Industrial Health 2007, 45, 743–749 Original Article

The Effects of Noise on Hearing and Oxidative

Stress in Textile Workers
Ilhami YILDIRIM1*, Metin KILINC2, Erdogan OKUR1, Fatma INANC TOLUN2,
M. Akif KILIÇ1, Ergul Belge KURUTAS2 and Hasan Çetin EKERB ÇER3

1Department of Otorhinolaryngology, Medical Faculty, Kahramanmaras Sutcuimam University, Hastane cad.

No: 32, 46050 Kahramanmaras, Turkey
2Department of Biochemistry, Medical Faculty, Kahramanmaras Sutcuimam University, Turkey
3Department of Public Health, Medical Faculty, Kahramanmaras Sutcuimam University, Turkey

Received April 21, 2004 and accepted September 2, 2005

Abstract: The aim of this study was to investigate the effects of noise on hearing, lipid peroxi-
dation and antioxidant enzymes in textile workers. Thirty textile workers exposed to high noise
105 dB (A) in a textile factory, and 30 healthy male volunteers in our hospital as a control group
were included in the study. In both groups, following audiometric tests, blood samples were
obtained. In these blood samples, Malonydialdehyte (MDA), Superoxide dismutase (SOD) and
Catalase (CAT) levels were investigated. Statistical analysis was performed by using SPSS ver-
sion 11.0 (SPSS Inc., Chicago 1L) software program. Mean pure tone audiometric thresholds in
workers were significantly higher than in control subjects at frequencies 2,000, 4,000 and 6,000
Hz (p<0.05). Hearing losses were more evident at high frequencies (4–6 kHz) than at low fre-
quencies in worker group. (p<0.05). It was observed that textile workers with longer employment
duration had poorer hearing threshoulds and the hearing loss had started on those who had
worked for 5–8 yr. While MDA levels were significantly higher in workers than controls
(p<0.001), CAT activity was significantly lower (p<0.005). Also, SOD activity was lower in work-
ers but difference was not statistically significant. We observed a significant change in hearing
threshold of the textile workers compared with that of the control group. Increase in MDA level
and decreases in CAT and SOD activities in textile workers, support the opinion that the noise
causes the oxidative stress. The fact that noise both causes hearing loss and increases oxidative
stress suggests that there may be a relationship between the oxidative stress and hearing loss.
But, further studies are needed in order to verify this opinion.

Key words: Textile workers, Hearing loss, MDA, SOD, CAT

Introduction
Harmful effects of loud noise on human health are
known for many years. With industrialization, more peo-
ple are exposed to noise. Some problems including hear-
ing loss occur in the industrial workers who are exposed
to noise1–3). In a research study on a group of workers
at hydroelectric power plant, it was observed that marked
*To whom correspondence should be addressed.
This study was reported as oral presentation at 27th National Meeting
of the Turk Otorhinolaryngology and Head and Neck Surgery Society,
Antalya, Turkey, 4–9 October 2003.
hearing loss occured especially at 4–6 kHz and this loss
started within first 10 yr, showing a slow progress at fol-
lowing years3). The textile industry in which many peo-
ple are employed comprises an important part of our econ-
omy. It underwent boom in the past 6–7 yr in
Kahramanmaras, a leading city in textile industry, in
southeast part of Turkey. Generally, the weaving rooms
of textile factories are the most noisy places in a factory,
and the individuals working in these places are exposed
to 95 dB (A) and higher noise levels2, 4).
It has been suggested that inner ear damages may occur
due to oxidative stress as well as mechanical trauma in
the organ of corti depending on noise5) and in the exper-
744 I YILDIRIM et al.

