Background: The purpose of this cross-sectional study is to estimate the prevalence of hearing loss among noise-exposed U.S. workers during 2010–2019 within the Construction sector. Methods: Audiograms for 26,653 workers at 833 Construction companies (and for 1.3 million other workers) were examined. Period prevalence and adjusted risk for hearing loss as compared with a reference industry (Couriers and Messengers) were estimated for the Construction sector and sub-sectors, and all industries combined. Results: The prevalence of hearing loss within the Construction sector was 23% compared to 20% for all industries combined. Several sub-sectors exceeded the overall prevalence and all but two had adjusted risks significantly higher than the reference industry. The sub-sectors with the highest prevalences for hearing loss were: Highway, Street, and Bridge Construction (28%), Site Preparation Contractors (26%), New Single-Family Housing Construction (except Operative Builders) (25%), Oil and Gas Pipeline and Related Structures Construction (25%), and Other Building Finishing Contractors (25%). The sub-sectors with the highest adjusted risks were Industrial Building Construction; Other Heavy and Civil Engineering Construction; Oil and Gas Pipeline and Related Structures Construction; Finish Carpentry Contractors; and Site Preparation Contractors; with risks 62%, 61%, 60%, 59% and 58% higher than the reference industry, respectively. Conclusions: Hearing loss continues to be a significant issue within Construction. Reducing noise exposure is critical, including buying quieter equipment, keeping moving parts oiled and well-maintained, enclosing noise sources, and employing administrative controls to reduce the number of workers in noisy areas. Barriers to workers consistently and correctly wearing their hearing protection also need to be addressed. Practical Applications: Within Construction, hazardous noise is common and the risk of hearing loss is high. This study identified the Construction sub-sectors with the highest prevalences and risks to guide interventions toward workers most in need of prevention and described strategies for reducing exposures. © 2024

OBJECTIVE: This study's objective was to estimate hearing loss prevalence for noise-exposed U.S. Utilities workers. METHODS: In this cross-sectional study of a retrospective cohort, audiograms were examined for 1.3 million workers (13,595 within Utilities) from 2010-2019. Hearing loss prevalence, and adjusted risk as compared with a reference industry, were estimated. RESULTS: The hearing loss prevalence for noise-exposed Utilities workers (25%) was higher than for noise-exposed workers in all industries combined (20%). Some sub-sectors surpassed the prevalence for all industries combined and/or had adjusted risks significantly higher than the reference industry. The highest prevalence sub-sectors were Hydroelectric Power Generation (37%) and Steam and Air-Conditioning Supply (29%). CONCLUSIONS: While often overlooked, noise-exposed workers in this sector have among the highest prevalences of hearing loss, and significantly higher risks. Increased attention and better hearing conservation strategies are needed.

For more than 50 years, the National Institute for Occupational Safety and Health (NIOSH), part of the United States (U.S.) Centers for Disease Control and Prevention (CDC), has been actively working to reduce the effects of noise and ototoxic chemicals on worker hearing. NIOSH has pioneered basic and applied research on occupational hearing risks and preventive measures. The Institute has issued recommendations and promoted effective interventions through mechanisms ranging from formal criteria documents to blogs and social media. NIOSH has conducted surveillance and published statistics to guide policy and target prevention efforts. Over the past five decades, substantial progress has been made in raising awareness of noise as a hazard, reducing the risk of occupational hearing loss, improving the use of hearing protection, and advancing measurement and control technologies. Nevertheless, noise remains a prevalent workplace hazard and occupational hearing loss is still one of the most common work-related conditions. NIOSH continues to work toward preventing the effects of noise and ototoxicants at work and has many resources to assist audiologists in their hearing loss prevention efforts. © 2023 Thieme Medical Publishers, Inc.. All rights reserved.

Nearly one in four (24.4%) U.S. adults aged 20-69 years show evidence of noise-induced hearing loss (1). Among those reporting exposure to noise outside of work, 19.9% showed possible noise-induced hearing loss. Exposure to non-job-related noise can be substantial (2). Loud music from personal listening devices and entertainment venues might place more than 1 billion teenagers and young adults at risk for hearing loss worldwide (3). Early noise exposure might increase the risk for age-related hearing loss later in life (4). CDC analyzed data from the 2022 FallStyles survey (conducted by Porter Novelli via the Ipsos' KnowledgePanel) on U.S. adult perceptions regarding preventing hearing loss from amplified music at venues or events. More than one half of U.S. adults agreed with one or more of the following protective actions: limiting sound levels, posting warning signs, and using hearing protection when music at such events reaches potentially hazardous levels. Hearing and other health professionals can make use of existing materials available from the World Health Organization (WHO), CDC, and other professional organizations to raise awareness about noise risks and promote protective behaviors.

