Distribution of risk factors for hearing loss: implications for evaluating risk of occupational noise-induced hearing loss

This paper presents an analysis of hearing threshold levels among 2066 white male workers employed in various U.S. industries studied in the 1968-72 NIOSH Occupational Noise and Hearing Survey (ONHS). The distribution of hearing threshold levels (HTL) is examined in relation to various risk factors (age, prior occupational noise, medical conditions) for hearing loss among a population of noise exposed and control (low noise-exposed) industrial workers. Previous analyses of a subset of these data from the ONHS focused on 1172 highly "screened" workers. An additional 894 male workers (609 noise-exposed and 285 controls), who were excluded for various reasons (i.e., nonoccupational noise exposure, otologic or medical conditions affecting hearing, prior occupational noise exposure) have been added to examine hearing loss in an unscreened population. Data are analyzed by age, duration of exposure, and sound level (8-h TWA) by individual test frequency. Results indicate that hearing threshold levels are higher among unscreened noise-exposed and control workers relative to screened workers. Analysis of risk factors such as nonoccupational noise exposure, medical conditions, and type of industry among unscreened controls indicated that these factors were not significantly associated with increased mean HTLs or risk of material impairment over and above what is expected due to age. Age-specific mean hearing threshold levels (and percentiles of the distribution) among the unscreened ONHS control population may be used as a comparison population of low-noise exposed white male industrial workers for evaluating the effectiveness of hearing conservation programs for workers less than 55 years of age. To make valid inferences regarding occupational noise-induced hearing loss, it is important to use hearing data from reference (control) populations that are similar with respect to the degree of subject screening, type of work force (blue vs white collar), and the distribution of other risk factors for hearing loss.     

Sound exposures and hearing thresholds of symphony orchestra musicians

To assess the risk of noise-induced hearing loss among musicians in the Chicago Symphony Orchestra, personal dosimeters set to the 3-dB exchange rate were used to obtain 68 noise exposure measurements during rehearsals and concerts. The musicians' Leq values ranged from 79-99 dB A-weighted sound pressure level [dB(A)], with a mean of 89.9 dB(A). Based on 15 h of on-the-job exposure per week, the corresponding 8-h daily Leq (excluding off-the-job practice and playing) ranged from 75-95 dB(A) with a mean of 85.5 dB(A). Mean hearing threshold levels (HTLs) for 59 musicians were better than those for an unscreened nonindustral noise-exposed population (NINEP), and only slightly worse than the 0.50 fractile data for the ISO 7029 (1984) screened presbycusis population. However, 52.5% of individual musicians showed notched audiograms consistent with noise-induced hearing damage. Violinists and violists showed significantly poorer thresholds at 3-6 kHz in the left ear than in the right ear, consistent with the left ear's greater exposure from their instruments. After HTLs were corrected for age and sex, HTLs were found to be significantly better for both ears of musicians playing bass, cello, harp, or piano and for the right ears of violinists and violists than for their left ears or for both ears of other musicians. For 32 musicians for whom both HTLs and Leq were obtained, HTLs at 3-6 kHz were found to be correlated with the Leq measured.     

Effects of nosocusis, and industrial and gun noise on hearing of U.S. adults.

Hearing losses estimated for exposure to industrial and gun noise and for "typical" nosocusis are applied to the distributions of the hearing levels of adult males and females of the general population of an industrialized society unscreened for exposure to noise or ear disease. Noise exposure and demographic data applicable to the United States, and procedures for predicting noise-induced permanent threshold shift (NIPTS) and nosocusis, were used to account for some 8.7 dB of the 13.4 dB average difference between the hearing levels at high frequencies for otologically and noise screened versus unscreened male ears; (this average difference is for the average of the hearing levels at 3000, 4000, and 6000 Hz, average for the 10th, 50th, and 90th percentiles, and ages 20-65 years). According to the present calculations, this difference is due, in order of importance, to (1) nosocusis, (2) exposure to gun noise, and (3) exposure of workers to industrial noise. For these same frequencies and overall average, adjustments for nosocusis accounts for 2 dB of the 5.9-dB difference between the hearing levels of screened and unscreened female ears. For the average at 500, 1000, and 2000 Hz, the overall differences between the screened and unscreened populations is but 3.4 dB for males and 2.9 dB for females. The adjustment procedures reduced these differences to -0.5 and 0.9 dB, respectively.     

