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PubMed2006

Stress response in rat brain after different durations of noise exposure.

The alteration in the levels of plasma corticosterone, brain norepinephrine (NE), and expression of brain heat shock proteins (Hsp70) after different durations of noise exposure (acute, 1 day; sub-acute, 15 days; chronic, 30 days) has been studied to analyze their role in combating time-dependent stress effects of noise. Broadband white noise (100dB) exposure to male Wistar albino rats significantly increased the levels of plasma corticosterone and NE in all three durations of noise exposure. The sustained increase observed in their levels in the chronic group suggests that animals are not getting adapted to noise even after 30 days of exposure. The important role of Hsp70 in combating noise induced stress is evident from the significant increase in its expression after chronic exposure, while there was a reciprocal decrease in the NE and corticosterone when compared with their levels after acute and sub-acute noise exposure. This clearly indicates that the time-dependent stress response to noise exposure is a complex mechanism involving highly interconnected systems such as hypothalamo-pituitary-adrenal (HPA) axis, heat shock proteins and may have serious implications in vital organs, particularly in the brain when there is a prolonged noise exposure.

Acoustic Stimulation↗
PubMed2005

Post-exposure treatment attenuates noise-induced hearing loss.

Reactive oxygen species (ROS) and reactive nitrogen species (RNS) are involved in sensory cell and neural death in the peripheral nervous system, including damage induced by noise trauma. Antioxidant administration prior to or concomitant with noise exposure can prevent auditory deficits, but the efficacy of a delayed treatment is not known. We have recently found continued reactive oxygen species/reactive nitrogen species formation in the ear for 7-10 days following noise exposure and reasoned that antioxidant intervention during this period should also reduce noise-induced hearing loss. Guinea-pigs were subjected to 4 kHz octave band noise at 120 decibels sound- pressure-level (dB SPL) for 5 hours and received treatment with ROS and RNS scavengers (salicylate and trolox) beginning 3 days prior, 1 hour, 1, 3, or 5 days after noise exposure. Auditory thresholds were assessed by sound-evoked auditory brainstem response at 4, 8, and 16 kHz, before and 10 days after noise exposure. Hair cell damage was analyzed by quantitative histology, and free radical activity was determined immunohistochemically via 4-hydroxynonenal and nitrotyrosine as markers of reactive oxygen species and reactive nitrogen species action. Delivered up to 3 days after noise exposure, salicylate and trolox significantly reduced auditory brainstem response deficits, reduced hair cell damage, and decreased reactive oxygen species and reactive nitrogen species formation. Earlier drug treatment was more effective than later treatment. Our results detail a window of opportunity for rescue from noise trauma, and provide evidence for both morphological and functional protection by delayed pharmacological intervention.

Aldehydes↗
PubMed2003

Combined effects of temperature and noise on human discomfort.

The trade-off between noise and temperature and their combined effects on discomfort were studied on 108 lightly clothed subjects (0.6 clo), individually exposed for 2 h in a climatic chamber. Every 10 min of the first hour, subjects could modify the experimental conditions by deciding a change in temperature or noise. However, any change in one parameter was experimentally associated with a fixed change in the other parameter according to eight predetermined designs and all trials for thermal improvement were detrimental to acoustic comfort and conversely. Four initial exposures started at thermoneutrality (24 degrees C) in a noisy environment (85 dBA, recorded fan noise), the reduction of noise being linked to a temperature change towards cool or warm climates. The other four conditions started at a low noise level (35 dBA) but in a cool (14 or 19 degrees C) or warm (29 or 34 degrees C) environment, the reduction of thermal discomfort towards 24 degrees C leading to a louder noise. After six possible voluntary changes, the environment was kept constant for 1 h. Ambient parameters, skin temperatures, and subjective estimates were recorded. Results showed that females accepted noisier environments than males, suggesting that thermal comfort is dominant for women. Noise was rated as the most unpleasant factor when initial conditions were noisy whereas temperature was the most disturbing factor when subjects began the experiment with thermal conditions far from thermoneutrality. Finally, although the combined effects of noise and temperature did not influence the physiological data, our results suggest that noise may alter thermal pleasantness in warm conditions.

Adult↗
PubMed1996

Time-dependent differential changes of immune function in rats exposed to chronic intermittent noise.

