Occupational Noise-Induced Hearing Loss in Indian
Steel Industry Workers: An Exploratory Study
Lakhwinder Pal Singh and Arvind Bhardwaj, Dr B R Ambedkar National
Institute of Technology, Jalandhar, India, and Kishore Kumar Deepak, All
India Institute of Medical Sciences, New Delhi, India
Objective: The present study focused on exploring
the current level of hearing protection and subsequently
determined the prevalence of occupational noise-
induced hearing loss among casting and forging industry
workers.
Background: The casting and forging industry
provides employment to a significant portion of the
population.
Method: The level of hearing protection was
assessed through questionnaire survey of 572 workers.
Out of these workers, 165 and another control group
of 57 participants were assessed by formal audiometry.
Audiometric tests were conducted at frequencies of
1.0 KHz to 8.0 KHz.The occurrence of hearing loss was
determined on the basis of a hearing threshold level
with a low fence of 25 dB. Student’s test and ANOVA
were used to compare the various groups; a p value
<.05 was considered statistically significant.
Results: More than 90% of the workers sampled
showed significant hearing loss at medium and high
frequencies. The analyses revealed a higher prevalence
of significant hearing loss among the forging workers
compared with the workers associated with the other
activities.
Conclusions: The workers of the Indian steel
industry are highly exposed to occupational noise.
The majority of workers are not protected from
noise-induced hearing loss. There is a need to provide
special ear protectors for workers engaged in forging. A
complete hearing protection program, including train-
ing, audiometry, job rotation, and the use of hearing
protection devices, needs to be introduced.
Keywords: occupational noise–induced hearing loss
Address correspondence to Lakhwinder Pal Singh, Faculty
in Department of Industrial and Production Engineering, Dr
B R Ambedkar National Institute of Technology, Jalandhar,
Punjab 144011, India; e-mail: lakhi_16@yahoo.com.
HUMAN FACTORS
Vol. 55, No. 2, April 2013, pp. 411-424
DOI:10.1177/0018720812457175
Copyright © 2012, Human Factors and Ergonomics Society.
Downloaded from hfs.sagepub.com at KoBSON on October 12, 2016
INTRODUCTION
The casting industry gives employment to
more than half a million people directly and
three times as many indirectly. At the same time,
the forging industry provides direct employment
to about 200,000 people, contributing directly to
the livelihood of more than three quarters of a
million people (Singh, Bhardwaj, & Deepak,
2010). Industrialization in India is primarily
focused on production, whereas health and safety
have a very low priority (Jaiswal, Parto, &
Pandav, 2006). Except a few major, reputed,
public and private industries, other industrialists
are insensitive toward the importance of occupa-
tional health and safety (Jaiswal et al., 2006).
Fransen et al. (2008) also reported that only 16%
of exposed participants reported using hearing
protection always or most of the time. Moreover,
the prevailing work schedules in small and
medium enterprises (SMEs) generally do not
include sufficient rest allowances; thus there is
also a strong need to set reasonable performance
standards for various activities with appropriate
rest allowances (Singh, Bhardwaj, Deepak, &
Bedi, 2009). Approximately 85% of workers
work more than 8 hr per day with additional
overtime of 2 to 4 hr per day (12 to 24 hr per
week), which is a major factor contributing
toward very high noise exposure (more than the
Occupational Safety and Health Administration
[OSHA] norms; Singh et al., 2010).
Occupational noise is an integral part of the
job especially in iron and steel industries that
may cause severe hearing loss. Worldwide,
approximately 16% of hearing disability is
caused by occupational noise exposure (Nelson,
Nelson, Barrientos, & Fingerhut, 2005).
Workers in industries such as mining, construc-
tion, printing, crushing, drop forging, iron and
steel companies, and so on are at high risk of
noise-induced hearing loss (NIHL; Nadi &
412 April 2013 - Human Factors
Dhatrak, 2008). The workers are exposed to
high noise throughout their lifetime of work. A
majority of the workers in small-scale hand tool
forging units are highly exposed to high noise
levels greater than 90 dB(A), 60 to 72 hr per
week, without proper ear protection, which is
very high as compared with OSHA norms
(Singh et al., 2009). Hearing protection must be
provided at no cost to employees and must be
worn by all workers exposed to a time-weighted
average of 90 dB(A) and higher (“OSHA’s
Noise Standard,” 2000).
Many studies showed that there is a dose-
response relationship between noise intensity
and hypertension incidence in the occupational
population (Ni et al., 2007). Patel and Ingle
(2007) indicated that the prevalence of hearing
loss is greater among dal (pulses) mill workers
and that these workers are more susceptible to
NIHL compared with grain market workers.
Impulse noise may damage the cochlea by
direct mechanical processes. Impulse noise can
interact with background continuous noise to
produce greater hearing loss than would have
been predicted by the simple sum of the indi-
vidual noises (Henderson & Harnemik, 1986).
Temporary threshold shift (TTS) recovery
time is dependent on the magnitude of the initial
hearing loss; also, TTS driven by noise expo-
sure is enhanced by heat and workload (Chen,
Dai, Sun, Lin, & Juang, 2007). Another study
established that exposure to high-level impact
noise on an interrupted 6-hr daily schedule for
20 days caused pure-tone thresholds to shift as
much as 30 dB despite the continuing noise
exposure (Hamernik, Ahroon, Davis, & Lei,
1994). Taylor et al. (1984) indicated that for
long-term exposures of 10 years or more, hear-
ing losses resulting from impact noise in the
drop-forging industry are as great as or greater
than those resulting from equivalent continu-
ous noise. The impulsive noise seems to be
more harmful for hearing at high noise expo-
sure levels (Toppila, Pyykko, Strack,
Kaksonnen, & Ishizaki, 2000). Mantysalo and
Vuori (1984) reported that impulse noise
seemed to produce permanent threshold shifts
at 4.0 KHz and 6.0 KHz after a shorter duration
of exposure than did continuous steady-state
noise. Exposure to high levels of impulse noise
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(despite the use of ear protectors) is more detri-
mental to hearing than are high levels of con-
tinuous noise (even continuous with slightly
impulsive features).
Hearing protective devices attenuate indus-
trial impulse noise effectively but do not pre-
vent advanced hearing loss among workers
(Starck, Topilla, & Pyykko, 2003). Therefore, it
is reasonable to assume that the qualities neces-
sary for ear protectors to protect hearing from
impulsive noise differ from those necessary to
protect from continuous noise. In addition to
NIHL, Dembe (2008) reviewed a variety of
studies on history of concerns about long work-
ing hours and the current scientific evidence
regarding their effects on workers’ health. The
ethical considerations regarding long working
hours are to be thought of as questions about the
type of society one wants to create. A just and
fair society will take actions to ensure that suit-
able jobs are available for as many people who
want to work as possible and that the jobs are
safe and properly compensated, allowing not
only for a beneficial work life but also for a life
that has time for rest, health, family, leisure
activities, and the attainment of one’s personal
values. Thus, in future studies, it would be more
realistic to study not only the effects of expo-
sure to noise; attention should be paid also to
subjective characteristics and individual factors
of work conditions.
The literature reviewed confirms that occu-
pational noise exposure does indeed lead to
hearing loss. Most of these studies were carried