imental researches, it has been shown that oxygen free depending on the employment duration (year) of noise
radicals increase in cochlea because of the oxidative exposure.
stress6, 7). In another study, It was pointed out that con- In both the textile workers and the control group, the
suming of endogenous antioxidant increased the hearing blood samples were obtained from the subjects after
loss in the experiment animals exposed to noise8). One overnight fasting. Blood samples were collected in plas-
of the indications of the occurrence of lipid peroxidation tic tubes containing k-EDTA. These samples were cen-
which also helps to estimate oxidative stress is the mea- trifuged at 2,000 rpm for 10 min and plasma was then
surement of malonyldialdehyte (MDA)9). Superoxide dis- separated. The obtained erythrocyte suspension was
mutase (SOD) and Catalase (CAT), on the other hand, are washed three times in cold 0.9%NaCl and centrifuged.
the antioxidant enzymes having a role in degrading and According to the types of analyses, hemolysate was pre-
eliminating the oxygen free radicals caused by lipid per- pared from the remaining erythrocyte suspension. The
oxidation10). plasma samples were stored at –20 ˚C and analysed with-
In this study, we aimed at investigating the effects of in 15 d.
noise on hearing of the textile workers exposed to long- Plasma MDA concentration was measured by the
term noise, and also on MDA levels, SOD and CAT method of Okawa with modification11), SOD activity was
enzyme activities in the blood. determined by the method described by Fridovic12), CAT
activity was determined by the method described by
Materials and Methods Beutler13).
Statistical analyses were performed by using SPSS ver-
Thirty textile workers working in a textile factory for sion 11.0 (SPSS Inc., Chicago) software program and a
eight hours a day, and 30 healthy male volunteers work- p value<0.05 was considered statistically significant.
ing at our hospital as a control group were included in
the study. Textile workers were working in the weaving Results
rooms of textile factory for 8 h a day. The average noise
level in the weaving rooms of the factory, which was mea- Mean pure tone audiometric thresholds were compared
sured in different places, was 105 dB (A) (Brüel&Kjær between worker and control groups at frequencies of
Sound Level Meter Type 2238, Denmark). Employment 250–6,000. Mean pure tone audiometric thresholds in
duration of workers in the textile factory changed from 1 workers were significantly higher than in control subjects
to 21 yr with a mean working period of 6.08 ± 4.16 yr. at frequencies 2,000, 4,000 and 6,000 Hz. (p<0.05)
Textile workers’ ages ranged from 22 to 43 yr with a (Table 1).
mean age of 27.67 ± 4.8 yr. Control group included 30 Textile workers were classified into three groups
volunteers working at our hospital for 8 h a day. depending on the employment duration (year) of noise
Employment duration of control group ranged from 2 to exposure. According to this classification, group I includ-
9 yr with a mean working period of 5.57 ± 1.83 yr. The ed 10 patients with the employment duration of less than
ages of control group ranged from 22 to 40 yr with a 5 yr; group II was consisted of 11 workers with the
mean age of 28.03 ± 4.29 yr. The average noise level at employment duration between 5 and 8 yr; group III was
our hospital, which was measured in different places, was composed of 9 workers with the employment duration of
68.5 dB (A) (Brüel&Kjær Sound Level Meter Type 2238, 9 yr and over. When compared to group I, poorer hear-
Denmark). The study was approved by the Sutcu Imam
University Local ethics committee and informed consent
was obtained from the workers and controls. Table 1. Comparing mean pure tone audiometric thresholds (dB
After taking the history of diseases and lifestyle from HL) of worker and control by six different frequencies
textile workers and control groups, otoscopic examination Frequencies Textile worker Control
p value
was performed. None of the patients and controls had (Hz) (n=30) (n=30)
any systemic diseases, history of alcohol and cigarette 250 13.10 ± 4.08 13.87 ± 5.08 NS
usage, sudden hearing loss and history of operation and 500 10.63 ± 4.66 12.38 ± 4.09 NS
trauma. 1,000 13.98 ± 7.97 11.58 ± 4.49 NS
Audiometric tests of workers and controls were per- 2,000 17.15 ± 13.54 9.50 ± 4.18 0.006
formed in hospital setting. Pure tone examinations 4,000 27.23 ± 17.23 14.02 ± 5.72 0.000
(250–6,000 Hz) were performed with Interacoustic 6,000 29.53 ± 14.34 17.55 ± 5.33 0.000
Clinical Audiometer AC 40 Model in sound treated booth
n: Number of subject.
(Industrial Acoustic Company, New York). For comparison, independent t-test was used.
Textile workers were classified into three groups NS: Not significant.

