Speech and neuroimaging effects following HiCommunication: a randomized controlled group intervention trial in Parkinson's disease.

Speech, voice and communication changes are common in Parkinson's disease. HiCommunication is a novel group intervention for speech and communication in Parkinson's disease based on principles driving neuroplasticity. In a randomized controlled trial, 95 participants with Parkinson's disease were allocated to HiCommunication or an active control intervention. Acoustic analysis was performed pre-, post- and six months after intervention. Intention-to-treat analyses with missing values imputed in linear multilevel models and complimentary per-protocol analyses were performed. The proportion of participants with a clinically relevant increase in the primary outcome measure of voice sound level was calculated. Resting-state functional MRI was performed pre- and post-intervention. Spectral dynamic causal modelling and the parametric empirical Bayes methods were applied to resting-state functional MRI data to describe effective connectivity changes in a speech-motor-related network of brain regions. From pre- to post-intervention, there were significant group-by-time interaction effects for the measures voice sound level in text reading (unstandardized b = 2.3, P = 0.003), voice sound level in monologue (unstandardized b = 2.1, P = 0.009), Acoustic Voice Quality Index (unstandardized b = -0.5, P = 0.016) and Harmonics-to-Noise Ratio (unstandardized b = 1.3, P = 0.014) post-intervention. For 59% of the participants, the increase in voice sound level after HiCommunication was clinically relevant. There were no sustained effects at the six-month follow-up. In the effective connectivity analysis, there was a significant decrease in inhibitory self-connectivity in the left supplementary motor area and increased connectivity from the right supplementary motor area to the left paracentral gyrus after HiCommunication compared to after the active control intervention. In conclusion, the HiCommunication intervention showed promising effects on voice sound level and voice quality in people with Parkinson's disease, motivating investigations of barriers and facilitators for implementation of the intervention in healthcare settings. Resting-state brain effective connectivity was altered following the intervention in areas implicated, possibly due to reorganization in brain networks.

Making a racket in America's fastest growing sport: Evaluation of noise exposure in pickleball.

OBJECTIVE: To measure noise exposure present on pickleball courts and assess the risk of noise-induced hearing loss (NIHL) per guidelines put forward by the National Institute of Occupational Safety and Health (NIOSH). METHODS: Observational study measuring noise levels at multiple recreational pickleball courts in the Richmond, VA area, documenting LAeq, LASmax, and LCpeak at courtside and waiting areas of pickleball courts. Measurements were completed using the NIOSH SLM application on an iPhone 13 with iMM-6 Calibrated Measurement Microphone (equivalent to IEC 61672-1 Class II) that was calibrated using ND-9 Sound Level Calibrator (IEC942 Class I). RESULTS: Average sound levels recorded at waiting areas adjacent to the courts, measured in LAeq, LASmax, and LCpeak, were 69.1 dBA, 92.0 dBA, and 112.1 dBC, respectively, while courtside measurements were 69.7 dBA, 92.2 dBA, and 115.6 dBC, respectively. These measurements were within NIOSH and OSHA recommendations. CONCLUSION: The data demonstrates that randomly sampled pickleball courts have noise levels that do not increase risk for NIHL for participants or bystanders alike based on NIOSH guidelines. However, prolonged noise exposure and ambient noise pollution may have other health implications and warrant further investigations. LEVEL OF EVIDENCE: Level 2.

The Arctic marine soundscape of the Amundsen Gulf, Western Canadian Arctic.

The underwater soundscape, a habitat component for Arctic marine mammals, is shifting. We examined the drivers of the underwater soundscape at three sites in the Amundsen Gulf, Northwest Territories, Canada from 2018 to 2019 and estimated the contribution of abiotic and biotic sources between 20 Hz and 24 kHz. Higher wind speeds and the presence of bearded seal (Erignathus barbatus) vocalizations led to increased SPL (0.41 dB/km/h and 3.87 dB, respectively), while higher ice concentration and air temperature led to decreased SPL (-0.39 dB/% and - 0.096 dB/°C, respectively). Other marine mammals did not significantly impact the ambient soundscape. The presence of vessel traffic led to increased SPLs (12.37 dB) but was quieter at distances farther from the recorder (-2.57 dB/log m). The presence of high frequency and broadband signals produced by ice led to increased SPLs (7.60 dB and 10.16 dB, respectively).

