Occupational Noise Exposure and Age as Predictors of Disabling Hearing Loss in Pakistan
DOI:
10.70211/ltsm.3026-7196.275Published:
2025-11-17Abstract
This study aimed to assess the prevalence, severity, and functional impact of hearing loss (HL) in Rawalpindi and Islamabad, Pakistan. A total of 400 participants, aged 12 to 70 years, were enrolled in the study, and data were collected using pure-tone audiometry (PTA) and the Hearing Handicap Inventory for Adults (HHIA). The results indicated that 18% of participants had some form of HL, with 22% meeting the criteria for disabling HL (≥35 dB HL). The severity of HL ranged from mild to profound, with 55% of participants exhibiting no measurable HL. Sensorineural HL was the most common type (60%), followed by conductive (24%) and mixed (10%) types. Bivariate analysis revealed that older age (≥60 years) and occupational noise exposure were significantly associated with HL ≥35 dB HL. The multivariable logistic regression model confirmed that age and occupational noise exposure were independent predictors of HL. Furthermore, hearing aid users reported significantly lower HHIA scores, indicating reduced psychosocial burden compared to non-users. This study highlights the need for early detection, public health interventions, and increased access to hearing aids, particularly in rural areas. The findings also demonstrate the importance of occupational noise control and workplace interventions to reduce the risk of HL in high-noise environments. The study contributes to the understanding of HL in Pakistan, offering valuable insights for improving hearing care accessibility and policy development.
Keywords:
Hearing Loss Audiometry Hearing Aid Occupational Noise Exposure Psychosocial Burden Pakistan Public Health HHIAReferences
B. O. Olusanya, A. C. Davis, and H. J. Hoffman, "Hearing loss grades and the International classification of functioning, disability and health," Bull. World Health Organ., vol. 97, no. 10, pp. 725-728, Oct. 2019. https://doi.org/10.2471/BLT.19.230367
C. S. Brown, S. D. Emmett, S. K. Robler, and D. L. Tucci, "Global Hearing Loss Prevention," Otolaryngol. Clin. North Am., vol. 51, no. 3, pp. 575-592, Jun. 2018. https://doi.org/10.1016/j.otc.2018.01.006
R. Hussain and R. Kabir, "Knowledge and discriminatory attitudes towards HLV/AIDS among the women of reproductive age group of Pakistan using the Multiple Indicator Cluster Survey (MICS)," Glob. Heal. J., vol. 8, no. 2, pp. 74-82, Jun. 2024. https://doi.org/10.1016/j.glohj.2024.05.004
M. Aizaz, F. A. Abbas, A. Abbas, S. Tabassum, and E. I. Obeagu, "Alarming rise in HLV cases in Pakistan: Challenges and future recommendations at hand," Heal. Sci. Reports, vol. 6, no. 8, Aug. 2023. https://doi.org/10.1002/hsr2.1450
A. Zubair, M. Ali, R. Munir, and M. B. Hossain, "Assessment of HLV Infection in HLV Patients Admitted to Pakistan Institute of Medical Sciences, Islamabad, Pakistan," AIDS Res. Treat., vol. 2025, no. 1, Jan. 2025. https://doi.org/10.1155/arat/5549074
F. Z. Muhammed, K. Yamaguchi, K. N. Handayani, and A. Hagishima, "Affordable Housing in Developing Regions: A Systematic Review of Materials, Methods and Critical Success Factors with Case Insights," Buildings, vol. 15, no. 22, p. 4015, Nov. 2025. https://doi.org/10.3390/buildings15224015
E. Eze, R. Gleasure, and C. Heavin, "Worlds apart: a socio-material exploration of mHealth in rural areas of developing countries," Inf. Technol. People, vol. 35, no. 8, pp. 99-141, Dec. 2022. https://doi.org/10.1108/ITP-04-2020-0228
