The review provides an overview of epidemiological studies that were carried out in the field of community noise and cardiovascular risk. The studies and their characteristics are listed in the tables. Risk estimates derived from the individual studies are given for 5 dB(A) categories of the average A-weighted sound pressure level during the day. The noise sources considered in the studies are road and aircraft noise. The health endpoints are mean blood pressure, hypertension and ischaemic heart disease, including myocardial infarction. Study subjects are children and adults. The evidence of an association between transportation noise and cardiovascular risk has increased since the previous review published in Noise and Health in the year 2000.

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Studies on the association between community noise and cardiovascular risk were subjected to a meta-analysis for deriving a common dose-effect curve. Peer-reviewed articles, objective assessment of exposure and outcome as well as control for confounding and multiple exposure categories were all necessary inclusion criteria. A distinction was made between descriptive (cross-sectional) and analytical (case-control, cohort) studies. Meta-analyses were carried out for two descriptive and five analytical studies for calculating a pooled dose-effect curve for the association between road traffic noise levels and the risk of myocardial infarction. No increase in risk was found below 60 dB(A) for the average A-weighted sound pressure levels during the day. An increase in risk was found with increasing noise levels above 60 dB(A) thus showing a dose-response relationship. A risk curve was estimated for the association using a polynomial fit of the data that can be used for risk assessment and the environmental burden of disease calculations.

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The effects of classroom noise and background speech on speech perception, measured by word-to-picture matching, and listening comprehension, measured by execution of oral instructions, were assessed in first- and third-grade children and adults in a classroom-like setting. For speech perception, in addition to noise, reverberation time (RT) was varied by conducting the experiment in two virtual classrooms with mean RT = 0.47 versus RT = 1.1 s. Children were more impaired than adults by background sounds in both speech perception and listening comprehension. Classroom noise evoked a reliable disruption in children΄s speech perception even under conditions of short reverberation. RT had no effect on speech perception in silence, but evoked a severe increase in the impairments due to background sounds in all age groups. For listening comprehension, impairments due to background sounds were found in the children, stronger for first- than for third-graders, whereas adults were unaffected. Compared to classroom noise, background speech had a smaller effect on speech perception, but a stronger effect on listening comprehension, remaining significant when speech perception was controlled. This indicates that background speech affects higher-order cognitive processes involved in children΄s comprehension. Children΄s ratings of the sound-induced disturbance were low overall and uncorrelated to the actual disruption, indicating that the children did not consciously realize the detrimental effects. The present results confirm earlier findings on the substantial impact of noise and reverberation on children΄s speech perception, and extend these to classroom-like environmental settings and listening demands closely resembling those faced by children at school.

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Traffic noise is the most important source of environmental annoyance. According to the Environmental Expert Council of Germany, severe annoyance persistent over prolonged periods of time is to be regarded as causing distress. Previously, extraaural noise effects were mostly assessed using a paradigm in which the sound level played the major role. On the basis of this paradigm the relatively low sound level of environmental noise was not considered to be a potential danger to health. In contrast to this numerous empirical results have shown long­term noise-induced health risks. Therefore a radical change of attitude - a change of paradigm - is necessary. For an immediate triggering of protective reactions (fight/flight or defeat reactions) the information conveyed by noise is very often more relevant than the sound level. It was shown recently that the first and fastest signal detection is mediated by a subcortical area - the amygdala. For this reason even during sleep the noise from aeroplanes or heavy goods vehicles may be categorised as danger signals and induce the release of stress hormones. In accordance with the noise stress hypothesis chronic stress hormone dysregulations as well as increases of established endogenous risk factors of ischaemic heart diseases have been observed under long-term environmental noise exposure. Therefore, an increased risk of myocardial infarction is to be expected. The results of individual studies on this subject in most cases do not reach statistical significance. However, according to the Environmental Expert Council, these studies show a consistent trend towards an increased cardiovascular risk if the daytime immission level exceeds 65 dB(A). Most of the previous studies on the extraaural effects of occupational noise have been invalidated by exposure misclassifications. In future studies on health effects of noise a correct exposure assessment is one of the most important preconditions.

