior change.

From a health-promotion perspective, several implications follow. First, risk communication should prioritize reducing daily listening time, encouraging breaks, and situational awareness (e.g., minimizing use in already noisy environments). Second, because self-reported volume level was not independently associated after adjustment in this sample, counseling may be most effective when framed around total exposure (time × volume), while still reinforcing safe-listening practices such as keeping volume at conversational levels and using well-fitting devices that do not require high output. Third, given the observed communication difficulties (e.g., straining to understand conversations), brief screening questions can be integrated into student health services, with referral pathways for audiologic assessment when needed.

Several limitations warrant consideration. Outcomes were self-reported and may not mirror audiometric thresholds; misclassification of exposure (e.g., perceived volume percentages) is possible; and the cross-sectional design precludes causal inference. The sample was drawn from one institution and was predominantly Malay, which may limit generalizability. Nonetheless, the internal consistency of the time-related effects across multiple outcomes supports the robustness of the main inference. Future research could add objective sound-level logging and longitudinal follow-up to clarify exposure–response thresholds and reversibility of symptoms.

In sum, the results support a practical message for students and educators: manage total listening time and embed safe-listening guidance into routine academic and wellness communications. This emphasis on exposure duration complements existing global recommendations and can be implemented with low cost and high potential benefit.

CONCLUSION:

Among 207 clinical-year students, self-reported auditory symptoms were common, and daily time of earphone use—not self-reported volume level—emerged as the consistent factor linked with symptoms and conversation strain after accounting for student characteristics and device factors. A small but meaningful minority reported high-impact effects, underscoring the need for pragmatic prevention on campus. The most actionable message is simple: manage total listening time (build in breaks, avoid prolonged continuous use), alongside general safe-listening practices. Student health services can incorporate brief screening questions and clear referral pathways for audiologic assessment. While the cross-sectional, self-reported nature of the data and the single institution setting limit causal inference and generalizability, the exposure pattern is coherent and readily translatable into guidance. Future studies using objective logging of sound exposure and longitudinal follow-up can refine thresholds for safe use and clarify reversibility of symptoms. Overall, prioritizing time-at-exposure in health education offers a low-cost, high-benefit approach to protect hearing in young adults.

CONFLICT OF INTEREST:

There is no conflict of interest between the authors.

REFERENCES:

1. Alhammad, A. M., Alzahrani, S. H., and Alotaibi, M. A. Prevalence of earphone use and hearing-related issues among medical students. Journal of Audiology and Otology. 2017; 21(2): 72–77.

2. Murthy, A., Shetty, S. S., and Prabhu, P. K. Patterns of earphone use and its effects on hearing among students in India. Indian Journal of Otolaryngology and Head and Neck Surgery. 2020; 72(3): 318–323.

3. World Health Organization. (2015). Make listening safe. World Health Organization.

4. Dillard LK, Arunda MO, Lopez-Perez L, Martinez RX, Jiménez L, Chadha S. Prevalence and global estimates of unsafe listening practices in adolescents and young adults: a systematic review and meta-analysis. BMJ Global Health. 2022 Nov 15; 7(11).

5. Choi JH, Park SS, Kim SY. Associations of earphone use with tinnitus and anxiety/depression. Noise and Health. 2021 Oct 1; 23(111): 108-16.

6. Amoodi H, Kadasa S, Alraddadi Y, Alrasheed A, Alkhuraisi L, Alomari K, Alshangiti S, Alzahrani KT. The relation between most common hearing problems and use of headphones among high school students in Saudi Arabia. Medical Science. 2023; 27(1): e209ms3005.

Received on 05.12.2025 Revised on 24.02.2026

Accepted on 29.04.2026 Published on 20.05.2026

Available online from May 25, 2026

Research J. Pharmacy and Technology. 2026;19(5):2196-2200.

DOI: 10.52711/0974-360X.2026.00316

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.