out in developed countries. The workers in
Indian SMEs perform in a less technically
developed and even noisier environment (Singh
et al., 2009). However, a very limited literature
is available on occupational NIHL. Therefore, it
is very essential to assess the level of occupa-
tional noise exposure and safety measures in
these units and subsequently to investigate the
prevalence of occupational NIHL in the Indian
context. Thus, the present study assumes a vital
significance.
Based on the literature survey, the following
hypotheses were considered:
Hypothesis 1: Steel workers are highly
exposed to occupational noise.
Noise-Induced Hearing Loss in India 413
Hypothesis 2: There will be a significant
loss of hearing among workers engaged
in the steel industry.
MATERIALS AND METHODS
This study included randomly selected small-
and medium-scale casting and forging units
(three each) located in northern India, since
work conditions in casting and forging units of
this region are similar. Hence the study was
conducted with 572 randomly selected workers
in 12 units. The initial questionnaire docu-
mented use of protective equipment and aware-
ness about benefits of personal protective
equipment (PPE), NIHL, hearing disability, and
noise-induced syndromes, such as speech inter-
ference, noise annoyance, headache, anxiety,
and sleep disturbance. The questionnaire was
pretested and validated by the independent
observers before it was used to assess the infor-
mation. Data were collected through one-to-one
interaction, as workers of these units were
mostly illiterate or less educated; therefore the
questions and statements were translated in
Punjabi and Hindi and then workers were asked
to fill out the questionnaires by tick mark (√).
The same was repeated until it was made clear.
Noise and Dose Assessment
A weighted (Leq) ambient noise was assessed
through the use of a Quest sound-level meter
(Model SOUNDPRO SP-DL-1-1/3). OSHA
norms for hearing conservation were incorpo-
rated, including an exchange rate of 5 dB(A),
criterion level at 90 dB(A), criterion time of 8
hr, threshold level equal to 80 dB(A), upper
limit equal to 140 dB(A), and with F/S response
rate. (If a worker is exposed to 90 dB[A] for 8
hr, he or she is receiving 100% dose of noise. At
an exchange rate of 5 dB[A], if the noise level
is 95 dB[A] for 8 hr, the worker is receiving a
dose of 200%; similarly, at 100 dB[A] for 8 hr,
the worker receives a dose of 300%, and so on.)
In addition, the noise exposure was measured
by a Noise Pro DLX-1 ANSI SI .25-1991
Personal Noise Dosimeter. Both noise sound-
level meter and noise dosimeters were newly
purchased and thus were already calibrated.
Long-term recording was done for 8 hr, and
time-weighted average dose was calculated. We
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made five observations in each type of opera-
tion. The sound pressure was recorded for 15
min each time on each workstation, and one
long-term recording for 8 hr was done. At each
section, sound pressure was recorded at least
four to five times at locations where the move-
ment of the workers was most frequent. The
noise measurements were done for 15 min, as
was one long-term, 8-hr reading. The difference
between the long-term and short-term readings
was 0.5 dB(A) for forging, punching and blank-
ing, and grinding sections and 1.0 dB(A) for
molding, machining, plating, and tool room.
The sound-level meter was positioned on a tri-
pod stand at a height of 1 m in a horizontal posi-
tion. The dosimeter was attached to the worker
at the belt, and the microphone was attached to
the collar. The noise dose (D) criteria and noise
dose D, in percentage, is given by the
following:
D = 100 C/T,
where C is the total length of the work period in
hours, and T is the reference duration corre-
sponding to the measured sound level, L, as
given by the following formula:
(L-90).
T = 8 ⁄ 2
5
Pure-Tone Audiometry
A sample of 165 exposed participants was
purposefully selected from sections such as
punching and blanking, forging, molding,
grinding, welding, and the tool room. A control
group of 57 nonexposed participants was also
selected. The exposed group was selected from
572 workers who answered the questionnaire.
The criteria were the approachability, availabil-
ity, and willingness of the workers to partici-
pate in the study. Since the audiometry room
was nonportable, the sample of 165 exposed
participants was selected from the industry in
and around Jalandhar, which may restrict ran-
dom selection of workers. The participants who
reported any ear abnormality (infection, etc.)
were excluded; therefore selected participants
had apparently normal hearing as assessed
through the questionnaire. The otoscopic exam-
ination was conducted in consultation with an
ears, nose, and throat specialist. The partici-
414 April 2013 - Human Factors
TABLE 1: Ambient Noise Levels: Leq(A) dB and Percentage Dose
Occupation
Punching/Blanking
Forger
Furnace job taker
Roap puller (hammer operator)
Molding/Casting
Grinding
Tool and die
Broaching
Gas cutting/Welding/Plating
pants were asked to report to the laboratory
only on the weekend (Sunday or holiday) after
they had rested or slept overnight and with gap
of 15 to 20 hr. Mean age of the exposed group
was statistically matched (at p value of less than
.05) with the control group.
Both groups were tested by pure-tone audi-
ometry at the institute’s ergonomics laboratory.
The participants were thoroughly instructed
about the test. The hearing threshold of both
ears was measured in an audiometric room.
Audiometric tests were conducted at frequen-
cies of 1.0 KHz to 8.0 KHz. A portable audiom-
eter (Arphi 500 km III) was used, which works
on 220/230-volts AC main supply as well as on
15-volts DC supply. The audiometer was cali-
brated and tested before the test; calibration was
outsourced from Arphi Electronics. The partici-
pants were instructed about the audiometry test
and the same was conducted. The prevalence of
hearing loss was determined on the basis of
hearing threshold levels with a lower limit of 25
dB.
Statistical Analysis
All data are given as mean values with stan-
dard deviations. We made comparisons for
hearing threshold (dB[A]) at different frequen-
cies between the exposed and control groups by
using Student’s test. ANOVA was used for the
comparison of hearing threshold (dB[A]) at dif-
ferent frequencies among occupation and year
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Mean Leq(A) dB Mean % Dose
 99.30 367.50
105.10 811.0
103.30 635.30
104.50 749.20
 90.60 110.40
 97.90 302.80
 89.60  95.10
 90.70 111.10
 89.40  92.00
of experience. A p value < .05 was considered
statistically significant.
RESULTS AND ANALYSIS
Occupational Noise Levels and Dose
In the molding section, noise was either
impulsive or intermittent at different locations.
In grinding and melting sections, there was
almost steady noise. There was hardly a differ-
ence of 0.5 to 1.0 dB(A) between long-term
recording and short-term recording. Most of the
work locations have an almost steady noise
production except the drop-forge hammers,
punching and blanking, trimming, and molding
sections. Noise level at various sections, such
as drop hammer, cutting and blanking presses,
punching press, grinding, barreling and machine
molding sections, was found greater than
90-dB(A) permissible limits. The workers
engaged in different processes of the casting
and forging industry are exposed to continuous,
intermittent, and impulse-impact noise. The
ambient noise level Leq(A) dB and 8-hr percent-
age dose are shown in Table. 1. The noise levels
in punching and blanking, forging, molding,
and grinding were higher than the prescribed
limits, that is, 90 dB(A). Therefore the percent-
age dose was also more than 100%. However
the noise levels at the tool room and welding,
gas cutting, and plating were found to be within
the prescribed limits; hence noise dose was
within the limits. It is also observed that
Noise-Induced Hearing Loss in India 415

