Technological advancements have facilitated the demand for electronic systems to track and measure progress during exercise activities. Electronic devices with music applications, such as iPods and smartphones, are popular during gym sessions as they support the ambiance to one’s exercise programme. Earphones are the popular choice for the transmission of music to the gym user’s ear. There is a direct correlation between the cardiovascular health and the aural health because of the effect of increased blood supply to the auditory system. Therefore, this research study explores the ear hygiene of gym users.
This study aimed at determining the ear hygiene and middle-ear status of gym users who wore earphones whilst exercising.
A purposive sampling method was adopted. Data were collected in two phases: phase 1 via a questionnaire and phase 2 included an otoscopic examination and tympanometry. Qualitative and quantitative data were analysed.
Fifty-four participants were included. Ear hygiene was not a priority for all gym users. The results revealed that 87% of the participants randomly cleaned their ears; however, 59% were cleaning their earphones. The middle ear assessment indicated that 17% of the participants presented with pathological indicators. Participants requested for the implementation of educational programmes pertaining to infection control measures for proper ear hygiene.
There is a dearth of health and wellness educational programmes that include ear hygiene practices, necessitating the development of prevention and promotion programmes for this niche area in audiology. The need for guidelines pertaining to ear hygiene practices amongst gym users is vital to ensure that the auditory system is monitored and protected when individuals participate in exercise sessions.
The 19th century saw the first industrial revolution in the textile industry as new production methods were employed (Crafts,
The World Economic Forum (
The 4th Industrial Revolution is about more than just technology-driven change; it is an opportunity to help everyone, including leaders, policy-makers and people from all income groups and nations, to harness converging technologies in order to create an inclusive, human-centred future.
Economic, educational, social and political spheres depend on the technology to communicate, learn and live. Individuals use technology connected to earpieces such as earphones and insert ear devices to socialise, to assist in health and wellness and to gain new knowledge. The World Health Organization describes good ear hygiene as follows (WHO,
not using medication in the ear that is not prescribed for you
not using dirty towels to clean one’s ears
not putting anything into your ears
not cleaning one’s ears with hairpins, toothpicks or anything else
not putting water into one’s ears
not leaving cotton wool in one’s ears unless directed by a healthcare worker.
Individuals who wear ear devices are advised to follow good ear hygiene practices, such as cleaning and disinfecting the ear devices regularly (Gompa & Anand,
Focal areas in the field of Audiology in the 21st century depend on the use of electronic ear devices for the assessment and management of hearing loss and ear care. Auditory brainstem assessment, otoacoustic emission assessments and personal amplification systems are but a few technological advancements in the current century that has provided the opportunity to assess and manage auditory-related disorders in an effective, efficient and precise manner (Iliadou et al.,
Ear-related electronic devices are popular in the 21st century, necessitating the promotion of ear care and the prevention of auditory pathologies. Earphones are the most commonly used electronic ear device amongst the general population as individuals use earphones for various activities, such as listening to music, podcasts and audiobooks, watching movies, gaming, and making phone calls (Hiipakka,
International studies identified that gym users are at a greater risk as exercise exacerbates the physiological changes and increases the ear’s susceptibility to auditory pathologies, such as OM and OE (Vittitow, Windmill, Yates, & Cunningham,
Audiologists in South Africa (SA) play an important role in the promotion of good ear hygiene practices and prevention of auditory pathologies. Globally, the research study on sports audiology focuses on social and professional sports participants (Du Plessis, Fothergill, Gertner, Hughes, & Schwaller,
Playing and watching sports are popular recreational activities globally. Increased participation in sports can be attested to social connects that are created during the shared participation and enjoyment of the sport (Department of Sports and Recreation,
Sports provide escapism and a healthy competitive atmosphere in SA (Department of Sports and Recreation,
It is estimated that, globally, there are 58 000 000 individuals who utilise gyms, on average, two times per week (Statistic Brain, 2017). The number of people attending and exercising at gyms has also increased in SA (Fitness and Health, 2017) despite the insufficient statistics on gym attendance in SA. South African gyms earn R12.5 billion a year, which is the highest in the world (Mapumulo,
Health professionals promote exercise to increase immunity and reduce stress levels (Gleeson,
