Tinnitus; an Index of Noise Pollution amongst
Church Worshippers in Port Harcourt Metropolis
Department of Ear, nose and Throat Surgery, Nigeria
Submission: December 04, 2018; Published: December 13, 2018
*Corresponding author: Matilda Ibekwe, Department of Ear, nose and Throat Surgery, Nigeria.
How to cite this article: Matilda Ibekwe. Tinnitus; an Index of Noise Pollution amongst Church Worshippers in Port Harcourt Metropolis. Glob J Oto, 2018;
18(4): 555993. DOI: 10.19080/GJO.2018.18.555994
Background: In this region, Christians constitute the majority of the population and as such most attend church at least once in a week. In recent times church music has changed from quiet hymns to very loud music with the full works. This obtains both in the orthodox and Pentecostal churches. The worshippers therefore are often exposed to very loud sounds without wearing protective hearing devices, hence may not be spared the attendant consequences. The aim of this study therefore is to determine the effect of loud music on the ears of worshippers in the churches, using tinnitus as an index.
Patients and Method: This is a quantitative descriptive study with data obtained by a self-administered questionnaire that was distributed in four randomly selected worship centers within Port Harcourt metropolis; two Pentecostal, one Protestant and one Catholic within a three month period; December 2017 to February 2018. Port Harcourt is the capital of Rivers state and majorly consists of Christian population. It has numerous number of churches scattered all over the metropolis. Worshippers that have been attending the said churches that gave their consent were included while first time attendees were excluded as well as those with previous ear problems prior to this study. Worshippers with discharging ears of any kind were excluded. A sound level meter by Audio control (23MB downloaded from Android play store on Huawei mobile) was also used to determine the average sound level during services in these worship centers. Ethical approval for the study was obtained from the hospital ethical committee. Results were analyzed with SPSS version 20 and presented in simple statistical tables.
Tinnitus is defined as perception of sound in the absence of an external stimuli . it can coexist with hearing loss as well as be noise induced. Tinnitus can be a transient sensation in which case it ceases spontaneously lasting just few seconds. It can also be permanent as such affecting the quality of life and interfering with daily life activities . Noise exposure is the commonest cause of tinnitus . According to WHO, noise ranks second in disease causing pollution in the world  and tinnitus is the 3rd worst symptom affecting humans exceeded only by intense and intractable pains and dizziness . About 15-20% of world population suffers from tinnitus and in about 25% of this affected population, it interferes with daily activity . Though there is presently designed programs and regulations on occupational exposure to noise, there are little or no regulations for exposure to recreational or leisure noise. There are numerous sources of leisure noise and music is prominent among these . Music in discos routinely exceed 90dBA , the sound levels in these places can be very high, causing tinnitus and temporary hearing impairment . Exposures to noise levels up to 90dB frequently causes the hair cells especially the outer hair cells of the inner ear to degenerate during such exposures . In addition to the loudness, the duration of exposure to the noise also determines the safety and permissibility .
The more intense the sound and longer exposure, the more the damage to the hair cells . Sound pressure levels (SPL) in churches can be high, in Brazil in four hour worship; a level of 85dB has been recorded. The worshippers including their religious leaders are exposed to health hazards during such church services from high sound levels that can lead to noise induced hearing loss . The high levels therefore compare to the SPL found in music studios, industrial environments like oil rigs, high noise recreational environment such as night clubs [12,13]. It is also of note that young adults expose themselves to high levels of noise from personal listening devices, attending night clubs and other loud leisure noise because they are not aware of the import of such exposures and the resulting tinnitus. About 89.5% of young adults had transient tinnitus after exposure to excessive noise . It is known that intermittent tinnitus is related to excessive noise exposure and the onset of tinnitus could be due to exposure to such excessive noise . In Nigeria, there are numerous worship centers in the capital cities . with the attendant noise pollution. In addition, these church buildings because often are built without consideration to acoustics become closed places where sounds are easily propagated and therefore high risks in producing noise induced hearing impairment . Therefore, a regulation was put in place by the National environmental noise standard and regulations enforcement Agency that the maximum
permissible noise level in worship centers should not exceed 75dB
 There is little work on effect of church music on hearing in
our environment. This study therefore is aimed at finding effect of
the noise levels in our churches on the worshippers using tinnitus
as an index.