An auditory brain-computer interface to detect changes in sound pressure level for automatic volume control.

Volume control is necessary to adjust sound levels for a comfortable audio or video listening experience. This study aims to develop an automatic volume control system based on a brain-computer interface (BCI). We thus focused on a BCI using an auditory oddball paradigm, and conducted two types of experiments. In the first experiment, the participant was asked to pay attention to a target sound where the sound level was high (70 dB) compared with the other sounds (60 dB). The brain activity measured by electroencephalogram showed large positive activity (P300) for the target sound, and classification of the target and nontarget sounds achieved an accuracy of 0.90. The second experiment adopted a two-target paradigm where a low sound level (50 dB) was introduced as the second target sound. P300 was also observed in the second experiment, and a value of 0.76 was obtained for the binary classification of the target and nontarget sounds. Further, we found that better accuracy was observed in large sound levels compared to small ones. These results suggest the possibility of using BCI for automatic volume control; however, it is necessary to improve its accuracy for application in daily life.

[Analysis on the quality control of suspected occupational disease from the characteristics of applicants diagnosed with noise deafness].

Objective: To analyze the audiology and occupational health data of applicants diagnosed of occupational noise deafness, and to explore the influencing factors in the diagnosis of suspected occupational noise deafness. Methods: In May 2022, the information of patients diagnosed with occupational noise deafness in Peking University Third Hospital from January 2018 to December 2021 was collected, and the occupational health data of their working environment, clinical audiological examination results and diagnosis basis of occupational noise deafness were collected and analyzed. Multi-factor unconditional logistic regression analysis was used to analyze independent risk factors for the diagnosis of occupational noise deafness. Results: A total of 129 subjects were included, all of which were suspected cases of occupational noise deafness found in various occupational health examination institutions. Eight cases (6.20%) were diagnosed as occupational noise deafness, and 121 cases (93.80%) were non-occupational noise deafness. After hearing examination, only 27.27% (24/88) of the patients' audiological changes were consistent with the starting point of occupational noise deafness diagnosis. Further analysis of the noise intensity in the workplace showed that 16 patients were identified as non-occupational noise deafness because the noise intensity of the working environment was less than 85 dB. Logistic regression analysis showed that the working hours were more than 8 hours (OR=9.274, 95%CI: 1.388-61.950, P=0.022) and the noise intensity of the working environment (OR=1.189, 95%CI: 1.059-1.334, P=0.003) were independent risk factors for the diagnosis of occupational noise deafness. Conclusion: The exclusion rate of suspected occupational noise deafness found in occupational health examination is higher after adequate rest. The test results of working environment noise intensity provided by the employer can help to determine occupational noise deafness.

Alternative audiometric calibration methods: Evaluation of sound level measuring apps for audiometric calibration.