Almost all noise-induced hearing loss (NIHL) is preventable. However, once acquired, NIHL is permanent and irreversible. In addition to hearing loss, evidence shows that prolonged or repeated exposure to high levels of noise is associated with other health effects, such as heart disease, hypertension, and insomnia. 1 The World Health Organization (WHO) 2 and the United Nations Environmental Programme (UNEP) 3 attest that exposure to loud sounds (noises) adversely affects the lives of millions of people at home, at work, and in the community. If just 20% of NIHL was prevented among working-age individuals, $123 billion could be obtained from increased earnings, an economic impact excluding costs associated with health care, special education, and reduced quality of life. 4 Noise is the most common modifiable environmental cause of hearing loss among young and middle-aged adults, and the most common self-reported cause of hearing loss among men. 5

Almost all noise-induced hearing loss (NIHL) is preventable. However, once acquired, NIHL is permanent and irreversible. In addition to hearing loss, evidence shows that prolonged or repeated exposure to high levels of noise is associated with other health effects, such as heart disease, hypertension, and insomnia. 1 The World Health Organization (WHO) 2 and the United Nations Environmental Programme (UNEP) 3 attest that exposure to loud sounds (noises) adversely affects the lives of millions of people at home, at work, and in the community. If just 20% of NIHL was prevented among working-age individuals, $123 billion could be obtained from increased earnings, an economic impact excluding costs associated with health care, special education, and reduced quality of life. 4 Noise is the most common modifiable environmental cause of hearing loss among young and middle-aged adults, and the most common self-reported cause of hearing loss among men. 5

BACKGROUND: This study estimated the prevalence of hearing protection device (HPD) non-use among US workers exposed to hazardous workplace noise and provided risk estimates. METHODS: Self-reported data from the National Health Interview Survey in 2007 (15,852 workers) and 2014 (23,656 workers) were examined. Weighted prevalence and adjusted prevalence ratios of HPD non-use (using HPDs half the time or less when exposed to hazardous noise) were estimated by demographic, industry, and occupation. Differences in the prevalences of non-use were estimated and compared. RESULTS: The prevalence of HPD non-use was 53% among all noise-exposed workers in 2014. Workers in the Accommodation and Food Services industry had the highest prevalence (90%) and risk (PR: 2.47, 95% confidence interval: 1.54-3.96) of HPD non-use. The industries with the lowest prevalences of noise exposure, including Finance and Insurance (2%) and Health Care and Social Assistance (4%), had some of the highest prevalences of HPD non-use (80% and 83%, respectively). There were no statistically significant changes in HPD non-use among industries between 2007 and 2014. Among occupations, HPD non-use increased 37% in Arts, Design, Entertainment, Sports and Media, and decreased 39% in Architecture and Engineering. CONCLUSION: The prevalence of HPD non-use remains high; especially within industries and occupations with fewer noise-exposed workers. These groups need targeted attention to increase awareness and compliance. Employers should require HPD use and trainings among noise-exposed workers and provide an assortment of HPDs tailored to noise level and type, workplace environment, communication and audibility needs, and individual comfort and convenience.

Objective: The purpose of this study is to estimate the prevalence of hearing loss among noise-exposed U.S. workers within the Services sector.Methods: Audiograms for 1.9 million workers (158,436 within Services) from 2006 to 2015 were examined. Prevalence and adjusted risk for hearing loss as compared with a reference industry were estimated for the Services sector/sub-sectors, and all industries combined.Results: The prevalence of hearing loss within Services was 17 compared to 16% for all industries combined. However, many sub-sectors greatly 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' also had high prevalences and risks.Conclusions: Large numbers of workers within Services have an elevated risk of hearing loss and need immediate hearing conservation efforts. Additional research and surveillance are needed for sub-sectors for which there is low awareness of hearing hazards or a lack of hearing data.

Objective: In occupational hearing conservation programmes, age adjustments may be used to subtract expected age effects. Adjustments used in the U.S. came from a small dataset and overlooked important demographic factors, ages, and stimulus frequencies. The present study derived a set of population-based age adjustment tables and validated them using a database of exposed workers.Design: Cross-sectional population-based study and retrospective longitudinal cohort study for validation.Study sample: Data from the U.S. National Health and Nutrition Examination Survey (unweighted n = 9937) were used to produce these tables. Male firefighters and emergency medical service workers (76,195 audiograms) were used for validation.Results: Cross-sectional trends implied less change with age than assumed in current U.S. regulations. Different trends were observed among people identifying with non-Hispanic Black race/ethnicity. Four age adjustment tables (age range: 18-85) were developed (women or men; non-Hispanic Black or other race/ethnicity). Validation outcomes showed that the population-based tables matched median longitudinal changes in hearing sensitivity well.Conclusions: These population-based tables provide a suitable replacement for those implemented in current U.S. regulations. These tables address a broader range of worker ages, account for differences in hearing sensitivity across race/ethnicity categories, and have been validated for men using longitudinal data.

