High Prevalence of Hearing Loss in Noise-Exposed Workers; Most Common Problem

On April 22, 2016, the CDC released a report finding hearing loss is the third most common chronic physical condition in the United States, and is more prevalent than diabetes or cancer. Occupational hearing loss, primarily caused by high noise exposure, is the most common U.S. work-related illness. Approximately 22 million U.S. workers are exposed to hazardous occupational noise. The CDC compared the prevalence of hearing impairment within nine U.S. industry sectors using 1,413,789 noise-exposed worker audiograms from the CDC’s National Institute for Occupational Safety and Health (NIOSH) Occupational Hearing Loss Surveillance Project. This is the first known study to quantify the disability-adjusted life years attributable to hearing impairment for noise-exposed U.S. workers, and to estimate the prevalence at each level of hearing impairment by industry sector.


The 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. 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.


The NIOSH Occupational Hearing Loss Surveillance Project collects de-identified audiograms for U.S. workers who were tested to comply with regulatory requirements because of high occupational noise exposure, defined as ≥85 decibels on the A-scale. Audiometric service providers and others that perform worker testing agreed to share these data with NIOSH. A cross-sectional retrospective cohort analysis was conducted using the last audiogram completed for each worker during 2003–2012. Audiograms missing necessary fields or with other quality issues, having hearing threshold values that suggested testing errors, or displaying attributes unlikely to be primarily caused by occupational exposures, were excluded. Industries were classified using the 2007 North American Industry Classification System.


The final sample included 1,413,789 audiograms for workers employed by 25,908 U.S. companies during 2003–2012. Among 99% of audiograms for which information on the worker’s sex was available, 78% were recorded for males and 22% for females. A greater percentage of males had any hearing impairment (14%) than did females (7%), and the prevalence and severity of impairment increased with age for both sexes. Workers with hearing impairment were represented in all industry sectors, with sharply decreasing numbers of workers with higher levels of impairment. The mining sector had the highest prevalence of workers with any impairment (17%) and with moderate or worse impairment (3%), followed by the construction sector (any impairment = 16%, moderate or worse impairment = 3%), and the manufacturing sector (14% and 2%). The public safety sector, which includes police protection, fire protection (including wildland firefighters), corrections, and ambulance services, had the lowest prevalence of workers with any impairment (7%).


Across all industries, 2.53 healthy years were lost annually per 1,000 noise-exposed workers. Mild impairment accounted for 52% of all healthy years lost and moderate impairment accounted for 27%. Workers in the mining and construction sectors lost 3.45 and 3.09 healthy years per 1,000 workers, respectively. Overall, 66% of the sample worked in the manufacturing sector and represented 70% of healthy years lost by all workers. Public safety workers lost 1.30 healthy years per 1,000 workers, the fewest among all workers.


Industry results highlight the high prevalence of hearing loss within the noise-exposed working population and the need for continued prevention efforts, especially in the mining, construction, and manufacturing sectors. The proportion of mining sector employees exposed to hazardous noise (76%) was the highest in any sector, and studies have consistently indicated elevated risks for occupational hearing loss within this sector. However, current noise regulations do not require audiometric testing for construction workers.


Without testing to identify workers losing their hearing, intervention might be delayed or might not occur. Although a comparatively smaller percentage of manufacturing workers are noise-exposed (37%), this sector accounts for the most noise-exposed workers in the United States, and, as expected, the largest number of workers with hearing impairment. Some manufacturing sub-sectors, such as wood product, apparel, and machinery manufacturing, have been found to have occupational hearing loss risks as high as those in the mining and construction sectors.


Approximately 78% of the healthy years lost were attributable to mild or moderate hearing impairment. Preventing any occupational hearing loss is the best way to reduce worker hearing impairment over a lifetime, because even mild-to-moderate impairment during working years can culminate in more healthy years lost during retirement. Prevention also has short-term benefits; persons with even mild hearing loss experience reduced audibility (loudness), reduced dynamic range of hearing (the difference between the softest and loudest perceptible sounds), and increased listening fatigue. They also often experience difficulties understanding speech, especially in the presence of background noise. Other effects include degraded communication, cognitive decline, and depression.


Occupational hearing loss is a permanent but entirely preventable condition with today's hearing loss prevention strategies and technology. Along with prevention efforts, early detection of hearing loss by consistent annual audiometric testing, and intervention to preclude further loss (e.g., refitting hearing protection, training), are critical. Although lost hearing cannot be recovered, workers can benefit from clinical rehabilitation, which includes fitting hearing aids, learning lip-reading, and adopting other compensation strategies to optimize hearing. Study results support beginning rehabilitation at a mild level of hearing impairment. Prevention, and early detection, intervention, and rehabilitation, might greatly improve workers’ quality of life.


See the CDC Report