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A meta-analysis of 14 studies (17 individual effect estimates) on the association between road traffic noise and coronary heart diseases was carried out. A significant pooled estimate of the relative risk of 1.08 (95% confidence interval: 1.04, 1.13) per increase of the weighted day-night noise level L _DN of 10 dB (A) was found within the range of approximately 52-77 dB (A) (5 dB-category midpoints). The results gave no statistically significant indication of heterogeneity between the results of individual studies. However, stratified analyses showed that the treatment of gender in the studies, the lowest age of study subjects and the lowest cut-off of noise levels had an impact on the effect estimates of different studies. The result of the meta-analysis complies quantitatively with the result of a recent meta-analysis on the association between road traffic noise and hypertension. Road traffic noise is a significant risk factor for cardiovascular diseases.

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Noise pollution is one of the four major pollutions in the world. Little evidence exists about the actual preventive benefits of psychological noise attenuation by urban green spaces, especially from the perspective of environmental medicine and, to the best of our knowledge, there is not a systematic analysis on this topic. The aim of this review was to systematically evaluate whether there is conclusive scientific evidence for the effectiveness of urban green spaces as a psychological buffer for the negative impact of noise pollution on human health and to promote an evidence-based approach toward this still growing environmental hazard. MEDLINE and EMBASE databases were searched for experimental and epidemiological studies published before June 04, 2013 in English and Spanish. Data was independently extracted in two step process by the authors. Due to the heterogeneity of the included studies qualitative assessment was performed. We found moderate evidence that the presence of vegetation can generally reduce the negative perception of noise (supported with an electroencephalogram test in one of the experimental studies; consistent with the data from two epidemiological studies; one experiment found no effect and one was inconclusive about the positive effect). This review fills a gap in the literature and could help researchers further clarify the proper implementation of urban green spaces as a psychological buffer in areas with population exposed to chronic noise pollution.

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Perceptual load and cognitive load can be separately manipulated and dissociated in their effects on speech understanding in noise. The Ease of Language Understanding model assumes a theoretical position where perceptual task characteristics interact with the individual's implicit capacities to extract the phonological elements of speech. Phonological precision and speed of lexical access are important determinants for listening in adverse conditions. If there are mismatches between the phonological elements perceived and phonological representations in long-term memory, explicit working memory (WM)-related capacities will be continually invoked to reconstruct and infer the contents of the ongoing discourse. Whether this induces a high cognitive load or not will in turn depend on the individual's storage and processing capacities in WM. Data suggest that modulated noise maskers may serve as triggers for speech maskers and therefore induce a WM, explicit mode of processing. Individuals with high WM capacity benefit more than low WM-capacity individuals from fast amplitude compression at low or negative input speech-to-noise ratios. The general conclusion is that there is an overarching interaction between the focal purpose of processing in the primary listening task and the extent to which a secondary, distracting task taps into these processes.

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Traffic noise (road noise, railway noise, aircraft noise, noise of parking cars), is the most dominant source of annoyance in the living environment of many European countries. This is followed by neighbourhood noise (neighbouring apartments, staircase and noise within the apartment). The subjective experience of noise stress can, through central nervous processes, lead to an inadequate neuro-endocrine reaction and finally lead to regulatory diseases. Within the context of the LARES-survey (Large Analysis and Review of European housing and health Status), noise annoyance in the housing environment was collected and evaluated in connection with medically diagnosed illnesses. Adults who indicated chronically severe annoyance by neighbourhood noise were found to have an increased health risk for the cardiovascular system and the movement apparatus, as well as an increased risk of depression and migraine. Furthermore adults with chronically strong annoyance by traffic noise additionally showed an increased risk for respiratory health problems. With regards to older people both neighbourhood and traffic noise indicated in general a lower risk of noise annoyance induced illness than in adults. It can be assumed that the effect of noise-induced annoyance in older people is concealed by physical consequences of age (with a strong increase of illnesses). With children the effects of noise-induced annoyance from traffic, as well as neighbourhood noise, are evident in the respiratory system. The increased risk of illness in the respiratory system in children does not seem to be caused primarily by air pollutants, but rather, as the results for neighbourhood noise demonstrate, by emotional stress.

