Prolonged use of personal listening devices and hearing loss: a systematic review and meta-analysis

Hearing loss affects approximately 1.5 billion people globally, with noise-induced hearing loss (NIHL) being the most preventable cause. The widespread use of personal listening devices (PLDs) has raised concerns about potential auditory damage, yet evidence remains conflicting. This systematic review and meta-analysis aimed to quantify the association between prolonged PLD use and objectively measured hearing loss. We systematically searched PubMed, Scopus, Embase, Google Scholar, Proquest, and the Cochrane Library from inception to October 2024. Studies reporting on PLD use (headphones, earphones, earbuds) and hearing outcomes (pure-tone audiometry, otoacoustic emissions) were included. Quality assessment was performed using the Joanna Briggs Institute checklists. A random-effects meta-analysis was conducted to pool odds ratios (ORs) for hearing loss among PLD users compared to non-users. Of 16,635 initial records, 8,056 unique records were screened after duplicate removal. Following title/abstract screening, 125 articles were assessed, of which 60 studies met inclusion criteria, encompassing 67,404 participants across 20 countries. The pooled OR for hearing loss among PLD users compared to non-users was 2.26 (95% CI: 1.19–4.30; p = 0.01; I²=72%). Subgroup analyses, interpreted as exploratory given limited study numbers in some strata, revealed that the association was significant in adults (OR = 2.43, 95% CI: 1.21–4.87) but not in children/adolescents (OR = 0.88, 95% CI: 0.43–1.80; p for subgroup difference = 0.05), a finding that likely reflects shorter cumulative exposure and methodological limitations rather than true safety. Earphone users showed a non-significant pooled OR of 9.09 (95% CI: 0.44–188.65; P = 0.15), and sensitivity analysis led to a revised significant pooled OR (2.60, 95% CI: 1.52–4.46; P = 0.0005); headphone users had a significant OR of 4.04 (95% CI: 1.15–14.16) based on one study. A dose-response gradient was observed for both duration (short: OR = 0.84; medium: OR = 3.20; long: OR = 4.55; p for subgroup difference = 0.07) and listening volume (low: OR = 0.81; moderate: OR = 1.70; high: OR = 9.87; p for subgroup difference < 0.0001), although the duration gradient did not reach statistical significance. Sensitivity analyses confirmed the robustness of findings, though the HKSJ-adjusted CI was wider (OR = 2.31, 95% CI: 0.89–5.97). Extended high-frequency audiometry detected subclinical damage in all 12 studies reporting these measures, and 10 of 11 otoacoustic emission studies showed significant amplitude reductions among PLD users. The certainty of evidence was rated as LOW due to serious risk of bias and inconsistency. Prolonged and high-volume PLD use is associated with 2.26-fold increased odds of objectively measured hearing loss, with clear dose-response gradients for duration and volume. However, the predominantly cross-sectional evidence precludes causal inference, and substantial unexplained heterogeneity limits precision. Subgroup findings require confirmation in larger, methodologically rigorous studies. These findings are broadly consistent with public health recommendations promoting safe listening habits, including the 60/60 rule (≤ 60% volume for ≤ 60 min/day), noise-canceling devices, and regular hearing screening for high-risk users. Future longitudinal studies with objective dosimetry are urgently needed to establish causality.