PREVALENCE AND ASSOCIATED FACTORS OF HEARING LOSS AMONG WORKERS EXPOSED TO NOISE COMBINED WITH TOLUENE AND XYLENE IN SAMUT PRAKAN PROVINCE, THAILAND
Keywords:
Noise, Ototoxicity, Hearing loss, Toluene, XyleneAbstract
This cross-sectional study aimed to examine the prevalence and associated factors of hearing loss among 93 workers exposed to noise levels ≥85 dBA and ototoxic chemicals. Data were collected through interviews, noise exposure assessments, air sampling for the evaluation of toluene and xylene exposure, and audiometric testing. Descriptive statistics, chi-square tests, and logistic regression analyses were used for data analysis. The results revealed a hearing loss prevalence of 54.8%. Factors that are significantly associated with hearing loss include age >35 years (p<0.01, OR=3.294), alcohol consumption (p<0.05, OR=0.403), use of hearing protection devices (p<0.05, OR=0.163), and exposure to toluene and xylene (p<0.001, OR=6.345). Multivariate logistic regression analysis indicated that workers aged >35 years had a 4.8 times higher risk of hearing loss compared to younger workers (p<0.05, aOR=4.785), while exposure to toluene and xylene at levels >0.5 OEL (mixture) increased the risk by 8.2 times (p<0.001, aOR=8.266). These findings suggest that co-exposure to ototoxic chemicals and high noise levels may contribute to a higher risk of hearing loss. Therefore, it is essential to raise awareness and promote proper preventive measures among industrial facilities and workers to mitigate the hazards associated with combined chemical and noise exposure.
References
World Report on hearing. World Health Organization, Department of Noncommunicable Diseases, 2021 https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss
รายงานสถานการณ์ โรคและภัยสุขภาพจากการประกอบอาชีพและสิ่งแวดล้อม ปี 2560. สำนักโรคจากการประกอบอาชีพและสิ่งแวดล้อม กรมควบคุมโรค กระทรวงสาธารณสุข https://ddc.moph.go.th/doed/pagecontent.php?page=888&dept=doed
Le TN, Straatman LV, Lea J, Westerberg B. Current insights in noise-induced hearing loss: a literature review of the underlying mechanism, pathophysiology, asymmetry, and management options. J Otolaryngol Head Neck Surg. 2017;46(1):41.
กรมสวัสดิการและคุ้มครองแรงงาน. มาตรฐานระดับเสียงที่ยอมให้ลูกจ้างได้รับเฉลี่ยตลอดระยะเวลาการทำงาน. 2561;135 ตอนพิเศษ 19 ง.:15–6.
Blair M, Slagley J, Schaal NC. Effect of noise and ototoxicants on developing standard threshold shifts at a U.S. Air Force depot level maintenance facility. J Occup Environ Hyg [Internet]. 2021 [cited 2023 Apr 6];18(7):323–33. Available from: https://pubmed.ncbi.nlm.nih.gov/34100693/
Campo, P., Morata, T. C., & Hong, O. (2013). "Chemical exposure and hearing loss." The Journal of Occupational Health, 55(3), 210-222.
Campo Pierre, Maguin Katy, Gabriel Stefan, Möller Angela, Nies Eberhard, Solé Gómez MDolores, et al. Combined exposure to noise and ototoxic substances. 2009 [cited 2023 Apr 6]; Available from: https://www.researchgate.net/publication/230765091_Combined_exposure_to_Noise_and_Ottoxic_Su bstances
Chang SJ, Chen CJ, Lien CH, Sung FC. Hearing loss in workers exposed to toluene and noise. Environ Health Perspect. 2006;114(8):1283–6. doi:10.1289/ehp.8959
Morata TC, Dunn DE, Kretschmer LW, Lemasters GK, Keith RW. Effects of occupational exposure to organic solvents and noise on hearing. Scand J Work Environ Health. 1993;19(4):245–254.
Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behav Res Methods. 2009;41(4):1149–60. doi:10.3758/BRM.
4.1149
Schaal N, Slagley J, Zreiqat M, Paschold H. Effects of combined exposure to metals, solvents, and noise on permanent threshold shifts. Am J Ind Med [Internet]. 2017 Mar 1;60(3):227–38. Available from: https://doi.org/10.1002/ajim.22690
Wantanee Phanprasit. Industrial hygiene: strategy, assessment, control and management. 2nd ed. 2017.
NIOSH Manual of Analytical Methods (NMAM), Fourth Edition. [cited 2023 Apr 17]; Available from: https://www.cdc.gov/niosh/docs/2003-154/pdfs/1501.pdf
Occupational Safety and Health Administration (OSHA). Occupational noise exposure: Appendix D—Audiometric test rooms. 29 CFR 1910.95 [Internet]. Washington, DC: U.S. Department of Labor; 2024 [cited 2025 May 6]. Available from: https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.95AppD
World Health Organisation Grades of hearing impairment (WHO, 2008) Available from: https://ec.europa.eu/health/scientific_committees/opinions_layman/en/hearing- loss-personal-music-player-mp3/figtableboxes/table-4.htm
ACGIH Board Ratifies 2024 TLVs and BEIs - ACGIH [Internet]. [cited 2024 May 23]. Available from: https://www.acgih.org/news_articles/acgih-board-ratifies-2021-tlvs-and-beis/
Huang, Q., & Tang, J. (2010). Age-related hearing loss or presbycusis. European Archives of Oto-rhino-laryngology, 267(8), 1179-1191.