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Noise is a stressor that affects the autonomic nervous system and the endocrine system. Under conditions of chronic noise stress the cardiovascular system may adversely be affected. Epidemiological noise studies regarding the relationship between aircraft noise and cardiovascular effects have been carried out on adults and on children focussing on mean blood pressure, hypertension and ischemic heart diseases as cardiovascular endpoints. While there is evidence that road traffic noise increases the risk of ischemic heart disease, including myocardial infarction, there is less such evidence for such an association with aircraft noise. This is partly due to the fact that large scale clinical studies are missing. There is sufficient qualitative evidence, however, that aircraft noise increases the risk of hypertension in adults. Regarding aircraft noise and children's blood pressure the results are still inconsistent. The available literature was evaluated for the WHO working group on "Aircraft Noise and Health" based on the experts' comprehensive knowledge in this field. With respect to the needs of a quantitative risk assessment for burden of disease calculations an attempt was made to derive an exposure-response relationship based on a meta-analysis. This association must be viewed as preliminary due to limitations which are concerned with the pooling of studies due to methodological differences in the assessment of exposure and outcome between studies. More studies are needed to establish better estimates of the risk.

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In recent years, the measurement of stress hormones including adrenaline, noradrenaline and cortisol has been widely used to study the possible increase in cardiovascular risk of noise exposed subjects. Since endocrine changes manifesting in physiological disorders come first in the chain of cause-effect for perceived noise stress, noise effects in stress hormones may therefore be detected in populations after relatively short periods of noise exposure. This makes stress hormones a useful stress indicator, but regarding a risk assessment, the interpretation of endocrine noise effects is often a qualitative one rather than a quantitative one. Stress hormones can be used in noise studies to study mechanisms of physiological reactions to noise and to identify vulnerable groups. A review is given about findings in stress hormones from laboratory, occupational and environmental studies.

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The existing questionnaires for determining the noise sensitivity of individuals provide information only about global noise sensitivity, although empirical data suggest that measuring noise sensitivity for different situations in daily life might be more logical. Therefore, the "Noise-Sensitivity-Questionnaire" (NoiSeQ) was developed to measure global noise sensitivity as well as the sensitivity of five domains of daily life, namely, leisure, work, habitation, communication, and sleep. The assessment of the measurement characteristics was based on the Generalizability (G) theory. The results of the G-study (N = 66) proved that a single application of the questionnaire is sufficient for determining an individual's noise sensitivity. Furthermore, the ratings are age and gender independent. The subsequently conducted Decision (D)-study (N = 288) provides information on the reliability of NoiSeQ. If the questionnaire is used for measuring global noise sensitivity, the reliability (relative and absolute G-coefficient) reaches a value above 0.90. According to ISO 10075-3, the questionnaire satisfies the precision level 1 "accurate measurement" in this case. The G-coefficients for all the subscales exceed the lower limit 0.70, with the exception of subscale leisure, which did not prove satisfactory. However, this subscale can reach a reliability of more than 0.70 if additional items are included. The validity of the instrument was proven for the subscales habitation (N = 72) and work (N = 72). In both the studies, the participants were asked to rate the annoyance in the presence of several rail and traffic noise scenarios. The subjects were characterized as low and high noise sensitive according to their sensitivity values obtained from NoiSeQ. In conclusion, a significant difference in annoyance rates was observed between the low and high noise sensitive groups for both the subscales habitation and work. This data support the validity of NoiSeQ.

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Road traffic noise is an important source of noise annoyance in the community. We performed a meta-analysis to assess whether there is an association between noise annoyance from road traffic noise and cardiovascular diseases (arterial hypertension and ischemic heart disease) in adult population. The meta-analysis included studies that: a. had noise annoyance as exposure, quantified either as "annoyed versus non-annoyed" or with various scales collected by standardized questionnaires; b. arterial hypertension or ischemic heart disease as outcome; c. had included only adult population (age >18 years); d. the studies had to have as effect size odds ratios or relative risk. From the individual studies those odds ratios were selected for meta-analysis which compared most distant categories. Eight studies that fulfilled criteria published between 1992 and 2006 were included in the meta-analysis: 6 studies had a cross-sectional design, 1 study had a case-control-design and 1 study had a cohort design. Increased annoyance was significantly associated with arterial hypertension (pooled risk estimate = 1.16, 95% confidence interval 1.02-1.29) while the association with ischemic heart disease did not reach statistical significance (pooled risk estimate = 1.07, 95% confidence interval 0.99-1.14). No publication bias was evidenced. The results of this meta-analysis demonstrated the existence of a positive and significant association between noise annoyance from road traffic and the risk of arterial hypertension and a positive yet insignificant association between noise annoyance and the risk of ischemic heart disease.

