Impacts of Hazardous Noise Levels on Hearing Loss and Tinnitus in Dental Professionals: A Comprehensive Study 

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Schulze, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5112767/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 03 Jan, 2025 Read the published version in Journal of Occupational Medicine and Toxicology → Version 1 posted 4 You are reading this latest preprint version Abstract Background Hazardous noise exposure is an important health concern in many workplaces and is one of the most common work-related injuries in the United States. Dental professionals are frequently exposed to high levels of occupational noise in their daily work environment. This noise is generated by various dental handpieces such as drills, suctions, and ultrasonic scalers. Prolonged exposure to such noise levels is known to have adverse effects on hearing health. Despite the prevalence of occupational noise in dentistry, there is a paucity of comprehensive research specifically examining the prevalence of hearing loss and tinnitus in dental professionals. Methods To evaluate the prevalence of hearing loss and tinnitus, data were collected from 60 dental professionals including participant demographics and audiometric thresholds. Thresholds were compared to the age- and sex-based reference ranges from the International Standards Organization (ISO 7029:2017). Results Results showed that 15–25% of males and 13–18% of females had hearing thresholds that exceeded 95th percentile limits based on the ISO normative age- and sex-distributions. Tinnitus was reported in 40% of the participants. Conclusion This study is the first to offer a comprehensive examination of the characteristics and prevalence of auditory dysfuncions in dental professionals, when compared to the ISO normative age and sex distributions of hearing status. Findings from this study highlight the need for increasing the awareness of occupational noise hazards among dental professionals and the importance of routine audiologic monitoring. Noise-induced hearing loss (NIHL) Tinnitus Dental professionals Noise exposure Occupational noise Figures Figure 1 Figure 2 Figure 3 Introduction Occupational hazards in healthcare are multifaceted, encompassing physical, chemical, biological, and ergonomic risks [ 1 ]. Noise-induced hearing loss is the most common work-related injury in the United States, with approximately 22 million workers exposed to hazardous noise levels each year. The audiological implications of prolonged noise exposure are often underestimated, particularly in professions such as dentistry where practitioners routinely operate handpieces that emit high-frequency sounds. Exposure to such noise levels throughout one’s career is known to have adverse effects on hearing health. The dental environment is characterized by the constant whirring of handpieces, ultrasonic scalers, and other instruments integral to diagnostic and therapeutic procedures. According to the National Institute for Occupational Safety and Health Administration (NIOSH), the recommended exposure limit (REL) is 85 dBA averaged over an 8-hour workday [ 2 ]. Additionally, every three-decibel increase in the sound intensity would warrant a reduction in number of hours allowed by half (i.e., 88 dBA for 4 hours, 91 dBA for 2 hours, etc.). Those who are exposed to noise levels at or above the limit would be at risk of developing significant hearing loss and other auditory dysfunctions. There are many factors that determine the adverse auditory impacts of noise exposure including distance from the noise source, duration of exposure, noise intensity, as well as individual susceptibility based on genetic factors and overall health [ 3 ]. Previous studies documented noise levels from dental instruments and revealed that the levels produced by the handpieces could be dangerously loud when compared to the 85 dBA for the 8-hour limit recommended by NIOSH. A study conducted by Damascus University reported that a micro motor handpiece cutting on acrylic can reach 92.2 dBA, and a turbine cutting on tooth can reach 91.2 dBA [ 4 ]. Barek et al. examined the sound intensities generated by different dental handpieces. Results showed that the Micro-Mega handpiece generated a maximum of 95 dB SPL in the audible range and 112 dB SPL at 50,000 Hz. The Siemens and KaVo handpieces generated 101 dB SPL and 115 dB SPL sounds in the ultrasonic frequency range respectively [ 5 ]. Another study revealed noise levels ranging from 98–102 dB SPL for a high-speed handpiece and 92–98 dB SPL for an ultrasonic scalar [ 6 ]. Overall, dental handpieces generate noises at dangerously loud ranges and pose the risk of hazardous noise exposure in dental professionals. Several studies examined hearing thresholds and tinnitus in dental professionals and identified evidence of noise-induced hearing loss. An early study comparing hearing thresholds of 137 dentists and 80 physicians noted elevated thresholds in the dentists at 4000 Hz and 6000 Hz, which is a characteristic of noise-induced hearing loss [ 7 ]. Willershausen et al. reported that dentists are at a higher risk for hearing loss when compared to academic professionals with statistically significant differences in hearing thresholds at 3000 Hz and 4000 Hz [ 8 ]. When comparing dental hygienists who often used ultrasonic scalers to those who rarely use it, the high-usage group had significantly worse thresholds at 3000 Hz [ 9 ]. Additionally, dental professionals who routinely use high-speed handpieces have more hearing loss when compared to dental students and dental professionals who do not use such handpieces [ 6 ]. One of the initial signs of changes in the auditory system is the presence of tinnitus, which is the perception of sound without an external source [ 10 ]. Tinnitus is closely associated with prolonged noise exposure [ 11 ]. Tinnitus in dental professionals has been explored in a few studies globally. A survey of South African dentists found that 31.85% experienced tinnitus [ 12 ]. Another survey of dental professionals in the United Arab Emirates found that 37% of the dental professionals reported tinnitus after working in a dental office [ 13 ]. Togoo et al. investigated the impact of noise on tinnitus among dental students, interns, and practitioners and revealed that 29% complained of tinnitus [ 14 ]. Moreover, the prevalence of tinnitus in