18. Wu, T. N., Liou, S. H., Shen, C. Y., Hsu, C. C., Chao, S. L., Wang, J. D., ... & Ko, K. N. (2020). Surveillance of noise-induced hearing loss in Taiwan, ROC: A report of the PRESS-NHL results. Preventive Medicine, 30(2), 135-142.
Feder, K., Michaud, D., McNamee, J., Fitzpatrick, E., Davies, H., & Leroux, T. (2017). Prevalence of hazardous occupational noise exposure, hearing loss, and hearing protection usage among a representative sample of working Canadians. Journal of Occupational and Environmental Medicine, 59(1), 92-113.
Agrawal Y, Platz EA, Niparko JK. Risk factors for hearing loss in US adults: data from the National Health and Nutrition Examination Survey, 1999 to 2002. Otol Neurotol. 2009;30(2):139–145145.https://doi.org/10.1097/MAO.0b013e318192483c
Qian P, Zhao Z, Liu S, Xin J, Liu Y. Alcohol as a risk factor for hearing loss: A systematic review and meta-analysis. PLoS One. 2023;18(1):e0280641.
Hindmarch I, Kerr JS, Sherwood N. The effects of alcohol on the central nervous system in humans. Neuropharmacology. 1991;30(12):1351–1359.
Zhong C, Wang J, Liu H, Zhao Y. Inner ear blood-labyrinth barrier and its dysfunction. Front Cell Neurosci. 2022;16:827971.
Babarinde, J.A., Adeyemo, A.A. & Adeoye, A.M. Hearing loss and hypertension: exploring the linkage. Egypt J Otolaryngol 37, 98 (2021). https://doi.org/10.1186/s43163-021-00162-1 21. Hindmarch I, Kerr JS, Sherwood N. The effects of alcohol on the central nervous system in humans. Neuropharmacology. 1991;30(12):1351–1359.
Curhan SG, Eavey RD, Wang M, Stampfer MJ, Curhan GC. Alcohol consumption and self-reported hearing loss in women. Am J Epidemiol. 2015 Jan 15;181(2):96–105. doi: 10.1093/aje/kwu233
Centers for Disease Control and Prevention (CDC). Noise and Hearing Loss Prevention: Construction Statistics. 2023. Available from: https://www.cdc.gov/niosh/noise/surveillance/construction.html
Ramakers GGJ, Kraaijenga VJC, Cattani G, van Zanten GA, Grolman W. Effectiveness of earplugs in preventing recreational noise-induced hearing loss: a randomized clinical trial. JAMA Otolaryngol Head Neck Surg. 2016;142(6):551–558. doi:10.1001/jamaoto.2016.0225
Fuente A, McPherson B. Occupational noise-induced hearing loss in developing countries: a review of epidemiology and policies. Noise Health. 2012;14(57):70–76. doi:10.4103/1463-1741.97295
Campo P, Lataye R, Loquet G, Bonnet P. Toluene-induced hearing loss: a human and experimental study. Neurotoxicol Teratol. 2001;23(6):701–710.
Sliwinska-Kowalska M, Prasher D, Rodrigues C, Zamyslowska-Szmytke E, Szymczak W, Davis A Exposure to toluene and hearing disorders. Int J Occup Med Environ Health. 2001;14(2):247–256.
Johnson AC, Morata TC. Occupational exposure to chemicals and hearing impairment. Nordic Expert Group Document. 2010;142:1–133.
Fuente A, McPherson B. Central auditory processing effects induced by solvent exposure. Neurotoxicology. 2006;27 (6):867–878.
Sliwinska-Kowalska M, Zamyslowska-Szmytke E, Szymczak W, Kotylo P, Fiszer M, Wesolowski W, Pawlaczyk-Luszczynska M. Effects of organic solvent and noise exposure on hearing in dockyard painters. Occup Environ Med. 2003;60 (10):712–716.
Sliwinska-Kowalska M, Pawelczyk M. Contribution of exposure to solvents to hearing loss in noise- exposed workers. Occup Environ Med. 2013;70(11):772–8.
Rabinowitz PM. Noise-induced hearing loss. Am Fam Physician. 2000;61(9):2749–56.
Lie A, Skogstad M, Johannessen HA, Tynes T, Mehlum IS, Nordby K-C, et al. Occupational noise exposure and hearing: a systematic review. Int Arch Occup Environ Health. 2016;89(3):351–72.
Morata TC. Chemical exposure as a risk factor for hearing loss. J Occup Environ Med. 2003;45(7):676–682.
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