TABLE 2: Speech Interference, Noise Annoyance, Headache, and Anxiety Attributed to Workplace
Noise

Subjective
Annoyance
Parameter Total Always Often Sometimes Seldom Never Scale (0-4)

Speech 572 240 (41.96%) 155 (27.10%) 86 (15.03%) 58 (10.14%) 33 (5.77%) 2.89
interference
Annoyance 572 40 (6.99%) 58 (10.14%) 103 (18.01%) 136 (23.78%)238 (41.08%) 1.18
Headache 572 18 (3.15%) 34 (5.94%) 97 (16.96%) 106 (18.62%)319 (55.80%) 0.82
Disturbed 572 31 (5.42%) 17 (2.97%) 55 (9.62%) 43 (7.52%) 320 (55.94%) 0.57
sleep/
anxiety

approximately 73% of workers were not using Use of PPE

ear protection. Therefore, the steel workers are
highly exposed to occupational noise.
As far as the psychobehavioral effects of noise
were concerned, speech interference was experi-
enced by 95% of the workers, of whom 42% were
mostly engaged in the forging, blanking, punch-
ing, trimming, barreling, and grinding sections and
reported constant speech interference. In addition,
27% of the workers involved in machine molding,
shot blasting, and size gauging reported frequent
speech interference. The rest of the workers in the
tool room, nickel plating, quality, and cupola-
induction furnace reported low interference. The
overall speech interference level on a 5-point scale
was higher (2.89). As far as noise annoyance was
concerned, only 3% of the workers reported they
were always annoyed, 6% often, and 17% some-
times; 19% of the workers seldom felt annoyed
and 55% never felt annoyed with high noise lev-
els. Overall noise annoyance level on a 5-point
scale was 1.18, which is very low (Table 2).
Similarly, headache and disturbed sleep or anxiety
were reported by a relatively much smaller pro-
portion of workers. The levels of headache and
anxiety were 0.82 and 0.57, respectively (Table 2).
Noise annoyance, headache, and anxiety were
found to be independent of age; at the same time,
noise annoyance reduced with an increase in the
work exposure. Noise annoyance was reported
only by the workers who had work exposure of up
to 5 years. As workers lose their hearing over time,
they report less subjective annoyance from the
lower level of noise they are still able to hear.
Although a majority of workers reported that
they are aware of the benefits of using PPE, a
large proportion of workers do not use PPE.
Workers without proper ear protection at work-
places are shown in Figure 1. The photographs
give a good picture of the type of workshops
studied and the location of microphones during
personal exposure recording. The subjective
responses regarding the use of PPE and detail
of level of use of PPE on a 5-point scale is
shown in Table 3.
Most workers were not wearing PPE in both
casting and forging units, whereas only 75% of
the workers were not wearing dungarees, 69%
of the workers were not using gloves, and 60%
of the workers were not using eye protection
(goggles). As far as the use of gum shoes or
boots was concerned, 63% workers were not
wearing proper boots; 65% workers were not
wearing nose-and-mouth masks, and 73% work-
ers were working without ear protection. Ear
protection and dungarees were the lowest-used
PPE on a 5-point scale, with scores of 0.85 and
0.79, respectively. The reasons stated for not
using PPE are shown in Table 4. Approximately
32% of workers reported that they felt uncom-
fortable wearing PPE. Approximately 12% of
workers reported that they were not in the habit
of using PPE, whereas 22% admitted their own
negligence. Approximately 34% of the workers
revealed that management does not even pro-
vide the PPE.

