Occupational hearing loss (OHL) is

hearing loss Hearing loss is a partial or total inability to hear. Hearing loss may be present at birth or acquired at any time afterwards. Hearing loss may occur in one or both ears. In children, hearing problems can affect the ability to acquire spoken l ...

that occurs as a result of occupational hazards, such as excessive noise and ototoxic chemicals. Noise is a common workplace hazard, and recognized as the risk factor for noise-induced hearing loss and

tinnitus Tinnitus is the perception of sound when no corresponding external sound is present. Nearly everyone experiences a faint "normal tinnitus" in a completely quiet room; but it is of concern only if it is bothersome, interferes with normal hearin ...

but it is not the only risk factor that can result in a work-related hearing loss. Also, noise-induced hearing loss can result from exposures that are not restricted to the occupational setting. OHL is a prevalent occupational concern in various work environments worldwide. In the United States, organizations such as the

Occupational Safety and Health Administration The Occupational Safety and Health Administration'' (OSHA ) is a large regulatory agency of the United States Department of Labor that originally had federal visitorial powers to inspect and examine workplaces. Congress established the agen ...

(OSHA), the

National Institute for Occupational Safety and Health The National Institute for Occupational Safety and Health (NIOSH, ) is the United States federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness. NIOSH is part of the C ...

(NIOSH) and the

Mine Safety and Health Administration The Mine Safety and Health Administration (MSHA) () is a large agency of the United States Department of Labor which administers the provisions of the Federal Mine Safety and Health Act of 1977 (Mine Act) to enforce compliance with mandatory safe ...

(MSHA) work with employers and workers to reduce or eliminate occupational hearing hazards through a hierarchy of hazard controls. OHL is one of the most common work-related illness in the

United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country Continental United States, primarily located in North America. It consists of 50 U.S. state, states, a Washington, D.C., ...

. Occupational hearing hazards include

industrial noise Occupational noise is the amount of acoustic energy received by an employee's auditory system when they are working in the industry. Occupational noise, or industrial noise, is often a term used in occupational safety and health, as sustained expos ...

, and exposure to various ototoxic chemicals. Combined exposure to both industrial noise and ototoxic chemicals may cause more damage than either one would in isolation. Many chemicals have not been tested for ototoxicity, so unknown threats may exist. A 2016 study by NIOSH found that the

mining Mining is the extraction of valuable minerals or other geological materials from the Earth, usually from an ore body, lode, vein, seam, reef, or placer deposit. The exploitation of these deposits for raw material is based on the econom ...

sector had the highest prevalence of hearing impairment at 17%, followed by the

construction Construction is a general term meaning the art and science to form objects, systems, or organizations,"Construction" def. 1.a. 1.b. and 1.c. ''Oxford English Dictionary'' Second Edition on CD-ROM (v. 4.0) Oxford University Press 2009 and ...

sector (16%) and the

manufacturing Manufacturing is the creation or production of goods with the help of equipment, labor, machines, tools, and chemical or biological processing or formulation. It is the essence of secondary sector of the economy. The term may refer to ...

sector (14%). The

public safety Public security or public safety is the prevention of and protection from events that could endanger the safety and security of the public from significant danger, injury, or property damage. It is often conducted by a state government to ensur ...

sector had the lowest rate of hearing impairment, at 7%. Overall, audiometric records show that about 33% of working-age adults with a history of occupational noise exposure have evidence of noise-induced hearing damage, and 16% of noise-exposed workers have material hearing impairment. In the service sector the prevalence of hearing loss was 17% compared to 16% for all industries combined. Several sub-sectors however exceeded the overall prevalence (10-33% higher) and/or had adjusted risks significantly higher than the reference industry. Workers in Administration of Urban Planning and Community and Rural Development had the highest prevalence (50%), and workers in Solid Waste Combustors and Incinerators had more than double the risk, the highest of any sub-sector. Some sub-sectors traditionally viewed as "low-risk" such as Real Estate and Rental and Leasing, and financial sub-sectors (Credit Unions, Call centers), and also had high prevalences and risks.

Personal protective equipment Personal protective equipment (PPE) is protective clothing, helmets, goggles, or other garments or equipment designed to protect the wearer's body from injury or infection. The hazards addressed by protective equipment include physical, ...

, administrative controls, and engineering controls can all work to reduce exposure to noise and chemicals, either by providing the worker with protection such as

earplug An earplug is a device that is inserted in the ear canal to protect the user's ears from loud noises, intrusion of water, foreign bodies, dust or excessive wind. Since they reduce the sound volume, earplugs are often used to help prevent heari ...

s, or by reducing the

noise Noise is unwanted sound considered unpleasant, loud or disruptive to hearing. From a physics standpoint, there is no distinction between noise and desired sound, as both are vibrations through a medium, such as air or water. The difference aris ...

or chemicals at the source or limiting the time or level of exposure.

