Hearing asymmetry among occupationally noise-exposed men and women under 60 years of age

Using mobile audiometry (Wulira App) to assess noise induced hearing loss among industrial workers in Kampala, Uganda: A cross-sectional study

BACKGROUND

Occupational noise is a common cause of hearing loss in low-income countries. Unfortunately, screening for hearing loss is rarely done due to technical and logistical challenges associated with pure tone audiometry. Wulira app is a valid and potentially cost-effective alternative to pure tone audiometry in screening for occupational hearing loss. We aimed to determine the prevalence of occupational hearing loss among workers in a metal industry company in Kampala district.

METHODOLOGY

We recruited 354 participants conveniently from a steel and iron manufacturing industry in Kampala. All eligible participants answered a pretested and validated questionnaire and were assessed for noise induced hearing loss in a quiet office room approximately 500 meters from the heavy machinery area using the Wulira app. Descriptive statistics such as proportions were used to describe the study population while inferential statistics were used to determine associations.

RESULTS

Of the 354 participants sampled, 333 (94.1%) were male, and the median age was 27, IQR (25-30). Regarding the risk factors of hearing loss, fourteen (3.9%) had history of smoking and more than half (65.5%) had worked in the industry for more than 2 years. The overall prevalence of hearing loss among industrial workers was 11.3% (40/354). 16.2% and 9% had mild hearing loss in the right and left ear respectively. Bilateral audiometric notch was present where fourteen (4%) of the participants had notch in their right ear while seven (2%) had notch in their left ear. Residing outside Kampala district was associated with hearing loss (OR, 95% CI, 0.213 (0.063-0.725), p = 0.013).

CONCLUSION

One in 10 workers in a metal manufacturing industry in Kampala had occupational hearing loss. Industrial workers residing outside Kampala were likely to develop hearing loss. Periodic screening should be done for early detection and intervention to prevent progression of hearing loss in this population.

Obstructive sleep apnea risk and hearing impairment among occupational noise-exposed male workers

This study aimed to investigate the association between obstructive sleep apnea (OSA) risk and hearing impairment among workers exposed to occupational noise. A cross-sectional study was conducted among 607 healthy male workers at a tire-manufacturing factory. The subjects underwent audiometric testing, and their OSA risk was examined based on the STOP-Bang questionnaire. Hearing impairment was defined as a hearing threshold >25 dB hearing level (HL) in any frequency of 1, 2, 3 and 4 kHz in either ear. High OSA risk was defined as a STOP-bang score of ≥3. Hearing thresholds at 1, 2, 3 and 4 kHz in both ears were significantly higher among workers with high OSA risk than among those with low OSA risk after adjusting for confounders. Multiple logistic regression analysis examining the association of OSA risk and STOP-Bang score with hearing impairment revealed an odds ratio of 1.738 (95% confidence interval [CI] 1.113-2.713, p = 0.015) and 1.256 (95% CI 1.031-1.529, p = 0.023), respectively, after adjusting for confounders. In addition, when the hearing impairment was reclassified into high- and low-frequency hearing impairment, a statistically significant OR was seen for high-frequency hearing impairment. In conclusion, high OSA risk was associated with hearing impairment in occupational noise-exposed workers, especially in the high-frequency range of 3 and 4 kHz. More efforts are required to improve the management of OSA and its risk factors to preserve hearing in occupational noise-exposed workers.

Occupational noise exposure and asymmetric hearing loss: Results from the HUNT population study in Norway

BACKGROUND

A large population study with adequate data on confounders is required to determine whether asymmetric hearing loss (AHL) is associated with occupational noise exposure.

METHODS

We performed a cross-sectional population study in Norway (the Health Investigation in Nord-Trøndelag: HUNT) with 24 183 participants, using pure-tone audiometry and questionnaires. AHL was defined as a difference in hearing threshold between the right and left ears of greater than or equal to 15 dB for the pure-tone average of 0.5 to 2 or 3 to 6 kHz.

