0196/0202/2014/356-0680/0฀•฀Ear฀&฀Hearing฀•฀Copyright฀©฀2014฀by฀Lippincott฀Williams฀&฀Wilkins฀•฀Printed฀in฀the฀U.S.A. 680 Objectives: Sensorineural hearing loss from sound overexposure has a considerable prevalence. Identification of sound hazards is crucial, as prevention, due to a lack of definitive therapies, is the sole alternative to hearing aids. One subjectively loud, yet little studied, potential sound hazard is movie theaters. This study uses smart phones to evaluate their applicability as a widely available, validated sound pressure level (SPL) meter. Therefore, this study measures sound levels in movie theaters to determine whether sound levels exceed safe occupational noise expo- sure limits and whether sound levels in movie theaters differ as a func- tion of movie, movie theater, presentation time, and seat location within the theater. Design: Six smart phones with an SPL meter software application were calibrated with a precision SPL meter and validated as an SPL meter. Additionally, three different smart phone generations were measured in comparison to an integrating SPL meter. Two different movies, an action movie and a children’s movie, were measured six times each in 10 different venues (n = 117). To maximize representativeness, movies were selected focusing on large release productions with probable high attendance. Movie theaters were selected in the San Francisco, CA, area based on whether they screened both chosen movies and to represent the largest variety of theater proprietors. Measurements were analyzed in regard to differences between theaters, location within the theater, movie, as well as presentation time and day as indirect indicator of film attendance. Results: The smart phone measurements demonstrated high accuracy and reliability. Overall, sound levels in movie theaters do not exceed safe exposure limits by occupational standards. Sound levels vary significantly across theaters and demonstrated statistically significant higher sound levels and exposures in the action movie compared to the children’s movie. Sound levels decrease with distance from the screen. However, no influence on time of day or day of the week as indirect indi- cator of film attendance could be found. Conclusions: Calibrated smart phones with an appropriate software application as used in this study can be utilized as a validated SPL meter. Because of the wide availability, smart phones in combination with the software application can provide high quantity recreational sound expo- sure measurements, which can facilitate the identification of potential noise hazards. Sound levels in movie theaters decrease with distance to the screen, but do not exceed safe occupational noise exposure lim- its. Additionally, there are significant differences in sound levels across movie theaters and movies, but not in presentation time. Key words: Cinema, Movie, Noise exposure, Noise-induced hearing loss, Recreational noise, Smart phone, Sensorineural hearing loss, Sound level measurement, Sound exposure measurement, Theater. (Ear฀&฀Hearing฀2014;35;680–686) INTRODUCTION Permanent฀ sensorineural฀ hearing฀ loss฀ (SNHL)฀ is฀ a฀ major฀ societal฀ burden฀ with฀ considerable฀ prevalence.฀ Currently,฀ it฀ affects฀every฀sixth฀person฀in฀the฀developed฀world฀(Shield฀2006;฀ Agrawal฀et฀al.฀2008)฀and฀an฀even฀higher฀percentage฀in฀devel- oping฀ countries฀ (WHO฀ 2012).