dental professionals in Oklahoma exceeded national averages in every age group [ 15 , 16 ]. Overall, dentists are 50% more likely to experience tinnitus when compared to the general population [ 17 ]. The American Dental Association (ADA) reported that the average dentist in the United States has a career of approximately 35 years, with some practicing well into their 70s and 80s. Sensory abilities, including hearing, decline with age. Hearing loss typically begins in the fourth decade of life and progresses throughout a person’s lifetime [ 18 ]. Although many studies documented the effects of occupational noise on dentists’ hearing, there are no known reports that compare their hearing thresholds to age- and sex-based reference ranges. The present study aimed to identify the risk of hearing loss and tinnitus among dental professionals and compare their hearing thresholds with these reference ranges. Additionally, we document the noise levels of common dental handpieces these professionals are exposed to as we know these handpieces can generate sounds that exceed the safe ranges. Materials and Methods Participants The data presented in this study contains both retrospective audiological data obtained as part of routine clinical care from an audiology clinic at an academic setting, as well data from recruited dental professionals. The study included data from 60 dental professionals, with an equal number of males and females. Exclusion criteria included those with history of chronic ear disease, ear surgery, ear trauma, known use of ototoxic medications, or hearing loss identified prior to working in the dental profession. This study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board at the University of the Pacific, under the approval number IRB2022-209. Informed consent was obtained from all participants prior to their involvement in the study. Case history and demographics form A case history form [Appendix A] was completed by all participants. Basic demographic information was collected from all participants including gender, age, years of experience, and dental specialty. Otologic history was also collected including information about tinnitus, otalgia, family history of hearing loss, balance disorders, and temporomandibular joint disorders. Participants who reported experiencing tinnitus were asked to complete the Tinnitus Handicap Inventory (THI) [19]. Audiometric assessments All audiometric assessments were completed at an audiology clinic at an academic setting. Followed by otoscopy, hearing evaluations were carried out for pure tone thresholds for air conduction from 250 Hz to 8000 Hz and bone conduction from 250 Hz to 4000 Hz. Pure tone audiometry was conducted using the GSI AudioStar Pro (Grason-Stadler Inc., Eden Prairie, MN, USA) or the Madsen Astera 2 (Natus Medical Incorporated, Middleton, WI, USA) clinical audiometers in a double-walled sound-treated room meeting the American National Standards Institute (ANSI) criteria (ANSI S3.1-1999 (R2003)). Tympanometry was performed using the GSI Tympstar Pro (Grason-Stadler Inc., Eden Prairie, MN, USA) to evaluate the status of the middle ear system. Data and statistical analysis Descriptive statistics were computed using Microsoft Excel, version 16.6 and GraphPad Prism, version 9.3.1. Descriptive statistics were used to examine prevalence of tinnitus and identify hearing thresholds that exceeded clinical norms and the 95th percentile age- and sex-based reference ranges from the International Standards Organization (ISO 7029:2017) [20]. Student’s t -test was performed to compare group means for male and female four-frequency pure tone average (4F-PTA), which is the averaged thresholds for 500, 1000, 2000, and 4000 Hz. Two-way ANOVA was performed to examine interactions between hearing thresholds at various frequencies versus lateralization (left or right ear) or sex. A z-test was used to compare the proportions of males and females who have hearing loss, defined as a 4F-PTA greater than 20 dB HL. Assessment of the strength of the association between years of experience and 4F-PTA was performed using the Pearson correlation coefficient. Lastly, Chi-square test was utilized to analyze the relationship between number of ears with thresholds that exceed the 95 th percentile age- and sex-based reference ranges for each frequency between males and females. An α-level of 0.05 was chosen for statistical significance. Results Demographics Data from 60 dental professionals, equal in number of males and females, were analyzed. Table 1 shows the age and gender distribution for the study population. The mean age for males was 62.8 (SD = 13.9) years old, with an age range of 33 to 80. The mean age for females was 56.0 (SD = 17.0) years old, with an age range of 30 to 80. Majority of the females (43%) were between the ages of 51 to 60 years old, while the majority of males (40%) were between the ages of 71 to 80 years old. Table 2 describes the participant sample, including their dental specialty and years of practice. Our participants spanned a wide range of specialties but primarily identified as general practitioners (44% in males and 70% in females). The other categories included technicians and professionals with specialty areas in orofacial pain, dental sleep medicine, and geriatrics. The majority of participants had 36 to 40 years of experience with an average of 27.5 years for females (SD = 10.89) and 37.8 years for males (SD = 13.7). Audiometric results Behavioral audiometric evaluations were completed on all participants. Word recognition testing was completed on all female participants and 29 of the 30 male participants. Word recognition scores were within normal limits (≥ 88%) for all female participants and were within normal limits for 12% (7/58) of the ears for the male participants. Tympanometry was within normal limits bilaterally for all participants suggesting normal middle ear function. Averaged audiometry thresholds for each frequency for each ear in both females and males are shown. On average, thresholds were within clinically normal range (≤ 20 dB HL) for all frequencies in both ears with the exception of 6000 Hz and 8000 Hz in females (Fig. 1A). In males, average thresholds were within clinically normal range for only 250 Hz, 500 Hz, and 1000 Hz and sloped to a mild to moderate sensorineural hearing loss from 2000 Hz to 8000 Hz (Fig. 1B). Hearing thresholds were not statistically