RESULTS

The mean age of the participants was 53 years (range, 19-99); 53% were women. The prevalence of AHL in this general Norwegian population was 6% for the 0.5 to 2 kHz range and 15% for 3 to 6 kHz. In unadjusted regression models, subjects reporting prolonged occupational noise exposure to high-level noise sources (N = 1652) had a higher risk of AHL at 3 to 6 kHz than those reporting no prior exposure (odds ratio [OR], 1.98; 95% confidence interval [CI], 1.75-2.25). After adjustment for age and sex, OR was 1.08; (95% CI, 0.95-1.24). After additional adjustment for head trauma, ear infections, blasting or shooting (all associated with AHL), smoking, and diabetes, OR was 1.00 (95% CI, 0.87-1.16). No association between occupational noise and right-ear hearing threshold advantage (left-right ear difference) was observed after adjustment for confounders.

CONCLUSION

Our study suggests that AHL is relatively common in the general population, especially at the high-frequency range in men and elderly subjects. Our study showed no relation between occupational noise exposure and AHL after confounder adjustment.

Assessment of occupational noise-related hearing impairment among dental health personnel

Objectives

The purpose of the study was to examine hearing thresholds among dental personnel. The secondary aim was to evaluate sound levels among dental equipment that dental personnel are exposed to.

Methods

Two hundred forty‐four dentists, dental technicians, dental assistants, and dental students participated. Sixty‐two participated as a control group. Audiological thresholds for the test groups were compared to the control group. All participants were from Jordan University Hospital. Participants completed a questionnaire in addition to their audiometric testing. Otoscopy, tympanometry, and pure tone audiometry were included in their assessment. Three‐factor ANOVA and t tests were utilized to assess the statistical differences of hearing thresholds among the groups and between the two ears. Pearson correlation test was used to assess the effect of age, experience, and duration of exposure on the degree of hearing loss in the test groups for both ears.

Results

The authors reported statistically significant differences among hearing thresholds between the control group and others. Left hearing thresholds were noted to be significantly poorer in the left versus right ear at 1000, 2000, 4000, and 8000 Hz in dental assistants. The authors also reported a significant relationship between the degree of hearing impairment among dental assistants and the daily duration of exposure to dental occupational noise, followed by age.

Conclusion

Hearing impairment was higher among dental professionals than the control group and especially among dental assistants and technicians. The authors recommended screening guidelines and adapting hearing protection methods for dental professionals and particularly for dental assistants and technicians.

The Effect of Short-Term Noise Exposure on Audiometric Thresholds, Distortion Product Otoacoustic Emissions, and Electrocochleography

Purpose The purpose of the study was to examine the effect of short-term noise exposure on audiometric thresholds, distortion product otoacoustic emissions (DPOAEs), and electrocochleography (ECochG) as a function of ear and sex. Method Preexposure and postexposure measures of audiometric thresholds, DPOAEs, and ECochG indices were examined. Sixteen male and 16 female adults participated. Participants were exposed to a 2000-Hz narrowband noise presented at 105 dBA for 10 min. Results Following noise exposure, significantly ( p < .0001) larger auditory threshold differences were observed for left ears. Larger auditory threshold differences were also observed for 3000 and 4000 Hz versus 2000 and 6000 Hz. DPOAE absolute amplitude differences increased with decreasing L ₁, L ₂ level ( p < .0001). DPOAE absolute amplitude differences also significantly rose with increasing f₂ frequencies ( p < .0001). Females generally had larger DPOAE absolute amplitude differences than males ( p < .05). Summating potential amplitudes were significantly larger for female left ears following noise exposure ( p = .03). Left-ear summating potential/action potential amplitude ratios and summating potential/action potential area ratios were increased following noise exposure ( p < .05). Conclusions Utilizing a test battery to examine the effects of short-term noise exposure can reveal the functional status of different structures in the cochlea. There appears to be a susceptibility of the left ear to short-term loud noise exposure. Findings with respect to a sex susceptibility to short-term loud noise exposure were not strong, as sex differences were only observed for a subset of the conditions.

