Prevention of noise-induced hearing loss in children - evidence-informed recommendations for safe listening at events.

Objective: Children's events are often perceived as excessively loud, with risks of noise-induced hearing loss and other adverse effects. In many countries, including Hungary, specific regulations for recreational noise levels are absent. This research aims to establish a scientific basis for safety categories and noise level limits to protect children's hearing.

Design: Noise levels were measured at events, and otoacoustic emissions were assessed to determine auditory impacts. Children and parents also completed loudness perception surveys.

Study sample: Thirteen events were analysed with 25 noise-level measurement points. We included children aged 3-12 years, conducted 38 otoacoustic emission tests on both ears before and after the event, and collected 51 completed questionnaires.

Results: Only seven measurement points were in the "safe" category, 40% were "risky", and 32% were "dangerous". While safe events did not alter inner ear function, it was reduced in several cases after risky events. High noise intensities were uncomfortable for 80% of the children.

Conclusions: Children's events often exceed safe noise levels, underscoring the critical need for sound monitoring and control. We recommend implementing guidelines, public education, and warnings to prevent hearing loss, with proposed regulations and age-related safety recommendations, presenting sound intensity categories with letters A to F.