significant when comparing left versus right ear in both males (two-way ANOVA, F (1, 464) = 0.0.054, p = 0.815), 95% CI [-3.40 to 4.32], and females (two-way ANOVA, F (1, 464) = 0.3723, p = 0.542), 95% CI [-1.57 to 2.99]. However, males exhibited more hearing loss when compared to females in the higher frequencies (two-way ANOVA, F (7, 944) = 10.97, p < 0.0001; p = 0.0005 for 2000 Hz, 95% CI [-21.60 to -4.06]; p < 0.0001 for 3000 Hz, 95% CI [-29.19 to -11.65]; p < 0.0001 for 4000 Hz, 95% CI [-34.02 to -16.48]; p < 0.0001 for 6000 Hz, 95% CI [-34.52 to -16.98], and p < 0.0001 for 8000 Hz, 95% CI [-35.52 to -17.98]). Hearing status in each ear was analyzed using a four-frequency air conduction threshold pure tone average (4F-PTA) of 500, 1000, 2000, and 4000 Hz. Clinically normal hearing is defined as a 4F-PTA of ≤ 20 dB HL in both ears and was documented in 32 participants, 22 females (73%) and 10 (33%) males. When examining individual ears (n=60 for both males and Data females), 61% (37/60) of the male, while only 25% (15/60) of the female ears showed hearing loss. There is a statistically significant difference in the prevalence of hearing loss between male and female dental professionals (Fig. 1C, z = 4.05, p < 0.001, 95% CI [0.19 to 0.54]). On average, males had a 4F-PTA of 25.5 ± 21.5 dB HL, and females had a 4F-PTA of 14.2 ± 10.8 dB HL. This difference is statistically significant (Fig. 1D, Student’s t -test, t (58) = 3.462, p = 0.001, 95% CI [4.83 to 18.08]). Additionally, we revealed a positive correlation between years of experience and 4F-PTA (Fig. 1E, males: r = 0.4976, p = 0.005, 95% CI [0.18 to 0.95]; females: r = 0.2909, p = 0.1189, 95% CI [-0.07 to 0.55]) Given that the mean age of our population was 56-63 years old, an age range where individuals are experiencing age-related hearing loss, we wanted to determine how many participants had hearing thresholds that exceeded the normal range for their age. We compared each participant’s thresholds with the 95 th percentile age- and sex-based reference ranges from the International Standards Organization (ISO 7029:2017) cohort of otologically normal persons [20] for each frequency. We found a general trend that more males (Fig. 2A) had elevated hearing thresholds when compared to the age- and sex-based normative ranges as compared to females (Fig. 2B) across all frequencies as well as the 4F-PTA. However, the difference was not statistically significant (Table 3, Chi-square test of independence: χ 2 (7) = 4.459, p = 0.725). Self-report of tinnitus Figure 3 shows participants’ self-report of tinnitus. Twenty-four out of 60 (40%) participants reported experiencing tinnitus. Ten (42%) reported intermittent tinnitus while 14 (58%) complained of constant tinnitus. However, based on the THI, none of the participants reported that their tinnitus was bothersome. Moreover, there was no statistically significant difference between sex and the frequency of tinnitus (Chi-square test of independence: χ 2 (2, 60) = 1.997, p = 0.368). Discussion The present study aimed to evaluate hearing loss and tinnitus as potential risk factors among dental professionals. We found that 25% of female and 61% of male ears have clinically defined hearing loss (4F-PTA of greater than 20 dB HL). More males have thresholds that exceed the 95th percentile age- and sex-based reference ranges as compared to females. 40% of the participants report experiencing either intermittent or constant tinnitus. Our findings are comparable to previous studies and suggest a compelling occupational noise concern in dental professionals. This study is the first to compare hearing thresholds of dental professionals to age- and sex-based reference ranges. The significant percentage of elevated hearing thresholds (Table 3 suggest a previously underreported risk of hearing loss for dental professionals. This indicates that noise exposure in the dental profession is more detrimental than previously recognized. Findings from this study also revealed a significant sex difference, with males exhibiting a higher prevalence of hearing loss as compared to females. This is consistent with previous studies where occupational noise exposure is more common in males than in females [ 21 – 24 ], even when accounting for noise exposure history [ 25 ]. This difference may be attributed to various factors including biological susceptibility [ 26 ] and recreational noise exposure [ 21 ]. Several studies have implicated that exposure to high-intensity sounds, leading to noise-induced hearing loss, during aging causes an acceleration and worsening of age-related hearing loss [ 27 – 29 ]. Dental professionals are at a particularly high risk due to frequent exposure to loud dental equipment that can exacerbate the natural age-related auditory decline. Additionally, there are non-auditory consequences of occupational noise exposure including annoyance [ 30 ], cardiovascular disease [ 31 , 32 ], and cognitive performance [ 33 ]. Given that dental professionals have long careers well into their 70s and 80s, it is imperative for them to prevent the consequences of noise exposure. Given the risk for hearing loss and tinnitus among dental professionals, several recommendations can be made to mitigate these risks. Firstly, implementing the use of high-quality hearing protection in dental clinics can significantly reduce noise exposure. Additionally, routine audiologic assessments can help in early detection, prevention, and management of hearing related issues. Lastly, raising awareness and providing education on the importance of hearing protection starting in dental school can empower dental professionals to take proactive measures to preserve their hearing health. Conclusion The evaluation of hearing status and presence of tinnitus among dental professionals in this study revealed a significant occupational health concern. The findings underscore the importance of preventive measures and regular auditory monitoring to mitigate the risks associated with prolonged noise exposure in dental practice. By addressing these risks, we can enhance the well-being and professional longevity of dental professionals. However, it is important to note that this study is limited by its cross-sectional design, which may not fully capture the long-term effects of noise exposure. Future studies can be executed to longitudinally investigate the impact of dental noises on the hearing acuity