Background

OHL is defined as any type of hearing loss, i.e.

sensorineural Sensorineural hearing loss (SNHL) is a type of hearing loss in which the root cause lies in the inner ear or sensory organ (cochlea and associated structures) or the vestibulocochlear nerve (cranial nerve VIII). SNHL accounts for about 90% of rep ...

, conductive, or mixed hearing loss, that occurs due to hazardous characteristics of a work environment. The hearing loss can range in severity from mild to profound and can be accompanied by

. Hazards of a work environment that can result in OHL include excessive noise, ototoxic chemicals, or physical trauma. OHL caused by excessive exposure to noise is also known as noise-induced hearing loss (NIHL). Noise exposure combined with ototoxic chemical exposure can results in more damage to hearing. OHL caused by physical trauma may include foreign bodies in the ear, vibration,

barotrauma Barotrauma is physical damage to body tissues caused by a difference in pressure between a gas space inside, or contact with, the body and the surrounding gas or liquid. The initial damage is usually due to over-stretching the tissues in tensi ...

, or

head injury A head injury is any injury that results in trauma to the skull or brain. The terms ''traumatic brain injury'' and ''head injury'' are often used interchangeably in the medical literature. Because head injuries cover such a broad scope of inju ...

. OHL, as well as hearing loss in general, can cause negative secondary social and emotional effects that can impact quality of life. Within the

United States of America The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territo ...

, approximately 10 million people have NIHL. Over twice that number (~22 million) are occupationally exposed to dangerous noise levels. Hearing loss accounted for a sizable percentage of

occupational illness An occupational disease is any chronic ailment that occurs as a result of work or occupational activity. It is an aspect of occupational safety and health. An occupational disease is typically identified when it is shown that it is more prevalen ...

in 2007, at 14% of cases. United States government agencies such as OSHA,

NIOSH The National Institute for Occupational Safety and Health (NIOSH, ) is the United States federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness. NIOSH is part of the ...

and MSHA are working to understand the causes of OHL and how it can be prevented while providing regulations and guidelines to help protect the hearing of workers in all occupations.

Causes

Noise exposure

Exposure to noise can cause

vibration Vibration is a mechanical phenomenon whereby oscillations occur about an equilibrium point. The word comes from Latin ''vibrationem'' ("shaking, brandishing"). The oscillations may be periodic, such as the motion of a pendulum—or random, su ...

s able to cause permanent damage to the ear. Both the volume of the noise and the duration of exposure can influence the likelihood of damage. Sound is measured in units called

decibel The decibel (symbol: dB) is a relative unit of measurement equal to one tenth of a bel (B). It expresses the ratio of two values of a power or root-power quantity on a logarithmic scale. Two signals whose levels differ by one decibel have a ...

s, which is a logarithmic scale of sound levels that corresponds to the level of loudness that an individual's ear would perceive. Because it is a logarithmic scale, even small incremental increases in decibels correlate to large increases in loudness, and an increase in the risk of hearing loss. Sounds above 80 dB have the potential to cause permanent hearing loss. The intensity of sound is considered too great and hazardous if someone must yell in order to be heard. Ringing in the ears upon leaving work is also indicative of noise that is at a dangerous level. Farming, machinery work, and construction are some of the many occupations that put workers at risk of hearing loss.

establishes recommended exposure limits (RELs) to protect workers against the health effects of exposure to hazardous substances and agents encountered in the workplace. These NIOSH limits are based on the best available science and practices. NIOSH established the REL for occupational noise exposures to be 85 decibels, A-weighted (dB as an 8-hour time-weighted average. Occupational noise exposure at or above this level are considered hazardous. The REL is based on exposures at work 5 days per week and assumes that the individual spends the other 16 hours in the day, as well as weekends, in quieter conditions. NIOSH also specifies a maximum allowable daily noise dose, expressed in percentages. For example, a person continuously exposed to 85 dB(A) over an 8-hour work shift will reach 100% of their daily noise dose. This dose limit uses a 3-dB time-intensity tradeoff commonly referred to as the exchange rate or equal-energy rule: for every 3-dB increase in noise level, the allowable exposure time is reduced by half. For example, if the exposure level increases to 88 dB(A), workers should only be exposed for four hours. Alternatively, for every 3-dB decrease in noise level, the allowable exposure time is doubled, as shown in the table below. OSHA's current

permissible exposure limit The permissible exposure limit (PEL or OSHA PEL) is a legal limit in the United States for exposure of an employee to a chemical substance or physical agent such as high level noise. Permissible exposure limits are established by the Occupationa ...