Audiometric calibration, which includes the calibration of different audiometer transducers and the measurements of ambient noise levels, is historically carried out using Class 1 sound level meters. As technologies advance, many mobile applications (apps) have been developed to measure sound levels. These apps can provide alternative methods for audiometric calibration in places where sound level meters are not available, such as field testing environments, low-to-mid-income countries, and humanitarian settings. These apps, however, cannot be used for audiometric calibration without first evaluating their performance, which depends on multiple factors including the external components (if any), the operating system and the hardware of the electronic devices. The evaluation of the apps is actually the evaluation of the app and associated factors (i.e., the app systems). This paper discusses methods to assess several key functions of apps implemented in either Android or iOS operation system for audiometric calibration: 1) checking the measurement accuracy at all testing frequencies, 2) deriving and using correction factors, 3) determining the self-noise levels, and 4) evaluating the linear/measurement range. As audiometric calibration usually uses octave or 1/3 octave bands to measure sound pressure levels of tones and narrowband noises with relatively steady temporal characteristics, the accuracy of an app can be evaluated by comparing the levels measured by the app and a Class 1 sound level meter at each frequency. The level difference between the app and the Class 1 sound level meter at each frequency can then be used to calculate correction factors that can be added to subsequent levels measured by the app to improve its accuracy. In addition, methods to determine the self-noise level and the linearity range of apps are discussed. Sample measurement scenarios and alternative methods are provided to illustrate the evaluation process to determine whether an app is suitable for measuring ambient noise levels and for calibrating different audiometric transducers.

Characterization of sound pressure levels and sound sources in the intensive care unit: a 1 week observational study.

Background: Exposure to elevated sound pressure levels within the intensive care unit is known to negatively affect patient and staff health. In the past, interventions to address this problem have been unsuccessful as there is no conclusive evidence on the severity of each sound source and their role on the overall sound pressure levels. Therefore, the goal of the study was to perform a continuous 1 week recording to characterize the sound pressure levels and identify negative sound sources in this setting. Methods: In this prospective, systematic, and quantitative observational study, the sound pressure levels and sound sources were continuously recorded in a mixed medical-surgical intensive care unit over 1 week. Measurements were conducted using four sound level meters and a human observer present in the room noting all sound sources arising from two beds. Results: The mean 8 h sound pressure level was significantly higher during the day (52.01 ± 1.75 dBA) and evening (50.92 ± 1.66 dBA) shifts than during the night shift (47.57 ± 2.23; F(2, 19) = 11.80, p < 0.001). No significant difference was found in the maximum and minimum mean 8 h sound pressure levels between the work shifts. However, there was a significant difference between the two beds in the based on location during the day (F(3, 28) = 3.91, p = 0.0189) and evening (F(3, 24) = 5.66, p = 0.00445) shifts. Cleaning of the patient area, admission and discharge activities, and renal interventions (e.g., dialysis) contributed the most to the overall sound pressure levels, with staff talking occurring most frequently. Conclusion: Our study was able to identify that continuous maintenance of the patient area, patient admission and discharge, and renal interventions were responsible for the greatest contribution to the sound pressure levels. Moreover, while staff talking was not found to significantly contribute to the sound pressure levels, it was found to be the most frequently occurring activity which may indirectly influence patient wellbeing. Overall, identifying these sound sources can have a meaningful impact on patients and staff by identifying targets for future interventions, thus leading to a healthier environment.

Excessive Noise in Neonatal Units and the Occupational Stress Experienced by Healthcare Professionals: An Assessment of Burnout and Measurement of Cortisol Levels.

Excessive noise in the work environment has been associated with extra-auditory symptoms, which can have harmful long-term effects on individuals. The purpose of this study was to identify noise levels in neonatal intensive care units and investigate their impact on the occurrence of stress among healthcare professionals, using cortisol levels as a biomarker for Burnout Syndrome. This descriptive, observational, and cross-sectional study was conducted in four public teaching hospitals in Fortaleza, Ceará, Brazil. Sound pressure levels in the environment were measured, and questionnaires were administered to collect sociodemographic data and assess perceptions of the work environment and Burnout symptoms. Saliva samples were collected at the beginning and end of work shifts for cortisol quantification. The average sound pressure ranged from 59.9 to 66.4 dB(A), exceeding the recommended levels set by Brazilian and international legislation. Among the 256 participants, the average age was 39.4 years, with 95% being female. The majority (70.9%) were nurses, and 22.7% were physicians. There was no significant association found between noise and Burnout Syndrome, nor with changes in cortisol levels. However, a significant association was observed between the perception of excessive noise and the sensation of a stressful work shift (p = 0.012). All evaluated professionals displayed symptoms of Burnout. The high sound pressure levels indicated that the assessed environments did not meet the recommended standards for acoustic comfort, and this was associated with the participants' perception of stressful work shifts. While Burnout symptoms were evident in our participants, it was not possible to confirm a correlation with high noise levels.