of dental students since they routinely have lengthy controlled practice sessions with dental handpieces. Declarations Funding Declaration: This research received no external funding. Ethics approval and consent to participate: This study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board at the University of the Pacific, under the approval number IRB2022-209. Informed consent was obtained from all participants prior to their involvement in the study. Consent for publication: All authors provide consent for the publication of this manuscript. Availability of data and material: The data that support the findings of this study are available on request from the corresponding authors, CZ and JH. Competing interests: The authors have no competing interests. Funding: No external funding was received for this study. Authors’ contributions: Conceptualization: CZ, AY, JH; Investigation: CZ, AY, SR, KS, BS, FN, JH; Methodology: CZ, AY, SR, KS, BS, FN, JH; Data analysis: CZ; Writing – original draft: CZ; Writing – review and editing: CZ, AY, KS, FN, JH Acknowledgements: The authors thank the following graduate students for their assistance with the data collection: Nico Scordakis, Isabella Gantman, Cheng Zeng, Ji Yeon Chung, Emily Bernard, Lauren Hudec, and Mackenzie Hichman. The authors would also like to thank the participants for their time and effort. This research was supported by start-up funds from the University of the Pacific, Department of Audiology (CZ, JH). References DiBenedetto DV: Occupational hazards of the health care industry: protecting health care workers . AAOHN J 1995, 43 (3):131-137. NIOSH: Criteria for a recommended standard: Occupational noise exposure, revised criteria 1998 . In . : National Institute for Occupational Safety Health (NIOSH) Cincinnati, OH; 1998. Natarajan N, Batts S, Stankovic KM: Noise-Induced Hearing Loss . J Clin Med 2023, 12 (6). Qsaibati ML, Ibrahim O: Noise levels of dental equipment used in dental college of Damascus University . Dent Res J (Isfahan) 2014, 11 (6):624-630. Barek S, Adam O, Motsch JF: Large band spectral analysis and harmful risks of dental turbines . Clin Oral Investig 1999, 3 (1):49-54. Theodoroff SM, Folmer RL: Hearing loss associated with long-term exposure to high-speed dental handpieces . Gen Dent 2015, 63 (3):71-76. Zubick HH, Tolentino AT, Boffa J: Hearing loss and the high speed dental handpiece . Am J Public Health 1980, 70 (6):633-635. Willershausen B, Callaway A, Wolf TG, Ehlers V, Scholz L, Wolf D, Letzel S: Hearing assessment in dental practitioners and other academic professionals from an urban setting . Head Face Med 2014, 10 :1. Wilson JD, Darby ML, Tolle SL, Sever JC, Jr.: Effects of occupational ultrasonic noise exposure on hearing of dental hygienists: a pilot study . J Dent Hyg 2002, 76 (4):262-269. Henry JA, Roberts LE, Caspary DM, Theodoroff SM, Salvi RJ: Underlying mechanisms of tinnitus: review and clinical implications . J Am Acad Audiol 2014, 25 (1):5-22; quiz 126. Phoon WH, Lee HS, Chia SE: Tinnitus in noise-exposed workers . Occup Med (Lond) 1993, 43 (1):35-38. Sidley CG: Prevalence of tinnitus and hearing loss in South African dentists and investigation into possible connections with noise levels and frequencies in the dental environment . Stellenbosch: Stellenbosch University; 2004. Elmehdi HM: Noise levels in UAE dental clinics: Health impact on dental healthcare professionals . J Public Health Front 2013, 2 (4):189-192. Togoo RA, Alhaider SH, Hakami RM, Alzamil NS, Alassmi AA, AlShahrani AA, Moadi RA, Ain TS: Impact of Noise on the Hearing and Tinnitus among Dental Students, Interns, and Dental Practitioners: A Cross-sectional Study . World Journal of Dentistry 2023. KochKin S, Tyler R, Born J: MarkeTrak VIII: The prevalence of tinnitus in the United States and the self-reported efficacy of various treatments . Hear Rev 2011, 18 (12):10-27. Myers J, John AB, Kimball S, Fruits T: Prevalence of tinnitus and noise-induced hearing loss in dentists . Noise Health 2016, 18 (85):347-354. Hoffman HJ, Dobie RA, Losonczy KG, Themann CL, Flamme GA: Declining Prevalence of Hearing Loss in US Adults Aged 20 to 69 Years . JAMA Otolaryngol Head Neck Surg 2017, 143 (3):274-285. Cruickshanks KJ, Wiley TL, Tweed TS, Klein BE, Klein R, Mares-Perlman JA, Nondahl DM: Prevalence of hearing loss in older adults in Beaver Dam, Wisconsin. The Epidemiology of Hearing Loss Study . Am J Epidemiol 1998, 148 (9):879-886. Newman CW, Jacobson GP, Spitzer JB: Development of the Tinnitus Handicap Inventory . Arch Otolaryngol Head Neck Surg 1996, 122 (2):143-148. ISO: Acoustics – Statistical Distribution of Hearing Thresholds Related to Age and Gender (ISO 7029:2017) . In . : AENOR; 2017. Wang Q, Wang X, Yang L, Han K, Huang Z, Wu H: Sex differences in noise-induced hearing loss: a cross-sectional study in China . Biol Sex Differ 2021, 12 (1):24. Lie A, Skogstad M, Johnsen TS, Engdahl B, Tambs K: The prevalence of notched audiograms in a cross-sectional study of 12,055 railway workers . Ear Hear 2015, 36 (3):e86-92. Masterson EA: Hearing impairment among noise-exposed workers—United States, 2003–2012 . MMWR Morbidity and mortality weekly report 2016, 65 . Helzner EP, Cauley JA, Pratt SR, Wisniewski SR, Zmuda JM, Talbott EO, de Rekeneire N, Harris TB, Rubin SM, Simonsick EM et al : Race and sex differences in age-related hearing loss: the Health, Aging and Body Composition Study . J Am Geriatr Soc 2005, 53 (12):2119-2127. Agrawal Y, Platz EA, Niparko JK: Prevalence of hearing loss and differences by demographic characteristics among US adults: data from the National Health and Nutrition Examination Survey, 1999-2004 . Arch Intern Med 2008, 168 (14):1522-1530. McFadden D: Sex differences in the auditory system . Developmental Neuropsychology 1998, 14 (2-3):261-298. Kujawa SG, Liberman MC: Acceleration of age-related hearing loss by early noise exposure: evidence of a misspent youth . J Neurosci 2006, 26 (7):2115-2123. Bielefeld EC, Tanaka C, Chen GD, Henderson D: Age-related hearing loss: is it a preventable condition? Hear Res 2010, 264 (1-2):98-107. Campo P, Venet T, Rumeau C, Thomas A, Rieger B, Cour C, Cosnier F, Parietti-Winkler C: Impact of noise or styrene exposure on the kinetics of presbycusis . Hear Res 2011, 280 (1-2):122-132. Fredriksson S, Li H, Soderberg M, Gyllensten K, Widen S, Persson Waye K: Occupational noise exposure, noise annoyance, hearing-related symptoms, and emotional