Industrial Health 2007, 45, 743–749

THE EFFECT OF NOISE ON HEARING 745

ing thresholds were found in group III at 4,000 Hz, and
in group II and III at 2,000 Hz (p<0.05). Also, the group
II and III had poorer hearing threshould at 6,000 Hz than
group I but difference between groups was not statisti-
cally significant (Table 2).
While MDA levels were found to be significantly high-
er in the study group than in the control group (p<0.001),
CAT activity was significantly lower (p<0.005). Also,
SOD activity was lower in study group than in control
group but difference was not statistically significant
(p>0.05) (Table 3).
According to hearing level, study group (textile work-
ers) was reclassified into two groups as follows: workers
with normal hearing or mild hearing loss less than 25 dB
and workers with hearing loss greater than 25 dB.
According to this classification, noise exposure duration
was 4.38 ± 2.48 yr in workers with normal hearing or mild
hearing loss and was 8.31 ± 4.91 yr in workers with hear-
ing loss greater than 25 dB. According to this new clas-
sification, MDA levels were significantly higher in work-
ers with normal hearing or mild hearing loss than in work-
ers with hearing loss (p<0.05). No statistical differences
for SOD and CAT activities were found between two
groups (p>0.05) (Table 4). The variables of age and
employment duration were not controlled during statisti-
cal analysis. In study and control subjects, mean ages
were similar, but mean employment duration of employ-
ment was not. Thus, to control for age and employment
duration, partial correlation coefficients were calculated
between MDA, SOD, CAT and hearing threshold. The
results are shown in Table 5. After controlling for age
and employment duration, the significant moderate corre-
lation coefficient (r=–0.43, p<0.05) between MDA and
hearing threshold became weaker and insignificant
(r=–0.37, p>0.05). Therefore, the t-test results in Table
4 must be interpreted carefully.
Pure tone audiometric thresholds according to age,
duration of employment workers and controls are shown
in Table 6.
Table 3. The mean values of MDA, SOD and CAT in workers and
control group

MDAa SODb CATc

Table 2. Mean hearing thresholds (dB HL) at all frequencies of (nmol/ml) (U/ghb) (×104 U/ghb)
textile workers classified into three groups depending on the employ-
ment duration (year) of noise exposure Worker 2.17 ± 1.09 1115.24 ± 281.02 6.9 ± 3.07
Control 1.37 ± 0.50 1203.19 ± 260.40 9.38 ± 3.68
Frequency Group I Group II Group III
(Hz) (0–4 yr, n=10) (5–8 yr, n=11) (9≥ yr, n=9) For comparisons, independent t-test was used.
a: p<0.001, b: p>0.05, c: p<0.005.
250 12.00 ± 5.71 12.95 ± 4.80 14.50 ± 6.54
500 8.65 ± 6.74 11.50 ± 5.30 11.78 ± 6.63 Table 5. Partial correlation coefficients
1,000 11.50 ± 7.45 16.14 ± 8.72 14.11 ± 8.21
n* r** p value
2,000 9.15 ± 9.42a 22.05 ± 14.77 20.06 ± 13.02
4,000 17.40 ± 10.07b 28.09 ± 19.46 37.11 ± 17.05 HL***-MDA 30 –0.37 NS
6,000 23.85 ± 12.47 30.23 ± 17.83 35.00 ± 14.85 HL-CAT 30 –0.05 NS
HL-SOD 30 –0.13 NS
n: Number of subjects.
For statistical comparisons, oneway ANOVA test was used. n*: Number of textile workers.
a: p<0.05, compared group I with group II and group III respectively. r **: Controlled for employment duration and age.
b: p<0.05, compared group I with group III. HL***: Hearing loss.

Table 4. The mean values of MDA, SOD and CAT in textile workers with
normal hearing or mild hearing loss less than 25 dB and those with hearing
loss greater than 25 dB

Workers with
p value
<25 dB (n=17) >25 dB (n=13)

MDAa (nmol/ml) 2.31 ± 1.53 1.46 ± 0.47 <0.05

CATb (×104 U/ghb) 7.67 ± 5.85 6.30 ± 3.9 NS

SODc (U/ghb) 1107.34 ± 285 1119.97 ± 297.80 NS

Age (yr) 26.94 ± 3.85 28.62 ± 5.85 NS

Employment duration (yr) 4.38 ± 2.48 8.31 ± 4.91 <0.05

For comparisons, independent t-test was used.
n: Number of textile workers.
NS: Not significant.
746 I YILDIRIM et al.

Table 6. Show the results of the all subjects including the age, working years, and hearing loss of the workers and controls
(1)

Textile Working Right ear (dB) Left ear (dB)

worker Age duration 250 500 1,000 2,000 4,000 6,000 250 500 1,000 2,000 4,000 6,000
subjects (yr) Hz Hz Hz Hz Hz Hz Hz Hz Hz Hz Hz Hz