Exposure to hazardous noise is one of the most common occupational risks, both in the U.S. and worldwide. Repeated overexposure to noise at or above 85 dBA can cause permanent hearing loss, tinnitus, and difficulty understanding speech in noise. It is also associated with cardiovascular disease, depression, balance problems, and lower income. About 22 million U.S. workers are currently exposed to hazardous occupational noise. Approximately 33% of working-age adults with a history of occupational noise exposure have audiometric evidence of noise-induced hearing damage, and 16% of noise-exposed workers have material hearing impairment. While the Mining, Construction, and Manufacturing sectors typically have the highest prevalence of noise exposure and hearing loss, there are noise-exposed workers in every sector and every sector has workers with hearing loss. Noise-induced hearing loss is preventable. Increased understanding of the biological processes underlying noise damage may lead to protective pharmacologic or genetic therapies. For now, an integrated public health approach that (1) emphasizes noise control over reliance on hearing protection, (2) illustrates the full impact of hearing loss on quality of life, and (3) challenges the cultural acceptance of loud noise can substantially reduce the impact of noise on worker health.

New technologies are reshaping health interventions across disciplines. This technological surge offers a clear opportunity to expand and improve hearing health, particularly in hearing loss prevention. A person's hearing health trajectory is defined by his or her overall hazardous exposures, environmental factors, and genetic determinates.1 Among the many factors that can contribute to hearing health (such as overall health, smoking, diet, and ototoxicant exposure), reducing noise exposure—particularly at work—has the greatest potential to significantly decrease the burden of hearing loss and tinnitus.2 About 24 percent of hearing impairment cases among U.S. workers is attributable to workplace noise exposures. Because noise-induced hearing loss is preventable, approximately one-fourth of hearing impairment cases in this population may be avoided by adopting preventive measures.3 While progress has been made toward the prevention of work-related hearing loss, it remains among the most common occupational illnesses. Overall, nearly one in four U.S. adults has audiometric evidence of noise-induced hearing loss—and most do not realize it.4 People continue to focus on the use of hearing protection to reduce noise exposure, even though only limited evidence is available on the effectiveness of this approach.5 However, new technologies to measure and control noise and test hearing hold the promise of expedited progress.

OBJECTIVES/HYPOTHESIS: To investigate factors associated with hearing impairment (HI) in adolescent youths during the period 1966-2010. STUDY DESIGN: Cross-sectional analyses of US sociodemographic, health, and audiometric data spanning 5 decades. METHODS: Subjects were youths aged 12 to 17 years who participated in the National Health Examination Survey (NHES Cycle 3, 1966-1970; n = 6,768) and youths aged 12 to 19 years in the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994; n = 3,057) and NHANES (2005-2010; n = 4,374). HI prevalence was defined by pure-tone average (PTA) >/= 20 dB HL for speech frequencies (0.5, 1, 2, and 4 kHz) and high frequencies (3, 4, and 6 kHz). Multivariable logistic models were used to estimate the odds ratio (OR) and 95% confidence interval (CI). RESULTS: Overall speech-frequency HI prevalence was 10.6% (95% CI: 9.7%-11.6%) in NHES, 3.9% (95% CI: 2.8%-5.5%) in NHANES III, and 4.5% (95% CI: 3.7%-5.4%) in NHANES 2005 to 2010. The corresponding high-frequency HI prevalences were 32.8% (95% CI: 30.8%-34.9%), 7.3% (95% CI: 5.9%-9.0%), and 7.9% (95% CI: 6.8%-9.2%). After adjusting for sociodemographic factors, overall high-frequency HI was increased twofold for males and cigarette smoking. Other significant risk factors in NHANES 2005 to 2010 included very low birth weight, history of ear infections/otitis media, ear tubes, fair/poor general health, and firearms use. CONCLUSIONS: HI declined considerably between 1966 to 1970 and 1988 to 1994, with no additional decline between 1988 to 1994 and 2005 to 2010. Otitis media history was a significant HI risk factor each period, whereas very low birth weight emerged as an important risk factor after survival chances improved. Reductions in smoking, job-related noise, and firearms use may partially explain the reduction in high-frequency HI. Loud music exposure may have increased, but does not account for HI differences. LEVEL OF EVIDENCE: NA.