Noise is a highly relevant environmental and clinical stressor. Compared to most other experimental stressors, noise is a modest activator of neuroendocrine pathways that mimic the situation in human health where neuroendocrine activation by environmental stressors is often absent or difficult to establish. Little is known about the effects of noise exposure on the immune system. In the present work, the effects of a low-intensity chronic intermittent unpredictable noise regimen on various parameters of immune function was studied. Male wistar rats were exposed to a randomized noise protocol (white noise, 85 dB, 2-20 kHz) for 10 h per day, 15 min per h over a total period of 3 weeks. Control animals were exposed to ambient sound only. Immune function was monitored after 24 h, 7 days, and 21 days of noise exposure. Noise induced several significant changes in immune function in a time-dependent differential pattern involving both immunosuppression and immunoenhancement. After 24 h, serum IgM levels were increased and peripheral phagocytic activity was decreased. Splenic lymphocytic proliferation to mitogens was significantly decreased after 7 days, but slightly elevated after 3 weeks. The activity of splenic NK cells was increased significantly after 24 h and 7 days, but suppressed after 3 weeks. These results show that various parameters of immune function are affected differentially over time in a period of chronic mild noise stress, possibly due to sequential activation of different physiological mechanisms.

Animals↗
PubMed2001

Simultaneous exposure to ethyl benzene and noise: synergistic effects on outer hair cells.

The effects on hearing of simultaneous exposure to the ototoxic organic solvent ethyl benzene and broad-band noise were evaluated in rats. The effects of three ethyl benzene concentrations (0, 300 or 400 ppm) and three noise levels (95 or 105 dB(lin) SPL or background noise at 65 dB(lin) SPL) and all their combinations were investigated for a 5 day exposure at 8 h/day. Distortion product otoacoustic emissions and compound action potentials were affected after 105 dB noise alone, and after 105 dB noise in combination with ethyl benzene (300 and 400 ppm). However, the amount of loss for these combinations did not exceed the loss for 105 dB noise alone. Outer hair cell (OHC) loss after exposure to 300 ppm ethyl benzene was located in the third row of OHCs. At 400 ppm, the loss spread out to the second and first row of OHCs. Noise alone hardly affected the OHC counts except for a minor loss in the first row of OHCs after 105 dB SPL. Noise at 105 dB in combination with ethyl benzene at 300 and 400 ppm, however, showed OHC loss greater than the sum of the losses induced by noise and ethyl benzene alone.

Action Potentials↗
PubMed1997

Changes in dorsal cochlear nucleus blood flow during noise exposure.

Changes in dorsal cochlear nucleus (DCN) blood flow during noise exposure were assessed using both intravital microscopy (IVM) and laser Doppler flowmetry (LDF). Mature Syrian golden hamsters were anesthetized, tracheotomized and implanted with a carotid artery catheter for monitoring blood pressure and infusion of fluorescent dye. An occipital craniectomy was performed and the cerebellum partly aspirated for access to the DCN. Fluorescent dye was infused to enhance observations of the DCN surface using a customized IVM. Red blood cell velocity, vessel diameter and blood pressure were continuously monitored. Subjects were presented with 110 dB SPL broad-band noise for 15 min. A second group was presented with the same protocol for laser Doppler assessment of blood-flow changes. Control groups included animals not exposed to noise using both IVM and laser Doppler measures. Additional control measurements were obtained for noise-exposed and control groups with laser Doppler measures obtained from the obex, a brainstem structure with no known auditory function. Arterioles of the DCN showed a low-frequency oscillatory pattern of red blood cell velocity in control animals and in baseline conditions of the noise-exposure group. Presentation of noise abolished these velocity oscillations. Additionally, significant decreases in both red blood cell velocity and vessel diameter were measured during stimulation. These microvascular measures recovered slightly during the post-stimulus period. Laser Doppler measures of the overall blood flow in the nucleus were consistent with IVM findings. Measurements from DCN and obex in groups not exposed to noise, and animals exposed to noise and measured from the obex, showed stable oscillatory flow. These data show exposure to noise eliminates oscillatory patterns of blood flow and induces decreases in vascular perfusion. Furthermore, these changes appear specific to the auditory structure studied.

Acoustic Stimulation↗
PubMed1998

The role of micro-noise trauma in the etiology of aging-related changes in the inner ear.

