Screaming-Induced Acute Noise Exposure During Pediatric Ear Procedures

To quantitatively evaluate noise exposure during pediatric ear procedures for children with developmental disorders, with a focus on screaming behavior and assess its implications for both patient-centered care and occupational safety.

We conducted a prospective observational study of 66 children who underwent earwax removal at a medical center in Japan. The noise levels were measured using smartphone-based sound-level meters and a calibrated dosimeter. Acoustic parameters (LAeq, LCeq, and LCpeak) were analyzed, and the screaming behavior was classified based on the peak sound pressure levels. Subgroup analyses were performed according to diagnosis, sex, age, and developmental quotient.

The mean LAeq and LCpeak were 78.0 dBA and 114.2 dBC, respectively. LAeq exceeded 85 dBA in 27.7% of cases and exceeded 100 dBA in 93.6% of cases, indicating a risk of acute noise-induced hearing loss. Assistants positioned directly in front of the patients were exposed to significantly higher levels than physicians. Screaming behavior was strongly associated with autism spectrum disorder (odds ratio: 6.28, p = 0.002), but not with developmental quotient scores. Spectral analysis revealed elevated sound pressure in the 500-4000 Hz range. Furthermore, the cumulative noise dose could exceed the recommended daily limits within minutes, underscoring the acute risk of short-term peaks rather than chronic exposure.

Pediatric ear procedures involving children with developmental disorders can generate hazardous noise, particularly during screaming episodes in children with autism spectrum disorder. These findings highlight the dual need to reduce patient distress through sensory-adapted environments and protect healthcare providers from acute acoustic trauma.

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