INTRODUCTION: Hearing loss is a worldwide societal and public health concern. Globally, disabling hearing loss affects 538 million adults (men, 12.2%; women, 9.8%). This study examined the prevalence and risk factors associated with deafness or serious difficulty hearing in two nationally representative surveys. METHODS: Data were analyzed in 2017 from the 2016 Behavioral Risk Factor Surveillance System (BRFSS) and the 2014 National Health Interview Survey. The BRFSS collected data through telephone interviews. The 2014 National Health Interview Survey collected face-to-face household interview data that included a hearing health supplement in the Sample Adult Core. Both surveys asked adults aged >/=18 years the disability question on deafness or serious difficulty hearing as defined by the American Community Survey. Weighted prevalence, prevalence ratios, and 95% CIs were calculated. Logistic regression was used to adjust for sociodemographic and geographic characteristics. RESULTS: Prevalence of deafness or serious difficulty hearing was 5.8% (BRFSS) and 6.0% (National Health Interview Survey); males had a 60% higher prevalence than females. The prevalence was significantly associated with increasing age, lower educational level and income, and was higher among non-Hispanic whites than among non-Hispanic blacks and Hispanics. Deafness or serious difficulty hearing was strongly associated with increasing degree of self-reported trouble hearing in the National Health Interview Survey. The BRFSS state-specific prevalence varied from 3.8% to 13.3%, with higher prevalence in the most public health-challenged states according to America's Health Rankings. CONCLUSIONS: The prevalence of deafness or serious difficulty hearing was approximately 6% in the National Health Interview Survey and BRFSS, but increased considerably for older, less advantaged individuals and in more public health-challenged states.

BACKGROUND: The purpose of this study was to estimate the prevalence of occupational noise exposure, hearing difficulty and cardiovascular conditions within US industries and occupations, and to examine any associations of these outcomes with occupational noise exposure. METHODS: National Health Interview Survey data from 2014 were examined. Weighted prevalence and adjusted prevalence ratios of self-reported hearing difficulty, hypertension, elevated cholesterol, and coronary heart disease or stroke were estimated by level of occupational noise exposure, industry, and occupation. RESULTS: Twenty-five percent of current workers had a history of occupational noise exposure (14% exposed in the last year), 12% had hearing difficulty, 24% had hypertension, 28% had elevated cholesterol; 58%, 14%, and 9% of these cases can be attributed to occupational noise exposure, respectively. CONCLUSIONS: Hypertension, elevated cholesterol, and hearing difficulty are more prevalent among noise-exposed workers. Reducing workplace noise levels is critical. Workplace-based health and wellness programs should also be considered.

OBJECTIVE: The objective of this study is to determine whether acoustic reflexes are pervasive (i.e. known with 95% confidence to be observed in at least 95% of people) by examining the frequency of occurrence using a friction-fit diagnostic middle ear analyser. DESIGN: Adult participants with very good hearing sensitivity underwent audiometric and middle ear testing. Acoustic reflexes were tested ipsilaterally and contralaterally in both ears across a range of elicitor frequencies. Reflex elicitors were 700 ms tones presented at maximum level of 100 dB HL. Two automated methods were used to detect the presence of an acoustic reflex. STUDY SAMPLE: A group of 285 adult volunteers with normal hearing. RESULTS: There were no conditions in which the proportion of participants exhibiting acoustic reflexes was high enough to be deemed pervasive. Ipsilateral reflexes were more likely to be observed than contralateral reflexes and reflexes were more common at 0.5 and 1 kHz elicitor frequencies as compared with 2 and 4 kHz elicitor frequencies. CONCLUSIONS: Acoustic reflexes are common among individuals with good hearing. However, acoustic reflexes are not pervasive and should not be included in damage risk criteria and health hazard assessments for impulsive noise.

BACKGROUND: The purpose of this study was to estimate the prevalence of hearing loss among noise-exposed US workers within the Agriculture, Forestry, Fishing, and Hunting (AFFH) sector. METHODS: Audiograms for 1.4 million workers (17 299 within AFFH) from 2003 to 2012 were examined. Prevalence, and the adjusted risk for hearing loss as compared with the reference industry (Couriers and Messengers), were estimated. RESULTS: The overall AFFH sector prevalence was 15% compared to 19% for all industries combined, but many of the AFFH sub-sectors exceeded the overall prevalence. Forestry sub-sector prevalences were highest with Forest Nurseries and Gathering of Forest Products at 36% and Timber Tract Operations at 22%. The Aquaculture sub-sector had the highest adjusted risk of all AFFH sub-sectors (PR = 1.70; CI = 1.42-2.04). CONCLUSIONS: High risk industries within the AFFH sector need continued hearing conservation efforts. Barriers to hearing loss prevention and early detection of hearing loss need to be recognized and addressed.