MD 27 5 10 10 20 30 55 65 25 20 15 45 60 60

MP 37 14 15 10 10 5 45 40 20 20 10 5 35 20

EK 25 2 5 5 5 0 5 10 10 5 5 5 20 45

YE 33 7 10 10 10 15 50 25 10 10 5 10 25 10

AY 29 6 10 10 15 10 15 15 10 10 10 15 20 15

MD 23 5 15 10 25 35 5 25 10 10 30 40 10 20

OI 31 5 5 5 10 25 50 40 15 10 10 30 55 30

CD 24 5 10 15 20 40 55 70 15 20 25 35 55 55

AD 31 3 10 5 10 5 10 50 10 5 10 10 5 20

MU 30 6 15 15 15 10 20 20 15 10 15 10 33 20

OK 28 6 5 5 5 0 10 15 15 10 5 5 10 40

MG 24 5 15 10 20 20 20 25 20 20 25 20 20 15

EO 31 9 20 15 10 25 50 50 6 6 10 25 50 50

EC 28 10 10 15 25 25 45 35 15 10 20 15 25 15

MY 25 6 10 5 5 0 5 10 10 5 5 0 0 10

CY 29 5 10 20 35 40 35 30 10 18 25 40 40 35

MS 26 3 15 20 30 30 35 30 15 20 30 35 35 25

EA 43 21 15 10 5 15 25 30 25 20 5 15 35 40

TS 24 3 10 5 5 15 15 20 15 5 10 15 20 20

AP 25 3 5 5 5 0 10 20 10 5 5 0 28 20

ZO 22 7 15 5 20 30 35 20 15 18 10 20 40 25

AI 35 7 5 5 10 5 0 30 30 28 10 15 3 30

OC 24 1 5 5 10 5 10 25 10 10 5 0 0 5

YK 24 7 10 5 18 18 40 45 10 5 16 18 40 45

HS 25 4 20 5 10 5 28 40 30 28 20 10 28 40

MS 31 1 10 5 10 10 20 35 15 15 10 10 16 16

ET 23 1,5 10 5 15 10 10 10 10 5 10 10 18 10

MK 23 5 20 5 10 20 25 25 15 10 10 15 20 25

MA 25 7 20 5 25 50 60 55 10 15 35 50 65 65

MT 25 3 10 5 15 10 10 18 15 10 10 3 25 18

Discussion It was demonstrated that noise-induced hearing loss

Today, noise affects human health as an important
stress factor. With industrialization, more people have
been exposed to noise causing various health problems,
one of which is noise-induced hearing loss1).
occured on textile workers as well2, 14, 15). An evident
hearing loss occurs also in the textile workers, especial-
ly who are exposed to noise at 95 dB (A) or more when
compared to the group that are not exposed to any noise2).
Hearing loss, especially at high frequency, occurs in indi-

Industrial Health 2007, 45, 743–749

THE EFFECT OF NOISE ON HEARING 747

(2)

Working Right ear (dB) Left ear (dB)

Control
Age duration 250 500 1,000 2,000 4,000 6,000 250 500 1,000 2,000 4,000 6,000
subjects
(yr) Hz Hz Hz Hz Hz Hz Hz Hz Hz Hz Hz Hz