Living in a box: Understanding acoustic parameters in the NICU environment.

Background: In the last years, a significant body of scientific literature was dedicated to the noisy environment preterm-born infants experience during their admission to Neonatal Intensive Care Units (NICUs). Nonetheless, specific data on sound characteristics within and outside the incubator are missing. Therefore, this study aimed to shed light on noise level and sound characteristics within the incubator, considering the following domain: environmental noise, incubator handling, and respiratory support. Methods: The study was performed at the Pediatric Simulation Center at the Medical University of Vienna. Evaluation of noise levels inside and outside the incubator was performed using current signal analysis libraries and toolboxes, and differences between dBA and dBSPL values for the same acoustic noises were investigated. Noise level results were furthermore classed within previously reported sound levels derived from a literature survey. In addition, sound characteristics were evaluated by means of more than 70 temporal, spectral, and modulatory timbre features. Results: Our results show high noise levels related to various real-life situations within the NICU environment. Differences have been observed between A weighted (dBA) and unweighted (dBSPL) values for the same acoustic stimulus. Sonically, the incubator showed a dampening effect on sounds (less high frequency components, less brightness/sharpness, less roughness, and noisiness). However, a strong tonal booming component was noticeable, caused by the resonance inside the incubator cavity. Measurements and a numerical model identified a resonance of the incubator at 97 Hz and a reinforcement of the sound components in this range of up to 28 dB. Conclusion: Sound characteristics, the strong low-frequency incubator resonance, and levels in dBSPL should be at the forefront of both the development and promotion of incubators when helping to preserve the hearing of premature infants.

Erratum: Methods for measuring and identifying sounds in the intensive care unit.

[This corrects the article DOI: 10.3389/fmed.2022.836203.].

Calibration matters: I. Sound level meter basics.

Calibration is an essential component of audiology practice to ensure the accuracy of the equipment for audiometric tests and the transferability of test results across different clinics and countries. The ability to check the accuracy of the equipment and the ambient noise levels allows clinicians to monitor the functions of their equipment, to reduce noise distractors in the testing environment, and to have confidence in their test results, especially in humanitarian or field test settings. Sound level meters are the primary instruments to measure the sound pressure levels of the transducers and the test rooms used for audiometric testing. The International Electrotechnical Commission released a 3-part IEC 61672 standard of the specifications of sound level meters in 2013, and it is adopted by the standards organizations of many countries. This first installment of the tutorial series references this international standard and discusses basic acoustics concepts, calibration principles, and key functions of sound level meters in the application of audiometric calibration. Subsequent installments will discuss how to measure the ambient noise levels, how to determine whether a test room is suitable for testing hearing thresholds using different transducers, and how to determine whether different transducers of audiometers meet the national or international standards.

Loudness and Pitch of Emotional Stage Speech in Kunqu Opera.

Equivalent sound level (Leq), sound pressure level (SPL) and fundamental frequency (F0) were analyzed in the stage speech of six Kunqu Opera roles, Young woman, Old woman, Young man, Old man, Colorful face and Clown. The roles differ in gender, age, personality and phonation types. Differences among emotions (neutral, sad, angry and happy), singers and roles were examined. For most roles, more similarities were observed between neutral and sad stage speech and between angry and happy stage speeches. In most cases, the latter group showed higher Leq, mean SPL and Mean F0 and larger standard deviation (SD) of SPL difference than the former. Some parameters, such as SD of SPL, the mean of SPL difference and the difference between Leq and mean SPL, also showed the intra-group differences.Young woman role, Young man role and Old woman role were similar in some parameters. Colorful face role and Old man role showed a lot of similarities. Clown role showed the least similarities with the other roles. With regard to gender and age, young roles showed smaller SPL difference, larger correlation coefficient between F0 and SPL and larger mean SPL differences between emotions than old roles; female roles had greater parameter consistency and larger correlation coefficient between F0 and SPL than male roles. The personality and phonation types also effected the characteristics of loudness and pitch. This study showed the importance of speakers' characteristics in emotional speech analysis.