(PEL) for workers is an average of 90 dB over an 8-hour work day. Unlike NIOSH, OSHA uses a 5-dB exchange rate, where an increase in 5-dB for a sound corresponds to the amount of time workers may be exposed to that particular source of sound being halved. For example, workers cannot be exposed to a sound level of 95 dB for more than 4 hours per day, or to sounds at 100 dB for more than 2 hours per day. Employers who expose workers to 85 dB or more for 8 hour shifts are required to provide hearing exams and protection, monitor noise levels, and provide training. NIOSHSoundLevelMeter

Sound level meter A sound level meter (also called sound pressure level meter (SPL)) is used for acoustic measurements. It is commonly a hand-held instrument with a microphone. The best type of microphone for sound level meters is the condenser microphone, whic ...

s and dosimeters are two types of devices that are used to measure sound levels in the workplace. Dosimeters are typically worn by the employee to measure their own personal sound exposure. Other sound level meters can be used to double check dosimeter measurements, or used when dosimeters cannot be worn by the employees. They can also be used to evaluate engineering controls aimed at reducing noise levels. Some recent studies suggest that some smartphone applications may be able to measure noise as precisely as a Type 2 SLM. Although most smartphone sound measurement apps are not accurate enough to be used for legally required measurements, th
NIOSH Sound Level Meter app
met the requirements of IEC 61672/ANSI S1.4 Sound Level Meter Standards (Electroacoustics - Sound Level Meters - Part 3: Periodic Tests).

Ototoxic chemical exposure

Chemically-induced hearing loss (CIHL) is a potential result of occupational exposures. Certain chemical compounds may have ototoxic effect

Exposure to organic solvents,

heavy metals upright=1.2, Crystals of osmium, a heavy metal nearly twice as dense as lead">lead.html" ;"title="osmium, a heavy metal nearly twice as dense as lead">osmium, a heavy metal nearly twice as dense as lead Heavy metals are generally defined as ...

, and asphyxiants such as

carbon monoxide Carbon monoxide ( chemical formula CO) is a colorless, poisonous, odorless, tasteless, flammable gas that is slightly less dense than air. Carbon monoxide consists of one carbon atom and one oxygen atom connected by a triple bond. It is the simpl ...

can all cause hearing loss. These chemicals can be inhaled, ingested, or absorbed through the skin. Damage can occur to either the inner ear or the auditory nerve. Certain medications may also have the potential to cause hearing loss. Both noise and chemical exposures are common in many industries, and can both contribute to hearing loss simultaneously. Damage may be more likely or more severe if both are present, in particular if noise is impulsive. Industries in which combinations of exposures may exist include construction, fiberglass, metal manufacturing, and many more. It is estimated that over 22 million workers are exposed to dangerous noise levels, and 10 million are exposed to solvents that could potentially cause hearing loss every year, with an unknown number exposed to other ototoxic chemicals. A 2018 informational bulletin by the US

(OSHA) and the

(NIOSH) introduces the issue, provides examples of ototoxic chemicals, lists the industries and occupations at risk and provides prevention informatio

Prevention

OHL is preventable, but currently the interventions to prevent it involve many components. Stricter legislation might reduce noise levels in the workplace. Hearing protection devices, such as

earmuffs Earmuffs are clothing accessories or personal protective equipment designed to cover a person's ears for hearing protection or warmth. They consist of a thermoplastic or metal head-band that fits over the top or back of the head, and a cushi ...

and

s can reduce noise exposure to safe levels, but, instructions are needed on how to put plugs into the ears correctly to achieve potential attenuation. Giving workers information on their noise exposure levels by itself was not shown to decrease noise. Engineering solutions might lead to similar noise reduction as that provided by hearing protection, but better evaluation of the noise exposures resulting from engineering interventions is needed, as most of the available information is limited to observations in laboratory conditions. Overall, the effects of hearing loss prevention programs are unclear. Better use of hearing protection as part of a program but does not necessarily protect against hearing loss. The 2017 Cochrane review concluded that in order to prevent NIHL in the workplace the quality of the implementation of prevention programs, particularly on the hearing protection component of the program, affects results, and that better quality of studies, especially in the field of engineering controls, and better implementation of legislation are needed. While the review concluded there is a lack of conclusive evidence it highlighted that this should not be interpreted as evidence of lack of effectiveness. The implication is that future research could affect conclusions reached.

Hierarchy of controls

The hierarchy of controls provides a visual guide to the effectiveness of the various workplace controls set in place to eliminate or reduce exposure to occupational hazards, including noise or ototoxic chemicals. The hierarchy includes the following from most effective to least effective: * Elimination: complete removal of the hazard *

Substitution Substitution may refer to: Arts and media *Chord substitution, in music, swapping one chord for a related one within a chord progression *Substitution (poetry), a variation in poetic scansion * "Substitution" (song), a 2009 song by Silversun Pic ...

: replacement that offers a smaller risk *

Engineering controls Engineering controls are strategies designed to protect workers from hazardous conditions by placing a barrier between the worker and the hazard or by removing a hazardous substance through air ventilation. Engineering controls involve a physi ...