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416 April 2013 - Human Factors

Figure 1. Workers without ear protection at different workplaces and noise dose assessment.

TABLE 3: Use of Personal Protective Equipment (PPE) by Workers (in percentages)

Some- Score on
PPE Total n Always Often times Seldom Never Scale (0-4)

Dungarees 572  7 10  8  5 70 0.79

Gloves 572  9 12 10  9 60 1.01
Goggles 572 12 15 13 10 50 1.29
Gum shoes/boots 572 10 12 15 10 53 1.16
Nose-mouth mask 572  9 14 12  9 56 1.11
Earplugs/muffs 573  5 12 10  9 64 0.85a
Helmet 572  7 15 11  5 62 1.00
Others (turban/Safa/cap) 572 20 35 15  5 25 2.20b
Note. Always = 4, often = 3, sometimes = 2, seldom = 1, never = 0.

a (5 × 4 + 12 × 3 + 10 × 2 + 9 × 1 + 64 × 0)
Earplugs/muffs = = 0.85.
100

b
(20 × 4 + 35 × 3 + 15 × 2 + 5 × 1 + 25 × 0)
Others (turban/Safa/cap) = = 2.20.
100

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Noise-Induced Hearing Loss in India 417

TABLE 4: Reasons for Not Using Personal Effect of Occupation on Hearing

Protective Equipment Threshold in Exposed and Control
Groups: Combined ANOVA
Reason n (%) Results
Feels uncomfortable 185 (32.34) Occupation significantly influenced hearing
Does not have habit 67 (11.71) thresholds. ANOVA statistics are shown in
Negligence 125 (21.85) Table 6. The multiple comparisons among vari-
Management does not provide 195 (34.09) ous subgroups were performed with ANOVA
Tukey analysis (Tables 7 and 8). There was a
significant difference between hearing thresh-
old levels at 1 KHz, 2 KHz, 4 KHz, 6 KHz, and
Hearing Threshold Exposed Group
8 KHz in the left ear of forgers and participants
Compared With the Control Group
engaged in other jobs. There seems to be rela-
The t statistics for overall hearing thresholds tively higher loss of hearing in the right ear as
for both the groups are shown in Table 5. There compared with the left ear, maybe because
was a significant hearing loss, that is, perma- right-handed workers stand at their jobs in such
nent hearing threshold shift (PTS), in both left a way that their right ears receive more sound
and right ears among the industry participants energy.
at all frequencies (1 KHz to 8 KHz).
Since the hearing threshold of the noise- Effect of Duration of Work
exposed group was significantly higher than Exposure on Hearing Threshold
that of the control group, the hearing capacity of Within the Exposed Group
the exposed group is significantly lower; there- Hearing loss significantly increased with
fore, Hypothesis 2, that there would be a signifi- work experience: As the duration of experience
cant loss of hearing among the workers engaged increases, there is significant loss of hearing in
in the steel industry, is accepted. the left ear at all frequencies. In the present

TABLE 5: T Test Statistics for Comparison Between Exposed Group (n = 165) and Control Group (n = 57)

Exposed Group Control Group

Parameter M (SD) M (SD) Mean Difference p

Experience 8.88 (5.51) 8.68 (6.89) 0.197 .827

Age 30.06 (7.78) 31.98 (8.89) –1.92 .123
Body mass index 21.59 (3.26) 23.47 (2.66) –1.88 .000*
Left ear hearing threshold  
  1 KHz 26.30 (13.59) 19.56 (7.75) 6.74 .000*
  2 KHz 32.73 (16.36) 22.81 (6.94) 9.92 .000*
  4 KHz 42.76 (18.05) 21.05 (7.83) 21.70 .000*
  6 KHz 45.24 (17.45) 25.79 (9.72) 19.45 .000*
  8 KHz 34.09 (18.46) 19.65 (9.35) 14.44 .000*
Right ear hearing threshold  
  1 KHz 27.85 (12.34) 19.82 (7.90) 8.02 .000*
  2 KHz 34.52 (15.48) 21.93 (7.12) 12.58 .000*
  4 KHz 43.91 (16.09) 21.67 (7.75) 22.24 .000*
  6 KHz 48.03 (16.53) 25.79 (9.81) 22.24 .000*
  8 KHz 34.15 (18.98) 18.07 (10.12) 16.08 .000*
*p < .05.