Calibration matters: II. Measurement of ambient noise in test rooms/areas.

Ambient noise measurement is a part of audiometric calibration in which one measures the ambient noise level in a sound room/test area intended for audiometric testing and then decides whether the background noise in the test room meets the maximum permissible ambient noise level (MPANL) requirements specified in national or international standards, e.g., ANSI/ASA S3.1:1999(R2018) or ISO 8253-1:2010 (R2021). If the ambient noise levels are below the MPANLs, clinicians can be sure that the test stimuli they present to patients are not masked by the background noise in the test room/area and their test results are valid and the subsequent clinical decisions are sound. Audiometric testing, however, may not always be carried out in sound rooms/test areas with ambient noise levels below the MPANLs, especially during community outreach or humanitarian services. A thorough understanding on the MPANL requirements for different transducers can help clinicians determine which equipment is appropriate for the test area. This tutorial discusses the rationale and assumptions behind the MPANL specifications, how to measure ambient noise levels of test rooms/areas, and how to apply the national and international standards to determine if the test room is suitable for audiometric testing. Alternative strategies are discussed when the ambient noise levels exceed the specified MPANLs. The rationale and procedures are explained using examples on how to lower the ambient noise levels in test areas, and how to determine the suitable test frequency range and the lowest threshold levels that can be assessed in the test area.

Impact of COVID-19 lockdown on ambient noise levels in seven metropolitan cities of India.

The paper analyzed the impact of lockdown on the ambient noise levels in the seventy sites in the seven major cities of India and ascertained the noise scenario in lockdown period, and on the Janta Curfew day in comparison to the pre-lock down period and year 2019 annual average values. It was observed that the majority of the noise monitoring sites exhibited a decrement in ambient day and night equivalent noise levels on the national Janta Curfew day and Lockdown period as compared with the normal working days attributed to the restricted social, economical, industrial, urbanization activity and reduced human mobility. A mixed pattern was observed at a few sites, wherein the ambient day and night equivalent noise levels during Janta curfew day and Lockdown period had been reported to be higher than that on the normal working days. The study depicts the noise scenario during the lockdown and pre-lockdown period for seventy sites in India and shall be instrumental in analyzing the consequences and implications of imposing lockdowns in future on the environmental noise pollution in Indian cities.

Determinación de zonas de ruido ambiental dañino en instalaciones no operativas de bases aéreas militares / Determination of harmful environmental noise zones in non-operating military air base facilities

Resumen Introducción: El ruido es un sonido desagradable que afecta la salud y que es factor de riesgo para hipertensión y cardiopatía isquémica. La aviación genera ruido y contaminación del aire que daña la audición y es un problema a nivel mundial y para la población en general y para quienes trabajan en los aeropuertos, por lo que debe ser analizado. Sobre el tema se han publicado trabajos diversos, más sin embargo son pocos los estudios hechos en zonas aledañas a bases aéreas y brindándose poca atención preventiva a la población que labora dentro de ellas. Objetivo: Determinar la existencia de niveles de ruido ambiental dañino en instalaciones de trabajo no operativas de bases aéreas militares. Material y métodos: Se midió el ruido ambiental en turnos laborales por 7 días, en las bases aéreas de Santa Lucía, y Zapopan, con sonómetro ambiental Extech® Mod. 407732, clase 2, normas ANSI y IEC 651 Type 2 y calibrador 407744 de 94 ó 114 dB., en áreas expuestas al ruido cercanas a la pista de aterrizaje en horas de máxima actividad aérea. Resultados: Se encontró ruido dañino no satisfactorio y peligroso entre los 68 dB y 82.06 dB de nivel equivalente sonoro de ruido (LEQ), fuera de norma para ruido ambiental. Conclusiones: Los niveles de ruido encontrado se salen de los parámetros aceptables de exposición al ruido ambiental en la comunidad, por tanto resulta nocivo y se debe contar con medios de protección y programas preventivos para evitar la pérdida de la audición.