: physical changes to reduce exposure *

Administrative controls Administrative controls are training, procedure, policy, or shift designs that lessen the threat of a hazard to an individual. Administrative controls typically change the behavior of people (e.g., factory workers) rather than removing the actu ...

: changes in work procedures or training *

(PPE): individual equipment to reduce exposure, e.g.

Engineering controls

is the next highest in the

hierarchy A hierarchy (from Greek: , from , 'president of sacred rites') is an arrangement of items (objects, names, values, categories, etc.) that are represented as being "above", "below", or "at the same level as" one another. Hierarchy is an important ...

of risk reduction methods when elimination and substitution of the hazard are not possible. These types of controls typically involve making changes in equipment or other changes to minimize the level of noise that reaches a worker's ear. They may also involve measures such as barriers between the worker and the source of the noise, mufflers, regular maintenance of the machinery, or substituting quieter equipment. The OSHA Technical Manual (OTM) on noise provides technical information about workplace hazards and controls to OSHA's Compliance Safety and Health Officers (CSHOs). The content of the OTM is based on currently available research publications, OSHA standards, and consensus standards. The OTM is available to the public for use by other health and safety professionals, employers, and anyone involved in developing or implementing an effective workplace safety and health program. Examples of noise control strategies adopted in the workplace can be seen among the winners of the Safe-in-Sound Excellence in Hearing Loss Prevention Awards.

Administrative controls

Administrative control Administrative controls are training, procedure, policy, or shift designs that lessen the threat of a hazard to an individual. Administrative controls typically change the behavior of people (e.g., factory workers) rather than removing the actu ...

, behind engineering control, is the next best form of prevention of noise exposure. They can either reduce the exposure to noise, or reduce the decibel level of the noise itself. Limiting the amount of time a worker is allowed to be around an unsafe level of noise exposure, and creating procedures for operation of equipment that could produce harmful levels of noise are both examples of administrative controls.

Personal protection

Elimination or reduction of the source of noise or chemical exposure is ideal, but when that is not possible or adequate, wearing

personal protective equipment Personal protective equipment (PPE) is protective clothing, helmets, goggles, or other garments or equipment designed to protect the wearer's body from injury or infection. The hazards addressed by protective equipment include physical, ...

(PPE) such as earplugs or earmuffs can help reduce the risk of hearing loss due to noise exposure. PPE should be a last resort and not be used in substitution for engineering or administrative controls. It is important that workers are properly trained on the use of PPE to ensure proper protection. A personal attenuation rating can be objectively measured through a hearing protection fit-testing system.

Other initiatives

In addition to the hierarchy of controls, other programs have been created to promote the prevention of hearing loss in the workplace. For example, the Buy Quiet program was created to encourage the purchase of quieter tools and machinery in the workplace. Additionally, the Safe-n-Sound Award was created to recognize organizations that excel in preventing occupational hearing loss.

History

Occupational hearing loss is a very present industrial issue that has been noticed since the Industrial Revolution. As industrial society continues to grow, this issue is becoming increasingly detrimental due to the exposure of chemicals and physical objects. Millions of employees have been affected by occupational hearing loss, especially in industry. Industrialized countries see most of these damages as they result in both economic and living problems. Within the United States of America alone, 10 of the 28 million people that have experienced hearing loss related to noise exposure. Rarely do workers express concerns or complaints regarding Occupational hearing loss. In order to gather relevant information, workers who have experienced loud work environments are questioned regarding their hearing abilities during everyday activities. When analyzing OHP, it is necessary to consider family history, hobbies, recreational activities, and how they could play a role in a person's hearing loss. In order to test hearing loss, audiometers are used to and are adjusted to

American National Standards Institute The American National Standards Institute (ANSI ) is a private non-profit organization that oversees the development of voluntary consensus standards for products, services, processes, systems, and personnel in the United States. The orga ...

(ANSI) regulations. The Occupation and Safety Health Association (OSHA) of the United States of America requires a program that conserves hearing when noise levels are greater than 85 dB.

References

{{Reflist

External links

Noise-Induced Hearing Loss
from the National Institutes of Health
Dangerous Decibels
Includes general information and a "virtual exhibit" as well as resources for teachers. * NIOS
Noise and Hearing Loss Prevention Topic Page
* NIOS
Power Tools Sound Pressure and Vibrations Database

New York City construction noise control products and vendor guidance sheet

Online Audiometric Test
with stimuli up to 80 dBHL. Confirm your hearing status and track if it changes over time. * A

featuring equal loudness curves * NIOS

www.cochlea.org/en/noise
- animation of damage of hairs, harmful intensities graph
www.cochlea.eu/en/hair-cells
- illustrations and images of hair cells Hearing loss Occupational safety and health Audiology Public health