Hearing loss from gun and railroad noise--relations with ISO standard 1999.

Pure-tone hearing thresholds and anamnestic data pertaining to nosocusis and exposure to gun noise were analyzed for 9778 male railroad train-crew workers. A major portion of losses in hearing sensitivity due to railroad noise are obscured in comparisons of hearing levels of trainmen with the hearing levels of the unscreened samples of United States males given in Annex B, ISO 1999 [ISO 1999 (1990), "Acoustics--Determination of occupational noise exposure and estimation of noise-induced hearing impairment" (International Organization for Standardization, Geneva)]. Comparisons of the hearing levels, adjusted for nosocusis, of trainmen who had used no guns, with the hearing levels of otologically and noise screened males (Annex A, ISO 1999) reveal significant losses due to railroad noise. Additional losses were found at high frequencies in trainmen who had used guns. It appears that the effective Leq8h exposure level of trainmen to railroad noise is about 92 dBA, and 87-89 dBA to gun noise. These results are in general agreement with those of study of railway workers by Prosser et al. [Br. J. Audiol. 22, 85-91 (1988)]. Asymmetries in losses between the two ears, effects of ear protection, losses from nosocusis, and losses from sport, as compared to military, gun noise exposures, are examined.     

Susceptibility to acoustic trauma in young and aged gerbils

The effect of age on susceptibility to noise-induced hearing loss (NIHL), the effect of gender on the interaction of age-related hearing loss (ARHL) and NIHL, and the relative contributions of ARHL and NIHL to total hearing loss are poorly understood. The issues are difficult to resolve empirically in human subjects because of lack of control over extrinsic variables and for ethical reasons. Accordingly, these issues were examined in a well-studied animal model of both ARHL and NIHL, the Mongolian gerbil. Animals were exposed to an intense tone (3.5 kHz, 113 dB SPL, 1 h) either as young adults (6-8 months) or near the end of the average lifespan of the species (34-38 months). Hearing thresholds were determined with the auditory brainstem response (ABR). ARHL was approximately 5-10 dB, with slightly more observed in males at 16 kHz (p<0.05). NIHL of approximately 15-20 dB was similar for the young and old groups, suggesting no differences in susceptibility as a function of age. There were no gender differences in NIHL. The relative contributions of ARHL and NIHL to total hearing loss in aged, noise-exposed gerbils were predicted by an addition of ARHL and NIHL in dB, similar to an international standard on hearing loss allocation, ISO-1999 [Determination of Occupational Noise Exposure and Estimation of Noise-Induced Hearing Impairment (1990)]. Previous evaluations of ISO-1999 using the gerbil animal model concluded that addition of ARHL and NIHL in dB overpredicts total hearing loss. However, in these studies, ARHL was large and nearly equal to NIHL. In the current study, where ARHL was much less than NIHL, addition of the two factors in dB, as recommended by ISO-1999, results in fairly accurate predictions of total hearing loss.     

Speech reception in quiet and in noisy conditions by individuals with noise-induced hearing loss in relation to their tone audiogram.

Tone thresholds and speech-reception thresholds were measured in 200 individuals (400 ears) with noise-induced hearing loss. The speech-reception thresholds were measured in a quiet condition and in noise with a speech spectrum at levels of 35, 50, 65, and 80 dBA. The tone audiograms could be described by three principal components: hearing loss in the regions above 3 kHz, from 1 to 3 kHz and below 1 kHz; the speech thresholds could be described by two components: speech reception in quiet and speech reception in noise at 50-80 dBA. Hearing loss above 1 kHz was related to speech reception in noise; hearing loss at and below 1 kHz to speech reception in quiet. The correlation between the speech thresholds in quiet and in noise was only R = 0.45. An adequate predictor of the speech threshold in noise, the primary factor in the hearing handicap, was the pure-tone average at 2 and 4 kHz (PTA2,4, R = 0.72). The minimum value of the prediction error for any tone-audiometric predictor of this speech threshold was 1.2 dB (standard deviation). The prediction could not be improved by taking into account the critical ratio for low-frequency noise nor by its upward spread of masking. The prediction error is due to measurement error and to a factor common to both ears. The latter factor is ascribed to cognitive skill in speech reception. Hearing loss above 10 to 15 dB HL (hearing level) already shows an effect on the speech threshold in noise, a noticeable handicap is found at PTA2,4 = 30 dB HL.     

