Abstract: Background　Recently，many studies have assessed the hearing loss （HL） of elderly people，people across occupational groups，and infants，but few have assessed this issue among medical students in China.Objective　To investigate the status of HL and hearing related symptoms among medical students，and to explore the effect of hearing habits on them.Methods　A total of 1 882 students of four-year （freshman-junior students） and five-year （freshman-senior students） graduation systems were selected by cluster sampling in Medical School，Hangzhou Normal University from March to May 2017.The questionnaire survey and pure-tone hearing tests（PTT）were conducted.The questionnaire comprised three parts：demographic characteristics （age，sex，major，grade），the hearing related symptoms（the occurrence of tinnitus，earache and aural fullness in the last year），and hearing habits（whether to use headphones，type of headphones，frequency of headphone usage，time of headphone usage，time of playing games with headphones，maximum volume of headphone，mode of cell phone conversation，noise environment to improve headphone volume，sleeping with headphones listening to music/radio，frequency of going entertainment places）．The sound-pressure levels of background noise measured at a dedicated sound-isolating room in the university laboratory building were below 30 dB.PTT were measured using a calibrated audiometer （AT235） with standard headphones （TDH-39P）．The speech-frequency HL （>25 dB）and high-frequency HL （>25 dB） were assessed.Factors influencing HL and hearing related symptoms were analyzed by multivariate Logistic regression models.Results　A total of 1 882 questionnaires were sent out，1 882 questionnaires were recovered，1 882 questionnaires were valid，with an effective recovery rate of 100.0%.Pure-tone averages of the right ear were higher than those of the left ear at hearing frequency of 0.125，0.250，0.500，1.000，2.000，4.000，6.000 kHz（P<0.05）．The number of students with speech frequency hearing loss （> 25 dB） was 32 （1.7%），high frequency hearing loss （> 25 dB） was 62 （3.3%），tinnitus was 913 （48.5%），earache was 533 （28.3%） and aural fullness was 502 （26.7%）．Among 1 664 medical students（88.4%）who used headphones，there were 963 （57.9%），610 （36.6%） and 91（5.5%） medical students used earplug，in-ear headphones or headset，respectively.The number of students with frequency of using earphones > 2 times/d was 513（27.3%）.Duration of using earphones was >1.0 h/d among 289 medical students（15.4%）．Duration of playing games with using earphones was ≥1 h/d among 547 medical students（29.1%）．Maximum volume of using earphones was ≥60% among 70 medical students（3.7%）．The number of students making phone calls by earphones was 521（27.6%）．Probability to increase earphone volume in a noisy environment was ≥50% among 1 142 medical students（60.7%）．Frequency of sleeping with earphones while listening to music or broadcast was ≥2 times/week among 158 medical students（8.4%）．Frequency of attending entertainment venues was >3 times/month among 36 medical students（1.9%）．The speech-frequency HL and high-frequency HL rates of the tinnitus group were higher than those in the non-tinnitus group（P<0.05）．The speech-frequency HL and high-frequency HL rates did not show any significant difference among ear pain，and aural fullness（P>0.05）．Sex〔female：OR=0.467，95%CI（0.267，0.816）〕was a factor affecting speech-frequency HL among medical students（P<0.05）．Probability to increase earphone volume in a noisy environment〔≥50%：OR=1.567，95%CI（1.282，1.915）〕 was a factor influencing tinnitus among medical students（P<0.05）．Frequency of using earphones〔>2 times/d：OR=1.443，95%CI（1.151，1.810）〕，and duration of using earphones 〔0.5-1.0 h/time：OR=1.447，95%CI（1.151，1.818）；>1.0 h/times：OR=1.648，95%CI（1.214，2.237）〕were factors of ear pain among medical students（P<0.05）．Sex 〔female：OR=1.338，95%CI（1.061，1.686）〕，duration of playing games with earphones〔≥1 h/d：OR=1.315，95%CI（1.053，1.642）〕，probability to increase earphone volume in a noisy environment〔≥50%：OR=1.398，95%CI（1.126，1.735）〕，and frequency of attending entertainment venues 〔>3 times/month：OR=3.324，95%CI（1.686，6.554）〕were factors for aural fullness among medical students（P<0.05）．Conclusion　The hearing status is not optimistic among medical students.The hearing status of the right ear is worse than that of the left ear.Improper usage of earphones and exposure to damaging sound levels at noisy entertainment venue can cause hearing damage.Bad hearing habits have long-term influence on the hearing of medical students.We suggest that qualified schools add PTT to the entrance examination，and strengthen the health education related to hearing.

