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The Effect of Occupational Noise Exposure on Tinnitus and Sound-Induced Auditory Fatigue Among Obstetrics Personnel: a Cross-Sectional Study

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The Effect of Occupational Noise Exposure on Tinnitus and Sound-Induced Auditory Fatigue Among Obstetrics Personnel: a Cross-Sectional Study Open Access Research BMJ Open: first published as 10.1136/bmjopen-2014-005793 on 27 March 2015. Downloaded from The effect of occupational noise exposure on tinnitus and sound-induced auditory fatigue among obstetrics personnel: a cross-sectional study Sofie Fredriksson,1 Oscar Hammar,1 Kjell Torén,1 Artur Tenenbaum,2 Kerstin Persson Waye1 To cite: Fredriksson S, ABSTRACT et al Strengths and limitations of this study Hammar O, Torén K, . Objective: There is a lack of research on effects The effect of occupational of occupational noise exposure in traditionally ▪ noise exposure on tinnitus The vast majority of previous research into noise- female-dominated workplaces. Therefore, the aim of and sound-induced auditory induced hearing disorders has been performed in fatigue among obstetrics this study was to assess risk of noise-induced industrial-like settings, whereas practically nothing personnel: a cross-sectional hearing-related symptoms among obstetrics is known of risks in non-industrial, traditionally study. BMJ Open 2015;5: personnel. female-dominated and communication-intense e005793. doi:10.1136/ Design: A cross-sectional study was performed at workplaces, such as hospitals. As such, this study bmjopen-2014-005793 an obstetric ward in Sweden including a presents novel results on occupational noise questionnaire among all employees and sound level exposure and hearing among obstetrics personnel. ▸ Prepublication history and measurements in 61 work shifts at the same ward. ▪ Both objective sound level measurements and additional material is Participants: 115 female employees responded to a analysis of subjective data indicate an increased available. To view please visit questionnaire (72% of all 160 employees invited). risk of noise-induced hearing-related symptoms. the journal (http://dx.doi.org/ Main outcome measures: Self-reported ▪ Owingtothestudy’s cross-sectional design the 10.1136/bmjopen-2014- hearing-related symptoms in relation to calculated influence of participants’ age cannot be 005793). occupational noise exposure dose and measured disentangled. ▪ Received 26 May 2014 sound levels. The study sample size and the cross-sectional Revised 28 October 2014 Results: Sound levels exceeded the 80 dB LAeq design without an unexposed control group limits http://bmjopen.bmj.com/ Accepted 30 October 2014 limit for protection of hearing in 46% of the the generalisation of the results and prevents us measured work shifts. One or more hearing-related from drawing definite conclusions on causality. symptoms were reported by 55% of the personnel. ▪ Further studies are needed to confirm the results In logistic regression models, a significant and assess the magnitude of the problem. association was found between occupational noise However, we suggest that occupational healthcare exposure dose and tinnitus (OR=1.04, 95% CI 1.00 services implement available preventative actions to 1.09) and sound-induced auditory fatigue such as making hearing protective devices avail- (OR=1.04, 95% CI 1.00 to 1.07). Work-related stress able for personnel as an act of precaution. and noise annoyance at work were reported by on September 26, 2021 by guest. Protected copyright. almost half of the personnel. Sound-induced auditory INTRODUCTION fatigue was associated with work-related stress and noise annoyance at work, although stress slightly Occupational noise exposure and effects on missed significance in a multivariable model. No hearing are well described in industrial-like, 1 significant interactions were found. traditionally male-dominated settings. In con- 1Department of Public Health Conclusions: This study presents new results trast, few studies have reported on traditionally and Community Medicine, showing that obstetrics personnel are at risk of female-dominated work environments. This Occupational and noise-induced hearing-related symptoms. Current has been acknowledged by the European Environmental Medicine, exposure levels at the workplace are high and Agency for Safety and Health at Work, who University of Gothenburg, occupational noise exposure dose has significant conclude that areas such as health and social Gothenburg, Sweden effects on tinnitus and sound-induced auditory 2Occupational Health Care services are largely overlooked concerning 2 Unit (Hälsan & Arbetslivet), fatigue among the personnel. These results indicate noise research, and that the noise in these Skaraborg Hospital, Skövde, that preventative action regarding noise exposure types of workplaces may interfere with per- is required in obstetrics care and that risk Sweden formance and