{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T08:53:56Z","timestamp":1784883236850,"version":"3.55.0"},"reference-count":28,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T00:00:00Z","timestamp":1753920000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nursing Reports"],"abstract":"<jats:p>Background\/Objectives: Anxiety before ophthalmic surgery under local anesthesia may hinder patient cooperation and surgical outcomes. Nurse-led auditory interventions offer a promising non-pharmacological approach to perioperative anxiety management. This study evaluated the effectiveness of superimposed binaural beats (SBBs)\u2014classical music layered with frequency differentials\u2014in reducing anxiety during pterygium surgery with conjunctival autografting. Methods: In this randomized controlled trial, 111 adult patients scheduled for elective pterygium excision with conjunctival autografting under local anesthesia were allocated to one of three groups: SBBs, plain music (PM), or silence (control). A trained perioperative nurse administered all auditory interventions. The patients\u2019 anxiety was assessed using the State\u2013Trait Anxiety Inventory\u2014State (STAI-S), and physiological parameters (blood pressure, heart rate, respiratory rate, and oxygen saturation) were recorded before and after surgery. Results: The SBB group showed significantly greater reductions in their STAI-S scores (p &lt; 0.001), systolic blood pressure (p = 0.011), heart rate (p = 0.003), and respiratory rate (p = 0.009) compared to the PM and control groups. No adverse events occurred. Conclusions: SBBs are a safe, nurse-delivered auditory intervention that significantly reduces perioperative anxiety and supports physiological stability. Their integration into routine nursing care for minor ophthalmic surgeries is both feasible and beneficial. Trial Registration: This study was registered with the Thai Clinical Trials Registry (TCTR) under registration number TCTR20250125002 on 25 January 2025.<\/jats:p>","DOI":"10.3390\/nursrep15080282","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T11:54:51Z","timestamp":1754308491000},"page":"282","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Nurse-Led Binaural Beat Intervention for Anxiety Reduction in Pterygium Surgery: A Randomized Controlled Trial"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-2390-2645","authenticated-orcid":false,"given":"Punchiga","family":"Ratanalerdnawee","sequence":"first","affiliation":[{"name":"Department of Anti-Aging and Regenerative Medicine, College of Integrative Medicine, Dhurakij Pundit University, Bangkok 10210, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mart","family":"Maiprasert","sequence":"additional","affiliation":[{"name":"Department of Anti-Aging and Regenerative Medicine, College of Integrative Medicine, Dhurakij Pundit University, Bangkok 10210, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jakkrit","family":"Klaphajone","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pongsiri","family":"Khunngam","sequence":"additional","affiliation":[{"name":"Department of Anti-Aging and Regenerative Medicine, College of Integrative Medicine, Dhurakij Pundit University, Bangkok 10210, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phawit","family":"Norchai","sequence":"additional","affiliation":[{"name":"Department of Anti-Aging and Regenerative Medicine, College of Integrative Medicine, Dhurakij Pundit University, Bangkok 10210, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Van Acker, S.I., Van den Bogerd, B., Haagdorens, M., Siozopoulou, V., N\u00ed Dhubhghaill, S., Pintelon, I., and Koppen, C. (2021). Pterygium-The Good, the Bad, and the Ugly. Cells, 10.","DOI":"10.3390\/cells10071567"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e003787","DOI":"10.1136\/bmjopen-2013-003787","article-title":"Geographical prevalence and risk factors for pterygium: A systematic review and meta-analysis","volume":"3","author":"Liu","year":"2013","journal-title":"BMJ Open"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"109900","DOI":"10.1016\/j.exer.2024.109900","article-title":"Risk factors for pterygium: Latest research progress on major pathogenesis","volume":"243","author":"Ding","year":"2024","journal-title":"Exp. Eye Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1038\/s41433-020-0786-3","article-title":"Pterygium: New insights","volume":"34","author":"Chu","year":"2020","journal-title":"Eye"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Dias, P., Clerc, D., da Rocha Rodrigues, M.G., Demartines, N., Grass, F., and H\u00fcbner, M. (2022). Impact of an Operating Room Nurse Preoperative Dialogue on Anxiety, Satisfaction and Early Postoperative Outcomes in Patients Undergoing Major Visceral Surgery-A Single Center, Open-Label, Randomized Controlled Trial. J. Clin. Med., 11.","DOI":"10.3390\/jcm11071895"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2300","DOI":"10.1097\/JS9.0000000000001105","article-title":"The association between cataract surgery and mental health in older adults: A review","volume":"111","author":"Wang","year":"2024","journal-title":"Int. J. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1080\/10641963.2020.1723619","article-title":"Effects of showing the operating room on preoperative anxiety and hemodynamics among patients with hypertension: A randomized controlled trial","volume":"42","author":"Yuzkat","year":"2020","journal-title":"Clin. Exp. Hypertens."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1016\/j.jopan.2022.04.009","article-title":"Effects of Nursing Care Using Binaural Beat Music on Anxiety, Pain, and Vital Signs in Surgery Patients","volume":"37","author":"Jang","year":"2022","journal-title":"J. Perianesth. Nurs."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"481","DOI":"10.37349\/ent.2023.00064","article-title":"Effects of acoustic neurostimulation in healthy adults on symptoms of depression, anxiety, stress and sleep quality: A randomized clinical study","volume":"3","author":"Kanzler","year":"2023","journal-title":"Explor. Neuroprot. Ther."