Key words: Ear diseases, Hearing loss, Hearing habit, Recreational noise, Earphone, Medical student

摘要： 背景　近几年来关于老年人、职业人群和婴幼儿听力损失的研究较多，而针对医学生群体的相关研究较少。目的　了解医学生听力损失及相关症状的现况，并探讨用耳习惯对其的影响。方法　2017年3—5月，采用整群抽样法在杭州师范大学医学院以班级为单位抽取在校的四年制（大一至大三）和五年制（大一至大四）的学生共1 882名，进行问卷调查和纯音测听。调查问卷分为3部分，主要包括人口学特征（年龄、性别、专业、年级）、听力相关症状（最近1年内耳鸣、耳痛、耳闷发生情况）、用耳习惯调查表（是否使用耳机、耳机使用类型、耳机使用频率、耳机使用时间、戴耳机玩游戏时间、耳机使用最大音量、手机通话方式、嘈杂环境提高耳机音量概率、戴耳机听音乐/广播入睡情况、出入娱乐场所频率）。在该高校实验楼（噪声<30 dB）的隔声室内，采用经专业校准后的听力计AT235，耳机型号为TDH-39P，进行纯音测听。判断医学生语频听力损失情况（>25 dB）与高频听力损失情况（>25 dB）。并采用多因素Logistic回归分析医学生听力损失及相关症状的影响因素。结果　共发放问卷1 882份，回收问卷1 882份，有效问卷1 882份，有效回收率100.0%。医学生右耳0.125、0.250、0.500、1.000、2.000、4.000、6.000 kHz听力阈值高于左耳（P<0.05）。语频听力损失（>25 dB）32人（1.7%），高频听力损失（>25 dB）62人（3.3%），耳鸣913人（48.5%），耳痛533人（28.3%），耳闷502人（26.7%）。使用耳机的1 664人（88.4%）中，使用耳塞式耳机963人（57.9%），入耳式耳机610人（36.6%），头戴式耳机91人（5.5%）；耳机使用频率>2次/d 513人（27.3%）；耳机使用时间>1.0 h/次 289人（15.4%）；戴耳机玩游戏时间≥1 h/d 547人（29.1%）；耳机使用最大音量≥60% 70人（3.7%）；手机通话使用耳机521人（27.6%）；嘈杂环境提高耳机音量概率≥50% 1 142人（60.7%）；经常（≥2次/周）戴耳机听音乐/广播入睡158人（8.4%）；出入娱乐场所频率>3次/月36人（1.9%）。有耳鸣症状的医学生语频听力损失、高频听力损失发生率高于无耳鸣者（P<0.05）；不同耳痛、耳闷症状的医学生语频听力损失、高频听力损失发生率比较，差异无统计学意义（P>0.05）。性别〔女：OR=0.467，95%CI（0.267，0.816）〕是医学生高频听力损失的影响因素（P<0.05）。嘈杂环境提高耳机音量概率〔≥50%：OR=1.567，95%CI（1.282，1.915）〕是医学生耳鸣的影响因素（P<0.05）。耳机使用频率〔>2次/d：OR=1.443，95%CI（1.151，1.810）〕、耳机使用时间〔0.5~1.0 h/次：OR=1.447，95%CI（1.151，1.818）；>1.0 h/次：OR=1.648，95%CI（1.214，2.237）〕是医学生耳痛的影响因素（P<0.05）。性别〔女：OR=1.338，95%CI（1.061，1.686）〕、戴耳机玩游戏时间〔≥1 h/d：OR=1.315，95%CI（1.053，1.642）〕、嘈杂环境提高耳机音量概率〔≥50%：OR=1.398，95%CI（1.126，1.735）〕、出入娱乐场所频率〔>3次/月：OR=3.324，95%CI（1.686，6.554）〕是医学生耳闷的影响因素（P<0.05）。结论　医学生听力状况不容乐观，右耳的听力状况较左耳差，不恰当使用耳机及接触大量娱乐噪声会对听力产生损伤，且不良用耳习惯对其听力具有长期性影响，建议有条件的学校在入学体检时增加纯音听力测试，并加强听力相关的健康教育工作。

关键词: 耳疾病, 听力损失, 用耳习惯, 娱乐性噪声, 耳机, 医学生