Exercise and training at a gym may have a negative impact on the individual because of an increase in blood pressure levels, thus increasing pressure to the auditory system and brain (Delp et al.,
Whilst there is a risk of harmful side-effects of exercise, it is evident that a healthy lifestyle requires exercise. Wellness programmes reinforce the positive effects of exercise on the overall physical and mental aspects of human life. The technological advances of the fourth industrial revolution have brought with it health and wellness accessories and wearables, such as wristbands, watches and hearables. Hearables are wireless in-ear computational devices that fit inside an individual’s ear canal and enhance the quality of listening (Banks,
A research study conducted on the effects of earphones focuses on call centre agents (Trompette & Chatillon,
The rationale for this study stemmed from the lack of specific educational infection control programmes available in SA targeting individuals who wear hearables on a social basis, despite the increased use of hearables during exercise programmes and at events, such as silent discos and secret sunrise exercise gatherings (Secret Sunrise,
Individuals who were exposed to noise during exercise performed significantly worse when assessed for temporary threshold shifts when compared with those who were exposed to noise only and exercise only (Lindgren & Axelsson,
The current study aimed at contributing to new knowledge within the area of sports audiology in SA, and it plays an integral role in building foundational information pertaining to ear hygiene practices of gym users.
To document any significant audiological case history information.
To document the ear hygiene practices and earphone usage of gym users.
To assess and document the tympanometry results of gym users who wear earphones.
This study employed an exploratory, mixed method research design. The data were collected in two phases: phase 1 utilised a questionnaire that was developed by the researcher to obtain qualitative data, and phase 2 included an otoscopic examination and tympanometry assessment that yielded quantitative data.
A purposive sampling method was undertaken to identify individuals who attended gyms. The sample comprised of individuals who were familiar with the researcher and individuals who were recruited via an advert on social media.
Fifty-four participants between the ages of 18 and 50 years were included in this study, 26 male and 28 female. Participants met the following inclusion criteria: participants were required to attend and exercise at a gym for 3 days a week or more; they were required to own a pair of earphones, which they wear during the exercise sessions; they needed to be over the age of 18 years and could identify with any gender description or nationality.
The data were collected at a location that was convenient for the participants and were then documented on a record sheet. The otoscopic examinations were performed by the researcher to ensure consistency and reliability of results. The researcher documented all findings onto the record sheet. The findings, such as impacted wax, abnormalities of the pinna and ear canal, were recorded. The middle-ear status was assessed via a calibrated tympanometer with a 226-Hz probe tone, which is an appropriate choice for the adult participants in this study. The tympanogram classification was based on the Jerger (
Participants received the results of the middle ear assessment immediately, and were counselled and referred to the appropriate healthcare practitioners if needed.
Ethical clearance was granted by the University of the Witwatersrand Medical Research Ethics Committee in 2018 (clearance number: M180216), and data were collected thereafter. Potential participants were provided with an information sheet, detailing the research methods and requirements. Individuals who agreed to participate were provided with an informed consent form. Descriptive statistics were employed for the analysis of the quantitative data.
The results are presented as per the aims of the study.
Five participants experienced multiple ear infections during childhood, of which two had undergone surgery to insert grommets and the other three had a history of ear infections as a result of swimming. Seven participants were experiencing ear problems at the time of data collection, which included an excessive wax build-up, tinnitus and hearing loss. Eight participants experienced dizziness after exercising, and 11 participants experienced tinnitus. Thirteen participants experienced a change in hearing ability after strenuous training sessions whilst listening to loud music via earphones. Participants revealed that the loss of hearing lasted for 30 sec to an hour.
Forty-seven participants indicated that ear cleaning formed a part of their hygiene practices. The number of times that participants cleaned their ears varied from every day to every second month. Twenty participants practised daily ear cleaning, 20 of them practised weekly ear cleaning, three practised monthly ear cleaning and four participants cleaned their ears at an interval of two or more months. Ear cleaning methods and tools were identified as earbuds (29), water (10), soap and water (8), cloth (6), finger (4), tissue (1), waxsol (1), syringe (1) and bobby pin (1).
