The COVID-19 pandemic has created substantial and dynamic disruptions in society, personal behavior, and potentially chronic sound exposures, which are associated with hearing loss, cardiovascular disease, and other health impacts. Leveraging preliminary data from our unique nationwide Apple Hearing Study, we explored changes in personal sound exposures resulting from COVID-19-related social distancing. Volunteer participants opted to share environmental sound data from their Apple Watch and headphone sound data from their iPhone. Participants for this analysis were chosen from four states which exhibited diverse responses to COVID-19. Equivalent continuous average sound exposures (in A-weighted decibels, dBA) were computed per person-day and normalized to 8 hour LEX8h exposures. Daily mean LEX8h exposures across two time periods, a baseline period (before the first known US COVID-19 death at the time of analysis) and an intervention period (starting with each state’s first COVID-related public health social distancing announcement and ending on April 22, 2020) were defined to assess changes in sound exposure. We modeled sound levels across 5,894 participants and 516,729 monitored days using a linear mixed-effects model with random effects for participant. The overall reduction in LEX8h between baseline and intervention was 2.6 ± 0.05 dBA (mean ± SE). There was a significant day-of-week effect during the baseline period, with the lowest exposures on Monday and the highest on Saturday. This effect was not noted during the intervention period. COVID-19 social distancing measures were associated with an approximately 3 dBA reduction in personal environmental sound exposures; this represents a substantial and meaningful reduction in this harmful exposure. Our analysis demonstrates the utility of everyday use devices in detecting behavior and exposure changes associated with the COVID-19 pandemic, and the usefulness of longitudinal, large-scale characterization of personal exposures and health impacts using wearable technology.

Globally, noise exposure from occupational and nonoccupational sources is common, and, as a result, noise-induced hearing loss affects tens of millions of people. Occupational noise exposures have been studied and regulated for decades, but nonoccupational sound exposures are not well understood. The nationwide Apple Hearing Study, launched using the Apple research app in November 2019 (Apple Inc., Cupertino, CA), is characterizing the levels at which participants listen to headphone audio content, as well as their listening habits. This paper describes the methods of the study, which collects data from several types of hearing tests and uses the Apple Watch noise app to measure environmental sound levels and cardiovascular metrics. Participants, all of whom have consented to participate and share their data, have already contributed nearly 300 × 106 h of sound measurements and 200 000 hearing assessments. The preliminary results indicate that environmental sound levels have been higher, on average, than headphone audio, about 10% of the participants have a diagnosed hearing loss, and nearly 20% of the participants have hearing difficulty. The study’s analyses will promote understanding of the overall exposures to sound and associated impacts on hearing and cardiovascular health. This study also demonstrates the feasibility of collecting clinically relevant exposure and health data outside of traditional research settings.

In order to further understand the combined effects of occupational and recreational noise exposure with regards to noise induced hearing loss (NIHL), an in-ear dosimeter prototype meant for continuous use was developed. The device acts as a hearing protection device (HPD) and can measure and log effective in-ear sound pressure level as well as unprotected levels. To enable its continuous use, this HPD is also equipped with a bypass feature for “transparent” hearing, input for music or communication devices and interfaces with Android smartphones. The proposed device allows for the implementation of an algorithm accounting for the auditory fatigue recovery rate, providing a true representation of the current accumulated noise dose. This allows for 24 h dosimetry and avoids having the user manually reset the dose back to 0% on the next day and thus assuming complete fatigue recovery has occurred. This paper details the proposed recovery algorithm, presents collected field data, and discusses the benefits as well as real-world challenges of using such a device.

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