Chart Book (6th edition): Occupational Diseases – Noise-Induced Hearing Loss in Construction and Other Industries
50. Noise-Induced Hearing Loss in Construction and Other Industries
Every year, thousands of construction workers suffer hearing loss from excessive noise exposure on the job. Noise-induced hearing loss (NIHL; see Glossary) affects workers’ quality of life and increases the risk of injury – for instance, when a worker cannot hear approaching vehicles or warning signals.1 The U.S. Occupational Safety and Health Administration (OSHA) set the permissible exposure limit (PEL; see Glossary) for construction noise to 90 A-weighted decibels (dBA; see Glossary) over an eight-hour period.2 However, NIHL often results from extended exposure to sound levels at or above 85 dBA, and can even occur at lower exposure levels.3 The National Institute for Occupational Safety and Health (NIOSH) recommended exposure level (REL; see Glossary) is 85 dBA for an eight-hour period,4 but noise exposure in construction may exceed this standard (see page 32).
Even if employees experience noise levels at or above OSHA’s PEL, employers have no obligation to test workers’ hearing (audiometric testing) on job sites.5 As a result, hearing loss among construction workers is rarely recognized as work-related. From 2011 to 2015, the U.S. Bureau of Labor Statistics (BLS) reported only 900 cases of NIHL in construction through the Survey of Occupational Injuries and Illnesses,6 and the rate was just 0.1 per 10,000 full-time equivalent workers in 2015 (FTEs; see Glossary; chart 50a). These numbers are too small for a valid conclusion.
In spite of this, according to the 2015 National Health Interview Survey (NHIS), a large household survey in the U.S., at least one in five (20.4%) construction workers reported some hearing trouble (see Glossary), 30% higher than that for all industries combined (15.7%; chart 50b). Yet, information about whether hearing loss was induced by the respondent’s job is unavailable in the current NHIS data.
To develop a national surveillance system for occupational hearing loss, NIOSH has collected millions of de-identified audiograms from thousands of workplaces across the nation.7 The results from the NIOSH database indicate that construction workers have the highest prevalence of hearing loss of any industry except for mining. Among construction workers tested between 2003 and 2012, 16.3% had hearing impairment (see Glossary) compared to 12.9% among all industries (chart 50c). It is estimated that hearing loss leads to more than three disability-adjusted life years (DALYs; see Glossary) per 1,000 construction workers, the second highest among all industries (chart 50d).
Hearing loss increases with age. Among construction workers ages 18-25 years surveyed by NIOSH, only less than 2% had hearing impairment. However, among those ages 56-65 years, nearly half (48.6%) had some hearing impairment (chart 50e).
Hearing loss varies by occupation. Findings from the Building Trades National Medical Screening Program (BTMed), which examined construction workers with an average of more than 20 years of occupational exposure, show that over 58% of construction workers examined between 1996 and 2015 had material hearing impairment (1998 NIOSH definition, see Glossary); among welders, it was 77% (chart 50f).
Under most circumstances, NIHL is preventable. Research suggests that hearing protection in construction can and should be improved through education, training, quieter tools, and predictive analytics.8 For example, encouraging construction workers to use the NIOSH Sound Level Meter App (download the free app) can raise their awareness about noise hazards in the work environment.9 Moreover, integrating hearing protection devices (HPD) training into multi-component construction interventions has proven effective, resulting in substantial improvement in use of HPD among participants.10
(Click on the image to enlarge or download PowerPoint or PDF versions below.)
Hearing trouble – Hearing trouble refers to workers who answered the National Health Interview Survey (NHIS) question, “Without the use of hearing aids or other listening devices, is your hearing excellent, good, a little trouble hearing, moderate trouble, a lot of trouble, or are you deaf,” with “a little trouble”, “moderate trouble”, “a lot of trouble”, or “deaf”.
Hearing impairment – Hearing impairment refers to the 2013 Global Burden of Disease study definition of hearing loss as an average decibel hearing threshold of at least 20 across 500, 1,000, 2,000, and 4,000 Hz in the better ear.