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Noise-induced hearing loss (NIHL) still remains a problem in developed countries, despite reduced occupational noise exposure, strict standards for hearing protection and extensive public health awareness campaigns. Therefore NIHL continues to be the focus of noise research activities. This paper summarizes progress achieved recently in our knowledge of NIHL. It includes papers published between the years 2008-2011 (in English), which were identified by a literature search of accessible medical and other relevant databases. A substantial part of this research has been concerned with the risk of NIHL in the entertainment sector, particularly in professional, orchestral musicians. There are also constant concerns regarding noise exposure and hearing risk in "hard to control" occupations, such as farming and construction work. Although occupational noise has decreased since the early 1980s, the number of young people subject to social noise exposure has tripled. If the exposure limits from the Noise at Work Regulations are applied, discotheque music, rock concerts, as well as music from personal music players are associated with the risk of hearing loss in teenagers and young adults. Several recent research studies have increased the understanding of the pathomechanisms of acoustic trauma, the genetics of NIHL, as well as possible dietary and pharmacologic otoprotection in acoustic trauma. The results of these studies are very promising and offer grounds to expect that targeted therapies might help prevent the loss of sensory hair cells and protect the hearing of noise-exposed individuals. These studies emphasize the need to launch an improved noise exposure policy for hearing protection along with developing more efficient norms of NIHL risk assessment.

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We report a cross-sectional study comparing the health-related quality of life (HRQOL) of individuals residing in the proximity of a wind farm to those residing in a demographically matched area sufficiently displaced from wind turbines. The study employed a nonequivalent comparison group posttest-only design. Self-administered questionnaires, which included the brief version of the World Health Organization quality of life scale, were delivered to residents in two adjacent areas in semirural New Zealand. Participants were also asked to identify annoying noises, indicate their degree of noise sensitivity, and rate amenity. Statistically significant differences were noted in some HRQOL domain scores, with residents living within 2 km of a turbine installation reporting lower overall quality of life, physical quality of life, and environmental quality of life. Those exposed to turbine noise also reported significantly lower sleep quality, and rated their environment as less restful. Our data suggest that wind farm noise can negatively impact facets of HRQOL.

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Vulnerable or susceptible groups are mentioned in most reviews and documents regarding noise and health. But only a few studies address this issue in a concrete and focused way. Groups at risk most often mentioned in the literature are children, the elderly, the chronically ill and people with a hearing impairment. The other categories encountered are those of sensitive persons, shiftworkers, people with mental illness (e.g., schizophrenia or autism), people suffering from tinnitus, and fetuses and neonates. The mechanism for this vulnerability has not been clearly described and relevant research has seldom focused on the health effects of noise in these groups in an integrated manner. This paper summarizes the outcomes and major conclusions of a systematic, qualitative review of studies over the past 5 years. This review was prepared for the 10 ^th Conference on Noise as a Public Health Problem (ICBEN, 2011). Evidence is reviewed describing effects, groups assumed to be at risk, and mechanisms pertaining to noise sensitivity and learned helplessness.

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One hundred and ninety residents around Frankfurt Airport (46% female; 17-80 years) were interviewed concerning noise annoyance due to transportation noise (aircraft, road traffic), perceived mental and physical health, perceived environmental quality, and noise sensitivity. The aim of the analyses was to test whether noise sensitivity reflects partly general environmental sensitivity and is associated with an elevated susceptibility for the perception of mental and physical health. In this study, the reported physical and mental health variables were not associated with noise exposure but with noise annoyance, and were interpreted to reflect nonspecific codeterminants of annoyance rather than noise effects. Noise sensitivity was found to influence total noise annoyance and aircraft noise annoyance but to a lesser degree annoyance due to road traffic noise. Noise sensitivity was associated with reported physical health, but not with reported mental health. Noise-sensitive persons reported poorer environmental quality in their residential area than less sensitive persons in particular with regard to air traffic (including the facets noise, pollution, and contaminations) and quietness. Other aspects of the perceived quality of the environment were scarcely associated with noise sensitivity. This indicates that noise sensitivity is more specific and a reliable predictor of responses to noise from the dominant source (in this case air traffic) rather than a predictor of the individual perception of the environmental quality in general.