exhaustion - a participatory-based intervention study in preschool and obstetrics care . Arch Environ Occup Health 2023, 78 (7-8):423-434. Li X, Dong Q, Wang B, Song H, Wang S, Zhu B: The Influence of Occupational Noise Exposure on Cardiovascular and Hearing Conditions among Industrial Workers . Scientific Reports 2019, 9 (1):11524. Yang Y, Zhang E, Zhang J, Chen S, Yu G, Liu X, Peng C, Lavin MF, Du Z, Shao H: Relationship between occupational noise exposure and the risk factors of cardiovascular disease in China: A meta-analysis . Medicine (Baltimore) 2018, 97 (30):e11720. Vasudevamurthy S, Kumar UA: Effect of Occupational Noise Exposure on Cognition and Suprathreshold Auditory Skills in Normal-Hearing Individuals . Am J Audiol 2022, 31 (4):1098-1115. Tables Tables 1 to 3 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files AppendixA.pdf Table1.pdf Table 1. Participant demographics. Table2.pdf Table 2. Practice specialty of our study participants and their years of experience. Table3.pdf Table 3. Number and percentage of ears (n=60 for males and females) with elevated hearing thresholds when compared to the 95th percentile age- and sex-based reference ranges from the International Standards Organization (ISO 7029:2017). Cite Share Download PDF Status: Published Journal Publication published 03 Jan, 2025 Read the published version in Journal of Occupational Medicine and Toxicology → Version 1 posted Editorial decision: Revision requested 20 Sep, 2024 Editor assigned by journal 20 Sep, 2024 Submission checks completed at journal 19 Sep, 2024 First submitted to journal 18 Sep, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5112767","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":356983035,"identity":"78a4e402-f11a-478f-9d76-335dff5e8dd9","order_by":0,"name":"Celia Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA40lEQVRIiWNgGAWjYFACHhAhIQciD1QYgKgEorRYGIO1nCFBS0ViA4g6w0CEFv7+swc/F/ySSN/OfvjhgQMFdgz87DkGeLVIHDiXLD2zTyJ3Z0+awYEDBskMkj1v8GsxYOwxkObtkcjdcCCH4fAHgwMMBjcI2GLAzGP8G6gl3eD8GwagLQcY7AlqYeMxk+b5IZEANByixUCCkF/O8JhZ8zZIGO6c8QzsFx6JM88K8Grh7z9jfJvnT528OX/y4w8H/tjJ8bcnb8CrBQwY24AuhLJ5CCsHgz8ILaNgFIyCUTAKMAAAXt9H63c/OGAAAAAASUVORK5CYII=","orcid":"","institution":"University of the Pacific","correspondingAuthor":true,"prefix":"","firstName":"Celia","middleName":"","lastName":"Zhang","suffix":""},{"id":356983036,"identity":"30ac5856-0be8-4cd6-9c04-7b9d9d34802f","order_by":1,"name":"Andrew Young","email":"","orcid":"","institution":"University of the Pacific","correspondingAuthor":false,"prefix":"","firstName":"Andrew","middleName":"","lastName":"Young","suffix":""},{"id":356983037,"identity":"2491020e-bb0e-4ee1-83c2-4967206d025e","order_by":2,"name":"Samantha Rodriguez","email":"","orcid":"","institution":"University of the Pacific","correspondingAuthor":false,"prefix":"","firstName":"Samantha","middleName":"","lastName":"Rodriguez","suffix":""},{"id":356983038,"identity":"41ea3cac-f416-4494-8825-b761ce5398b7","order_by":3,"name":"Karen A. Schulze","email":"","orcid":"","institution":"University of the Pacific","correspondingAuthor":false,"prefix":"","firstName":"Karen","middleName":"A.","lastName":"Schulze","suffix":""},{"id":356983039,"identity":"bf5518e2-0816-47d8-8405-0ddcf17656ec","order_by":4,"name":"Bina Surti","email":"","orcid":"","institution":"University of the Pacific","correspondingAuthor":false,"prefix":"","firstName":"Bina","middleName":"","lastName":"Surti","suffix":""},{"id":356983040,"identity":"e6768e57-cd7f-4a4f-bb0d-3ce4b1ea5a58","order_by":5,"name":"Fadi Najem","email":"","orcid":"","institution":"University of the Pacific","correspondingAuthor":false,"prefix":"","firstName":"Fadi","middleName":"","lastName":"Najem","suffix":""},{"id":356983041,"identity":"feff3197-b6e8-42a8-9392-f882f9c02c03","order_by":6,"name":"Jiong Hu","email":"","orcid":"","institution":"University of the Pacific","correspondingAuthor":false,"prefix":"","firstName":"Jiong","middleName":"","lastName":"Hu","suffix":""}],"badges":[],"createdAt":"2024-09-18 23:38:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5112767/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5112767/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12995-024-00447-0","type":"published","date":"2025-01-03T15:57:26+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":71937433,"identity":"91d8eaea-37bb-433a-b007-60b91da6fe24","added_by":"auto","created_at":"2024-12-20 00:44:16","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":409760,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMean audiometric thresholds for study participants.\u003c/strong\u003e Red circles represent the right ear and blue X’s represent the left ear. \u003cem\u003e\u003cstrong\u003e(A)\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e \u003c/em\u003eDotted line represents the male participants (left) and \u003cem\u003e\u003cstrong\u003e(B)\u003c/strong\u003e\u003c/em\u003e solid line represents the female participants (right). The horizontal dotted line at 20 dB HL identifies the upper limit for normal clinical hearing determination. Bars = standard deviation. \u003cem\u003e\u003cstrong\u003e(C) \u003c/strong\u003e\u003c/em\u003ePercentage of male and female participants with a clinically defined hearing loss (4F-PTA of greater than 20 dB HL). 61% (37/60) of the male and 25% (15/60) of the female ears showed a clinically defined hearing loss. \u003cem\u003e\u003cstrong\u003e(D)\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e \u003c/strong\u003e4F-PTA for males and females.\u003cstrong\u003e \u003c/strong\u003eEach dot represents the average of the left and right ear for each participant.\u003cstrong\u003e \u003c/strong\u003e\u003cem\u003e\u003cstrong\u003e(E)\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e \u003c/strong\u003eCorrelation analysis reveals a positive correlation between the years of experience and 4F-PTA (males: \u003cem\u003er\u003c/em\u003e = 0.4976, \u003cem\u003ep\u003c/em\u003e = 0.005; females: \u003cem\u003er\u003c/em\u003e= 0.2909, \u003cem\u003ep\u003c/em\u003e = 0.1189). ** \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01,\u003cstrong\u003e \u003c/strong\u003e*** \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-5112767/v1/674e560acafc27dad59893d3.png"},{"id":71937431,"identity":"bc41b5c1-4da2-4239-93b9-9ccb71125804","added_by":"auto","created_at":"2024-12-20 00:44:16","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":5713,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAudiometric thresholds in dB HL for males and females plotted by age. \u003c/strong\u003eCurved lines represent the International Organization for Standardization (ISO) normative age-distributions for the 5th percentile (upper black line) and the 95th percentile (lower black line) for each sex, \u003cem\u003e\u003cstrong\u003e(A)\u003c/strong\u003e\u003c/em\u003e males and \u003cem\u003e\u003cstrong\u003e(B) \u003c/strong\u003e\u003c/em\u003efemales, and frequency, including the four-frequency pure tone average (4F-PTA). The horizontal dotted line at 20 dB HL identifies clinically normal hearing. Red circles represent the right ear, and blue circles represent the left ear.