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.     

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.     

The influence of music and stress on musicians’ hearing

Hearing and hearing disorders among classical and rock/jazz musicians was investigated. Pure tone audiometry was done in 140 classical and 139 rock/jazz musicians. The rock/jazz musicians answered a questionnaire concerning hearing disorders and psychosocial exposure. All results were compared to age appropriate reference materials. Hearing thresholds showed a notch configuration in both classical and rock/jazz musicians indicating the inclusion of high sound levels but an overall well-preserved hearing thresholds. Female musicians had significantly better hearing thresholds in the high-frequency area than males. Rock/jazz musicians showed slight worse hearing thresholds as compared to classical musicians. When assessing hearing disorders, a large number of rock/jazz musicians suffered from different hearing disorders (74%). Hearing loss, tinnitus and hyperacusis were the most common disorders and were significantly more frequent in comparison with different reference populations. Among classical musicians, no extended negative progress of the pure tone hearing threshold values was found in spite of the continued 16 years of musical noise exposure. In rock/jazz musicians, there was no relationships between psychosocial factors at work and hearing disorders. The rock/jazz musicians reported low stress and high degree of energy. On the average, the rock/jazz musicians reported higher control, lower stress and higher energy than a reference material of white-collar workers.     

Industrial noise levels and annoyance in Egypt

Annoyance and increase of accident risk of workers from industrial noise levels in Egypt were studied. 683 workers from 15 Egyptian sites of industry, ranging from food to metal industry were evaluated. The goals of this study are to carry out measurements to evaluate industrial noise levels, are these levels exceeded the permissible levels set by Egyptian noise standard and policy to protect public health of workers?, to examine worker’s attitudes towards industrial noise, to know the relationship between industrial noise levels and degree of annoyance. Results showed that equivalent continuous noise levels ranged from 70 to 100 dB (A). Annoyance of respondents showed that 47.1% were highly annoyed, 5.8% their hearing were harmed. There was a strong relationship between industrial noise levels and percentage of highly annoyed respondents. By increasing industrial noise level possibility of workers to make accident was also increased. Respondents suggest less maximum daily exposure duration than those set by Egyptian law.     

Evaluation of the risk of noise-induced hearing loss among unscreened male industrial workers

Variability in background risk and distribution of various risk factors for hearing loss may explain some of the diversity in excess risk of noise-induced hearing loss (NIHL). This paper examines the impact of various risk factors on excess risk estimates of NIHL using data from the 1968-1972 NIOSH Occupational Noise and Hearing Survey (ONHS). Previous analyses of a subset of these data focused on 1172 highly "screened" workers. In the current analysis, an additional 894 white males (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 2066) to assess excess risk of noise-induced material impairment in an unscreened population. Data are analyzed by age, duration of exposure, and sound level (8-h TWA) for four different definitions of noise-induced hearing impairment, defined as the binaural pure-tone average (PTA) hearing threshold level greater than 25 dB for the following frequencies: (a) 1-4 kHz (PTA1234), (b) 1-3 kHz (PTA123), (c) 0.5, 1, and 2 kHz (PTA512), and (d) 3, 4, and 6 kHz (PTA346). Results indicate that populations with higher background risks of hearing loss may show lower excess risks attributable to noise relative to highly screened populations. Estimates of lifetime excess risk of hearing impairment were found to be significantly different between screened and unscreened population for noise levels greater than 90 dBA. Predicted age-related risk of material hearing impairment in the ONHS unscreened population was similar to that predicted from Annex B and C of ANSI S3.44 for ages less than 60 years. Results underscore the importance of understanding differential risk patterns for hearing loss and the use of appropriate reference (control) populations when evaluating risk of noise-induced hearing impairment among contemporary industrial populations.     

SELF-EVALUATION SCORES OF HEARING DIFFICULTIES AND QUALITY OF LIFE COMPONENTS AMONG RETIRED WORKERS WITH NOISE-RELATED HEARING LOSS

This study is intended to clarify the relationships between hearing loss caused both by noise exposure and aging and self-rated scores of hearing disabilities and to elucidate the structure of the quality of life (QOL) determinants and their moderating conditions among retired workers with noise-related hearing loss. The questionnaire consisted of three parts: background questions, the hearing disabilities and handicap scale (HDHS), and questions regarding QOL covering five areas, self-rated health, personal health practice, social support network, life satisfaction, and life events. Two hundred ten retired workers aged 56-65 years old (60·6±1·6) with noise-related hearing loss responded to our questionnaire. All were previously engaged in noise exposed work such as shipbuilding, steel and woodwork. According to the hearing disability score (DIS score), subjects were divided into three groups and comparisons were made of the hearing handicap score (HD score) among those groups. Although groups with a higher DIS score showed a higher HD score, a large individual difference in HD score was observed in each of the three groups with the same DIS score level. The results of multiple regression analysis including two variables (life satisfaction and HD score) as the dependent variables and seven variables as the independent variables showed that the strongest explanatory variable for life satisfaction was social support network, followed by handicaps caused by hearing disabilities, self-rated health and personal health practice. It was demonstrated that hearing disabilities and handicap measured by the Japanese version of the HDHS were directly associated with the deterioration in QOL. Measures of the social support network, life satisfaction, and hearing disabilities and handicaps may assist in the detection of workers who can be targeted for a variety of interventions, such as audiological rehabilitation or the creation of a barrier-free community that is supportive of the hearing impaired.     

