Research shows that sound levels in video games often approach or exceed safety thresholds. Researchers advocate increased public health campaigns to raise awareness of potential hazards. A systematic review of existing evidence published in the open-access journal BMJ Public Health suggests that video game players worldwide may be at risk of permanent hearing loss and/or tinnitus, which is characterized by a persistent ringing or buzzing sound in the ears.

Researchers reached this conclusion after reviewing studies involving more than 50,000 people and found that reported sound levels often approached or exceeded established safety limits.

They urged that given the popularity of these games, greater public health efforts are needed to raise awareness of the potential risks. While headphones, earbuds and music venues have been identified as sources of potentially unsafe sound levels, relatively little attention has been paid to the impact of video games, including esports, on hearing loss, the researchers said.

Gamers often play at high sound levels for hours at a time, they added. It is estimated that the number of global game players will exceed 3 billion in 2022. To build the evidence base, the researchers searched research databases for relevant studies, white papers, communications, reports and conference proceedings, collectively known as "grey literature", published at any time in English, Spanish or Chinese.

Extensive research and findings on sound exposure in games

About 14 peer-reviewed studies were included in the review, from nine countries in North America, Europe, Southeast Asia, Asia and Oceania, involving a total of 53,833 people. Eleven of these were cohort (observational epidemiological) studies, six examined the relationship between hearing and computers or video games; four studies focused on gaming centers or PC rooms, which are popular in Asia; and one study focused on mobile devices.

Reported noise levels ranged from 43.2 decibels (mobile devices) to 80-89 decibels (game centers), while the length of exposure varied by mode and frequency of exposure - from daily to monthly for at least an hour, with an average of three hours per week.

Impulse sounds include bursts of sound lasting less than 1 second and with a peak value that is at least 15 dB louder than background sound. One study reported that pulsating sounds during gaming can reach up to 119 decibels; the permissible exposure limit is about 100 decibels for children and 130-140 decibels for adults.

The researchers explain that the International Telecommunications Union (ITU), in collaboration with the World Health Organization, developed a time-intensity trade-off for permissible exposure levels and exposure duration, known as exchange rates. For example, a permissible noise exposure level of 80 dB for 40 hours per week with an exchange rate of 3 dB means that for every 3 dB increase in noise level, the permissible exposure time is halved: 20 hours at 83 dB; 10 hours at 86 dB; 2.5 hours at 92 dB; and 38 minutes at 98 dB.

For children, the permissible noise exposure level is defined as 75 decibels for 40 hours per week. Therefore, the researchers explain, children can safely listen to a sound of 83 decibels for about 6.5 hours per week, a sound of 86 decibels for about 3.25 hours, a sound of 92 decibels for 45 minutes, and a sound of 98 decibels for only 12 minutes. Six studies reported the prevalence of video games among adolescents, ranging from 20% to 68%. Two studies in South Korea reported that gaming center usage was around 60%.

Link between gaming and hearing loss

Five studies assessed the relationship between gaming and self-reported hearing loss, hearing thresholds, or tinnitus. Two of the studies found that game center use among elementary school children was associated with increased odds of severe tinnitus and high-frequency hearing loss in both ears. Another large observational study reported that video gaming was associated with increased odds of self-reported hearing loss severity. One study reports that more than 10 million people in the United States may be exposed to "loud" or "very loud" sounds from video or computer games. One study measured the sound levels of five video games using headphones connected to consoles and found that four shooting games had average sound levels of 88.5, 87.6, 85.6 and 91.2 decibels, respectively, and a racing game had an average sound level of 85.6 decibels.

Therefore, the authors concluded that daily sound exposure levels from these video games are close to the maximum permissible sound exposure levels.

A further 16 peer-reviewed articles and 14 gray literature references games as a potential source of excessive sound exposure. A gray literature attempt was made to discover the hearing levels that gamers prefer when wearing headphones. The authors concluded that gaming headsets may reach unsafe hearing levels, "which may put some gamers at risk for sound-induced hearing loss."

Three studies assessed gender differences in gaming behavior. These findings suggest that boys play video games more frequently, for longer periods of time, and with greater intensity than girls. The researchers acknowledge that some of these studies date back to the early 1990s, and that only 2 studies published in the past 10 years objectively measured average sound levels in video games or gaming centers, although both studies reported high sound levels in these situations.

"Although the data presented in this review are limited, these data suggest that some gamers, particularly those who play games frequently, are likely exceeding permissible sound exposure limits at or above the average sound levels described in this review paper, and are therefore engaging in unsafe listening practices that may put them at risk of developing permanent hearing loss and/or tinnitus," they concluded.

They added that there are some critical gaps in the existing evidence. For example, further research into the impact of esports, geographic region, gender and age on hearing loss is critical to develop preventive measures and global policy measures.

They suggested: "The findings suggest that it may be necessary to prioritize interventions, such as initiatives focused on education and raising awareness of the potential risks of gaming, that can help promote the health of gamers."

Compiled source: ScitechDaily