Abstract Introduction: Noise is an unpleasant sound that affects health and is a risk factor for hypertension and ischemic heart disease. Aviation generates noise and air pollution that damages hearing and is a problem worldwide and for the general population and for those who work in airports, so it must be analyzed. Various works have been published on the subject, however, there are few studies carried out in areas surrounding air bases and little preventive care is provided to the population that works within them. Objective: Determine the existence of harmful environmental noise levels in non-operational work installations of military air bases. Material and Methods: Ambient noise was measured in work shifts for 7 days, at the air bases of Santa Lucía and Zapopan, with Extech® Mod. 407732, class 2 environmental sound level meter, ANSI and IEC 651 Type 2 standards and 407766 gauge of 94 or 114 dB, in áreas exposed to noise near the runway at peak hours air activit Results: No satisfactory and dangerous harmful noise was found between 68 dB and 82.06 dB of noise equivalent noise level (LEQ), out of the norm for ambient noise. Conclusions: The noise found does not meet what is established for the levels of exposure of environmental noise in the community, it must have means of protection and preventive programs to prevent hearing loss.

Railway Line Occupancy Control Based on Distance Determination Sound Method.

The purpose of this research paper is to present the application of the developed sound method as a supporting tool to deal with railway traffic flow control. It is found that controlling railway line occupancy is the main issue associated with railway traffic flow. For this purpose, the line occupancy control based on a sound method has been developed. The concept of using sound waves as a source of information about approaching people, animals, vehicles, etc., has been known for centuries, and is due to the natural properties of the sense of hearing. There are many engineering attempts on the use of this phenomenon, which are mostly based on applications of distributed fiber-optic sensing technology. This paper presents the results of the sound pressure measurement in the immediate proximity of the rail to analyze and evaluate the use of the acoustic wave as an information carrier on approaching rail vehicles. The purpose of this research is to discuss the sound method introduced here, and apply it in different circumstances.

Methods for Measuring and Identifying Sounds in the Intensive Care Unit.

Background: Despite many studies in the field examining excessive noise in the intensive care unit, this issue remains an ongoing problem. A limiting factor in the progress of the field is the inability to draw conclusions across studies due to the different and poorly reported approaches used. Therefore, the first goal is to present a method for the general measurement of sound pressure levels and sound sources, with precise details and reasoning, such that future studies can use these procedures as a guideline. The two procedures used in the general method will outline how to record sound pressure levels and sound sources, using sound level meters and observers, respectively. The second goal is to present the data collected using the applied method to show the feasibility of the general method and provide results for future reference. Methods: The general method proposes the use of two different procedures for measuring sound pressure levels and sound sources in the intensive care unit. The applied method uses the general method to collect data recorded over 24-h, examining two beds in a four-bed room, via four sound level meters and four observers each working one at a time. Results: The interrater reliability of the different categories was found to have an estimate of >0.75 representing good and excellent estimates, for 19 and 16 of the 24 categories, for the two beds examined. The equivalent sound pressure levels (LAeq) for the day, evening, and night shift, as an average of the sound level meters in the patient room, were 54.12, 53.37, and 49.05 dBA. In the 24-h measurement period, talking and human generated sounds occurred for a total of 495 (39.29% of the time) and 470 min (37.30% of the time), at the two beds of interest, respectively. Conclusion: A general method was described detailing two independent procedures for measuring sound pressure levels and sound sources in the ICU. In a continuous data recording over 24 h, the feasibility of the proposed general method was confirmed. Moreover, good and excellent interrater reliability was achieved in most categories, making them suitable for future studies.