Does Contralateral Inhibition of Transient Evoked Otoacoustic Emissions Suggest Sex or Ear Laterality Effects?

PURPOSE

The purpose of this study was to examine contralateral inhibition of transient evoked otoacoustic emissions (TEOAEs) in young adults with normal hearing as a function of ear and sex.

METHOD

Young female (n = 50) and male (n = 50) adults with normal hearing participated. TEOAEs were measured bilaterally with 80 dB peSPL nonlinear clicks and 60 dB peSPL linear clicks with and without a contralateral broadband noise elicitor at 65 dB SPL. Absolute TEOAE inhibition and normalized TEOAE inhibition (i.e., percentage of inhibition) were examined.

RESULTS

With both 80 and 60 dB peSPL evoking stimuli, there were significant main effects of ear and sex (p < .05). TEOAE levels were larger in women and in the right ear. There were no statistically significant main effects of ear and sex on absolute TEOAE inhibition (p > .05). Significant main effects of ear and sex were, however, found with normalized TEOAE inhibition (p < .05; greater in men and in the left ear). Statistically significant negative correlations and significant linear predictive relations were found between TEOAE levels and normalized TEOAE inhibitions in both ears (p < .001). There is no evidence of the same with absolute inhibition of TEOAEs (p > .05).

CONCLUSIONS

If one considers that efferent inhibition of TEOAEs is an absolute quantity, the significant effect of ear and sex on normalized inhibition and the negative association and linear predictive relationship between TEOAE level and inhibition can be viewed as spurious effects. As such, contralateral inhibition of TEOAEs does not suggest sex or ear laterality effects.

Current insights in noise-induced hearing loss: a literature review of the underlying mechanism, pathophysiology, asymmetry, and management options

BACKGROUND

Noise-induced hearing loss is one of the most common forms of sensorineural hearing loss, is a major health problem, is largely preventable and is probably more widespread than revealed by conventional pure tone threshold testing. Noise-induced damage to the cochlea is traditionally considered to be associated with symmetrical mild to moderate hearing loss with associated tinnitus; however, there is a significant number of patients with asymmetrical thresholds and, depending on the exposure, severe to profound hearing loss as well.

MAIN BODY

Recent epidemiology and animal studies have provided further insight into the pathophysiology, clinical findings, social and economic impacts of noise-induced hearing loss. Furthermore, it is recently shown that acoustic trauma is associated with vestibular dysfunction, with associated dizziness that is not always measurable with current techniques. Deliberation of the prevalence, treatment and prevention of noise-induced hearing loss is important and timely. Currently, prevention and protection are the first lines of defence, although promising protective effects are emerging from multiple different pharmaceutical agents, such as steroids, antioxidants and neurotrophins.

CONCLUSION

This review provides a comprehensive update on the pathophysiology, investigations, prevalence of asymmetry, associated symptoms, and current strategies on the prevention and treatment of noise-induced hearing loss.

Asymmetric Hearing Loss in Chinese Workers Exposed to Complex Noise

OBJECTIVES

Evaluate the audiometric asymmetry in Chinese industrial workers and investigate the effects of noise exposure, sex, and binaural average thresholds on audiometric asymmetry.

DESIGN

Data collected from Chinese industrial workers during a cross-sectional study were reanalyzed. Of the 1388 workers, 266 met the inclusion criteria for this study. Each subject underwent a physical examination and an otologic examination and completed a health-related questionnaire. χ and t tests were used to examine the differences between the asymmetric and symmetric hearing loss groups.