There were ninety four worshippers, 57.4% males and 42.6%
females. The catholic denomination comprised 85.1% while
Pentecostal which is the least, made up 12.8%. The average
sound level is also highest in the Pentecostal and catholic
churches 98.4dBA and 98.3 dBA respectively while it is lowest in
the protestant church 87.6dBA. The age 25-44years were more
affected with 22.4% (Tables 1& 2). Tinnitus was present in 76.6%
of the respondents, (Figure 1). Majority of the respondents has
been worshippers for more than 5yrs; 61.7%. About 48.9% found
the music loud while 14.9% found it extremely loud, Table 3.
Incidentally 59.6% of these worshippers are aware of the effect of
noise on their hearing. In the majority 66.7% the tinnitus stopped
within 24 hours while in 30.6% it lasted up to a week and in2.8%
it did not cease. The hearing was not the same after the tinnitus
in 44.8%, (Table 3) When the sociodemographic characteristics
are considered there is statistical significance of tinnitus
with age distribution; p-value of 0.0001 (Table 4). In terms of
denomination, catholic denomination had 72.5% of worshippers
with tinnitus while the rest all had 100% but this difference is
not statistically significant. There is however significant chances
of developing tinnitus the closer the worshippers sit to the loud
speakers. The length of time the worshipper has been attending
church as well as the frequency is significant in the developing of
tinnitus (Tables 5 & 6).
This study even though it was carried out in three major
worship centers in Port Harcourt metropolis, had only 94
members that consented and filled the self - administered
questionnaire properly. The catholic denomination constituted
the greater percentage 85.1% of the study while the least was
the protestant. We could not deduce an explanation for this. The
finding of more males being affected than females is similar to a
study in Brazil by Flores et al. The age’s 15-44years were the
most affected and this constitutes the youth and the work force.
Among the respondents, 76.6% had tinnitus and about 36.1%
has been suffering intermittent tinnitus at least once a month.
About 13.9% have up to more than five episodes in a month. It
is important to note that intermittent tinnitus is often as a result
of excessive noise exposure [ 14]. In majority of these 66.7%
there was spontaneous resolution within 24 hours however
a good percentage 30.6% lingered up to a week, but in 2.8% it
did not resolve. It is known that ringing tinnitus is also related
to excessive noise . In about 44.8% of these worshippers
their hearing was gradually being affected since it was not the
same after the tinnitus. This lays credence to the study that
found temporary shifts in threshold of hearing to be insidious
 Tinnitus was found to be significantly present in almost all
the age category. This shows that the risk of deleterious effect of
excessive noise exposure in the churches is significant for all ages
with a p-value of 0.0001. The study also shows that from about
age 44 years, the risk of developing tinnitus and possible hearing
loss on exposure to excessive noise is even greater, 100% of them
The length of time the worshippers had been in church and
their frequency of worship when compared with their awareness
of effect of the noise on their ear are statistically significant.
They tend to be more aware of the effect. In addition, the closer
they are to the loud speakers, the more their chances to develop
tinnitus. The average sound levels are highest in the Pentecostal
church followed closely by the Catholic Church. It is of note that
these levels are much higher than the prescribed 75dB A by the
Nigerian national environmental noise standard and regulation
Act . Most times, the worship sessions in these churches last
2-7 hours, yet the noise levels compare to that in some industrial
environments. When there is such high intensity of sound, the
duration of exposure should be less. This is because the higher the
sound and longer the exposure, the more the damage to the hair
cells . In such settings, high intense sounds from music has
been associated with temporary hearing impairment . There
is therefore need to educate the public on the effects or risks of
damage to the hearing from exposure to loud sounds from music
 this is because loud sounds are not that offensive to the ear until they reach up to 120dB A  This could explain why just
about 14.9% only found the noise extremely loud amongst the
respondents while 48.9% found the music often loud and 27.7%
of them sits lose to the loud speakers. It is important to note that
tinnitus could be the first symptom of hearing dysfunction .
There is need for education and public enlightenment on the
dangers of loud sounds to the ears. Educate the public on the
significance of tinnitus and what to do to avoid it. There should be
effort at enforcing strict adherence to the law concerning sound
levels in worship centers.
The worship sessions in our churches appear to have become
too loud as evidenced by the high sound levels. This has begun
to affect the ear health of the worshippers with the attendant
presence of intermittent tinnitus in majority of them. Public
education on this is of great importance.