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 418
TABLE 6: Effect of Occupation on Hearing Threshold Parameters in Exposed and Control Groups: Combined ANOVAs Results
Punching/Blank- Hot Piece Trans- Hammer Molding/ Tool Room Welding Control
ing Operators Hot Forging fer Furnace to Operating Grinding Casting and Die and Gas Group
Variable (n = 21) (n = 32) Forger (n = 12) (n = 14) (n = 42) (n = 19) (n = 11) Cutting (n = 12) (n = 51) p

Experience 6.74 (5.56) 14.25 (4.2) 4.42 (4.14) 7.82 (3.41) 7.25 (3.78) 8.29 (5.84) 13.09 (4.57) 6.917 (5.07) 8.68 (6.89) .000*
Age 26.91 (7.87) 34.13 (7.28) 25.42 (4.64) 27.57 (3.61) 28.5 (5.84) 30.85 (7.97) 37.72 (10.70) 29.33 (9.39) 31.98 (8.89) .000*
Left ear hearing  
threshold dB(A)
  1 KHz 27.86 (17.64) 35.31 (12.44) 24.17 (10.41) 31.43 (10.27) 22.62 (11.54) 22.14 (15.29) 23.64 (12.46) 18.33 (3.89) 19.56 (7.75) .000*
  2 KHz 35.71 (20.26) 46.56 (17.80) 31.25 (12.08) 36.79 (13.67) 29.05 (12.65) 25.00 (10.95) 26.82 (11.51) 19.17 (5.57) 22.81 (6.94) .000*
  4 KHz 43.33 (21.75) 58.91 (13.72) 34.58 (11.76) 44.29 (19.40) 38.10 (15.81) 34.52 (13.13) 48.18 (15.21) 30.83 (13.95) 21.05 (7.83) .001*
  6 KHz 43.33 (23.78) 59.19 (15.97) 39.17 (12.58) 46.43 (16.10) 45.12 (16.51) 36.43 (9.64) 39.09 (9.95) 38.75 (14.79) 25.79 (9.72) .000*
  8 KHz 30.95 (20.03) 47.34 (18.87) 28.75 (9.79) 33.57 (19.95) 34.64 (18.33) 29.05 (16.63) 28.64 (12.06) 22.08 (9.87) 19.65 (9.35) .000*
Right ear hearing  
threshold dB(A)
  1 KHz 28.81 (13.86) 34.53 (12.27) 24.17 (8.21) 28.93 (9.64) 25.24 (13.34) 24.76 (13.55) 30.00 (8.66) 23.33 (5.77) 19.82 (7.90) .000*
  2 KHz 31.67 (14.86) 43.91 (15.33) 29.58 (13.56) 35.36 (11.67) 31.59 (16.71) 33.81 (14.99) 39.09 (14.28) 25.00 (9.05) 21.93 (7.12) .000*
  4 KHz 43.10 (17.35) 50.00 (14.86) 41.25 (16.80) 46.43 (12.47) 42.50 (17.22) 38.57 (19.18) 46.36 (12.27) 40.83 (10.62) 21.67 (7.75) .000*
  6 KHz 47.86 (16.01) 54.38 (11.13) 46.67 (17.36) 51.07 (14.69) 48.21 (20.09) 44.76 (18.40) 42.27 (14.03) 39.58 (11.95) 25.79 (9.81) .000*

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  8 KHz 37.14 (22.34) 40.16 (12.21) 35.83 (14.12) 30.00 (11.44) 33.45 (22.78) 34.05 (21.48) 33.64 (18.45) 19.17 (14.59) 18.07 (10.12) .000*

*p < .05.
Noise-Induced Hearing Loss in India 419

TABLE 7: ANOVA Post Hoc Tukey’s Analysis for Multiple Comparisons Among Various Processes

Left Ear p Value at 95% Confidence Interval

Group (I) Group (J) 1000 Hz 2000 Hz 4000 Hz 6000 Hz 8000 Hz

1 2 .349 .071 .004* 0.008* .009*

  8 .291 .01* .147 0.953 .938
  9 .1 .003* .00* 0.001* .203
2 3 .108 .015* .00* 0.004* .018*
  4 .981 .303 .042* 0.192 .149
  5 .002* .00* .00* 0.00* .002*
  6 .00* .00* .00* 0.004* .021*
  7 .097 .001* .444 0.006* .024*
  8 .00* .00* .00* 0.00* .00*
  9 .00* .00* .00* 0.00* .00*
456 8 .073 .014* .166 0.777 .807
  9 .016 .009* .00* 0.00* .134
  9 .991 .999 .013* 0.21 .475
  9 .906 .284 .00* 0.00* .001*
7 8 .961 .88 .045 1 .998
  9 .972 .989 .00* 0.228 .832

Note. Group 1 = punching/blanking (n = 21); Group 2 = forger (n = 32); Group 3 = hot work piece transfer furnace
to hammer (n = 12); Group 4 = hammer operator (n = 14); Group 5 = grinder (n = 42); Group 6 = molding (n = 19);
Group 7 = tool room (n = 11); Group 8 = gas cutter/welder (n = 12); Group 9 = control (n = 51).
*p = significant at 95% confidence interval.