W. H. K. Liang, L. W. E. Gn, Y. C. D. Tan, and G. H. Tan, "Speech and language delay in children: a practical framework for primary care physicians," Singapore Med. J., vol. 64, no. 12, pp. 745-750, Dec. 2023. https://doi.org/10.4103/singaporemedj.SMJ-2022-051
P. Tatsiopoulou, G.-N. Porfyri, E. Bonti, and I. Diakogiannis, "Priorities in the Interdisciplinary Approach of Specific Learning Disorders (SLD) in Children with Type I Diabetes Mellitus (T1DM). From Theory to Practice," Brain Sci., vol. 11, no. 1, p. 4, Dec. 2020. https://doi.org/10.3390/brainsci11010004
A. Javed et al., "Reducing the stigma of mental health disorders with a focus on low- and middle-income countries," Asian J. Psychiatr., vol. 58, p. 102601, Apr. 2021. https://doi.org/10.1016/j.ajp.2021.102601
K. Hreha, R. Samper-Ternent, H. E. Whitson, L. P. Downer, J. S. West, and B. Downer, "The Association of Vision and Hearing loss on Cognitive Function and Loneliness: Evidence From the Mexican Health and Aging Study," J. Aging Health, vol. 37, no. 5-6, pp. 337-346, Jun. 2025. https://doi.org/10.1177/08982643241247583
E. Uğur, B. Uludag, Ç. Aydın, T. A. Gilik, and B. O. Konukseven, "Evaluation of the effect of hearing loss on cognitive-vestibular functions in the geriatric population," Egypt. J. Otolaryngol., vol. 40, no. 1, p. 97, Sep. 2024. https://doi.org/10.1186/s43163-024-00656-8
H. G. Saber, F. N. Fatouh, A. Askoura, G. O. Wassif, and E. R. Mohamed, "Cognitive function and psychological well-being in older adults with sensorineural hearing loss: An Egyptian perspective," Clin. Epidemiol. Glob. Heal., vol. 33, p. 102008, May 2025. https://doi.org/10.1016/j.cegh.2025.102008
C. Frisby, V. Manchaiah, N. Dawood, C. Nieman, and D. W. Swanepoel, "Hearing loss and hearing aid stigma in low- and middle-income settings: a scoping review," Disabil. Rehabil., pp. 1-18, Aug. 2025. https://doi.org/10.1080/09638288.2025.2540506
K. Khoza-Shangase and T.-J. Munyembate, "Patient Experiences with Hearing Aids in South African Public Healthcare," J. Otorhinolaryngol. Hear. Balanc. Med., vol. 6, no. 1, p. 8, May 2025. https://doi.org/10.3390/ohbm6010008
N. Scarinci et al., "How do adults with hearing loss, family members, and hearing care professionals respond to the stigma of hearing loss and hearing aids?," Int. J. Audiol., vol. 64, no. sup1, Apr. 2025. https://doi.org/10.1080/14992027.2024.2406885
N. Riaz, M. Ajmal, and M. S. Khan, "Frequency of otitis media with effusion among children aged 1-5 years presenting to immunization center of tertiary care hospitals, Rawalpindi," World J. Otorhinolaryngol. - Head Neck Surg., vol. 8, no. 4, pp. 315-320, Dec. 2022. https://doi.org/10.1016/j.wjorl.2021.03.002
A. Aliyeva and E. Sari, "Role of occupational factors in noise-ınduced hearing loss: a single-center real-world data study," Egypt. J. Otolaryngol., vol. 41, no. 1, p. 43, Mar. 2025. https://doi.org/10.1186/s43163-025-00790-x
M. Aldè, U. Ambrosetti, S. Barozzi, and S. Aldè, "The Ongoing Challenges of Hearing Loss: Stigma, Socio-Cultural Differences, and Accessibility Barriers," Audiol. Res., vol. 15, no. 3, p. 46, Apr. 2025. https://doi.org/10.3390/audiolres15030046
K. Wasano, T. Nakagawa, and K. Ogawa, "Prevalence of Hearing loss by Age: 2nd to 10th Decades of Life," Biomedicines, vol. 10, no. 6, p. 1431, Jun. 2022. https://doi.org/10.3390/biomedicines10061431
A. Bhamjee, T. le Roux, K. Schlemmer, M. A. Graham, and F. Mahomed-Asmail, "Audiologists' Perceptions of Hearing Healthcare Resources and Services in South Africa's Public Healthcare System," Heal. Serv. Insights, vol. 15, Jan. 2022. https://doi.org/10.1177/11786329221135424