Energy-independent factors influencing noise-induced hearing loss in the chinchilla model.

The effects on hearing and the sensory cell population of four continuous, non-Gaussian noise exposures each having an A-weighted L(eq)=100 dB SPL were compared to the effects of an energy-equivalent Gaussian noise. The non-Gaussian noise conditions were characterized by the statistical metric, kurtosis (beta), computed on the unfiltered, beta(t), and the filtered, beta(f), time-domain signals. The chinchilla (n=58) was used as the animal model. Hearing thresholds were estimated using auditory-evoked potentials (AEP) recorded from the inferior colliculus and sensory cell populations were obtained from surface preparation histology. Despite equivalent exposure energies, the four non-Gaussian conditions produced considerably greater hearing and sensory cell loss than did the Gaussian condition. The magnitude of this excess trauma produced by the non-Gaussian noise was dependent on the frequency content, but not on the average energy content of the impacts which gave the noise its non-Gaussian character. These results indicate that beta(t) is an appropriate index of the increased hazard of exposure to non-Gaussian noises and that beta(f) may be useful in the prediction of the place-specific additional outer hair cell loss produced by non-Gaussian exposures. The results also suggest that energy-based metrics, while necessary for the prediction of noise-induced hearing loss, are not sufficient.     

Noise exposure and hearing conservation for farmers of rural Japanese communities

Agricultural mechanization in Japan has progressed dramatically since 1955 with the introduction of tractors, harvesters, and processing machines. These technological developments have resulted in an increase in exposure to sources of noise that are not only annoying, but damaging to hearing. The present study was undertaken to determine, whether Japanese farmers are at risk for noise-induced hearing loss in comparison with office workers, and by evaluating the present conditions regarding occupational noise levels among agricultural workers.The results suggest that farmers, especially male farmers, have a high prevalence of hearing loss in the higher frequency ranges. Daily noise exposure levels in L_Aeq ranged from 81.5 to 99.1 dBA for tea harvesting and processing, and from 83.2 to 97.6 for sugar cane harvesting. Taking into account their rather long working hours and excessive noise from farm machinery, it is concluded that farmers are at risk for noise-induced hearing loss. These findings clearly indicate a strong need for implementation of hearing conservation programs among agricultural workers exposed to machinery noise.     

Noise-induced hearing loss as influenced by other agents and by some physical characteristics of the individual

The interaction of noise with a variety of other agents and with some physical characteristics of the individual to produce noise-induced hearing loss is reviewed critically. The review is restricted, for the most part, to publications since 1970. Other agents interacting with steady-state noise that are reviewed here include: (1) ototoxic drugs (kanamycin, neomycin, ethacrynic acid, furosemide, and salicylates), (2) impulse noise, and (3) whole-body vibration. Physical characteristics of the individual that are reviewed are: (1) age, (2) presence of previous hearing loss from prior noise exposure, (3) eye color, and (4) race. Suggestions for future research in this general area are also made. Some of these suggestions are as follows: (1) to extend studies of the interaction of steady-state noise with impulse noise, salicylates, and whole-body vibration to encompass a broader range of exposure conditions, including exposure conditions typically encountered by the worker, (2) to develop an animal model of presbycusis to explore the interactions of noise-induced hearing loss and presbycusis, and (3) to explore the potential interactions resulting from concurrent exposure to multiple agents, such as impulse noise and ototoxic drugs, in younger, more susceptible animals.     

Hearing loss from interrupted, intermittent, and time varying Gaussian noise exposures: the applicability of the equal energy hypothesis

Eight groups of chinchillas (N=74) were exposed to various equivalent energy [100 or 106 dB(A) sound pressure level (SPL)] noise exposure paradigms. Six groups received an interrupted, intermittent, time varying (IITV) Gaussian noise exposure that lasted 8 h/d, 5 d/week for 3 weeks. The exposures modeled an idealized workweek. At each level, three different temporal patterns of Gaussian IITV noise were used. The 100 dB(A) IITV exposure had a dB range of 90-108 dB SPL while the range of the 106 dB(A) IITV exposure was 80-115 dB SPL. Two reference groups were exposed to a uniform 100 or 106 dB(A) SPL noise, 24 h/d for 5 days. Each reference group and the three corresponding IITV groups comprised a set of equivalent energy exposures. Evoked potentials were used to estimate hearing thresholds and surface preparation histology quantified sensory cell populations. All six groups exposed to the IITV noise showed threshold toughening effects of up to 40 dB. All IITV exposures produced hearing and sensory cell loss that was similar to their respective equivalent energy reference group. These results indicate that for Gaussian noise the equal energy hypothesis for noise-induced hearing loss is an acceptable unifying principle.     