OBJECTIVE: The purpose was to estimate the prevalence of hearing loss for noise-exposed U.S. workers within the Healthcare and Social Assistance (HSA) sector. METHODS: Audiograms for 1.4 million workers (8,702 within HSA) from 2003-2012 were examined. Prevalences and adjusted risks for hearing loss as compared with a reference industry were estimated for the HSA sector and all industries combined. RESULTS: While the overall HSA sector prevalence for hearing loss was 19%, the prevalences in the Medical Laboratories sub-sector and the Offices of All Other Miscellaneous Health Practitioners sub-sector were 31% and 24%, respectively. The Child Day Care Services sub-sector had a 52% higher risk than the reference industry. CONCLUSIONS: High risk industries for hearing loss exist within the HSA sector. Further work is needed to identify the sources of noise exposure and protect worker hearing.

INTRODUCTION: The 2016 National Academies of Sciences report "Hearing Health Care for Adults: Priorities for Improving Access and Affordability" included a call to action for government agencies to strengthen efforts to collect, analyze, and disseminate population-based data on hearing loss in adults. METHODS: CDC analyzed the most recent available data collected both by questionnaire and audiometric tests of adult participants aged 20-69 years in the 2011-2012 National Health and Nutrition Examination Survey (NHANES) to determine the presence of audiometric notches indicative of noise-induced hearing loss. Prevalence of both unilateral and bilateral audiometric notches and their association with sociodemographics and self-reported exposure to loud noise were calculated. RESULTS: Nearly one in four adults (24%) had audiometric notches, suggesting a high prevalence of noise-induced hearing loss. The prevalence of notches was higher among males. Almost one in four U.S. adults who reported excellent or good hearing had audiometric notches (5.5% bilateral and 18.0% unilateral). Among participants who reported exposure to loud noise at work, almost one third had a notch. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Noise-induced hearing loss is a significant, often unrecognized health problem among U.S. adults. Discussions between patients and personal health care providers about hearing loss symptoms, tests, and ways to protect hearing might help with early diagnosis of hearing loss and provide opportunities to prevent harmful noise exposures. Avoiding prolonged exposure to loud environments and using personal hearing protection devices can prevent noise-induced hearing loss.

Importance: As the US population ages, effective health care planning requires understanding the changes in prevalence of hearing loss. Objective: To determine if age- and sex-specific prevalence of adult hearing loss has changed during the past decade. Design, Setting, and Participants: We analyzed audiometric data from adults aged 20 to 69 years from the 2011-2012 cycle of the US National Health and Nutrition Examination Survey, a cross-sectional, nationally representative interview and examination survey of the civilian, noninstitutionalized population, and compared them with data from the 1999-2004 cycles. Logistic regression was used to examine unadjusted, age- and sex-adjusted, and multivariable-adjusted associations with demographic, noise exposure, and cardiovascular risk factors. Data analysis was performed from April 28 to June 3, 2016. Interventions: Audiometry and questionnaires. Main Outcomes and Measures: Speech-frequency hearing impairment (HI) defined by pure-tone average of thresholds at 4 frequencies (0.5, 1, 2, and 4 kHz) greater than 25 decibels hearing level (HL), and high-frequency HI defined by pure-tone average of thresholds at 3 frequencies (3, 4, and 6 kHz) greater than 25 decibels HL. Results: Based on 3831 participants with complete threshold measurements (1953 men and 1878 women; mean [SD] age, 43.6 [14.4] years), the 2011-2012 nationally weighted adult prevalence of unilateral and bilateral speech-frequency HI was 14.1% (27.7 million) compared with 15.9% (28.0 million) for the 1999-2004 cycles; after adjustment for age and sex, the difference was significant (odds ratio [OR], 0.70; 95% CI, 0.56-0.86). Men had nearly twice the prevalence of speech-frequency HI (18.6% [17.8 million]) as women (9.6% [9.7 million]). For individuals aged 60 to 69 years, speech-frequency HI prevalence was 39.3% (95% CI, 30.7%-48.7%). In adjusted multivariable analyses for bilateral speech-frequency HI, age was the major risk factor (60-69 years: OR, 39.5; 95% CI, 10.5-149.4); however, male sex (OR, 1.8; 95% CI, 1.1-3.0), non-Hispanic white (OR, 2.3; 95% CI, 1.3-3.9) and non-Hispanic Asian race/ethnicity (OR, 2.1; 95% CI, 1.1-4.2), lower educational level (less than high school: OR, 4.2; 95% CI, 2.1-8.5), and heavy use of firearms (≥1000 rounds fired: OR, 1.8; 95% CI, 1.1-3.0) were also significant risk factors. Additional associations for high-frequency HI were Mexican-American (OR, 2.0; 95% CI, 1.3-3.1) and other Hispanic race/ethnicity (OR, 2.4; 95% CI, 1.4-4.0) and the combination of loud and very loud noise exposure occupationally and outside of work (OR, 2.4; 95% CI, 1.4-4.2). Conclusions and Relevance: Adult hearing loss is common and associated with age, other demographic factors (sex, race/ethnicity, and educational level), and noise exposure. Age- and sex-specific prevalence of HI continues to decline. Despite the benefit of delayed onset of HI, hearing health care needs will increase as the US population grows and ages.

