Based on the information interpreted from the supporting document 5, worker Y is suffering from noise

induced hearing loss which can cause physical changes in the inner ear of worker Y, inner ear consists of
nerve, hair cells, cochlea, auditory nerves, and semicircular canals, etc.

Due to prolonged exposure of noise or short exposure of very high noise can damage the internal
auditory organs of the ear which can cause physical changes in the inner ear of the patient, the physical
changes occurred due to NIHL explained below.

Figure- Parts of outer, middle and inner ear

Source: NIH/NIDCD - https://www.nidcd.nih.gov/health/noise-induced-hearing-loss

As the question asked about the physical changes in the inner ear of worker Y, the figure shows the
parts of the inner ear which will be helpful in explaining the physical changes in inner ear of worker Y.
Some of the physical changes in the inner ear can be identified which are mentioned below.

 Hair cells and membrane damage: prolonged exposure to loud noise can cause damage of hair
cells in the inner ear and primarily impact on the cochlea which is present in inner ear, exposure
of regular loud noise can damage the cells and inner membrane present in the cochlea. Due to
damage in the inner hair cells and membrane leading to hearing loss as inner ear is mainly
responsible for converting vibrating sound into electrical signals which goes to brain.
 Physical damage of stereocilia: Stereocilia is a small hair like structure present on the surface of
hair cells, these cells detects the vibration of sounds and convert them into an electrical signals.
These hair cells are very sensitive and delicate which are essential for proper hearing. Exposure
to loud noise for almost 18 months might cause damage of these cells leading to noise induced
hearing loss in worker Y. Regular intense and prolonged noise exposure can lead to shearing
force which may cause stereocilia core breakage and further premature death of hair cells.

Figure- inner ear impacted due to NIHL (Anatomical Structure)

Source: https://www.mdpi.com/2077-0383/12/6/2347
 Changes in the basilar membrane: This membrane plays an important role in discriminating
frequencies and distinguishes between the sounds and helps brain to detecting the pitch.
Damaged hair cell sits on the basilar membrane and in response to sound vibration they cause
mechanical shearing force which leads to disturbance in accuracy of frequency discrimination
and problem in receiving specific frequencies of sound.

Fig- Mechanism of hearing damage due to NIHL.

Source: https://www.mdpi.com/2077-0383/12/6/2347

 Damage/rupture in organ of corti: Scala media of cochlea contain organ of corti which helps in
transduction of vibrating sounds into neuron signal which can be detected by the brain. Organ of
corti contains various sensory hair cells as well as non- sensory cells which are known as
supporting cells. Prolonged exposure of loud noise can rupture of organ of corti due to high
pressure waves, this rupture leads to separation of organ of corti from the basilar membrane
and displacement of stereocilia. Hence, due to NIHL organ of corti undergoes various physical
changes like damage of hair cells, and supporting cells.
 Changes in fluid of inner ear: The human cochlea is physically spiral shaped and consists of 3
fluid filled chamber, sound vibration in the cochlea cause movement of fluid and flexible basilar
membrane movement. Excessive noise can cause imbalance in the required volume of the fluid
gets altered in the 3 chambers of the cochlea which can cause problem in detecting the sound of
different frequencies.
  Inflammatory responses: Inflammatory responses can be triggered in the inner ear due to
excessive exposure to loud noise which may lead to emission or release of harmful or damaging
substances and free radicals which can cause more harm to nerve and sensory cells and can act
as a catalyst for NIHL.
 Damage of auditory nerve: When the vibrating sound converted into electrical signal then
these auditory nerves carry these signals to the brain which is translated into a sound that we
understand and recognize. Auditory nerves can get damaged due to prolonged exposure to the
loud noise. Synaptic connection which is a connection between hair cells and auditory nerves
can get damaged which can lead to reduction in the efficiency of transmitting the electrical
signals to the brain

 Cochlear structural damage: As per the supporting document 5 the threshold shift of worker Y
indicates that there may be structural damage to the cochlea occurred, which also include
damage of sensory cells and supporting cells of cochlea. Damage of these connected structures
can affect the effectiveness of transmission of auditory signals and informations.

Hence, above mentioned physical changes may be likely in the inner ear of the worker Y as per the
supporting document 5 interpretation.

References:

https://www.nidcd.nih.gov/health/noise-induced-hearing-loss
https://www.mdpi.com/2077-0383/12/6/2347
https://www.hse.gov.uk/pubns/books/l108.htm
https://my.clevelandclinic.org/health/diseases/21776-noise-induced-hearing-loss-nihl