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1016\/j.identj.2023.11.009","article-title":"Can Binaural Beat Music Be Useful as a Method to Reduce Dental Patients\u2019 Anxiety?","volume":"74","author":"Salehabadi","year":"2024","journal-title":"Int. Dent. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"105264","DOI":"10.1016\/j.actpsy.2025.105264","article-title":"Effect of different perioperative music interventions on anxiety and blood pressure levels during intravitreal injections","volume":"258","author":"Song","year":"2025","journal-title":"Acta Psychol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"590","DOI":"10.4103\/ija.ija_740_22","article-title":"Effect of binaural beat music and noise cancelling headphones on intraoperative anxiety in patients undergoing spinal anaesthesia\u2014A randomised controlled study","volume":"67","author":"Ligree","year":"2023","journal-title":"Indian J. Anaesth."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1038\/eye.2016.160","article-title":"Medscape. The effect of music with and without binaural beat audio on operative anxiety in patients undergoing cataract surgery: A randomized controlled trial","volume":"30","author":"Wiwatwongwana","year":"2016","journal-title":"Eye"},{"key":"ref_14","first-page":"122","article-title":"Effects of newly-developed superimposed binaural beat on anxiety in university students in Thailand: A Randomized controlled trial","volume":"18","author":"Chairinkam","year":"2019","journal-title":"CMU J. Nat. Sci."},{"key":"ref_15","unstructured":"Spielberger, C.D., Gorusch, R., and Lushene, R. (1970). State-Trait Anxiety Inventory Manual, Consulting Psychologists Press."},{"key":"ref_16","unstructured":"Spielberger, C.D. (1989). State-Trait Anxiety Inventory: Bibliography, Consulting Psychologists Press. [2nd ed.]."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e29392","DOI":"10.1097\/MD.0000000000029392","article-title":"The effect of binaural beat audio on anxiety in patients undergoing fiberoptic bronchoscopy: A prospective randomized controlled trial","volume":"101","author":"Opartpunyasarn","year":"2022","journal-title":"Medicine"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1080\/0167482X.2020.1751607","article-title":"A randomized controlled study examining a novel binaural beat technique for treatment of preoperative anxiety in a group of women undergoing elective caesarean section","volume":"42","author":"Parodi","year":"2021","journal-title":"J. Psychosom. Obstet. Gynaecol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e97","DOI":"10.4317\/medoral.24051","article-title":"Binaural beats or 432 Hz music? which method is more effective for reducing preoperative dental anxiety?","volume":"26","author":"Menziletoglu","year":"2021","journal-title":"Med. Oral Patol. Oral Cir Bucal"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/j.bjoms.2017.02.014","article-title":"Effectiveness of binaural beats in reducing preoperative dental anxiety","volume":"55","author":"Isik","year":"2017","journal-title":"Br. J. Oral. Maxillofac. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1089\/end.2020.0353","article-title":"Effects of Listening to Binaural Beats on Anxiety Levels and Pain Scores in Male Patients Undergoing Cystoscopy and Ureteral Stent Removal: A Randomized Placebo-Controlled Trial","volume":"35","author":"Okuducu","year":"2021","journal-title":"J. Endourol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1089\/jicm.2023.0804","article-title":"Effect of Binaural Beats on Anxiety and Tolerance in Patients Undergoing Upper Gastrointestinal Endoscopy Without Sedation: A Randomized Controlled Trial","volume":"30","author":"Demirci","year":"2024","journal-title":"J. Integr. Complement. Med."},{"key":"ref_23","first-page":"499","article-title":"Study on the impact and clinical effect of high-quality nursing intervention on the quality of life of elderly cataract patients","volume":"40","author":"Zuo","year":"2024","journal-title":"Pak. J. Med. Sci."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Wu, M., Xia, L., Zhang, L., Xu, Y., Cheng, Y., Zhang, X., and Chen, L. (2023). Perioperative management for elderly patients undergoing day surgery: Evidence-based practice for nursing care and day surgery. Front. Med., 10.","DOI":"10.3389\/fmed.2023.1298778"},{"key":"ref_25","first-page":"e02","article-title":"Nursing Care during the Perioperative within the Surgical Context","volume":"40","year":"2022","journal-title":"Investig. Educ. Enferm."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"209","DOI":"10.17712\/nsj.2022.4.20220025","article-title":"Review of electroencephalography signals approaches for mental stress assessment","volume":"27","author":"Attar","year":"2022","journal-title":"Neurosciences"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"112292","DOI":"10.1016\/j.exger.2023.112292","article-title":"Autonomic nervous system and postural control regulation during orthostatic test as putative markers of physical resilience among community-dwelling older adults","volume":"182","author":"Koivunen","year":"2023","journal-title":"Exp. Gerontol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1007\/s10877-006-9022-3","article-title":"Effect of peripheral vasoconstriction on pulse oximetry","volume":"20","author":"Talke","year":"2006","journal-title":"J. Clin. Monit. Comput."}],"container-title":["Nursing Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2039-4403\/15\/8\/282\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:20:20Z","timestamp":1760034020000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2039-4403\/15\/8\/282"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,31]]},"references-count":28,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["nursrep15080282"],"URL":"https:\/\/doi.org\/10.3390\/nursrep15080282","relation":{},"ISSN":["2039-4403"],"issn-type":[{"value":"2039-4403","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,31]]}}}