S. Akhtar, J. A. Nasir, T. Abbas, and A. Sarwar, "Diabetes in Pakistan: A systematic review and meta-analysis," Pakistan J. Med. Sci., vol. 35, no. 4, Jul. 2019. https://doi.org/10.12669/pjms.35.4.194
U. Saleem, N. Aslam, R. Siddique, S. Iqbal, and M. Manan, "Hepatitis C virus: Its prevalence, risk factors and genotype distribution in Pakistan," Eur. J. Inflamm., vol. 20, Sep. 2022. https://doi.org/10.1177/1721727X221144391
D. E. Paping, J. L. Vroegop, H. El Marroun, R. J. Baatenburg de Jong, and M. P. van der Schroeff, “The association of sociodemographic factors and risk behavior with unsafe use of personal listening devices in adolescents,” Int. J. Environ. Health Res., vol. 33, no. 7, pp. 700–709, Jul. 2023. https://doi.org/10.1080/09603123.2022.2047901
N. Diviani, S. Chadha, M. O. Arunda, and S. Rubinelli, “Attitudes towards Safe Listening Measures in Entertainment Venues: Results from an International Survey among Young Venue-Goers,” Int. J. Environ. Res. Public Health, vol. 18, no. 23, p. 12860, Dec. 2021. https://doi.org/10.3390/ijerph182312860
A. Sheppard, M. Ralli, A. Gilardi, and R. Salvi, "Occupational Noise: Auditory and Non-Auditory Consequences," Int. J. Environ. Res. Public Health, vol. 17, no. 23, p. 8963, Dec. 2020. https://doi.org/10.3390/ijerph17238963
S. F. Ahmed et al., "Deep learning modelling techniques: current progress, applications, advantages, and challenges," Artif. Intell. Rev., vol. 56, no. 11, pp. 13521-13617, Nov. 2023. https://doi.org/10.1007/s10462-023-10466-8
A. E. Arısoy, E. S. Arısoy, N. Bayar Muluk, C. Cingi, and A. G. Correa, Eds., Hearing Loss in Congenital, Neonatal and Childhood Infections. in Comprehensive ENT. Cham: Springer International Publishing, 2023. https://doi.org/10.1007/978-3-031-38495-0
M. Chen, Y. Tao, Z. Lin, S. Li, W. He, and L. Zhang, "Risk Factors Associated with Falls in Hospitalized Older Adults Patients," Gerontol. Geriatr. Med., vol. 10, Jan. 2024. https://doi.org/10.1177/23337214241302711
S. Horgan et al., "Optimizing Older Adult Mental Health in Support of Healthy Ageing: A Pluralistic Framework to Inform Transformative Change across Community and Healthcare Domains," Int. J. Environ. Res. Public Health, vol. 21, no. 6, p. 664, May 2024. https://doi.org/10.3390/ijerph21060664
A. Kupferberg and G. Hasler, "The social cost of depression: Investigating the impact of impaired social emotion regulation, social cognition, and interpersonal behavior on social functioning," J. Affect. Disord. Reports, vol. 14, p. 100631, Dec. 2023. https://doi.org/10.1016/j.jadr.2023.100631
D. W. Sherman et al., "A Systematic Review of the Relationship between Social Isolation and Physical Health in Adults," Healthcare, vol. 12, no. 11, p. 1135, Jun. 2024. https://doi.org/10.3390/healthcare12111135
L. Brandt, S. Liu, C. Heim, and A. Heinz, "The effects of social isolation stress and discrimination on mental health," Transl. Psychiatry, vol. 12, no. 1, p. 398, Sep. 2022. https://doi.org/10.1038/s41398-022-02178-4
M. C. Pinzón-Díaz et al., "Technologies and Auditory Rehabilitation Beyond Hearing Aids: An Exploratory Systematic Review," Audiol. Res., vol. 15, no. 4, p. 80, Jul. 2025. https://doi.org/10.3390/audiolres15040080
S. Akhtar, F. Rabbani, J. Nafis, A. Siddiqui, and Z. Merali, "A qualitative study assessing acceptability and appropriateness of a technology-assisted mental health intervention by community frontline workers: mPareshan implementation research in rural Pakistan," BMC Psychiatry, vol. 25, no. 1, p. 16, Jan. 2025. https://doi.org/10.1186/s12888-024-06459-8