\u003c/p\u003e","description":"","filename":"placeholderimage.png","url":"https://assets-eu.researchsquare.com/files/rs-5112767/v1/6b36d01843051bf88d4d5f18.png"},{"id":71937430,"identity":"b05eebda-2e21-413c-acd2-74c1e407f13b","added_by":"auto","created_at":"2024-12-20 00:44:16","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":40346,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of tinnitus in male and female dental professionals.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-5112767/v1/e2a3c5a7ab780b94aae8a7ee.png"},{"id":73093929,"identity":"f67354ec-96dc-46a5-a525-fd576cbd8ee6","added_by":"auto","created_at":"2025-01-06 16:22:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1604935,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5112767/v1/7e1187a3-b03c-42ae-bc94-659bb120ec56.pdf"},{"id":71937435,"identity":"0a8ef8a6-2240-444d-bcf1-c07f05fe13e1","added_by":"auto","created_at":"2024-12-20 00:44:16","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":105484,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixA.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5112767/v1/7e61146944b1c0a2084bc312.pdf"},{"id":71938278,"identity":"2ef3db7f-e879-498b-9b21-c68c538d6582","added_by":"auto","created_at":"2024-12-20 00:52:16","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":44822,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Participant demographics.\u003c/p\u003e","description":"","filename":"Table1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5112767/v1/a1952366eeee67608d097803.pdf"},{"id":71937428,"identity":"3b300f1c-2515-4f19-882c-a07a26081b15","added_by":"auto","created_at":"2024-12-20 00:44:16","extension":"pdf","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":54058,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Practice specialty of our study participants and their years of experience.\u003c/p\u003e","description":"","filename":"Table2.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5112767/v1/94c14269d878137c3bd7e55f.pdf"},{"id":71938279,"identity":"6b9ddfbc-9f6b-481c-9a70-8b1c280864f5","added_by":"auto","created_at":"2024-12-20 00:52:16","extension":"pdf","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":36772,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e Number and percentage of ears (n=60 for males and females) with elevated hearing thresholds when compared to the 95th percentile age- and sex-based reference ranges from the International Standards Organization (ISO 7029:2017).\u003c/p\u003e","description":"","filename":"Table3.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5112767/v1/4980fc144677214588883118.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impacts of Hazardous Noise Levels on Hearing Loss and Tinnitus in Dental Professionals: A Comprehensive Study ","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOccupational hazards in healthcare are multifaceted, encompassing physical, chemical, biological, and ergonomic risks [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Noise-induced hearing loss is the most common work-related injury in the United States, with approximately 22\u0026nbsp;million workers exposed to hazardous noise levels each year. The audiological implications of prolonged noise exposure are often underestimated, particularly in professions such as dentistry where practitioners routinely operate handpieces that emit high-frequency sounds. Exposure to such noise levels throughout one\u0026rsquo;s career is known to have adverse effects on hearing health.\u003c/p\u003e \u003cp\u003eThe dental environment is characterized by the constant whirring of handpieces, ultrasonic scalers, and other instruments integral to diagnostic and therapeutic procedures. According to the National Institute for Occupational Safety and Health Administration (NIOSH), the recommended exposure limit (REL) is 85 dBA averaged over an 8-hour workday [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Additionally, every three-decibel increase in the sound intensity would warrant a reduction in number of hours allowed by half (i.e., 88 dBA for 4 hours, 91 dBA for 2 hours, etc.). Those who are exposed to noise levels at or above the limit would be at risk of developing significant hearing loss and other auditory dysfunctions. There are many factors that determine the adverse auditory impacts of noise exposure including distance from the noise source, duration of exposure, noise intensity, as well as individual susceptibility based on genetic factors and overall health [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePrevious studies documented noise levels from dental instruments and revealed that the levels produced by the handpieces could be dangerously loud when compared to the 85 dBA for the 8-hour limit recommended by NIOSH. A study conducted by Damascus University reported that a micro motor handpiece cutting on acrylic can reach 92.2 dBA, and a turbine cutting on tooth can reach 91.2 dBA [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Barek et al. examined the sound intensities generated by different dental handpieces. Results showed that the Micro-Mega handpiece generated a maximum of 95 dB SPL in the audible range and 112 dB SPL at 50,000 Hz. The Siemens and KaVo handpieces generated 101 dB SPL and 115 dB SPL sounds in the ultrasonic frequency range respectively [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Another study revealed noise levels ranging from 98\u0026ndash;102 dB SPL for a high-speed handpiece and 92\u0026ndash;98 dB SPL for an ultrasonic scalar [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Overall, dental handpieces generate noises at dangerously loud ranges and pose the risk of hazardous noise exposure in dental professionals.