Participants’ earphone hygiene practices revealed that 32 participants cleaned their earphones; however, there were variations in the frequency of cleaning practices. Three participants practised daily earphone cleaning, 15 practised weekly cleaning, six practised monthly cleaning and seven cleaned their earphones every few months when it became visibly dirty. Methods of earphone cleaning varied between using a cloth (9) to using chemicals, such as Dettol wipes (1), alcohol swabs (2), chlorohexidine (1), germicide (1), hand sanitizer (1), cologne (1) and surgical spirits (1). One of the participants used a safety pin to clean the earphones.
Forty-six participants indicated their willingness to participate in education programmes geared at ear hygiene practices. Participant 4 stated that ‘the implementation of community programmes at the level of primary intervention would prevent future complications’. Participants indicated that their understanding and perceptions surrounding ear hygiene were limited and poor.
The average participant exercised three or four times a week and utilised earphones at every session. The mean volume level used by the participants to hearing music was at 70% of the maximum volume on the device.
The results are presented in terms of ears rather than participants. The otoscopic examination revealed that 90 ears were free from abnormalities, five ears presented with a partial wax occlusion, 11 ears were fully occluded with wax and two ears showed visible exostoses. The participant who presented with the exostoses indicated that he or she cycles outdoors on a regular basis.
The tympanometry results revealed that 90 ears presented with Type A tympanograms, two ears with Type As tympanograms, two ears presented with Type B tympanograms and three ears with Type C tympanograms.
Eleven per cent of participants presented with a full wax occlusion and 4% with a partial wax occlusion. This number is quite large in relation to the sample size. The presence of wax is normal and healthy; however, it becomes problematic when it blocks the ear canal as it may decrease hearing thresholds (Prusick,
Type B and C tympanograms can be related to middle-ear pathologies, such as OM (Onusko,
Participants who revealed that they have a hearing loss did not disclose the cause of the hearing loss; however, it is vital to monitor the noise levels when using earphones during exercise sessions in order to prevent further damage on the hearing mechanisms. The noise exposure in gyms may be because of loud music during group classes, weights crashing and general music noise within the gym. The current study highlights the need for a large-scale study that monitors the noise levels in gyms as exercising results in the auditory system being more sensitive to sound (Vittitow et al.,
A study by Punch et al. (
Intense workout sessions increase the susceptibility of developing audiological symptoms (Ireland,
The ear is a self-cleaning mechanism, and it is, therefore, recommended that individuals do not need to clean their ears (Prusick,
Education provides individuals with the tools they need to identify problems and create solutions (Zimmerman, Woolf, & Haley,
Exercise is vital in the overall healthy lifestyle regime; therefore, one should be equipped with the knowledge of preventing the audiological abnormalities that could result during exercise sessions. Various types of exercise activities have different effects on the audiological system and may cause audiological symptoms during and after training sessions. By providing the gym user with the required ear hygiene knowledge, the audiologist can promote good ear health and prevent ear damage. There is a need for aural hygiene awareness, especially in the gym setting, and the role of the audiologist is highlighted in this niche area. The audiologist can consider the following recommendations:
Lobby that medical aids create a mandatory hearing assessment within their health and vitality programmes, thus, promoting the monitoring of one’s hearing status.
Make requests to the gyms for posters that indicate the need to disinfectant surfaces, including one’s earphones.
Offer screening at gym sites to promote awareness of aural hygiene and hearing.
Petition the producers of hearables to request for a warning sign to be placed on hearables to prevent misuse at loud volumes.
Petition the producers of earphones and request that cleaning instructions are made available within the instruction manual.
Exercise is necessary for a healthy body and mind; therefore, one cannot stop exercising in order to decrease the risks of auditory damage. However, audiologists play a significant role in educating and equipping the gym users about ear hygiene and care. There is a niche area of sports audiology, which should be explored in a deeper manner.
The authors thank all the participants who gave up their time to be a part of the study.
The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.
Both A.F. and D.P. contributed equally to this work.
This research work received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Data sharing is not applicable to this article.
The views and opinions expressed in this article are those of the authors and do not reflect the official policy or position of any affiliated agency of the authors.