M. Saleem et al., "A Digital Tool (Technology-Assisted Problem Management Plus) for Lay Health Workers to Address Common Mental Health Disorders: Co-production and Usability Study in Pakistan," JMIR Form. Res., vol. 9, p. e59414, Jan. 2025. https://doi.org/10.2196/59414
P. Morvan, J. Buisson-Savin, C. Boiteux, E. Bailly-Masson, M. Buhl, and H. Thai-Van, "Factors in the Effective Use of Hearing Aids among Subjects with Age-Related Hearing Loss: A Systematic Review," J. Clin. Med., vol. 13, no. 14, p. 4027, Jul. 2024. https://doi.org/10.3390/jcm13144027
L. Petrocchi-Bartal, K. Khoza-Shangase, and A. Kanji, "Early Intervention for Children with Hearing loss in the South African Context: A Narrative Review of Legislative and Policy Frameworks," Disabilities, vol. 5, no. 2, p. 52, May 2025. https://doi.org/10.3390/disabilities5020052
M. Knoetze, V. Manchaiah, B. Mothemela, and D. W. Swanepoel, "Factors Influencing Hearing Help-Seeking and Hearing Aid Uptake in Adults: A Systematic Review of the Past Decade," Trends Hear., vol. 27, Jan. 2023. https://doi.org/10.1177/23312165231157255
P. Glavič, Ed., Feature Papers to Celebrate the Inaugural Issue of Standards. MDPI, 2024. https://doi.org/10.3390/books978-3-7258-0704-8
W. A. Mustafa and H. Alquran, Eds., Medical Data Processing and Analysis. MDPI, 2025. https://doi.org/10.3390/books978-3-7258-3504-1
L. E. Humes, "The World Health Organization's hearing-impairment grading system: an evaluation for unaided communication in age-related hearing loss," Int. J. Audiol., vol. 58, no. 1, pp. 12-20, Jan. 2019. https://doi.org/10.1080/14992027.2018.1518598
H. Göthberg et al., "Prevalence of hearing loss and need for aural rehabilitation in 85-year-olds: a birth cohort comparison, almost three decades apart," Int. J. Audiol., vol. 60, no. 7, pp. 539-548, Jul. 2021. https://doi.org/10.1080/14992027.2020.1734878
B. Engdahl and L. Aarhus, "Prevalence and predictors of self-reported hearing aid use and benefit in Norway: the HUNT study," BMC Public Health, vol. 24, no. 1, p. 474, Feb. 2024. https://doi.org/10.1186/s12889-024-17852-z
T. Z. H. binti T. Zam Zam, A. A. A. Dzulkarnain, S. Rahmat, and M. Jusoh, "Translation, Adaptation and Cross-Cultural Validation of Hearing Handicap Inventory for Adult in Malay Language," J. Audiol. Otol., vol. 23, no. 3, pp. 129-134, Jul. 2019. https://doi.org/10.7874/jao.2018.00395
N. Ismail, A. Shalaby, R. Behairy, H. Khodary, and M. Ashraf, "The developed Arabic version of the Hearing Handicap Inventory for the Elderly," Egypt. J. Otolaryngol., vol. 36, no. 1, p. 4, Dec. 2020. https://doi.org/10.1186/s43163-020-00004-6
M. Gillis, "Hearing loss is associated with delayed neural responses to continuous speech," Eur. J. Neurosci., vol. 55, no. 6, pp. 1671-1690, 2022. https://doi.org/10.1111/ejn.15644
Y. Wang et al., "Associations Between Occupational Noise Exposure, Aging, and Gender and Hearing Loss: A Cross-Sectional Study in China," Audiol. Res., vol. 15, no. 4, p. 91, Jul. 2025. https://doi.org/10.3390/audiolres15040091
G. P. Georgiou, "Transforming Speech-Language Pathology with AI: Opportunities, Challenges, and Ethical Guidelines," Healthcare, vol. 13, no. 19, p. 2460, Sep. 2025.
License
Copyright (c) 2025 Huma Hanif, Ibtasam Thakur, Georgios P. Georgiou, Paris Binos

This work is licensed under a Creative Commons Attribution 4.0 International License.