study, the post hoc Tukey’s analysis reveals that
workers with work exposure from 10 to 15
years and more than 15 years experienced sig-
nificant hearing loss in the left ear at all fre-
quencies as compared with workers with work
exposure of 5 years or less. In the right ear,
significant loss appears at 2 KHz and 8 KHz
only. The right ear shows greater loss at 5 years
of work experience as compared with the left
ear. The reason may be the work position of the
right-handed workers, that is, the right ear was
closer to the noise source and hence received
more sound energy. The effect of occupational
experience is shown in Table 9.
DISCUSSION
The results of the present study showed a sig-
nificant hearing loss, that is, PTS, in both ears at
1.0 to 8.0 KHz for metallurgy (steel) workers.
Therefore, the industry workers showed a sig-
nificant hearing loss within less than 9 years of
work exposure at all frequencies, as compared
with the control group. Whereas previous studies
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(e.g., Celik, Yalçin, & Oztürk, 1998) reported a
significant difference within the first 10 years of
noise exposure only for the thresholds obtained
at 4 KHz (p < .0005) in a group of noise-exposed
industrial workers and the control group with
normal hearing. Other researchers (e.g., Taylor et
al., 1984) reported that long-term exposures of
10 years or more in the drop-forging industry
resulted in hearing losses as great as or greater
than those resulting from equivalent continuous
noise. Toppila et al. (2000) also reported that
impulsive noise appears to be more harmful for
hearing at high noise exposure levels. Since in
the present study, workers were not protected
from noise exposure to continuous as well as
impulsive noise levels above 90 dB(A), the
prevalence of hearing loss was higher. Moreover,
they work for 60 to 72 hr per week, which is
significantly more than the prescribed working
hours of 48 hr per week as per the Indian Factory
Act and 40 hr per week in the United States or
European countries. Thus, the hearing loss was
associated with occupational noise exposure and
420 April 2013 - Human Factors

TABLE 8: ANOVA Post Hoc Tukey’s Analysis for Multiple Comparisons Among Various Processes

Right Ear p Value at 95% Confidence Interval

Group (I) Group (J) 1000 Hz 2000 Hz 4000 Hz 6000 Hz 8000 Hz

1 8 .977 .939 .998 .667 0.044*

  9 .035 .1 .00* .00* 0.003*
23 3 .131 .04* .683 .88 0.998
  5 .034* .13 .138 .488 0.957
  6 .012* .004* .394 .769 0.743
  8 .145 .001* .36 .04* 0.004*
  9 .00* .00* .00* .00* 0.00*
  9 .934 .676 .001* .005* 0.078
456 9 .116 .022* .00* .00* 0.519
  9 .802 .025* .00* .001* 0.032*
  9 .239 .009* .00* .00* 0.004*
8 9 .872 .991 .004* .466 1
Note. Group 1 = punching/blanking (n = 21); Group 2 = forger (n = 32); Group 3 = hot work piece transfer furnace
to hammer (n = 12); Group 4 = hammer operator (n = 14); Group 5 = grinder (n = 42); Group 6 = molding (n = 19);
Group 7 = tool room (n = 11); Group 8 = gas cutter/welder (n = 12); Group 9 = control (n = 51).
*p = significant at 95% confidence interval.

TABLE 9: Effect of Occupational Experience (in years) on Hearing Threshold (dB[A]) by Frequency

Occupational Experience (in years)

≤5 years 5-10 years 10-15 years >15 years

Variable (n = 65) (n = 39) (n = 38) (n = 23) p

Left ear hearing  

threshold
  1 KHz 19.69 (8.58) 26.63 (13.17) 31.32 (14.13) 35.87 (16.00) .000*
  2 KHz 24.53 (10.83) 32.75 (15.44) 39.74 (17.32) 43.91 (17.96) .000*
  4 KHz 31.87 (14.81) 41.88 (15.22) 53.55 (15.37) 56.74 (15.49) .000*
  6 KHz 38.28 (15.41) 44.62 (14.82) 51.58 (17.48) 56.09 (18.65) .000*
  8 KHz 27.73 (15.48) 34.13 (16.67) 38.68 (17.31) 44.35 (24.27) .000*
Right ear hearing  
threshold
  1 KHz 27.34 (11.47) 24.38 (11.22) 31.05 (14.34) 30.00 (11.96) .087
  2 KHz 34.22 (14.37) 29.38 (15.24) 36.71 (17.14) 41.09 (14.06) .024*
  4 KHz 42.34 (16.78) 42.75 (14.58) 44.61 (17.14) 49.35 (14.48) .321
  6 KHz 46.87 (17.82) 45.38 (14.91) 49.87 (17.80) 53.04 (12.22) .270
  8 KHz 33.67 (19.83) 27.38 (17.57) 39.08 (19.62) 37.83 (16.84) .037*
*p < .05.

other risk factors; that is, gross occupational Within the exposed group, data analysis
exposure to noise was demonstrated as a cause demonstrates a higher prevalence of significant
of hearing loss, similar to Ahmad et al. (2001). hearing loss among the workers exposed to