RESULTS

One hundred thirty-one subjects (49.2%) had a binaural hearing threshold difference of 15 dB or more for at least one frequency, and there was no statistically significant difference between the left and right ears. The asymmetric hearing loss group was not exposed to higher cumulative noise levels (t = 0.522, p = 0.602), and there was no dose-response relation between asymmetry and cumulative noise levels (χ = 6.502, p = 0.165). Men were 1.849 times more likely to have asymmetry than women were (95% confidence interval, 1.051 to 3.253). Among the workers with higher high-frequency hearing thresholds, audiometric asymmetry was 1.024 times more prevalent than that among those with lower high-frequency hearing thresholds (95% confidence interval, 1.004 to 1.044).

CONCLUSIONS

The results indicated that occupational noise exposure contributed minimally to asymmetry, whereas sex and binaural average thresholds significantly affected audiometric asymmetry. There was no evidence that the left ears were worse than the right ears.

Risk of hearing loss among workers with vibration-induced white fingers

BACKGROUND

We examined the risk of hearing loss for workers who use hand-held vibrating tools with vibration-induced white fingers (VWF) compared to workers without VWF.

METHODS

Data on 184 participants from a 21-year cohort were gathered with questionnaires and measurements. The effects on hearing status of VWF, hand-arm vibration exposure, smoking habits, age and two-way interactions of these independent variables were examined with binary logistic regression. Analyses were made for the right hand and ear as well as for the hand with VWF and the ear with worse categorized hearing status.

RESULTS

Workers with VWF in their right hand had an increased risk of hearing loss (odds ratio 2.2-2.3) in the right ear. Workers with VWF in any hand did not have any increased risk of hearing loss in the ear with worse hearing status.

CONCLUSIONS

This study supports the hypothesis that VWF increases the risk of hearing loss among workers who use hand-held vibrating tools in a noisy environment.

Otoacoustic emissions and tympanometry in a general adult population in Sweden: Emisiones otoacústicas y timpanometría en la población general adulta de Suecia

The present study concerns a general adult population in Sweden, not exposed to hazardous occupational noise. Tympanometry and spontaneous (SOAE), transient evoked (TEOAE) and distortion-product (DPOAE) otoacoustic emissions were investigated in 493 randomly selected men and women aged from 20 to 79 years. Effects of gender, age, ear side and middle ear state were determined, with and without adjusting for hearing threshold level. No statistically significant effects on middle ear pressure or compliance were present. For TEOAEs and DPOAEs, the effect of gender and age was statistically significant (p < 0.01), with larger signal levels for female subjects and young subjects, even after adjusting for hearing threshold level. No effect of middle ear pressure on otoacoustic emissions was present, but high middle ear compliance was associated with low emission levels (p < 0.01). Reference data for middle ear compliance and pressure and prevalence data on SOAEs, TEOAEs and DPOAEs for male and female subjects in different age groups were determined. Mean signal levels of TEOAEs and DPOAEs are presented.

Auditory status of persons with intellectual disability at the German Special Olympic Games

Among persons with intellectual disability, the prevalence of hearing impairments is high. During the German Special Olympics Summer Games 2004, a hearing screening was conducted on 755 athletes with intellectual disabilities. Obligatory screening included ear inspection and recording of otoacoustic emissions, and optional screening included tympanometry and brief pure-tone audiometry. 38.0% of the athletes failed the screening. 53.0% needed ear wax removal. 56.1% of the fails indicated sensorineural hearing loss and 13.6% indicated mixed hearing loss. 12.5% of the fails were caused by unremovable ear wax, 1.4% by ear canal affections, and 16.4% by middle ear problems. Left ear fails were more frequent than right ear fails. A peripheral hearing disturbance can thus be expected in every third subject. The high failure rate, a considerable percentage of previously undetected profound hearing loss (1.1%), and the frequent need for ear wax removal, suggest that nearly half of persons with intellectual disabilities need regular otological or audiological consultations.

Prevalence of hearing loss among 18-year-old Swedish men during the period 1971-1995

AIMS

To study the hearing of 18-year-old men by using screening audiograms obtained at military conscription.

METHODS

The study group comprised 301,873 Swedish men belonging to six age cohorts born from 1953 to 1977 who had been screened at age 18 years from 1971 to 1995. The prevalence of mild to moderate hearing loss was investigated.