\u003c/p\u003e \u003cp\u003eSeveral studies examined hearing thresholds and tinnitus in dental professionals and identified evidence of noise-induced hearing loss. An early study comparing hearing thresholds of 137 dentists and 80 physicians noted elevated thresholds in the dentists at 4000 Hz and 6000 Hz, which is a characteristic of noise-induced hearing loss [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Willershausen et al. reported that dentists are at a higher risk for hearing loss when compared to academic professionals with statistically significant differences in hearing thresholds at 3000 Hz and 4000 Hz [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. When comparing dental hygienists who often used ultrasonic scalers to those who rarely use it, the high-usage group had significantly worse thresholds at 3000 Hz [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Additionally, dental professionals who routinely use high-speed handpieces have more hearing loss when compared to dental students and dental professionals who do not use such handpieces [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOne of the initial signs of changes in the auditory system is the presence of tinnitus, which is the perception of sound without an external source [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Tinnitus is closely associated with prolonged noise exposure [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Tinnitus in dental professionals has been explored in a few studies globally. A survey of South African dentists found that 31.85% experienced tinnitus [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Another survey of dental professionals in the United Arab Emirates found that 37% of the dental professionals reported tinnitus after working in a dental office [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Togoo et al. investigated the impact of noise on tinnitus among dental students, interns, and practitioners and revealed that 29% complained of tinnitus [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Moreover, the prevalence of tinnitus in dental professionals in Oklahoma exceeded national averages in every age group [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Overall, dentists are 50% more likely to experience tinnitus when compared to the general population [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe American Dental Association (ADA) reported that the average dentist in the United States has a career of approximately 35 years, with some practicing well into their 70s and 80s. Sensory abilities, including hearing, decline with age. Hearing loss typically begins in the fourth decade of life and progresses throughout a person\u0026rsquo;s lifetime [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Although many studies documented the effects of occupational noise on dentists\u0026rsquo; hearing, there are no known reports that compare their hearing thresholds to age- and sex-based reference ranges. The present study aimed to identify the risk of hearing loss and tinnitus among dental professionals and compare their hearing thresholds with these reference ranges. Additionally, we document the noise levels of common dental handpieces these professionals are exposed to as we know these handpieces can generate sounds that exceed the safe ranges.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003eParticipants\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data presented in this study contains both retrospective audiological data obtained as part of routine clinical care from an audiology clinic at an academic setting, as well data from recruited dental professionals. The study included data from 60 dental professionals, with an equal number of males and females. Exclusion criteria included those with history of chronic ear disease, ear surgery, ear trauma, known use of ototoxic medications, or hearing loss identified prior to working in the dental profession. This study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board at the University of the Pacific, under the approval number IRB2022-209. Informed consent was obtained from all participants prior to their involvement in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase history and demographics form\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA case history form [Appendix A] was completed by all participants. Basic demographic information was collected from all participants including gender, age, years of experience, and dental specialty. Otologic history was also collected including information about tinnitus, otalgia, family history of hearing loss, balance disorders, and temporomandibular joint disorders. Participants who reported experiencing tinnitus were asked to complete the Tinnitus Handicap Inventory (THI) [19].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAudiometric assessments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll audiometric assessments were completed at an audiology clinic at an academic setting. Followed by otoscopy, hearing evaluations were carried out for pure tone thresholds for air conduction from 250 Hz to 8000 Hz and bone conduction from 250 Hz to 4000 Hz. Pure tone audiometry was conducted using the GSI AudioStar Pro (Grason-Stadler Inc., Eden Prairie, MN, USA) or the Madsen Astera 2 (Natus Medical Incorporated, Middleton, WI, USA) clinical audiometers in a double-walled sound-treated room meeting the American National Standards Institute (ANSI) criteria (ANSI S3.1-1999 (R2003)). Tympanometry was performed using the GSI Tympstar Pro (Grason-Stadler Inc., Eden Prairie, MN, USA) to evaluate the status of the middle ear system.