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Using Total Worker Health® Concepts to Address Hearing Health

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Using Total Worker Health® Concepts to Address Hearing Health Using Total Worker Health® Concepts to Address Hearing Health Description of Noise such as hearing loss, tinnitus (ringing Summary in the ears), and hyperacusis (abnormal Exposure sensitivity to sound). Exposure to hazardous types and Hearing health is important in all stag- levels of noise is common both at Among the risk factors we can con- es of life, and many factors influence work and in daily life. Therefore, trol, the single most important is expo- hearing health. Each individual is on while protecting workers on the sure to loud noise. Exposures are not a personal “hearing health trajectory” job is very important, it is also im- restricted to the workplace; exposures – a lifelong path in which genetic, bi- portant to raise awareness and en- occur throughout our lifetime in our ological, behavioral, environmental, courage protective behavior outside communities and home environment. of work. In addition, other risk fac- and social factors over time contribute tors—both on and off the job—can to hearing ability as life progresses [Da- interact with noise to increase or de- vis et al. 2016]. This trajectory begins at Health Effects of crease risk. Through its Total Work- conception and is influenced by health, er Health® (TWH) Program, the Na- socio-economic factors, disease, genet- Noise Exposure tional Institute for Occupational Safe- ics, injury, access to health care, life- In addition to hearing loss, overexposure ty and Health (NIOSH) recommends style choices (e.g., smoking, diet), rec- to noise can cause tinnitus and hyper- an integrated approach to address the reational activities (e.g., motorcycling, acusis. Noise is a nonspecific biological hearing health of workers. An inte- concerts, loud sports), environmental stressor; as such, it can cause reactions grated approach is a comprehensive conditions, and occupational exposures in other bodily system as well. Exposure consideration of risk factors intended [Davis et al. 2016]. These elements in- to high noise levels can cause adverse to protect workers from work-related teract to influence how well one will be changes in blood pressure and chemis- injury and illness and help them ad- able to hear as he or she ages. Although try [Themann et al. 2013a]. Noise and vance their overall health and well- some of the factors are difficult (if not hearing loss have been associated with being, on and off the job. The -ap impossible) to control (like ageing it- a wide variety of health problems, rang- proach includes addressing expo- self), many can be modified to reduce ing from stress and hypertension to de- sures at work, environmental factors, the risk of hearing loss. These include pression. Symptoms such as headaches, and personal factors [NIOSH 2018c]. disease prevention, good nutrition and irritability, increased tension, fatigue, This Workplace Solutions document physical fitness, limiting exposures to sleep disorders, and cardiovascular dis- focuses on the application of TWH hazards, and participating in hearing ease have also been described. Noise can concepts to promote better hearing loss prevention programs at work. A sometimes lead to performance decre- health and reduce the risks associated comprehensive, integrated approach to ments (especially for complex or simul- with noise exposure. health is needed to effectively prevent taneous tasks) and has been associated or reduce the risk of auditory disorders with increased accident risk and absen- Centers for Disease Control and Prevention National Institute for Occupational Safety and Health Photo by ©fotokostic/Getty Images teeism [NIOSH 2011; Themann et al. 2013a]. Implementing NIOSH Recommended Exposure Limit strategies that minimize noise exposure could have positive health effects beyond hearing health. NIOSH establishes recommended exposure limits (RELs) for various hazards on the basis of the best available science and practice. The NIOSH REL for noise is 85 decibels, using Exposure Limits the A-weighted frequency response (often written as dB(A) In the United States, occupational regulations and standards or dBA) averaged over an 8-hour workday—usually referred were established to protect workers against the health effects to as the time-weighted average (TWA). The A-weighting of of exposure to hazardous substances and agents when cer- noise levels is used to provide a rating that indicates the in- tain values (or limits) are reached. Note that the exposure jurious effects of noise on human hearing. Exposures at or limits for noise have been established to prevent hearing above the REL are considered hazardous [NIOSH 1998]. loss caused by repeated exposure to excessive noise. Other NIOSH recommends a 3 dB exchange rate, or time-intensity health effects (e.g., stress, cardiovascular disease) may occur trade-off, for occupational noise exposure. This means that at lower levels, and other risk