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Industrial wind turbines (IWTs) are a new source of noise in previously quiet rural environments. Environmental noise is a public health concern, of which sleep disruption is a major factor. To compare sleep and general health outcomes between participants living close to IWTs and those living further away from them, participants living between 375 and 1400 m (n = 38) and 3.3 and 6.6 km (n = 41) from IWTs were enrolled in a stratified cross-sectional study involving two rural sites. Validated questionnaires were used to collect information on sleep quality (Pittsburgh Sleep Quality Index - PSQI), daytime sleepiness (Epworth Sleepiness Score - ESS), and general health (SF36v2), together with psychiatric disorders, attitude, and demographics. Descriptive and multivariate analyses were performed to investigate the effect of the main exposure variable of interest (distance to the nearest IWT) on various health outcome measures. Participants living within 1.4 km of an IWT had worse sleep, were sleepier during the day, and had worse SF36 Mental Component Scores compared to those living further than 1.4 km away. Significant dose-response relationships between PSQI, ESS, SF36 Mental Component Score, and log-distance to the nearest IWT were identified after controlling for gender, age, and household clustering. The adverse event reports of sleep disturbance and ill health by those living close to IWTs are supported.

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In order to determine the influence of noise sensitivity on sleep, subjective sleep quality, annoyance, and performance after nocturnal exposure to traffic noise, 12 women and 12 men (age range, 19-28 years) were observed during four consecutive nights over a three weeks period. After a habituation night, the participants were exposed with weekly permuted changes to air, rail and road traffic noise. Of the four nights, one was a quiet night (32 dBA), while three were noisy nights with exposure to equivalent noise levels of 39, 44, and 50 dBA in a permuted order. The traffic noise caused alterations of most of the physiological parameters, subjective evaluation of sleep, annoyance, and performance. Correlations were found between noise sensitivity and subjective sleep quality in terms of worsened restoration, decreased calmness, difficulty to fall asleep, and body movements. The results suggest that alterations of subjective evaluation of sleep were determined by physical parameters of the noise but modified by individual factors like noise sensitivity.

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There is a need for better understanding of various characteristics in hyperacusis in the general population. The objectives of the present study were to investigate individuals in the general population with hyperacusis regarding demographics, lifestyle, perceived general health and hearing ability, hyperacusis-specific characteristics and behavior, and comorbidity. Using data from a large-scale population-based questionnaire study, we investigated individuals with physician-diagnosed (n = 66) and self-reported (n = 313) hyperacusis in comparison to individuals without hyperacusis (n = 2995). High age, female sex, and high education were associated with hyperacusis, and that trying to avoid sound sources, being able to affect the sound environment, and having sough medical attention were common reactions and behaviors. Posttraumatic stress disorder, chronic fatigue syndrome, generalized anxiety disorder, depression, exhaustion, fibromyalgia, irritable bowel syndrome, migraine, hearing impairment, tinnitus, and back/joint/muscle disorders were comorbid with hyperacusis. The results provide ground for future study of these characteristic features being risk factors for development of hyperacusis and/or consequences of hyperacusis.

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Sleep is a physiologic recuperative state that may be negatively affected by factors such as psychosocial and work stress as well as external stimuli like noise. Chronic sleep loss is a common problem in today's society, and it may have significant health repercussions such as cognitive impairment, and depressed mood, and negative effects on cardiovascular, endocrine, and immune function. This article reviews the definition of disturbed sleep versus sleep deprivation as well as the effects of noise on sleep. We review the various health effects of chronic partial sleep loss with a focus on the neuroendocrine/hormonal, cardiovascular, and mental health repercussions.