Eleven chinchillas between 1 and 2.4 years of age had the malleus/incus complex removed from one middle ear and then lived in the Washington University animal facilities for 4 years post-surgery. Each animal had one ear (termed ambient-noise) in which the conductive apparatus was intact; the other ear (termed noise-protected) had a 50-60 dB conductive hearing loss. The background sound level in the animal facility was 59 dBA with periodic brief sounds up to 102 dBA. After the 4-year experimental period, both ears were fixed, embedded in plastic and dissected for microscopic examination as flat preparations. The quantitative and qualitative findings in the noise-protected ears were compared to those in the ambient-noise ears. Both groups of ears sustained losses of sensory and supporting cells throughout the organ of Corti. A variable amount of age pigment was found to have accumulated in the outer hair cells and all supporting cells. In the noise-protected ears, inner hair cell loss ranged from 1.0 to 3.1% and averaged 1.7 +/- 0.8%; outer hair cell loss ranged from 1.8 to 6.4% and averaged 3.6 +/- 1.2%. In the ambient-noise ears, inner hair cell loss ranged from 0.7 to 2.8% and averaged 1.6 +/- 0.7%; outer hair cell loss ranged from 1.3 to 5.4% and averaged 3.6 +/- 1.2%. Within-animal comparison of cell losses in the noise-protected and ambient-noise ears revealed no significant difference between the two groups. It is concluded that long-term exposure to micro-noise does not accelerate the spontaneous loss of sensory cells which occurs with aging. Although not quantified, there was no obvious difference in the amount or cellular distribution of age pigment in the two groups. Thus, it appears that the formation of age pigment in the ear is the result of the cells' basic metabolic processes rather than the wear and tear from sensory transduction.

Aging↗
PubMed2003

Effects of noise from functional magnetic resonance imaging on auditory event-related potentials in working memory task.

The effects of functional magnetic resonance imaging (fMRI) acoustic noise were investigated on the parameters of event-related responses (ERPs) elicited during auditory matching-to-sample location and pitch working memory tasks. Stimuli were tones with varying location (left or right) and frequency (high or low). Subjects were instructed to memorize and compare either the locations or frequencies of the stimuli with each other. Tape-recorded fMRI acoustic noise was presented in half of the experimental blocks. The fMRI noise considerably enhanced the P1 component, reduced the amplitude and increased the latency of the N1, shortened the latency of the N2, and enhanced the amplitude of the P3 in both tasks. The N1 amplitude was higher in the location than pitch task in both noise and no-noise blocks, whereas the task-related N1 latency difference was present in the no-noise blocks only. Although the task-related differences between spatial and nonspatial auditory responses were partially preserved in noise, the finding that the acoustic gradient noise accompanying functional MR imaging modulated the auditory ERPs implies that the noise may confound the results of auditory fMRI experiments especially when studying higher cognitive processing.

Acoustic Stimulation↗
PubMed1979

Effects of four noise competitors on the California Consonant Test.

Thirty-five normal-hearing listeners' speech discrimination scores were obtained for the California Consonant Test (CCT) in four noise competitors: (1) a four talker complex (FT), (2) a nine-talker complex developed at Bowling Green State University (BGMTN), (3) cocktail party noise (CPN), and (4) white noise (WN). Five listeners received the CCT stimuli mixed ipsilaterally with each of the competing noises at one of seven different signal-to-noise ratios (S/Ns). Articulation functions were plotted for each noise competitor. Statistical analysis revealed that the noise types produced few differences on the CCT scores over most of the S/Ns tested, but that noise competitors similar to peripheral maskers (CPN and WN) had less effect on the scores at more severe levels than competitors more similar to perceptual maskers (FT and BGMTN). Results suggest that the CCT should be sufficiently difficult even without the present of a noise competitor for normal-hearing listeners in many audiologic testing situations. Levels that should approximate CCT maximum discrimination (D-Max) scores for normal listeners are suggested for use when clinic time does not permit the establishment of articulation functions. The clinician should determine the S/N of the CCT tape itself before establishing listening levels.

Adult↗
PubMedDate not supplied

Chronic effects of workplace noise on blood pressure and heart rate.