฀ SNHL฀ has฀ multiple฀ causes,฀ of฀ which฀ a฀ prominent฀ contributor฀ is฀ exposure฀ to฀ high฀ levels฀ of฀ sound฀(Rabinowitz฀2010).฀To฀date,฀no฀effective฀causal฀therapy฀ exists฀to฀reverse฀SNHL฀following฀sound฀overexposure฀(noise)฀ (Oishi฀&฀Schacht฀2011).฀Therefore,฀prevention฀remains฀critical฀ in฀avoiding฀the฀considerable฀associated฀morbidity. Hazardous฀ occupational฀ noise฀ exposures฀ (ONEs)฀ are฀ well฀ deined฀and฀standardized฀by฀the฀National฀Institute฀for฀Occupa- tional฀Health฀and฀Safety฀(NIOSH)฀(NIOSH฀1998),฀the฀American฀ National฀Standard฀Institute฀(ANSI)฀(ANSI-S3.44฀1996),฀and฀the฀ International฀Organization฀for฀Standardization฀(ISO)฀(ISO-1999฀ 1990).฀According฀ to฀ these฀ standards,฀ continuous฀ sound฀ levels฀ greater฀ than฀ 85฀ dB฀ of฀ A-weighted฀ SPL฀ [dB฀ (A)]฀ for฀ 8฀ hours฀ daily฀ are฀ related฀ to฀ an฀ increased฀ lifetime฀ risk฀ of฀ developing฀ permanent฀SNHL฀(ISO-1999฀1990;฀ANSI-S3.44฀1996;฀NIOSH฀ 1998).฀Exposure฀to฀occupational฀noise,฀however,฀may฀not฀be฀an฀ exposure฀to฀continuous,฀but฀rather฀to฀luctuating฀sound฀ levels.฀ Thus,฀the฀total฀energy฀of฀ luctuating฀sound฀ levels฀is฀expressed฀ in฀ a฀ continuous,฀ energy-equivalent฀ sound฀ level฀ (L eq )฀ over฀ the฀ measured฀time฀(NIOSH฀1998;฀Earshen฀2003).฀In฀addition฀to฀the฀ L eq ,฀safe฀ONE฀limits฀represent฀a฀noise฀dose฀and,฀as฀such,฀further฀ depend฀on฀acceptable฀exposure฀duration.฀The฀acceptable฀expo- sure฀duration฀is฀determined฀by฀a฀deined฀exchange฀rate,฀which฀ describes฀the฀required฀increase฀in฀overall฀sound฀level฀that฀neces- sitates฀ a฀ decrease฀ in฀ exposure฀ time฀ by฀ one฀ half.฀An฀ exchange฀ rate฀of฀3฀dB฀as฀recommended฀by฀NIOSH฀(NIOSH฀1998)฀results฀ in฀the฀reduction฀of฀a฀safe฀exposure฀time฀from฀8฀to฀4฀hr฀for฀88฀dB฀ (A)฀and฀to฀2฀hr฀for฀91฀dB฀(A),฀respectively.฀Based฀on฀these฀stan- dards,฀ONE฀is฀regulated฀by฀the฀Occupational฀Health฀and฀Safety฀ Administration฀(OSHA)฀in฀the฀United฀States,฀by฀the฀European฀ Agency฀for฀Safety฀and฀Health฀at฀Work฀(EU-OSHA)฀in฀Europe,฀ and฀by฀similar฀agencies฀in฀other฀countries. Hazardous฀recreational฀sound฀exposures฀(RSE),฀on฀the฀con- trary,฀are฀not฀as฀rigorously฀regulated฀or฀deined฀ as฀ ONE.฀ One฀ reason฀is฀that฀the฀accurate฀measurement฀of฀RSE฀requires฀both฀ measures฀of฀sound฀levels฀and฀duration฀in฀highly฀variable฀envi- ronments.฀A฀ second฀ reason฀ for฀ the฀ less฀ rigorous฀ regulation฀ is฀ that฀ at-risk฀ environments฀ for฀ RSE฀ are฀ generally฀ sought฀ inten- tionally.฀In฀most฀recreational฀environments฀such฀as฀music฀clubs฀ (Babisch฀2000b)฀and฀concert฀halls฀(Yassi฀et฀al.฀1993;฀Opperman฀ et฀al.฀2006),฀the฀sound฀level฀and฀duration฀is฀not฀under฀the฀direct฀ control฀of฀the฀individual.฀Even฀with฀user฀control฀such฀as฀self- adjusted฀volume฀settings฀in฀personal฀music฀players,฀hazardous฀ listening฀habits฀based฀on฀ONE฀standards฀have฀been฀reported฀in฀ 10฀ to฀ 25%฀ of฀ participants฀ (Ising฀ et฀ al.฀ 1994;฀ Williams฀ 2005,฀ 2009).฀A฀ third฀ reason฀ for฀ the฀ less฀ rigorous฀ regulation฀ of฀ RSE฀ Comprehensive Measures of Sound Exposures in Cinemas Using Smart Phones Markus฀E.฀Huth, 1,2 ฀Gerald฀R.฀Popelka, 1 ฀and฀Nikolas฀H.฀Blevins 1 1 Department฀ of฀ Otolaryngology,฀ Head฀ and฀ Neck฀ Surgery,฀ Stanford฀ University฀School฀of฀Medicine,฀Stanford,฀California,฀USA;฀and฀ 2 Department฀ of฀Otorhinolaryngology,฀Head฀and฀Neck฀Surgery,฀Inselspital,฀University฀of฀ Bern,฀Freiburgstrasse,฀Bern,฀Switzerland.