OBJECTIVE: This field study aimed to assess the noise reduction of hearing protection for individual workers, demonstrate the effectiveness of training on the level of protection achieved, and measure the time required to implement hearing protector fit testing in the workplace. DESIGN: The National Institute for Occupational Safety and Health (NIOSH) conducted field studies in Louisiana and Texas to test the performance of HPD Well-Fit. STUDY SAMPLE: Fit tests were performed on 126 inspectors and engineers working in the offshore oil industry. RESULTS: Workers were fit tested with the goal of achieving a 25-dB PAR. Less than half of the workers were achieving sufficient protection from their hearing protectors prior to NIOSH intervention and training; following re-fitting and re-training, over 85% of the workers achieved sufficient protection. Typical test times were 6-12 minutes. CONCLUSIONS: Fit testing of the workers' earplugs identified those workers who were and were not achieving the desired level of protection. Recommendations for other hearing protection solutions were made for workers who could not achieve the target PAR. The study demonstrates the need for individual hearing protector fit testing and addresses some of the barriers to implementation.

Hearing loss is the third most common chronic physical condition in the United States, and is more prevalent than diabetes or cancer (1). Occupational hearing loss, primarily caused by high noise exposure, is the most common U.S. work-related illness (2). Approximately 22 million U.S. workers are exposed to hazardous occupational noise (3). CDC compared the prevalence of hearing impairment within nine U.S. industry sectors using 1,413,789 noise-exposed worker audiograms from CDC's National Institute for Occupational Safety and Health (NIOSH) Occupational Hearing Loss Surveillance Project (4). CDC estimated the prevalence at six hearing impairment levels, measured in the better ear, and the impact on quality of life expressed as annual disability-adjusted life years (DALYs), as defined by the 2013 Global Burden of Disease (GBD) Study (5). The mining sector had the highest prevalence of workers with any hearing impairment, and with moderate or worse impairment, followed by the construction and manufacturing sectors. Hearing loss prevention, and early detection and intervention to avoid additional hearing loss, are critical to preserve worker quality of life.

BACKGROUND: Hearing loss and tinnitus are two potentially debilitating physical conditions affecting many people in the United States. The purpose of this study was to estimate the prevalence of hearing difficulty, tinnitus, and their co-occurrence within U.S. POPULATIONS: METHODS: Data from the 2007 National Health Interview Survey (NHIS) were examined. Weighted prevalence and adjusted prevalence ratios for self-reported hearing difficulty, tinnitus, and their co-occurrence were estimated and compared by demographic, among workers with and without occupational noise exposure, and across industries and occupations. RESULTS: Seven percent of U.S. workers never exposed to occupational noise had hearing difficulty, 5% had tinnitus and 2% had both conditions. However, among workers who had ever been exposed to occupational noise, the prevalence was 23%, 15%, and 9%, respectively (P < 0.0001). CONCLUSIONS: Hearing difficulty and tinnitus are prevalent in the U.S.; especially among noise-exposed workers. Improved strategies for hearing conservation or better implementation are needed. Am. J. Ind. Med. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