Environmental noise levels in the United States are increasing, yet there are few studies in which the nonauditory effects of workplace noise are assessed. In the current study, the authors examined chronic effects of noise on blood pressure and heart rate in 374 workers at an automobile plant. Data were collected from subjects prior to the start of their workshift. Participants completed questionnaires about diet, alcohol use, lifestyle, noise annoyance, use of hearing protection, noise exposure outside of the work environment, personal and family health histories, and demographic information. Resting blood pressure, heart rate, and body mass index were obtained. Noise exposure levels were extracted retrospectively from company records for each participant for the past 5 yr. Summary statistics were generated for each variable, and the authors performed bivariate correlations to identify any unadjusted associations. The authors then completed statistical modeling to investigate the effects of noise on blood pressure and heart rate, after they controlled for other variables (e.g., gender, race, age). The authors controlled for confounding variables, after which use of hearing protection in high-noise areas was a significant predictor of a decrease in both systolic and diastolic blood pressures. The results suggested that the reduction of noise exposure by means of engineering controls or by consistent use of hearing protection by workers may positively affect health outcomes.

Adult↗
PubMed1988

The effects of progressive muscular relaxation on subjectively reported disturbance due to hospital noise.

Hospital noise has repeatedly been demonstrated to exceed levels recommended by the Environmental Protection Agency. Hospital noise from staff and machinery has been implicated in the etiologies of many behavioral disorders such as sleep deprivation, sensory overload, and altered comfort levels. Relaxation techniques have been shown to be effective in decreasing the aversiveness of many situations. This study tested the effects of progressive muscular relaxation (PMR) on subjectively reported disturbance due to hospital noise. In addition, noise sensitivity as a personality attribute was correlated with disturbance due to hospital noise and efficacy of PMR. A sample of 100 acutely ill hospitalized patients were randomly assigned to an experimental group or control group. The experimental group was instructed in the Bernstein-Borkovec technique of PMR; the control group received a short visit. Results revealed that the experimental groups had a significantly lower amount of disturbance due to hospital noise after being instructed in the use of PMR than prior to the intervention. Control group subjects demonstrated no such change. Noise sensitivity was found to be unrelated to either disturbance due to hospital noise or efficacy of PMR in decreasing disturbance due to hospital noise.

Affective Symptoms↗
PubMed2005

Cognitive performance and perceived effort in speech processing tasks: effects of different noise backgrounds in normal-hearing and hearing-impaired subjects.

Cognitive tests of speech understanding were administered (presented as text, or in auditory or audiovisual modality) and perceived effort was rated. This was done in four background conditions: in silence, and in three types of noise (S/N=+10 dB) varying in temporal structure and meaningfulness. Four groups of 12 subjects each (young/elderly with normal hearing and young/elderly with hearing impairment) participated. The presence of noise had a negative effect on accuracy and speed of performance in the speech processing tasks, and resulted in higher scores of perceived effort, even when the stimuli were presented as text. Differences in performance between noise conditions existed. In the subjective scores, the noise with temporal variations, but without meaningful content, was the most disruptive of the three noise conditions. In the objective scores the hearing-impaired subjects showed poorer results in noise with temporal variations. The elderly subjects were more distracted by noise with temporal variations, and especially by noise with meaningful content. In noise, all subjects, particularly those with impaired hearing, were more dependent upon visual cues than in the quiet condition.

Adult↗
PubMed2000

Predicting exposure conditions that facilitate the potentiation of noise-induced hearing loss by carbon monoxide.

Hearing loss is the most common occupational disease in the United States, with noise serving as the presumed causative agent in most instances. This investigation characterizes the exposure conditions that facilitate the potentiation of noise-induced hearing loss (NIHL) by carbon monoxide (CO). Auditory function was compared in rats exposed 4 weeks earlier to noise alone, CO alone, combined exposure, and air in the exposure chamber. This interval between exposure and auditory threshold assessment was selected to permit recovery of temporary threshold shifts. The compound action potential (CAP) threshold evoked by pure tone stimuli was used as a measure of auditory sensitivity. The no adverse effect level (NOAEL) with respect to potentiation of NIHL was found to be 300 ppm CO. Potentiation of NIHL by CO increases linearly as CO concentration increases between 500 -1500 ppm. Benchmark dose software (version 1. 1B) published by the U.S. EPA National Center for Environmental Assessment was employed to determine a benchmark concentration of CO that produced either a 5-dB potentiation of NIHL or an increase in auditory threshold equivalent to 10% of the effect of noise alone. The lower bound for these benchmark concentrations were 320 and 194 ppm CO, respectively. Unlike CO dose, the relationship between noise severity and potentiation of NIHL by CO shows a nonlinear relationship. The greatest potentiation was observed at moderate noise exposures (100 dB, 2-h, octave band-limited noise, or OBN) that produce limited permanent threshold shifts. Repeated exposures to 95-dB noise for 2-h periods in combination with 1200 ppm CO also yielded potentiation of NIHL, though such effects were not observed following a single combined exposure. These results underscore the potential risk of hearing loss from combined exposure to noise and CO, and the risks associated with repeated exposure.