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This paper summarizes the findings from the past 3 year's research on the effects of environmental noise on sleep and identifies key future research goals. The past 3 years have seen continued interest in both short term effects of noise on sleep (arousals, awakenings), as well as epidemiological studies focusing on long term health impacts of nocturnal noise exposure. This research corroborated findings that noise events induce arousals at relatively low exposure levels, and independent of the noise source (air, road, and rail traffic, neighbors, church bells) and the environment (home, laboratory, hospital). New epidemiological studies support already existing evidence that night-time noise is likely associated with cardiovascular disease and stroke in the elderly. These studies collectively also suggest that nocturnal noise exposure may be more relevant for the genesis of cardiovascular disease than daytime noise exposure. Relative to noise policy, new effect-oriented noise protection concepts, and rating methods based on limiting awakening reactions were introduced. The publications of WHO's ''Night Noise Guidelines for Europe'' and ''Burden of Disease from Environmental Noise'' both stress the importance of nocturnal noise exposure for health and well-being. However, studies demonstrating a causal pathway that directly link noise (at ecological levels) and disturbed sleep with cardiovascular disease and/or other long term health outcomes are still missing. These studies, as well as the quantification of the impact of emerging noise sources (e.g., high speed rail, wind turbines) have been identified as the most relevant issues that should be addressed in the field on the effects of noise on sleep in the near future.

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Traffic noise, which is steadily increasing, is considered to be an important environmental health problem. The aim of this study was to estimate the degree of annoyance and sleep disturbance related to road traffic noise in residential settings in an urban community. The study is based on a questionnaire on environmentally related health effects distributed to a stratified random sample of 1000 individuals, 19-80 years old, in a municipality with heavy traffic in the county of Stockholm. The response rate was 76%. The individual noise exposure was estimated using evaluated noise dispersion models and local noise assessments. Frequent annoyance was reported by 13% of subjects exposed to Leq 24 hr >50 dBA compared to 2% among those exposed to <50 dBA, resulting in a difference of 11% (95% Confidence Interval (CI) 7%, 15%). Sometimes or frequently occurring sleep disturbance was reported by 23% at Leq 24 hr >50 dBA and by 13% at levels <50 dBA, a difference of 11% (95% CI 4%, 18%). A positive exposure- response relation was indicated for annoyance as well as for sleep disturbances when classifying the individuals into four different exposure categories (< 45, 46­ 50, 51-55 and >55 dBA Leq 24 hr). There was some habituation to noise for problems related to sleep but not for annoyance. The prevalence of both annoyance and sleep problems was higher when bedroom windows were facing streets. People living in apartments had more sleep problems compared to people living in detached or semi-detached houses. In conclusion traffic noise exposure, even at low levels, was associated with annoyance and sleep disturbance. Access to a quiet side seemed to be a major protective factor for noise related problems.

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This study looked at output levels produced by new generation personal music systems (PMS), at the level of eardrum by placing the probe microphone in the ear canal. Further, the effect of these PMS on hearing was evaluated by comparing the distortion product otoacoustic emissions and high frequency pure tone thresholds (from 3 kHz to 12 kHz) of individuals who use PMS to that of age matched controls who did not use PMS. The relationship between output sound pressure levels and hearing measures was also evaluated. In Phase I output SPLs produced by the PMS were measured in three different conditions - a) at volume control setting that was preferred by the subjects in quiet b) at volume control setting that was preferred by the subject in presence of 65 dB SPL bus noise c) at maximum volume control settings of the instrument. In Phase II pure tone hearing thresholds and DPOAEs were measured. About 30% of individuals in a group of 70 young adults listened to music above the safety limits (80 dBA for 8 hours) prescribed by Ministry of Environment and Forests, India. Addition of bus noise did not increase the preferred volume control settings of the subjects significantly. There were no significant differences between the experimental and control groups for mean pure tone threshold and for mean DPOAE amplitude comparisons. However, a positive correlation between hearing thresholds and music levels and a negative correlation between DPOAE measures and music levels were found.

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The mandate of the International Commission on Biological Effects of Noise (ICBEN) is to promote a high level of scientific research concerning all aspects of noise-induced effects on human beings and animals. In this review, ICBEN team chairs and co-chairs summarize relevant findings, publications, developments, and policies related to the biological effects of noise, with a focus on the period 2011-2014 and for the following topics: Noise-induced hearing loss; nonauditory effects of noise; effects of noise on performance and behavior; effects of noise on sleep; community response to noise; and interactions with other agents and contextual factors. Occupational settings and transport have been identified as the most prominent sources of noise that affect health. These reviews demonstrate that noise is a prevalent and often underestimated threat for both auditory and nonauditory health and that strategies for the prevention of noise and its associated negative health consequences are needed to promote public health.

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