factors (e.g., ototoxic expo- sures, overall physical health) may alter one’s personal hear- for every 3 dB increase in exposure level, the allowable ex- ing loss risk. posure time is halved; for example, when the noise level in- creases from 85 dBA to 88 dBA, the allowable exposure time decreases from 8 hours to 4 hours. The 3 dB exchange rate OSHA Permissible Exposure Limit is based on the equal energy principle: with every 3 dB in- The Occupational Safety and Health Administration (OSHA) crease in noise level, the energy is doubled and therefore the permissible exposure limit (PEL) for noise is 90 dBA, and exposure time is halved. Table 1 shows allowable exposure the action level (AL) is 85 dBA, both as an 8-hour TWA us- times for various noise levels under the NIOSH REL. ing a 5-dB exchange rate [Occupational Noise Exposure 29 CFR 1910.95]. This means that hearing protection, admin- Exposure limits are not always set at levels that will protect istrative controls, and annual monitoring are required when the entire exposed population. In setting the REL for noise, exposures exceeed the AL, and engineering controls are re- NIOSH acknowledged that 8% of the noise-exposed popu- quired when exposures exceed the PEL. The OSHA occu- lation could still develop a hearing loss if exposed over a 40- pational noise standard also mandates that exposures to year working lifetime to average daily noise levels of 85 dBA. impact or impulsive noise not exceed 140 dB peak sound Because individual susceptibility to noise exposure varies, pressure level.* NIOSH recommends the use of hearing protection when- ever noise levels exceed 85 dBA—regardless of exposure du- *The MSHA rule (30 CFR Part 62) is similar to OSHA’s. ration. 2 Table 1. Allowable exposure times ANSI/ASA 2013]. Occupational hearing loss is one of the under the NIOSH REL most common work-related illnesses in the United States. According to the National Health Interview Survey, 24% of Time to reach maximum cases of hearing difficulty among the working population are daily allowable noise dose attributable to workplace exposures [Tak and Calvert 2008]. Exposure level (per NIOSH REL) Hearing loss is prevalent in many industries—both those 85 dBA 8 hours traditionally associated with noise exposure (such as man- 88 dBA 4 hours ufacturing, construction, and mining) as well as industries 91 dBA 2 hours generally assumed to have minimal risk of noise exposure (such as real estate and health care) [Masterson et al. 2013, 94 dBA 60 minutes 2015]. 97 dBA 30 minutes Many workers do not use hearing protection because they 100 dBA 15 minutes think it interferes with communication or warning signals. Other workers may adopt a fatalistic attitude and believe EPA that hearing loss is inevitable or that management is not concerned about their hearing health [Morata et al. 2005]. The United States Environmental Protection Agency (EPA) recommends maintaining environmental noises below 70 dBA (averaged over 24 hours) to prevent hearing loss in Research on Noise Exposure: the general population [EPA 1974]. This recommendation is based on evidence available at the time; EPA used the Environmental/Non-work Factors same scientific evidence and the same equal-energy rule that Noise levels during some daily activities (for example, mow- NIOSH used in setting its REL. Also like the NIOSH REL, ing the lawn or waiting for an approaching subway) and the EPA assumed 40-year lifetime exposures in making its some recreational activities (such motorcycling or listen- recommendations. ing to a personal music player) can exceed 70 or even 85 dBA. Some hobbies (such as hunting, target shooting, con- The difference between the NIOSH REL and the EPA rec- ommendation for environmental noise exposures is due to certs, or setting off fireworks) can exceed 140 dB and are several key factors. The NIOSH REL assumes an 8-hour ex- loud enough to trigger immediate auditory disorders. The posure (during the workshift) with time for the ear to recov- NIOSH Hearing Loss and Prevention Topic Page [NIOSH er before the next exposure; the EPA limit is averaged over 2018b] shows the decibel levels from various daily activities 24 hours with no time between exposures. In addition, the and other noise sources. CDC Vital Signs and the CDC Na- NIOSH limit is based on exposure for 250 working days a tional Center for Environmental Health [CDC 2017, 2019] year, whereas the EPA limit is based on exposures for 365 also have information about decibel levels and sources of po- days a year. Finally, the NIOSH REL is set at a level that will tential hearing loss. protect 92% of workers, whereas the EPA limit is set at a lev- el that will protect 96% of the population [NIOSH 2016b]. Studies of populations who are not exposed to noise at work show a much lower risk of hearing difficulties than popu- lations exposed at work [Masterson et al. 2016], and some WHO studies show no group effects for those exposed to recre- The World Health Organization [WHO] also recommends ational noise or music [Neitzel et al.
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