Action Potentials↗
PubMedDate not supplied

Interrupted noise as a tinnitus masker: an annoyance study.

Tinnitus can be masked by a simultaneous and/or nonsimultaneous stimuli. The usefulness of the masker depends on its power and its perceived annoyance. The purpose of the current study was to compare annoyance produced by interrupted and continuous noises. Data were gathered from six normal-hearing subjects without tinnitus and six subjects with tinnitus. Continuous white noise and interrupted white noise (2, 4, 10, 20, and 40 pulses per second) were presented at 20, 40, and 60 dB. Subjects adjusted the interrupted noise to be as annoying as the reference signal. The general findings were: (1) interrupted noises were more annoying than the continuous noises for both groups, and (2) the perception of annoyance in both groups was very similar at the highest level and significantly different at lower levels. For normal-hearing listeners, the differences between annoyance produced by continuous and interrupted noise were independent of the pulse rate for rates slower than 10 pulses per second, gradually decreasing for the higher rates. Despite the advantages of interrupted noise, it is not suitable as a tinnitus masker since it is more annoying than continuous noise.

Acoustic Stimulation↗
PubMed2000

Impact of noise source configuration on directional hearing aid benefit and performance.

OBJECTIVE: To evaluate the impact of the position of noise source(s) and reverberation on the directional benefit and performance of three commercially available directional hearing aids. DESIGN: Directional benefit and performance were measured for four different configurations of competing noise source(s) in two different reverberant rooms. Three pairs of hearing aids representing three commercial models were selected based on electroacoustic evaluation of directivity. Directional benefit and performance of 25 subjects with symmetrical, sloping, sensorineural hearing loss were measured in all test environments using a modified version of the Hearing in Noise Test. RESULTS: Both reverberation and configuration of the competing noise source(s) significantly affected directional benefit and performance. There was no significant correlation between directional benefit and directional performance. The order of benefit and performance across hearing aid brands (from best to worst) varied depending on the noise source configuration. CONCLUSIONS: Data revealed increasing reverberation significantly decreased directional benefit and performance. The absolute and relative (rank ordering) directional benefit and performance varied across hearing aid brand, with noise source configuration. These results suggest that data collected in traditional test environments (e.g., a single competing noise placed at 180 degrees azimuth) cannot be used to accurately predict directional benefit or performance in the majority of other test and real-world environments. The impact of reverberation and noise source configuration on directional benefit/performance can be explained fairly well by the interaction between the spatial properties of the noise source(s) and the polar directivity patterns of the hearing aids.

Aged↗
PubMed1991

Air jet noise exposure rapidly increases blood pressure in young borderline hypertensive rats.

The present study tested the hypothesis that air jet noise exposure elicits sympathetically-mediated increases in the blood pressure of weaning-aged borderline hypertensive rats (BHR). BHR were the F1 offspring of spontaneously hypertensive female rats and male Wistar-Kyoto rats. Beginning at weaning (4 weeks of age), restrained BHR were exposed to air jet noise (30-120 s pulses of 120 dB) for 2 h/day, 5 days per week. Controls were restrained but did not receive air jet noise exposure. After only 1 week of air jet exposure, the systolic blood pressure (SBP) levels of the noise-exposed rats were increased significantly above those of restrained controls. Measures of mean arterial pressure (MAP) made in the home cage after 2 weeks of noise exposure confirmed the increased SBP. Ten weeks of air jet noise exposure increased MAP compared with restrained controls (144 +/- 4 versus 128 +/- 4 mmHg), with both SBP and diastolic blood pressure (DBP) being significantly increased. Baroreceptor sensitivity, assessed by bradycardic responses to graded doses of phenylephrine (0.5, 1, 2 and 4 micrograms/kg, intravenously), did not differ from restrained controls after 10 weeks of noise exposure. Autonomic (largely sympathetic) influence on home-cage blood pressure, inferred from ganglion blockade with chlorisondamine, also did not differ between groups after 10 weeks of stress. After maximal vasodilation with hydralazine, the DBP of air jet noise-exposed rats was somewhat higher than restrained controls (62 +/- 5 versus 49 +/- 3 mmHg; P = 0.08), suggesting that structural changes may have contributed to the increased MAP in air jet noise-exposed rats.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2006