RESULTS

Of the entire study group, 13.1% had elevation of one or more pure tone thresholds. In most cases, 11.9%, the elevation was situated in the high-frequency region. High-frequency hearing loss was more common in the left ear (7.5%) than in the right ear (6.2%). The prevalence of hearing loss decreased during the period 1971 to 1981 from 15.7% to 8.3%. During the last part of the study period, 1986 to 1995, the prevalence increased from 9.8% to 16.3%. The increase included mild to moderate degrees of hearing loss with thresholds below 35 dB HL. The prevalence of threshold elevations was highest in sparsely populated areas of Sweden and lowest in large, metropolitan areas of Sweden from 1971 to 1986. During the last part of the study period the geographical differences decreased or disappeared.

CONCLUSIONS

The total prevalence of hearing loss was in accordance with other reports. The frequency 6 kHz was most affected by threshold elevations. The prevalence of hearing loss decreased in the first part of the study period, and increased at the end of the study period. Hearing loss was most commonly seen in rural areas.

Asymmetry in Noise-Induced Hearing Loss

OBJECTIVE

Noise-induced hearing loss (NIHL) is more severe in the left ear than the right ear. The aim of this study was to examine the possible association of handedness and acoustic reflex parameters on right or left NIHL predominance.

STUDY DESIGN

Retrospective case review and prospective series.

SETTING

Tertiary center.

PATIENTS

Three samples were studied: 1) the files of 4,277 army personnel with NIHL were reviewed to analyze the relation between the side affected and age, sex, duration of noise exposure, and acoustic damage; 2) an additional 119 army personnel with NIHL were evaluated for the possible association of handedness and NIHL asymmetry; and 3) fifty-one normal-hearing subjects were tested for threshold and latency of acoustic reflex by handedness.

INTERVENTION

None.

MAIN OUTCOME MEASURE

Differences in NIHL asymmetry by background and noise-related variables and handedness.

RESULTS

NIHL was more pronounced in the left ear, regardless of demographic characteristics, noise exposure parameters, acoustic reflex measures, or handedness.

CONCLUSION

The asymmetry in hearing loss severity may be attributed to the cortical pathways, specifically to the more pronounced efferent auditory system on the right side, which reduces the susceptibility of the right ear to cochlear insult.

Temporary threshold shift in military pilots measured using conventional and extended high-frequency audiometry after one flight

Noise of such a high level that it can result in hearing deterioration is an inherent characteristic of military flying. Susceptibility to hearing impairment was studied using 51 Finnish Air Force military personnel as subjects. The test persons flew missions on a British Aerospace Hawk 51 advanced jet trainer, Boeing F-18 Hornet, Mikoyan & Gurevich MiG-21bis and Saab 35 Draken interceptors, and a Valmet Redigo turboprop liaison aircraft. The duration of noise exposure was one flight mission, which varied from 30 to 60 min. Noise doses and levels were measured using a miniature microphone at the inlet of the ear canal, while a second microphone was located at the level of the subject's shoulder. Hearing thresholds were measured before each flight using conventional (0.125-8 kHz) and extended high-frequency (EHF) (8.20 kHz) audiometry. The measurements were repeated as soon as possible after the flight. The study showed that the pre-flight threshold levels of the subjects were good. Both conventional and EHF audiometry revealed statistically significant temporary threshold shifts (TTS) at several frequencies and with all aircraft types involved. The changes were, however, minor. The risk of noise-induced hearing impairment at the studied exposure levels is, in all probability, rather small. The role of extended high-frequency audiometry would be in research, and it might be performed for flying personnel upon entering service and every fifth year thereafter.