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Noise-Induced Hearing Loss in India 421
impulsive noise in carrying out forging tasks as
compared with the workers associated with the
other activities. Therefore we found that the
prolonged exposure to impulsive and impact
noise at 101.2 to 105.3 dB(A) for 10 years or
more proved to be more hazardous to hearing as
compared with continuous or intermittent noise.
There was a significant difference between
hearing threshold levels at 1.0 KHz, 2.0 KHz,
4.0 KHz, 6.0 KHz, and 8.0 KHz in the left ear of
forgers and participants engaged in other jobs.
At the same time, hearing threshold in the right
ear of forgers was significantly higher as com-
pared with the control group at all frequencies
and workers in the tool room at 2.0 KHz, 4.0
KHz, 6.0 KHz, and 8.0 KHz. Hence, PTS was
significantly influenced by the type of occupa-
tional noise exposure.
PTS is a result of chronic auditory fatigue,
that is, repeated TTS. It has been established by
Chen et al. (2007) that TTS driven by noise
exposure is enhanced by heat and workload. In
the forging section, the workers were exposed
to impulsive noise, heat stress, and high physi-
cal workload; thus they were more prone to
hearing loss. The workers in the molding sec-
tion experienced significant hearing loss in both
ears at 3 to 8 KHz; these workers were also
exposed to intermittent or impulsive noise, heat
stress, and high physical workload. According
to Tambs, Hoffman, Borchgrevink, Holmen,
and Engdahl (2006), the effect of impulse noise
was strongest at 3 to 8 KHz and varied little
within this frequency range. Impulse noise pro-
duces PTS at 4 and 6 KHz.
Exposure to high levels of impulse noise
(despite the use of ear protectors) is more detri-
mental to hearing than are high levels of con-
tinuous noise (Mantysalo & Vuori, 1984).
Therefore, it is reasonable to consider that bet-
ter ear protectors must be provided to protect
the hearing of workers exposed to impulsive
noise in forging and machine molding sections
as compared with workers exposed to continu-
ous noise in other sections, such as grinding and
so on. The workers did not use PPE, such as ear
protectors, as they feel uncomfortable with the
existing PPE provided by the management of
different organizations. Hence, there is a need
to provide ergonomically designed ear protec-
tors that can be worn comfortably by workers in
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extreme weather conditions, especially in the
months of June to August, that is, beyond com-
fortable working conditions. Past researchers
(e.g., Tambs et al., 2006) showed average
threshold shifts in both ears of 13 dB (3.0 KHz).
The effects of impulse noise were strongest at
3.0 to 8.0 KHz and varied little within this fre-
quency range. Our findings are consistent with
the findings of Mantysalo and Vuori (1984) that
impulse noise produces PTS at 4.0 KHz and 6.0
KHz after a shorter duration of exposure than
does continuous, steady-state noise. Exposure
to high levels of impulse noise (despite the use
of ear protectors) is more detrimental to hearing
than are high levels of continuous noise (even
continuous with slightly impulsive features).
In the present study, we reported that a
majority of workers were not using ear protec-
tion. Thus in the Indian industrial scenario,
workers are working at a very high risk of hear-
ing loss, especially those workers engaged in
forging and molding sections. The frequencies
most sensitive to impulse noise are 4.0 KHz and
6.0 KHz. Therefore, it is reasonable to assume
that the characteristics of ear protectors needed
to protect hearing from impulsive noise differ
from those needed to protect from continuous
noise. Thus, appropriate and quality ear prod-
ucts are required, that is, ergonomically
designed ear protectors.
Researchers have previously reported a sig-
nificant effect of work experience on hearing
threshold. Taylor et al. (1984) reported that for
long-term exposure of less than 10 years, hear-
ing loss resulting from impact noise in the drop-
forging industry is greater than that resulting
from continuous noise. Hong (2005) showed
significantly poorer hearing in the left ear. In
the present study, the post hoc Tukey analysis
reveals that the workers with longer work expo-
sure (10 to 15 years) experienced more signifi-
cant hearing loss in the left ear at all frequencies
as compared with the workers with work expo-
sure up to 5 years. This finding was again con-
sistent with Nomura, Nakao, and Yano (2005)
and Ighoroje, Marchie, and Nwobodo (2004),
who found that hearing loss was significantly
associated with working experience of more
than 10 years and overtime. Concurrently, there
may be a confounding effect of age; Tabuchi et
al. (2005) reported that as workers’ ages
422 April 2013 - Human Factors
increased, the percentage of workers having
some degree of hearing loss also increased.
Subjective Investigation
The subjective response revealed that work-
ers did not report much noise annoyance. The
lower proportion of noise annoyance could be
attributed to two factors. First, workers have
accepted the noise as a part of their job. Second,
the hearing threshold is shifted, and the workers
have adapted to the increasing exposure to high
noise levels. At the same time, the effect of
occupational noise on sleep has seldom been
reported by the workers. This finding was in
accordance with Gitanjali and Dhamotharan
(2003).
In a previous study, Fransen et al. (2008) also
reported that only 16% of exposed participants
reported using hearing protection always or
most of the time. In the present study, the major-
ity of workers were not using PPE in the work-
place, and approximately 66% workers were
not wearing PPE either because of bad design,
as they feel uncomfortable after wearing the
available PPE, or because they were not being
provided PPE by management. In both cases,
the management was responsible; however, the
workers may be negligent in this concern.
Therefore, there is a strong need for manage-
ment to provide ergonomically designed PPE to
workers.
As already described, the industry lacks in
enforcing the use of PPE, and at most small-
scale units, management does not even bother
with it. Another significant factor could also be
that workers work under subcontractors, who
literally ignore these aspects. It is also true that
workers do not expect much health and safety
care from the management; rather, they have
accepted hazardous conditions as a part of their
job. Consequently, the workers have to work in
low-resources settings with respect to health
and safety. As the workers do not use ear protec-
tion, a majority of the workers are directly
exposed to noise.
The steel industry of the region still operates
with traditional machinery and equipment,
which makes the shops very noisy. Therefore,
technological changes with ergonomic consid-
erations at macro- and microlevels play a vital
role in the success of technology transfer. Only
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a practical and systematic incorporation of
ergonomic considerations can ensure the appro-
priateness, safety, and effective use of the trans-
ferred technology (Meshkati, 1989). Failure to