well-being. High sound levels, assessments may be needed in previously unstudied Correspondence to non-industrial communication-intense sound regardless of their source, can cause hearing Sofie Fredriksson; environments. loss, tinnitus and sound sensitivity, and may [email protected] also result in sound-induced auditory fatigue, Fredriksson S, et al. BMJ Open 2015;5:e005793. doi:10.1136/bmjopen-2014-005793 1 Open Access BMJ Open: first published as 10.1136/bmjopen-2014-005793 on 27 March 2015. Downloaded from the latter described by participants as avoidance of every- overlap. A convenient sample of 10 employees per shift – day sounds and a need for silence.137 The symptom each wore a personal dosimeter (Larson Davis 705+), ‘sound-induced auditory fatigue’ was first identified in with the microphone attached to the right shoulder, and pilot studies, interviewing preschool personnel, and later kept a written log documenting work activities during shown to be prevalent in questionnaire surveys.7 We the measured shift. A total of 610 separate measure- hypothesise the symptom to be a result of constant or over- ments were collected, as 10 individuals each wore a dos- loading stimulation of sounds during the day. The effect imeter during the 61 shifts measured. However, due to may possibly be due to the high information content, technical errors, a few faulty measurements were mainly of speech, such that overload is not merely a excluded, leaving 529 (87%) to be included in the ana- consequence of the sound energy as seen in auditory lysis. The dosimeters were set to measure A-weighted threshold shift, but as a result of an information-intense equivalent and maximum (fast) levels with a sampling sound environment. Apart from hearing-related symp- interval of 30 s. All dosimeters were calibrated using the toms, noise exposure can also evoke non-auditory effects software Blaze V.5.06 before measurements began. The such as annoyance and stress.8 According to a recent equivalent levels reported refer to the full-shift length meta-analysis, noise levels in hospitals have steadily and will hence vary between 7.25 and 10 h, hereinafter 9 increased since the mid-1960s. One heavily female- denoted as LAeq(7–10 h). Sound levels were analysed at dominated workplace in the hospital is in the area of group level as arithmetic mean and compared to obstetrics care. According to data from Statistics Sweden in Swedish Work Authorities’ exposure regulations. Sound 2011, more than 99% of midwives are women. One peer- levels exceeding the lower action level of 80 dB reviewed study reported on sound level measurements in a LAeq(8 h) indicate a risk for hearing damage and the hospital in India, where the highest nighttime level employer is responsible to take preventative action, such (71.9 dB LAeq) was measured in the obstetrics and gynae- as providing employees with hearing protection devices 10 cology ward, with slightly lower levels in the labour ward. (HPDs). The exposure limits 85 dB LAeq(8 h) and In addition to potentially harmful noise levels in the 115 dB LAFmax are set as a maximum allowed level, obstetrics care area, midwives report a high degree of above which the employer is required to take measures work-related stress and burnout,11 and, according to a in order to reduce the noise exposure, and where the recent report, burnout syndrome has doubled among use of HPDs are mandatory. Employees must not be midwives employed in the western region of Sweden exposed to noise levels at or above the exposure limits during the last few years.12 The fact that obstetrics per- (taking attenuation of HPDs into account). sonnel are exposed to high levels of stress may be important when considering noise exposure at the work- Questionnaire survey place, since the combination of these exposures may All personnel (n=160, all women) employed at the – http://bmjopen.bmj.com/ interact in causing adverse health effects.13 15 general obstetrics ward were included in a questionnaire There is a substantial lack of knowledge regarding survey. A total of 115 (72%) participated by responding occupational noise exposure, noise annoyance at work either electronically (n=63) or in paper format (n=52), and hearing-related symptoms among obstetrics care and these data were pooled together, as no statistical personnel, as well as possible interaction effects between differences were seen on explanatory or outcome vari- noise exposure, noise annoyance at work and work- ables (p>0.05). The questionnaire was constructed using related stress. Therefore, the aim of this study was to items specifically constructed for this study as well as assess the risk of noise-induced hearing-related symp- items adapted from previous studies and international toms among obstetrics personnel by measuring sound standards (ISO/TS 15666).716Similar self-reported items on September 26, 2021 by guest. Protected copyright. levels in the labour
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