A brief overview of current approaches for underwater sound analysis and reporting.

Soundscapes have substantially changed since the industrial revolution and in response to biodiversity loss and climate change. Human activities such as shipping, resource exploration and offshore construction alter natural ecosystems through sound, which can impact marine species in complex ways. The study of underwater sound is multi-disciplinary, spanning the fields of acoustics, physics, animal physiology and behaviour to marine ecology and conservation. These different backgrounds have led to the use of various disparate terms, metrics, and summary statistics, which can hamper comparisons between studies. Different types of equipment, analytical pathways, and reporting can lead to different results for the same sound source, with implications for impact assessments. For meaningful comparisons and derivation of appropriate thresholds, mitigation, and management approaches, it is necessary to develop common standards. This paper presents a brief overview of acoustic metrics, analysis approaches and reporting standards used in the context of long-term monitoring of soundscapes.

Instant improvement in monaural spatial hearing abilities through cognitive feedback.

Several studies report that sound localization performance of acute and chronic monauralized normal-hearing listeners can improve through training. Typically, training sessions are administered daily for several days or weeks. While this intensive training is effective, it may also be that monaural localization abilities improve instantly after providing explicit top-down information about the direction dependent change in timbre and level. The aim of the present study was to investigate whether cognitive feedback (i.e., top-down information) could instantly improve sound localization in naive acutely monauralized listeners. Forty-three normal-hearing listeners (experimental group), divided over five different centers, were tested. Two control groups, consisting of, respectively, nine and eleven normal-hearing listeners, were tested in one center. Broadband sounds (0.5-20 kHz) were presented from visible loudspeakers, positioned in azimuth (- 90° to 90°). Participants in the experimental group received explicit information about the noticeable difference in timbre and the poor localization in the monauralized listening condition, resulting in an instant improvement in sound localization abilities. With subsequent roving of stimulus level (20 dB), sound localization performance deteriorated immediately. The reported improvement is related to the context of the localization test. The results provide important implications for studies investigating sound localization in a clinical setting, especially during closed-set testing, and indicate the importance of top-down information.

Variability of environmental sound levels: An observational study from a general adult intensive care unit in the UK.

Background: Intensive care units are significantly louder than WHO guidelines recommend. Patients are disturbed by activities around them and frequently report disrupted sleep. This can lead to slower recovery and long-term health problems. Environmental sound levels are usually reported as LAeq24, a single daily value that reflects mean sound levels over the previous 24-h period. This may not be the most appropriate measure for intensive care units (ICUs) and other similar areas. Humans experience sound in context, and disturbance will vary according to both the individual and acoustic features of the ambient sounds. Loudness is one of a number of measures that approximate the human perception of sound, taking into account tone, duration, and frequency, as well as volume. Typically sounds with higher frequencies, such as alarms, are perceived as louder and more disturbing. Methods: Sound level data were collected from a single NHS Trust hospital general adult intensive care unit between October 2016 and May 2018. Summary data (mean sound levels (LAeq) and corresponding Zwicker calculated loudness values) were subsequently analysed by minute, hour, and day. Results: The overall mean LAeq24 across the study duration was 47.4 dBA. This varied by microphone location. We identified a clear pattern to sound level fluctuations across the 24-h period. Weekends were significantly quieter than weekdays in statistical terms but this reduction of 0.2 dB is not detectable by human hearing. Peak loudness values over 90 dB were recorded every hour. Conclusions: Perception of sound is sensitive to the environment and individual characteristics and sound levels in the ICU are location specific. This has implications for routine environmental monitoring practices. Peak loudness values are consistently between 90 and 100 dB. These may be driven by alarms and other sudden high-frequency sounds, leading to more disturbance than LAeq24 sound levels suggest. Addressing sounds with high loudness values may improve the ICU environment more than an overall reduction in the 24-h mean decibel value.