take account of national and cultural variables
may nullify the gains that one might reasonably
expect to follow from the application of ergo-
nomics in many areas of the world (Chapanis,
1974).
Moreover, the prevailing work schedules in
SMEs generally do not include sufficient rest
allowances; thus there is also a strong need to
set reasonable performance standards for vari-
ous activities with appropriate rest allowances
(Singh et al., 2009). Approximately 85% of
workers work more than 8 hr a day with addi-
tional overtime of 2 to 4 hr a day (12 to 24 hr a
week), which is a major factor contributing to
very high noise exposure (more than the OSHA
norms; Singh et al., 2010). Such long working
hours increase risk of NIHL since the workers
are rarely using ear protection. This risk can be
reduced by ensuring the proper use of ear pro-
tection, and in case the workers are not getting
accustomed with the use of PPE, the job can be
rotated with low-noise jobs. Thus ethical impli-
cations of unconventional shift work and long
work-hour schedules should be considered
(Dembe, 2008). A just and fair society system
will take actions to ensure that jobs are safe and
properly compensated, allowing a life that has
time for rest, health, family, leisure activities,
and the attainment of one’s personal values.
These global problems require that ergonomics
should be open to new disciplines, particularly
those in the social sciences. However, it is dif-
ficult to generalize research on human-centered
sociotechnical design without taking into con-
sideration national characteristics, economics,
and political constraints (Moray, 2000).
It is very pertinent to mention that the casting
and forging industry of the region is primarily
focused on executing production targets and
getting more orders from customers, whereas
health and safety concern were low priority.
This finding is in accordance with results of a
previous study (Jaiswal et al., 2006), that indus-
trialization in India is primarily focused on pro-
duction, whereas health and safety have a very
low priority. Certainly it is companies’ respon-
sibility to implement the health and safety
Noise-Induced Hearing Loss in India 423
measures and to provide counseling to the
workers to educate them regarding the benefits
of wearing PPE. The study validates findings of
the International Labour Office, which esti-
mates that in 2001, there were 2.2 million deaths
attributed to work-related injuries and diseases
(www.ilo.org/safework). Occupational work is
indeed an essential component of human soci-
ety. It provides basic needs (food, shelter, and
clothes) to families and communities. But it is
very important to safeguard the interests of
industrial workers in terms of their health and
safe environment, and let us not forget that
health is non-negotiable.
CONCLUSIONS
Workers in the Indian steel industry are
highly exposed to occupational noise. The
majority of workers are not being protected
from occupational NIHL, as they work without
proper ear protection. This study shows alarm-
ing evidence of NIHL among the industry’s
workers, especially forge workers as compared
with others. Exposure to high levels of impulse
noise despite the use of ear protectors is more
detrimental to hearing than are high levels of
continuous noise. It should be recognized that
ear protectors in a context of impulsive noise
should have different technical characteristics
than those to be used in a context of continuous
noise. Therefore, it is more important to ensure
that good-quality and appropriate ear protectors
are provided. The design of the ear protectors
should be such that workers feel comfortable
wearing them while they work. At the same
time, job rotation should be introduced so that
the overall noise dose can be reduced. There is
a strong need to take immediate measures at the
management level. However, the workers also
need to become more aware of the benefits of
ear protection. Overall, compared with the
United States and Europe, managers of small-
scale industry in India are lagging behind in
implementing the use of ear protection, setting
up hearing conservation programs, and address-
ing the problem of noise control.
ACKNOWLEDGMENTS
The authors acknowledge the cooperation and help
extended by the management of the casting and forging
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small and medium enterprises in collecting the qualita-
tive information and providing the workers. The
authors also acknowledge the volunteer participation
and cooperation extended by the workers.
KEY POINTS
•• A majority of the workers are not protected from
occupational noise exposure.
•• The casting and forging industry of the region is
primarily focused on executing production tar-
gets and fetching more orders from customers,
whereas health and safety concerns are lowest
priority.
•• The study shows alarming signals of noise-
induced hearing loss among the workers, espe-
cially forge workers as compared with the others.
•• The forge workers are exposed to high levels
of impulse noise, which is more detrimental to
hearing than are high levels of continuous noise.
Therefore, it is more vital to ensure that better ear
protectors are provided to protect the hearing of
workers.
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Lakhwinder Pal Singh is working in the Department
of Industrial and Production Engineering at Dr B R
Ambedkar National Institute of Technology,
Jalandhar-144011 (Punjab). He is a life member of
the Indian Society of Ergonomics (ISE). His PhD is
in the area of occupational health and safety. His
areas of research interest are occupational health and
environment, industrial-occupational ergonomics,
sustainability, green supply-chain management, and
operations management. He has more than 25 publi-
cations in national and international journals and
conferences.
Arvind Bhardwaj has worked in the Department of
Industrial and Production Engineering at Dr B R
Ambedkar National Institute of Technology,
Jalandhar-144011(Punjab) for the past 22 years. He
is dean of students’ welfare at the institute. He has
guided more than 10 PhDs. He has published more
than 30 papers in international journals. He has
handled various research projects and provided con-
sultancy to small-scale industry.
Kishore Kumar Deepak is a professor of physiology
at All India Institute of Medical Sciences. He had
also been subdean of examinations and an adjunct
faculty member at the Center for Medical Education
Technology. He has sustained interest in the field of
medical education in physiology spanning more than
28 years. Although he has acquired professional
training in medical education in the United Kingdom
through the Indo-UK Technical Cooperation
Program, he has contributed to the growth of physi-
ology through outstanding works carried out primar-
ily in India. He has 46 indexed publications (available
in PubMed; search for “Deepak KK”). He has con-
tributed 10 chapters in various books and has pub-
lished three books. He is fortunate to guide 40
students for their master’s and doctoral theses. He
has been honored by more than seven awards.
Date received: November 2, 2011
Date accepted: June 12, 2012

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