Material hearing impairment – Material hearing impairment refers to the 1998 NIOSH definition of hearing loss as an average overall hearing threshold of at least 25 decibels averaged over 1,000, 2,000, 3,000, and 4,000 Hz in both ears.
DALYs – Refers to the number of years living with a disability, and is intended to measure the gap between actual and ideal health in a population. World Health Organization. Metrics: Disability-Adjusted Life Year (DALY), http://www.who.int/healthinfo/global_burden_disease/metrics_daly/en/ (Accessed September 2017).
Recommended Exposure Limit (REL) – A recommended exposure limit by the National Institute for Occupational Safety and Health which is based on risk evaluations using human or animal health effects data as well as an assessment of what can be feasibly achieved by engineering controls and measured by analytical techniques.
Full-time equivalent workers (FTEs) – It is used to convert the hours worked by part-time employees into the hours worked by full-time employees for risk comparison. FTEs is determined by the hours worked per employee on a full-time basis assuming a full-time worker working 40 hours per week, 50 weeks per year, or 2,000 hours per year, https://www.bls.gov/iif/oshdef.htm.
1. Masterson E, Themann C, Luckhaupt S, Li J, Calvert G. 2016. Hearing difficulty and tinnitus among U.S. workers and non-workers in 2007. American Journal of Industrial Medicine, 59(4): 290-300.
2. Occupational Safety and Health Administration. Safety and Health Regulations for Construction, Part 1926, http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10625 (Accessed September 2017).
3. Better Hearing Institute, http://www.betterhearing.org/ (Accessed September 2017).
4. National Institute for Occupational Safety and Health. Noise and hearing loss prevention, https://www.cdc.gov/niosh/topics/noise/default.html (Accessed September 2017).
5. Masterson E, Bushnell P, Themann C, Morata T. 2016. Hearing impairment among noise-exposed workers- United States, 2003-2012. Morbidity and Mortality Weekly Report (MMWR), 65(15): 389-394.
6. U.S. Bureau of Labor Statistics. 2011-2015 Survey of Occupational Injuries and Illnesses, https://www.bls.gov/iif/oshsum.htm (Accessed September 2017).
7. National Institute for Occupational Safety and Health. Occupational hearing loss surveillance, https://www.cdc.gov/niosh/topics/ohl/status.html (Accessed September 2017).
8. Schneider S. 2016. Preventing hearing loss in construction in the USA: Challenges and opportunities. Acoustics Australia, 44(1): 83-85.
9. National Institute for Occupational Safety and Health. Noise and hearing loss prevention: NIOSH sound level meter app, https://www.cdc.gov/niosh/topics/noise/app.html (Accessed September 2017).
10. Royster J. 2017. Preventing noise-induced hearing loss. North Carolina Medical Journal, 78(2): 113-117.
Charts 50c and e – Normal hearing is defined as a threshold of less than 20 decibels; mild impairment: 20-34 decibels; moderate: 35-49, severe: 50-64; profound: 65+.
Chart 50a – U.S. Bureau of Labor Statistics. 2004-2015 Survey of Occupational Injuries and Illnesses, https://www.bls.gov/iif/oshsum.htm (Accessed August 2017).
Chart 50b – National Center for Health Statistics. 2015 National Health Interview Survey. Calculations by the CPWR Data Center.
Charts 50c-d – Masterson E, Bushnell P, Themann C, Morata T. 2016. Hearing impairment among noise-exposed workers – United States, 2003-2012. Table 3. Morbidity and Mortality Weekly Report (MMWR), 65(15): 389-394.
Chart 50e—National Institute for Occupational Safety and Health. Occupational Hearing Loss (OHL) Worker Surveillance Data, https://www.cdc.gov/niosh/data/datasets/sd-1001-2014-0/default.html (Accessed November 2017). Calculations by the CPWR Data Center.
Chart 50f – BTMed disease prevalence: Exams completed through 2015. Contact: John Dement, Duke University Medical Center.