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.     

Survey of noise in coal preparation plants

In response to the continuing problem of noise induced hearing loss (NIHL) among mine workers, the National Institute for Occupational Safety and Health (NIOSH) has conducted numerous noise surveys in coal preparation plants. The research, consisting of worker dose monitoring, task observations, and equipment noise profiling, was completed in eight separate preparation plants. Worker dose monitoring was conducted for three shifts in most cases. Workers experiencing higher than allowable doses were task-observed for one full shift to correlate dose to noise source(s). Finally, noise levels on all floors, and in lunch rooms and control rooms, were characterized. Results indicate that only workers who routinely spend a significant portion of their shift in the plants (away from the control rooms) are susceptible to overexposure from noise. Certain pieces of equipment (screens, centrifuges, sieve bends) are the loudest primary noise sources responsible for the worker noise exposures.     

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.     

Auditory handicap of hearing impairment and the limited benefit of hearing aids

The aim of this article is to promote a better understanding of hearing impairment as a communicative handicap, primarily in noisy environments, and to explain by means of a quantitative model the essentially limited applicability of hearing aids. After data on the prevalence of hearing impairment and of auditory handicap have been reviewed, it is explained that every hearing loss for speech can be interpreted as the sum of a loss class A (attenuation), characterized by a reduction of the levels of both speech signal and noise, and a loss D (distortion), comparable with a decrease in speech-to-noise ratio. On the average, the hearing loss of class D (hearing loss in noise) appears to be about one-third (in decibels) of the total hearing loss (A + D, hearing loss in quiet). A hearing aid can compensate for class-A-hearing losses, giving difficulties primarily in quiet, but not for class-D hearing losses, giving difficulties primarily in noise. The latter class represents the first stage of auditory handicap, beginning at an average hearing loss of about 24 dB.     

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.     

Risk factors for hearing loss at different frequencies in a population of 47,388 noise-exposed workers.

Weighted regression analysis was applied to determine the dependence of the hearing thresholds of 47,388 noise-exposed workers on age, sex, noise immission level, ear disease, head injury, tinnitus, hearing protector usage, and audiometric frequency in the range from 0.5 to 6 kHz. It could be shown that the hearing thresholds at any frequency are dominated by the age of the worker and that women, after equivalent exposure conditions, hear better than men. The relative effects of sex, noise immission level, ear diseases, tinnitus, and hearing protector usage are related to the audiometric frequency. Users of hearing protectors at the last audiometric investigation hear worse than nonusers. Hearing protector usage is strongly related with the hearing threshold in the low-frequency range. The noise immission level does not noticeably affect the hearing threshold below 3 kHz. The most important frequency of the noise immission level is as expected 4 kHz. For 4 kHz, it was shown that the variables age, noise immission level, tinnitus, head injuries, and ear diseases act in a good approximation additively on the pure-tone hearing threshold.     

Noise exposure of workers of the construction sector

Noise is one of the most highly found physical contaminants in the construction sector. The most negative effects caused by noise exposure are related to the hearing system and may produce professional deafness or even permanent deafness. As these effects have a very important influence on people’s health and well-being, it is necessary to assess the noise exposure and to develop mechanisms for studying and proposing preventive solutions.This work has studied the noise levels which the workers of the construction sector are exposed to. A number of representative measurements have been carried out using a sound level meter and a dosimeter to collect data from workers devoted to different tasks in the construction process. Analysis of the most important levels and indexes have been done with those data, and afterwards, they have been compared with the limits imposed by the different current regulations.     