RK 30 7 15 10 15 10 25 25 20 10 15 10 25 24

MD 33 6 10 10 15 10 10 20 5 10 15 5 5 20

AK 25 3 10 10 10 5 10 3 15 10 5 5 15 10

MC 35 9 5 5 5 5 10 13 5 5 5 5 10 20

RK 26 5 5 5 5 10 15 20 5 10 10 10 15 15

EV 30 6 10 15 15 15 15 25 5 10 10 15 25 25

MC 29 8 10 10 10 10 20 24 10 10 15 15 10 24

FY 25 5 15 10 10 15 5 25 20 15 5 5 25 15

HK 30 8 10 5 5 10 10 17 25 16 16 16 15 10

MT 23 5 20 15 15 15 5 20 15 15 15 20 10 15

SB 25 5 5 5 10 5 10 10 5 10 10 5 5 5

AK 30 8 15 15 10 10 15 10 20 15 10 5 15 16

MP 30 8 5 0 0 0 5 23 10 10 5 0 3 23

IG 24 5 15 20 17 17 20 20 15 10 10 10 24 20

EP 25 4 15 10 10 14 24 20 20 20 10 14 24 25

CY 40 9 20 20 23 20 23 24 25 15 20 15 10 24

HP 27 3 20 20 15 10 10 20 15 15 5 15 15 20

TK 28 4 20 20 13 5 5 15 20 10 10 10 16 5

FK 22 2 10 20 15 15 10 10 15 15 10 5 5 24

AG 34 7 16 16 10 15 20 20 16 10 15 10 15 15

IG 33 4 15 5 5 5 15 15 15 5 5 5 24 20

AA 30 4 15 20 20 5 20 15 15 10 10 10 15 20

OS 23 5 15 10 5 10 5 20 20 16 16 16 16 3

HO 26 4 15 20 15 10 25 25 20 20 25 15 23 20

SB 28 6 10 20 20 10 10 15 10 15 20 6 20 15

MD 32 6 15 15 15 10 20 24 15 15 15 10 17 25

LD 27 7 10 15 5 5 5 10 15 10 5 5 5 15

ID 22 4 20 10 10 7 7 17 25 20 15 10 20 10

AO 26 5 15 10 10 5 15 10 15 10 10 5 10 10

SK 23 5 10 10 10 5 5 20 5 5 15 5 10 25

viduals exposed to loud noise for a long time1, 3). In our
study, hearing loss in textile workers compared with con-
trol was more evident at frequencies of 4 and 6 kHz. This
findings were consistant with previous studies3, 16, 17).
Çelik et al.3) reported that hearing loss started within the
first 10 yr and showed a slow progress at following years.
In our study, the groups with longer employment dura-
tion (group II and III) had poorer hearing thresholds at
high frequencies compared to the group with shorter
employment duration (group I). Also, group III had poor-
er hearing threshould at high frequencies than group II
but difference between groups was not statistically sig-
748
nificant. So, it can be said that the losses at high fre-
quencies in textile workers start within 8 yr of working
period, and get more evident between 5 and 8 yr, fol-
lowed by slight increase on later periods. Our results sup-
port the opinion that hearing loss started within the first
10 yr and showed slow progress at following years.
It suggested that noise affects hearing system in two
different ways: mechanical trauma directly to the organ
of Corti due to high vibration level of noise and increased
oxidative metabolism related to increased metabolic stress
in the inner ear5). Free oxygen radicals play an impor-
tant role in tissue damage caused by metabolic stress. In
different studies, it has been shown that free oxygen rad-
icals in cochlea play a role in noise-induced hearing
loss6, 18). If the free radicals produced by oxidative stress
are not balanced by an antioxidant defence system, then
they may lead to various damages in tissues. SOD and
CAT are two of the endogenous antioxidants in the
body19, 20).
MDA has been proven to be one of the best indicators
for lipid peroxidation caused by oxidative stress9). In a
study conducted by Liu18), it was found that increases in
MDA content in cochlear tissue of guinea pigs exposed
to acoustic trauma were correlated with increases in hear-
ing thresholds. In another study, it was demonstrated that
hearing loss was significantly higher in hydroelectric
power plant workers exposed to continuous noise than in
controls, also, that increases in MDA levels were corre-
lated with noise-related hearing impairment21). In our
study, blood MDA levels were found to be significantly
higher in textile workers than in controls as well. This
can be an indicator for oxidative stress in textile workers
exposed to long-term continuous noise. According to the
reports which showed that the level of free radical
increased in cochlea by acoustic stimulation, the signifi-
cant increase in MDA level7, 8) and evident hearing loss
in textile workers compared to controls suggested that
oxidative stress caused by noise exposure in cochlea may
lead to hearing impairment.
Generally, MDA levels were higher in textile workers
than in controls. On the other hand, among the textile
workers, MDA levels were found to be lower in workers
with marked hearing loss than in those with mild hearing
loss or normal hearing. However, after controlling for
age and employment duration, this differentiation became
insignificant.
It was found that superoxide and hydroxyl radicals were
increased in cochlea of the experimental animals exposed
to noise6, 7). SOD and CAT are antioxidant enzymes play-
ing a role in removing free oxygen radicals produced by
oxidative stress. Possible protective effects of these
enzymes have been noted in some experimental stud-
ies19, 22, 23). In our study, CAT activity was found to be
I YILDIRIM et al.
significantly lower in workers than controls. Also, SOD
activity was lower in workers but difference was not sta-
tistically significant. Decreases in CAT and SOD activ-
ities may be due to this consumption. In some experi-
mental studies on noise-related hearing loss, it has been
reported that oxidative stress caused by reduction in
antioxidant enzymes or substances may be attenuated by
giving exogenous antioxidants8, 18, 23–25). If it could be
proven that there is a strong association between noise-
related hearing loss and oxidative stress, then some exoge-
nous antioxidant therapies may have merit in the preven-
tion and /or treatment of noise-related hearing loss.
Conclusion
Remarkable hearing losses at high frequencies were
found in subjects working in a noisy weaving rooms in
textile factory when compared to the control group. Our
findings suggest that the hearing losses at high frequen-
cies in textile workers start within the first 8 yr, get more
evident between 5 and 8 yr. and show a slight increase
on later periods.
Increase in MDA and decrease in CAT and SOD in
textile workers support the opinion that the noise causes
the oxidative stress. The fact that noise both causes hear-
ing loss and increases the oxidative stress makes one think
that there is a relationship between oxidative stress and
hearing loss. But, a further survey is needed in order to
confirm this opinion.
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