Hearing threshold levels for an otologically unscreened, non-occupationally noise-exposed population in Sweden

The aim of this study was to investigate the hearing threshold levels (HTL) of an otologically unscreened population in Sweden. The results are compared to other studies of otologically unscreened populations, and a new mathematical model of hearing threshold levels as a function of age is presented. The subjects were males and females aged from 19 to 81 years, selected from the province of Ostergötland in Sweden. The test battery included otoscopy, tympanometry, pure-tone audiometry, and a questionnaire. Subjects exposed to occupational noise were excluded, and in total 603 persons were included in the analysis. The regression analysis resulted in different hyperbolic tangent functions with four parameters: HTL=A+B x tanh(C x age+D).

The Effect of Recreational Gunfire Noise on Hearing in Workers Exposed to Occupational Noise

Hearing sensitivity for an experimental group of 278 industrial workers who engaged in recreational shooting was compared with that of an age-matched control group of 278 nonshooting industrial workers to examine the effect of gunfire exposure on auditory thresholds. The influence of age and the number of unprotected gunshot exposures per year also was examined. The subjects in the experimental group completed a questionnaire to define the types of firearms used, the number of years shooting, and the number of protected and unprotected gunshot exposures per year. Results revealed that hearing sensitivity for frequencies 3.0, 4.0, and 6.0 kHz for both ears in the experimental group was an average of approximately 5 to 10 dB poorer than that of the control subjects. Although both subject groups demonstrated poorer 3.0-to-6.0-kHz hearing sensitivity for left-ear compared with right-ear listening, the degree of asymmetry between ears was greater for the experimental subjects. Older shooters had more hearing loss and greater threshold asymmetry than younger shooters, but there was no significant relationship between hearing sensitivity and the number of unprotected exposures per year. This latter finding was attributed to a fourfold increase in the number of unprotected annual exposures that were reported by younger shooters, who had inherently better hearing than did the older shooters.

An investigation of the association between exposure to styrene and hearing loss

The importance of the association between advancing age and hearing loss is well recognized. Further, prolonged significant noise exposures are also known to result in permanent hearing loss. However, little is known of the contribution of industrial chemical exposures to hearing loss. Information available, from both animal and human studies, raises the possibility that certain aromatic hydrocarbons are ototoxic. The purpose of this study was to assess whether occupational styrene exposure causes hearing loss in a group of workers in the fiber-reinforced plastics manufacturing industry. The hearing acuity of 299 subjects was determined, using pure-tone screening audiometry, at the beginning of a single workshift and again at the end of the shift. On the same day, the personal, time-weighted average exposures of each subject to both styrene and noise were measured. In addition, information on the following factors was obtained from each participant: previous work history, including exposures to noise and chemicals; use of personal protective equipment for noise or solvents; personal and family history of hearing problems; and smoking history. Current exposures together with work histories were used to construct lifetime noise and styrene exposure indices. No conclusive evidence was found for a chronic styrene-induced effect on hearing acuity, when both noise and styrene lifetime exposures were taken into account. As expected, age and noise exposures were highly important variables, both positively associated with hearing loss. In addition, the detrimental effect of noise exposure on hearing acuity was found to be strengthened with increased age. Noise and styrene exposures were highly correlated, clearly illustrating the importance of considering all associated variables in analysis of such data. No evidence was found for a relationship between smoking, recreational noise, solvent exposures, and hearing loss.

Dose-response relationship between smoking and impairment of hearing acuity in workers exposed to noise

The study included an inquiry and clinical examination of 443 reindeer herders (mean age 43 years) who frequently used noisy tools and vehicles, in particular snowmobiles and chain-saws. Age-adjusted hearing thresholds at 3 and 4 kHz deteriorated significantly with increased exposure to noise. There was the dose-response relationship between the amount of smoking and the impairment of hearing acuity when exposure time to noise was used as covariance. The amount of smoking was not significant until very heavy smoking (more than 144,000 cigarettes, i.e. 20 cigarettes/day for more than 20 years), and no smoking effect could be seen using the classification of current smoking habits. The results support the practice that screening of hearing acuity should be repeated more often in smokers than in non-smokers in noisy work so that hearing damage can be found in an incipient stage and noise-induced hearing loss effectively prevented.