Conditioning-induced protection from impulse noise in female and male chinchillas

Sound conditioning (pre-exposure to a moderate-level acoustic stimulus) can induce resistance to hearing loss from a subsequent traumatic exposure. Most sound conditioning experiments have utilized long-duration tones and noise at levels below 110 dB SPL as traumatic stimuli. It is important to know if sound conditioning can also provide protection from brief, high-level stimuli such as impulses produced by gunfire, and whether there are differences between females and males in the response of the ear to noise. In the present study, chinchillas were exposed to 95 dB SPL octave band noise centered at 0.5 kHz for 6 h/day for 5 days. After 5 days of recovery, they were exposed to simulated M16 rifle fire at a level of 150 dB peak SPL. Animals that were sound conditioned showed less hearing loss and smaller hair cell lesions than controls. Females showed significantly less hearing loss than males at low frequencies, but more hearing loss at 16 kHz. Cochleograms showed slightly less hair cell loss in females than in males. The results show that significant protection from impulse noise can be achieved with a 5-day conditioning regimen, and that there are consistent differences between female and male chinchillas in the response of the cochlea to impulse noise.     

Impact noise: the importance of level, duration, and repetition rate

The applicability of the equal energy hypothesis (EEH) to impact noise exposures was studied using chinchillas. Hearing thresholds were estimated by recording the evoked potentials from a chronic electrode implanted in the inferior colliculus. The animals were exposed to broadband impacts of 200-ms duration. The study was carried out in two parts. In experiment I, six exposure levels (107, 113, 119, 125, 131, and 137 dB SPL) and three repetition rates (4/s, 1/s and 1/4s) were employed. In the second experiment, the total duration of the exposure as well as the total energy were kept constant by trading level and rate. Results indicate that hearing loss resulting from exposure to impact noise does not conform to the predictions of the EEH. The permanent threshold shift as well as the hair cell loss are more or less equal across the lower peak exposure levels. However, both the hearing loss and the hair cell damage increase for exposures with higher peak levels. Furthermore, hearing loss and cochlear damage are dependent upon the rate of exposure. Thus the amount of hearing loss and hair cell damage appears to depend on the interaction of several factors including peak level, rate, and the susceptibility of the animal.     

Psychophysical suppression measured with bandlimited noise extended below and/or above the signal: effects of age and hearing loss

The objectives of this study were to measure suppression with bandlimited noise extended below and above the signal, at lower and higher signal frequencies, between younger and older subjects, and between subjects with normal hearing and cochlear hearing loss. Psychophysical suppression was assessed by measuring forward-masked thresholds at 0.8 and 2.0 kHz in bandlimited maskers as a function of masker bandwidth. Bandpass-masker bandwidth was increased by introducing noise components below and above the signal frequency while keeping the noise centered on the signal frequency, and also by adding noise below the signal only, and above the signal only. Subjects were younger and older adults with normal hearing and older adults with cochlear hearing loss. For all subjects, suppression was larger when noise was added below the signal than when noise was added above the signal, consistent with some physiological evidence of stronger suppression below a fiber's characteristic frequency than above. For subjects with normal hearing, suppression was greater at higher than at lower frequencies. For older subjects with hearing loss, suppression was reduced to a greater extent above the signal than below and where thresholds were elevated. Suppression for older subjects with normal hearing was poorer than would be predicted from their absolute thresholds, suggesting that age may have contributed to reduced suppression or that suppression was sensitive to changes in cochlear function that did not result in significant threshold elevation.     

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.     

Identification of vowels in quiet, noise, and reverberation: relationships with age and hearing loss

Vowel identification in quiet, noise, and reverberation was tested with 40 subjects who varied in age and hearing level. Stimuli were 15 English vowels spoken in a (b-t) context in a carrier sentence, which were degraded by reverberation or noise (a babble of 12 voices). Vowel identification scores were correlated with various measures of hearing loss and with age. The mean of four hearing levels at 0.5, 1, 2, and 4 kHz, termed HTL4, produced the highest correlation coefficients in all three listening conditions. The correlation with age was smaller than with HTL4 and significant only for the degraded vowels. Further analyses were performed for subjects assigned to four groups on the basis of the amount of hearing loss. In noise, performance of all four groups was significantly different, whereas, in both quiet and reverberation, only the group with the greatest hearing loss performed differently from the other groups. The relationship among hearing loss, age, and number and type of errors is discussed in light of acoustic cues available for vowel identification.     

Traffic noise annoyance and speech intelligibility in persons with normal and persons with impaired hearing

Annoyance ratings in speech intelligibility tests at 45 dB(A) and 55 dB(A) traffic noise were investigated in a laboratory study. Subjects were chosen according to their hearing acuity to be representative of 70-year-old men and women, and of noise-induced hearing losses typical for a great number of industrial workers. These groups were compared with normal hearing subjects of the same sex and, when possible, the same age. The subjects rated their annoyance on an open 100 mm scale. Significant correlations were found between annoyance expressed in millimetres and speech intelligibility in percent when all subjects were taken as one sample. Speech intelligibility was also calculated from physical measurements of speech and noise by using the articulation index method. Observed and calculated speech intelligibility scores are compared and discussed. Also treated is the estimation of annoyance by traffic noise at moderate noise levels via speech intelligibility scores.