PURPOSE: To determine whether adults, aged 66-96 years, with exfoliation syndrome (XFS)/exfoliation glaucoma (XFG), or primary open-angle glaucoma (POAG) have poorer hearing than controls of similar age. METHODS: Case (XFS/XFG and POAG) and control status was diagnosed in the Reykjavik Glaucoma Studies (RGS) using slit-lamp examination, visual field testing and optic disc photographs; the RGS data were merged with the Age, Gene/Environment Susceptibility-Reykjavik Study that collected hearing data using air-conduction, pure-tone thresholds obtained at 0.5, 1, 2, 3, 4, 6 and 8 kHz categorized by better ear and worse ear, based on pure-tone averages (PTAs) calculated separately for low and middle frequencies (PTA512 - mean of thresholds at 0.5, 1 and 2 kHz) and high frequencies (PTA3468 - mean of thresholds at 3, 4, 6 and 8 kHz). Multivariable linear regression was used to test for differences in PTAs between cases and controls. RESULTS: The mean age for 158 XFS/XFG cases (30.4% male) was 77.4 years, 95 POAG cases (35.8% male) was 77.9 years, and 123 controls (46.3% male) was 76.8 years. Using multivariable linear regression analysis, there were no consistent, statistically significant differences in PTAs between the two case groups and controls in either the low- or high-frequency range, even when stratified by age group. CONCLUSION: Among the older individuals examined in this study hearing loss is highly prevalent and strongly associated with male gender and increasing age. As we did not find consistent statistically significant difference in hearing between cases and controls the diagnosis of XFS/XFG or POAG does not as such routinely call for audiological evaluation.

OBJECTIVE: We estimate the prevalence of hearing-aid use in Iceland and identify sex-specific factors associated with use. DESIGN: Population-based cohort study. STUDY SAMPLE: A total of 5172 age, gene/environment susceptibility - Reykjavik study (AGES-RS) participants, aged 67 to 96 years (mean age 76.5 years), who completed air-conduction and pure-tone audiometry. RESULTS: Hearing-aid use was reported by 23.0% of men and 15.9% of women in the cohort, although among participants with at least moderate hearing loss in the better ear (pure-tone average [PTA] of thresholds at 0.5, 1, 2, and 4 kHz ≥ 35 dB hearing level [HL]) it was 49.9% and did not differ by sex. Self-reported hearing loss was the strongest predictor of hearing-aid use in men [OR: 2.68 (95% CI: 1.77, 4.08)] and women [OR: 3.07 (95% CI: 1.94, 4.86)], followed by hearing loss severity based on audiometry. Having diabetes or osteoarthritis were significant positive predictors of use in men, whereas greater physical activity and unimpaired cognitive status were important in women. CONCLUSIONS: Hearing-aid use was comparable in Icelandic men and women with moderate or greater hearing loss. Self-recognition of hearing loss was the factor most predictive of hearing-aid use; other influential factors differed for men and women.

Barlow and colleagues addressed the important question of variation in pure-tone audiometric thresholds within and across audiometers in their article entitled “Concerns with Amplitude Variation in Calibrated Audiometer Systems in Clinical Simulations.”[1] We agree that the reliability of thresholds obtained across test systems and individuals is a vital concern when monitoring hearing health. However, we believe that a few important details are missing, which limits the validity of this study. | The authors reported, “Each of the audiometers had recently undergone certified traceable calibration by its recommended laboratory, meaning that the tone presentation from each should theoretically be identical” [page 300]. Ideally, this would be the case; however, it is not necessarily true. An audiometer is considered “in calibration” when its output is within a certain tolerance range. The International Electrotechnical Commission (IEC) 60645-1 standard allows a deviation of ± 3.7 dB from the indicated value at test frequencies from 125 Hz through 4000 Hz, and ±6.2 dB up to and including 8000 Hz. This means, for example, that an audiometer set to generate a 50-dB HL tone at 6000 Hz could produce anywhere from 43.8 dB HL to 56.2 dB HL and be considered “in calibration.” In some cases, the ±3.7 dB calibration tolerance (i.e., 7.4 dB range) at frequencies below 6000 Hz is close to the range of variation reported for the audiometers in this study. Without verifying that all four audiometers actually produced identical outputs, the measured differences cannot be assumed to be solely due to earphone placement. (Note: The allowable deviation according to American National Standards Institute (ANSI) standard S3.6 is ±3 dB at test frequencies from 125 Hz through 5000 Hz, and ± 5 dB at 6000 Hz and higher.)

Dobie and Clark’s recent article “Exchange rates for intermittent and fluctuating occupational noise: A systematic review of studies of human permanent threshold shift” aimed to compare the suitability of a 3-dB versus 5-dB exchange rate (ER) in predicting hearing loss from non-impulsive intermittent or fluctuating noise exposures by reviewing studies of human noise-induced permanent threshold shift. The authors concluded that 3-dB ER systematically overestimates the risk of noise-induced hearing loss for intermittent or fluctuating noise. We contend that the authors did not arrive at their conclusions through an appropriate investigation. The article used flawed methodologies in the treatment and analysis of the data/studies and drew conclusions that were not substantiated by the cited data. | The authors indicated that their review did not aim to make recommendations for regulation of occupational noise, but suggested that their review provided evidence for a re-examination of recommendations in their concluding remarks. The National Institute for Occupational Safety and Health (NIOSH) maintains its recommendation of the 3-dB ER to provide sufficient protection for the many variations of continuous, intermittent and fluctuating noise exposure scenarios encountered in the workplace. In view of the advances in noise measurement and the studies’ other weaknesses, we question the suitability of revisiting a narrow segment of the human evidence (excluding robust animal studies and temporary threshold shift studies) based on outdated methodologies to address such an important issue.