Is it necessary to penalize impulsive noise +5 dB due to higher risk of hearing damage?

It is studied whether the +5 dB penalty for impulsiveness established by ISO 1999:1990 accounts for a higher risk of noise-induced hearing loss. A total of 16 normal-hearing human subjects were exposed for 10 min to two types of binaural industrial-recordings: (1) a continuous broad-band noise normalized to L(EX,8 h)=80 dBA and (2) the combination of the previous stimulus with an impulsive noise normalized to L(EX,8 h)=75+5(db penalty)=80 dBA (peak level 117 dBC and repetition rate of 0.5 impacts per second). Distortion product otoacoustic emissions (DPOAEs) were measured in a broad frequency range before and in the following 90 min after the exposure. The group results show that the continuous exposure had a bigger impact on DPOAE levels, with a maximum DPOAE shift of approximately 5 dB in the frequency range of 2-3.15 kHz during the first 10 min of the recovery. No evident DPOAE shift is seen for the impulsive + continuous stimulus. The results indicate that the penalty overestimated the effects on DPOAE levels and support the concept that the risk of hearing loss from low-level impulses may be predicted on an equal-energy basis.     

Noise level, inner hair cell damage, audiometric features, and equal-energy hypothesis

Rabbits were exposed to 2- to 7-kHz noise either for a short duration at a high sound-pressure level (15 or 30 min at 115 dB SPL), or a long duration at a low level (512 h at 85 dB SPL). The high-level exposure produced a hearing loss in the frequency range 2-6 kHz, whereas the low-level exposure gave maximum hearing loss at 12-20 kHz. The 115-dB exposure caused significantly more damage to inner hair cells than the 85-dB exposure. The implications of the present results for evaluating audiograms, equal-energy hypothesis, risk criteria, and subjective auditory features are pointed out.     

Presbycusis and noise-induced permanent threshold shift.

Bies and Hansen [J. Acoust. Soc. Am. 88, 2743-2754 (1990)] have proposed an alternative formulation of the relationship between noise exposure and noise-induced hearing impairment to that presented in International Standard ISO 1999, in which they assume that presbycusis and noise-induced permanent threshold shift (NIPTS) are additive on an antilogarithm basis. Data concerning deterioration in hearing threshold levels at 4000 Hz due to aging in war veterans with NIPTS do not support the Bies and Hansen assumption but provide support for the formula for combining presbycusis and NIPTS incorporated in International Standard ISO 1999.     

Amplitude modulation thresholds in chinchillas with high-frequency hearing loss

Estimates of auditory temporal resolution were obtained from normal chinchillas using sinusoidally amplitude modulated noise. Afterwards, the animals were exposed to noise whose bandwidth was progressively increased toward the low frequencies in octave steps. The first exposure was to an octave band of noise centered at 8 kHz. Three additional octave bands of noise were subsequently added to the original exposure in order to progressively increase the extent of the high-frequency hearing loss. The first exposure produced a temporary hearing loss of 50 to 60 dB near 8 kHz and elevated the amplitude modulation thresholds primarily at intermediate (128 Hz) modulation frequencies. Successive noise exposures extended the temporary hearing loss toward lower frequencies, but there was little further deterioration in the amplitude modulation function until the last exposure when the hearing loss spread to 1 kHz. The degradation in the amplitude modulation function observed after the last exposure, however, was due to a reduction in the sensation level of the test signal rather than to a decrease in the hearing bandwidth. The results of this study suggest that the high-frequency regions of the cochlea may be important for temporal resolution.     