Speech recognition for unilateral and bilateral cochlear implant modes in the presence of uncorrelated noise sources.

OBJECTIVE: The purpose of the current investigation was to compare speech recognition in noise for bilateral and unilateral modes within postlingually deafened, adult bilateral cochlear implant recipients. In addition, it was of interest to evaluate the time course of the bilateral speech-recognition advantage and the effect of changing signal-to-noise ratio (SNR) on the magnitude of the bilateral advantage. DESIGN: In the first experiment, 16 postlingually deafened adults who were bilaterally implanted with the MED-EL C40+ cochlear device were evaluated in unilateral left, unilateral right, and bilateral conditions 4 to 7 mo after activation. Speech recognition in the presence of five spatially separated, uncorrelated noise sources was evaluated using both a single fixed SNR of +10 dB and an adaptive-SNR method. In a follow-up study, a subset of 10 participants was re-evaluated using an identical fixed-SNR method 12 to 17 mo after activation to examine the time course of speech-recognition performance in both unilateral and bilateral modes at a single SNR. A third study was performed with a subset of six participants to examine performance over a range of SNRs. In this study, speech recognition was measured 12 to 17 mo after activation in quiet and at +5, +10, +15, and +20 dB SNRs using the same five uncorrelated noise sources. RESULTS: The speech-recognition data revealed a significant bilateral advantage of 3.3 dB using the adaptive-SNR method. A significant bilateral advantage of 9% was also measured using a fixed +10 dB SNR. Results from the second study revealed that experience resulted in a significant (11 to 20%) increase in speech-recognition-in-noise performance for both unilateral and bilateral modes; however, the magnitude of the bilateral advantage was not affected by experience. Results from the third study revealed the largest bilateral advantage at the poorest SNR evaluated. In addition, performance in quiet was significantly better than that measured in the presence of noise, even at the +20 dB SNR. CONCLUSIONS: The results of these experiments support a small but significant bilateral speech-recognition-in-noise advantage for cochlear implant recipients in an environment with multiple noise sources. This advantage is presumed to be attributable to the combined effects of binaural squelch and diotic summation. Although experience generally improved speech-recognition-in-noise performance in both unilateral and bilateral modes, a consistent bilateral advantage (approximately 10%) was measured at 4 to 7 mo and at 12 to 17 mo postactivation.

Acoustic Stimulation↗
PubMed2005

Traffic noise and risk of myocardial infarction.

BACKGROUND: The biologic plausibility for noise stress-related cardiovascular responses is well established. Epidemiologic studies on the relationship between transportation noise and ischemic heart disease suggest a higher risk of myocardial infarction in subjects exposed to high levels of traffic noise. METHODS: To determine the risk of road traffic noise for the incidence of myocardial infarction (MI), we carried out a hospital-based case-control study in the city of Berlin. We enrolled consecutive patients (n=1881), age 20-69 years, with confirmed diagnosis of MI from 1998 through 2001. Controls (n=2234) were matched according to sex, age, and hospital. Outdoor traffic noise level was determined for each study subject based on noise maps of the city. Standardized interviews were conducted to assess possible confounding factors and the annoyance from various noise sources. RESULTS: The adjusted odds ratio for men exposed to sound levels of more than 70 dB(A) during the day was 1.3 (95% confidence interval=0.88-1.8) compared with those where the sound level did not exceed 60 dBA. In the subsample of men who lived for at least 10 years at their present address, the odds ratio was 1.8 (1.0-3.2). Noise-exposed women were not at higher risk. CONCLUSIONS: The results support the hypothesis that chronic exposure to high levels of traffic noise increases the risk for cardiovascular diseases.

Adult↗