Occupational noise exposure, noise annoyance, hearing-related symptoms, and emotional exhaustion - a participatory-based intervention study in preschool and obstetrics care.

A participatory-based intervention was performed in Sweden, aimed at improving the sound environment in one preschool (n = 20) and one obstetric ward (n = 50), with two controls each (n = 28, n = 66). Measured sound levels, and surveys of noise annoyance, hearing-related symptoms and emotional exhaustion were collected before, and three and nine months after the interventions, comparing intervention and control groups over time. The results of this first implementation in a limited number of workplaces showed significantly worsening of hyperacusis, sound-induced auditory fatigue, emotional exhaustion and increased sound levels in the preschool, and worsening of noise annoyance in both intervention groups. Increased risk awareness, limited implementation support and lack of psychosocial interventions may explain the worsening in outcomes, as might the worse baseline in the intervention groups. The complexity of the demands in human-service workplaces calls for further intervention studies.

Occupational and environmental noise exposure during pregnancy and rare health outcomes of offspring: a scoping review focusing on congenital anomalies and perinatal mortality.

As environmental and occupational noise can be health hazards, recent studies have investigated the effects of noise exposure during pregnancy. Despite biological plausibility and animal studies supporting an association, studies focusing on congenital anomalies and perinatal mortality as outcomes of noise exposure are still scarce. We performed a scoping review to collect, summarise, and discuss the existing scientific research about the relationships between noise exposure during pregnancy and congenital anomalies and/or perinatal mortality. We searched electronic databases for papers published between 1970 and March 2021. We included 16 studies (seven on congenital anomalies, three on perinatal mortality, and two on both congenital anomalies and perinatal mortality). We assessed four studies on congenital hearing dysfunction as the definition of congenital anomalies includes functional anomalies. We found few studies on this topic and no studies on the combined effects of occupational and environmental noise exposures. Evidence suggests a small increase in the risk of congenital anomalies in relation to occupational and to a lesser extent environmental noise exposure. In addition, few studies investigated perinatal mortality and the ones that did, used different outcome definitions, so no conclusions could be made. However, a recent big cross-sectional study demonstrated an association between road traffic noise and stillbirth. A few studies suggest a possible association between congenital hearing dysfunction and occupational noise exposure during pregnancy. Future studies with larger samples, better exposure assessments, and better statistical modelling strategies are needed to investigate these relationships further.

The Impact of Occupational Noise Exposure on Hyperacusis: a Longitudinal Population Study of Female Workers in Sweden.

OBJECTIVES: The aim was to assess the risk of hyperacusis in relation to occupational noise exposure among female workers in general, and among women working in preschool specifically. DESIGN: A retrospective longitudinal study was performed. Survey data were collected in 2013 and 2014 from two cohorts: randomly selected women from the population in region Västra Götaland, Sweden, and women selected based on having received a preschool teacher degree from universities in the same region. The final study sample included n = 8328 women born between 1948 and 1989. Occupational noise exposure was objectively assigned to all time periods from the first to the last reported occupation throughout working life, using the Swedish Job-Exposure Matrix (JEM) with three exposure intervals: <75 dB(A), 75 to 85 dB(A), and >85 dB(A). The JEM assigns preschool teachers to the 75 to 85 dB(A) exposure interval. The outcome hyperacusis was assessed by self-report using one question addressing discomfort or pain from everyday sounds. In the main analysis, a hyperacusis event was defined by the reported year of onset, if reported to occur at least a few times each week. Additional sensitivity analyses were performed using more strict definitions: (a) at least several times each week and (b) every day. The risk (hazard ratio, HR) of hyperacusis was analyzed in relation to years of occupational noise exposure, using survival analysis with frailty regression modeling accounting for individual variation in survival times which reflect, for example, noise exposure during years prior to onset. Occupational noise exposure was defined by the occupation held at year of hyperacusis onset, or the occupation held at the survey year if no event occurred. Models were adjusted for confounders including age, education, income, family history of hearing loss, and change of jobs due to noise. RESULTS: In total, n = 1966 hyperacusis events between 1960 and 2014 were analyzed in the main analysis. A significantly increased risk of hyperacusis was found among women working in any occupation assigned to the 75 to 85 dB(A) noise exposure group [HR: 2.6, 95% confidence interval (CI): 2.4-2.9], compared with the reference group <75 dB(A). The risk was tripled among preschool teachers specifically (HR: 3.4, 95% CI: 3.0-3.7), with the crude Kaplan-Meier curve showing a higher rate of onset early in the working life in preschool teachers compared with all the other exposure groups. The risk was increased, but not statistically significant in the main analysis, for the highest exposure group >85 dB(A), where only six hyperacusis events were identified (HR: 1.4, 95% CI: 0.6-3.1). In the sensitivity analysis, where hyperacusis was defined as occurring every day, the HR was significant also in the highest exposure group (HR: 3.8, 95% CI: 1.4-10.3), and generally slightly higher in the other exposure groups compared to the main analysis. CONCLUSIONS: This study indicates increased risk of hyperacusis already below the permissible occupational noise exposure limit in Sweden (85 dB LAeq,8h) among female workers in general, and in particular among preschool teachers. Prospective studies and less wide exposure intervals could confirm causal effects and assess dose-response relationships, respectively, although this study at present suggest a need for risk assessment, improved hearing prevention measures, and noise abatement measures in occupations with noise levels from 75 dB(A). The results could also have implications for management of occupational disability claims.

Working in preschool increases the risk of hearing-related symptoms: a cohort study among Swedish women.

PURPOSE: To assess whether working in preschools increases the risk of hearing-related symptoms and whether age, occupational noise, and stressful working conditions affect the risk. METHODS: Questionnaire data on hearing-related symptoms were analysed in women aged 24-65 (4718 preschool teachers, and 4122 randomly selected general population controls). Prevalence and risk ratio (RR) of self-reported hearing loss, tinnitus, difficulty perceiving speech, hyperacusis and sound-induced auditory fatigue were assessed by comparing the cohorts in relation to age and self-reported occupational noise and stressful working conditions (effort-reward imbalance and emotional demands). RR was calculated using log-binomial regression models adjusted for age, education, income, smoking, hearing protection, and leisure noise. Incidence rates and incidence rate ratios (IRR) were calculated for retrospectively reported onset of all symptoms except sound-induced auditory fatigue. RESULTS: Compared to the controls, preschool teachers had overall more than twofold RR of sound-induced auditory fatigue (RR 2.4, 95% confidence interval 2.2-2.5) and hyperacusis (RR 2.3, 2.1-2.5) and almost twofold for difficulty perceiving speech (RR 1.9, 1.7-2.0). Preschool teachers had a threefold IRR of hyperacusis (IRR 3.1, 2.8-3.4) and twofold for difficulty perceiving speech (IRR 2.4, 2.2-2.6). Significantly although slightly less increased RR and IRR were observed for hearing loss and tinnitus. RR and IRR were generally still increased for preschool teachers when stratified by age and occupational exposure to noise and stress. CONCLUSIONS: This large cohort study showed that working as preschool teacher increases the risk of self-reported hearing-related symptoms, indicating a need of preventative measures.