The role of magnesium in the susceptibility of soldiers to noise-induced hearing loss

A number of studies have demonstrated that magnesium, administered prophylactically, can reduce the amount of hearing loss resulting from noise exposure. This study explored the possible role of naturally occurring body magnesium concentration in susceptibility of soldiers to noise-induced hearing loss. Participants were 68 adult males who had received extensive noise exposure over several years as a result of training with weapon systems. Each participant provided a pure-tone audiogram, blood sample, and noise-exposure history. A variety of pure-tone indices was correlated with serum magnesium levels as determined by atomic absorption spectroscopy. No significant correlations were observed between any audiometric index and body magnesium. The results of this study, therefore, do not support the hypothesis that there is a strong association between naturally occurring body magnesium and susceptibility to noise-induced hearing loss.     

Speech intelligibility of normal listeners and persons with impaired hearing in traffic noise

Speech intelligibility (PB words) in traffic-like noise was investigated in a laboratory situation simulating three common listening situations, indoors at 1 and 4 m and outdoors at 1 m. The maximum noise levels still permitting 75% intelligibility of PB words in these three listening situations were also defined. A total of 269 persons were examined. Forty-six had normal hearing, 90 a presbycusis-type hearing loss, 95 a noise-induced hearing loss and 38 a conductive hearing loss. In the indoor situation the majority of the groups with impaired hearing retained good speech intelligibility in 40 dB(A) masking noise. Lowering the noise level to less than 40 dB(A) resulted in a minor, usually insignificant, improvement in speech intelligibility. Listeners with normal hearing maintained good speech intelligibility in the outdoor listening situation at noise levels up to 60 dB(A), without lip-reading (i.e., using non-auditory information). For groups with impaired hearing due to age and/or noise, representing 8% of the population in Sweden, the noise level outdoors had to be lowered to less than 50 dB(A), in order to achieve good speech intelligibility at 1 m without lip-reading.     

Recent studies of temporary threshold shift (TTS) and permanent threshold shift (PTS) in animals

It is well known that excessive exposure to noise results in temporary and/or permanent changes in hearing sensitivity in both human and animal subjects. The purpose of this review is to describe the major findings from laboratory studies of experimentally induced hearing losses, both temporary and permanent, resulting from exposure to noise in animal subjects which have been published since the report of Kryter et al. (1966). The data reviewed support the following general statements: (1) The chinchilla is the most widely used and most appropriate animal model for studies of noise-induced hearing loss; (2) with continuous exposures to moderate-level noise, thresholds reach asymptotic levels (ATS) within 18-24 h; (3) permanent threshold shifts, however, depend upon the level, frequency, and the duration of exposure; (4) below a "critical level" of about 115 dB, permanent threshold shift (PTS) and cell loss are generally related to the total energy in continuous exposures; (5) periodic rest periods inserted in an exposure schedule are protective and result in less hearing loss and cochlear damage than equal energy continuous exposures; and (6) under some schedules of periodic exposure, threshold shifts increase over the first few days of exposure, then recover as much as 30 dB as the exposure continues.     

Modification of digital music files for use in human temporary threshold shift studies

An exposure that is reproducible across clinical/laboratory environments, and appealing to subjects, is described here. Digital music files are level-equated within and across songs such that playlists deliver an exposure that is consistent across time. Modified music is more pleasant to listen to than pure tones or shaped noise, and closely follows music exposures subjects may normally experience. Multiple therapeutics reduce noise-induced hearing loss in animals but human trial design is complicated by limited access to noise-exposed subject populations. The development of standard music exposure parameters for temporary threshold shift studies would allow comparison of protection across agents with real-world relevant stimuli in human subjects.     

Cubic distortion product otoacoustic emissions in young and aged chinchillas exposed to low-frequency noise.

The aim of this study was to examine susceptibility to noise-induced hearing loss in animals with and without age-related hearing loss (AHL), using cubic distortion product otoacoustic emissions (CDPs) to assess the functional status of the outer hair cell (OHC) system. Subjects were young (< or = 3-yr-old) and aged (10- to 15-yr-old) chinchillas. CDP thresholds and input/output (I/O) functions were measured before and after exposure to 95 dB or 106 dB SPL low-frequency noise. The results indicate that (a) aging in the chinchilla is associated with significant elevations of CDP thresholds and depression of CDP I/O functions, (b) noise exposures cause equivalent CDP threshold elevations and amplitude reductions in young animals with normal hearing and older animals with AHL, and (c) CDP threshold and amplitude measures provide information that complements evoked potentials measured from the auditory midbrain.