BACKGROUND: The purpose of this study was to estimate the incidence and prevalence of hearing loss for noise-exposed U.S. workers by industry sector and 5-year time period, covering 30 years. METHODS: Audiograms for 1.8 million workers from 1981-2010 were examined. Incidence and prevalence were estimated by industry sector and time period. The adjusted risk of incident hearing loss within each time period and industry sector as compared with a reference time period was also estimated. RESULTS: The adjusted risk for incident hearing loss decreased over time when all industry sectors were combined. However, the risk remained high for workers in Healthcare and Social Assistance, and the prevalence was consistently high for Mining and Construction workers. CONCLUSIONS: While progress has been made in reducing the risk of incident hearing loss within most industry sectors, additional efforts are needed within Mining, Construction and Healthcare and Social Assistance.

Moshammer and colleagues (1) have recommended routine implementation of a temporary threshold shift (TTS) screening test to identify workers particularly at risk of developing noise-induced hearing loss (NIHL) from occupational exposure to hazardous noise. Their work addresses an important occupational health problem. NIHL ranks among the most common work-related injuries in many countries, with an estimated global annual incidence of 1.6 million cases and accounting for approximately 16% of disabling adult hearing losses worldwide (2,3). Individuals vary in their susceptibility to the damaging effects of noise and no suitable method currently exists to predict the susceptibility of a particular worker. | In their study, Moshammer et al. measured TTS in newly-hired employees following exposure to a 20-minute, high intensity, low frequency experimental noise. They then followed the workers over time to see who ultimately developed a permanent threshold shift (PTS). The authors report that a TTS of 14 dB or more measured 2.5 minutes after the experimental exposure identifies workers at greater risk for PTS. They recommend routinely using this procedure to screen for susceptibility to noise in workplace hearing loss prevention programs. | However, this recommendation is premature in view of the study results. The TTS measure had a sensitivity of 82%, meaning that 18% of those who developed PTS were not identified by the TTS screening – a high false negative rate, particularly as we already know how to prevent PTS through reduction of noise exposures and consistent use of properly-fit hearing protection. Specificity was 70% at best, corresponding to a false positive rate 30%. If this procedure were implemented, approximately a third of the workers would be told that they are particularly at risk for NIHL when they aren’t, raising unnecessary alarm and opening the door to potential discrimination in work assignments, promotions, etc.

BACKGROUND: We examined the association between self-reported hearing protection use at work and incidence of hearing shifts over a 5-year period. METHODS: Audiometric data from 19,911 workers were analyzed. Two hearing shift measures-OSHA standard threshold shift (OSTS) and high-frequency threshold shift (HFTS)-were used to identify incident shifts in hearing between workers' 2005 and 2009 audiograms. Adjusted odds ratios were generated using multivariable logistic regression with multi-level modeling. RESULTS: The odds ratio for hearing shift for workers who reported never versus always wearing hearing protection was nonsignificant for OSTS (OR 1.23, 95% CI 0.92-1.64) and marginally significant for HFTS (OR 1.26, 95% CI 1.00-1.59). A significant linear trend towards increased risk of HFTS with decreased use of hearing protection was observed (P = 0.02). CONCLUSION: The study raises concern about the effectiveness of hearing protection as a substitute for noise control to prevent noise-induced hearing loss in the workplace.

OBJECTIVE: The purpose of this study was to compare the prevalence of workers with National Institute for Occupational Safety and Health significant threshold shifts (NSTS), Occupational Safety and Health Administration standard threshold shifts (OSTS), and with OSTS with age correction (OSTS-A), by industry using North American Industry Classification System codes. METHODS: From 2001 to 2010, worker audiograms were examined. Prevalence and adjusted prevalence ratios for NSTS were estimated by industry. NSTS, OSTS, and OSTS-A prevalences were compared by industry. RESULTS: Twenty percent of workers had an NSTS, 14% had an OSTS, and 6% had an OSTS-A. For most industries, the OSTS and OSTS-A criteria identified 28% to 36% and 66% to 74% fewer workers than the NSTS criteria, respectively. CONCLUSIONS: Use of NSTS criteria allowing for earlier detection of shifts in hearing is recommended for improved prevention of occupational hearing loss.