We read the letter from Koh et al with interest. The main purpose of our article(1) was to provide concrete evidence that our youths are today exposed to excessive amount of leisure noise. We believe that the perils of loud music listening among our youths are not fully appreciated by both medical professionals and adolescents alike. Our aim was to bring awareness to this issue, so that together, we can make a difference.
       The best methodology for tackling the problem is, of course, debatable. The authors described the use of a mannequin, coupled with a student educator, and reported a substantial proportion of students who intended to reduce listening volumes in future. This is a novel and interesting way to bring the message across. The reported student responses also appear to be positive. It would be interesting to follow up on the long-term effectiveness of this methodology.  While many overseas studies(2-5) on hearing conservation programmes have reported that, compared to pre-instruction responses, young adults’ post-instruction hearing knowledge and noise awareness improved significantly, not all translate to a change in belief, attitude, and ultimately, behaviour. 
       Certainly, it is a great first step, and the efforts made by the Eastern Health Alliance are to be highlighted and commended. We would encourage other hospitals and polyclinics to also reach out to young people to educate them about the hearing hazards of loud music. 
       Finally, we also firmly believe that all schools in Singapore should conduct a hearing conservation and awareness programme, possibly starting at the primary school level. In this respect, the Health Promotion Board could work closely with the Ministry of Education. The hazards of loud music could also be incorporated into students’ health curriculum. These efforts at the school level, coupled with those of our health sector, can ultimately make a difference.
Yours sincerely,
Gary Jek Chong Lee1, Ming Yann Lim2, Angeline Yi Wei Kuan1, Joshua Han Wei Teo1, Hui Guang Tan1, Wong Kein Low2
1School of Engineering, Temasek Polytechnic, 2Department of Otolaryngology, Singapore General Hospital, Singapore. jekchong@tp.edu.sg
1.  Lee JC, Lim MY, Kuan YW, et al. The music listening preferences and habits of youths in Singapore and its relation to leisure noise-induced hearing loss. Singapore Med J 2014;55:72-7.
2.  Folmer RL, Griest SE, Martin WH. Hearing conservation education programs for children: a review. J Sch Health 2002; 72:51-7.
3.  Weichbold V, Zorowka P. Effects of a hearing protection campaign on the discotheque attendance habits of high-school students. Int J Audiol 2003; 42:489-93.
4.  Randolph RF, Hudak RL, Vaught C. Communicating hearing loss information to young children effectiveness of lecture and printed materials. AAOHN J 2003; 51:433-8.
5.  Griest SE, Folmer RL, Martin WH. Effectiveness of “Dangerous Decibels,” a school-based hearing loss prevention program. Am J Audiol 2007; 16:S165-81.