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData and statistical analysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDescriptive statistics were computed using Microsoft Excel, version 16.6 and GraphPad Prism, version 9.3.1. Descriptive statistics were used to examine prevalence of tinnitus and identify hearing thresholds that exceeded clinical norms and the 95th percentile age- and sex-based reference ranges from the International Standards Organization (ISO 7029:2017) [20]. Student\u0026rsquo;s \u003cem\u003et\u003c/em\u003e-test was performed to compare group means for male and female four-frequency pure tone average (4F-PTA), which is the averaged thresholds for 500, 1000, 2000, and 4000 Hz. Two-way ANOVA was performed to examine interactions between hearing thresholds at various frequencies versus lateralization (left or right ear) or sex. A z-test was used to compare the proportions of males and females who have hearing loss, defined as a 4F-PTA greater than 20 dB HL. Assessment of the strength of the association between years of experience and 4F-PTA was performed using the Pearson correlation coefficient. Lastly, Chi-square test was utilized to analyze the relationship between number of ears with thresholds that exceed the 95\u003csup\u003eth\u003c/sup\u003e percentile age- and sex-based reference ranges for each frequency between males and females. An \u0026alpha;-level of 0.05 was chosen for statistical significance.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eDemographics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData from 60 dental professionals, equal in number of males and females, were analyzed. Table 1 shows the age and gender distribution for the study population. The mean age for males was 62.8 (SD = 13.9) years old, with an age range of 33 to 80. The mean age for females was 56.0 (SD = 17.0) years old, with an age range of 30 to 80. Majority of the females (43%) were between the ages of 51 to 60 years old, while the majority of males (40%) were between the ages of 71 to 80 years old.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2 describes the participant sample, including their dental specialty and years of practice. Our participants spanned a wide range of specialties but primarily identified as general practitioners (44% in males and 70% in females). The other categories included technicians and professionals with specialty areas in orofacial pain, dental sleep medicine, and geriatrics. The majority of participants had 36 to 40 years of experience with an average of 27.5 years for females (SD = 10.89) and 37.8 years for males (SD = 13.7).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAudiometric results\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBehavioral audiometric evaluations were completed on all participants. Word recognition testing was completed on all female participants and 29 of the 30 male participants. Word recognition scores were within normal limits (\u0026ge; 88%) for all female participants and were within normal limits for 12% (7/58) of the ears for the male participants. Tympanometry was within normal limits bilaterally for all participants suggesting normal middle ear function.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAveraged audiometry thresholds for each frequency for each ear in both females and males are shown. On average, thresholds were within clinically normal range (\u0026le; 20 dB HL) for all frequencies in both ears with the exception of 6000 Hz and 8000 Hz in females (Fig. 1A). In males, average thresholds were within clinically normal range for only 250 Hz, 500 Hz, and 1000 Hz and sloped to a mild to moderate sensorineural hearing loss from 2000 Hz to 8000 Hz (Fig. 1B). Hearing thresholds were not statistically significant when comparing left versus right ear in both males (two-way ANOVA, \u003cem\u003eF\u0026nbsp;\u003c/em\u003e(1, 464) = 0.0.054, \u003cem\u003ep\u003c/em\u003e = 0.815), 95% CI [-3.40 to 4.32], and females (two-way ANOVA, \u003cem\u003eF\u0026nbsp;\u003c/em\u003e(1, 464) = 0.3723, \u003cem\u003ep\u003c/em\u003e = 0.542), 95% CI [-1.57 to 2.99]. However, males exhibited more hearing loss when compared to females in the higher frequencies (two-way ANOVA, \u003cem\u003eF\u003c/em\u003e (7, 944) = 10.97, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.0001; \u003cem\u003ep\u003c/em\u003e = 0.0005 for 2000 Hz, 95% CI [-21.60 to -4.06]; \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.0001 for 3000 Hz, 95% CI [-29.19 to -11.65]; \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.0001 for 4000 Hz, 95% CI [-34.02 to -16.48]; \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.0001 for 6000 Hz, 95% CI [-34.52 to -16.98], and\u003cem\u003e\u0026nbsp;p\u003c/em\u003e \u0026lt; 0.0001 for 8000 Hz, 95% CI [-35.52 to -17.98]).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHearing status in each ear was analyzed using a four-frequency air conduction threshold pure tone average (4F-PTA) of 500, 1000, 2000, and 4000 Hz. Clinically normal hearing is defined as a 4F-PTA of \u0026le; 20 dB HL in both ears and was documented in 32 participants, 22 females (73%) and 10 (33%) males. When examining individual ears (n=60 for both males and Data females), 61% (37/60) of the male, while only 25% (15/60) of the female ears showed hearing loss. There is a statistically significant difference in the prevalence of hearing loss between male and female dental professionals (Fig. 1C, \u003cem\u003ez\u003c/em\u003e = 4.05, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001, 95% CI [0.19 to 0.54]). On average, males had a 4F-PTA of 25.5 \u0026plusmn; 21.5 dB HL, and females had a 4F-PTA of 14.2 \u0026plusmn; 10.8 dB HL. This difference is statistically significant (Fig. 1D, Student\u0026rsquo;s \u003cem\u003et\u003c/em\u003e-test, t (58) = 3.462, \u003cem\u003ep\u003c/em\u003e = 0.001, 95% CI [4.83 to 18.08]). Additionally, we revealed a positive correlation between years of experience and 4F-PTA (Fig. 1E, males: \u003cem\u003er\u003c/em\u003e = 0.4976, \u003cem\u003ep\u003c/em\u003e = 0.005, 95% CI [0.18 to 0.95]; females: \u003cem\u003er\u003c/em\u003e = 0.2909, \u003cem\u003ep\u003c/em\u003e = 0.1189, 95% CI [-0.07 to 0.55])\u003c/p\u003e\n\u003cp\u003eGiven that the mean age of our population was 56-63 years old, an age range where individuals are experiencing age-related hearing loss, we wanted to determine how many participants had hearing thresholds that exceeded the normal range for their age. We compared each participant\u0026rsquo;s thresholds with the 95\u003csup\u003eth\u003c/sup\u003e percentile age- and sex-based reference ranges from the International Standards Organization (ISO 7029:2017) cohort of otologically normal persons [20] for each frequency. We found a general trend that more males (Fig. 2A) had elevated hearing thresholds when compared to the age- and sex-based normative ranges as compared to females (Fig. 2B) across all frequencies as well as the 4F-PTA. However, the difference was not statistically significant (Table 3, Chi-square test of independence: \u0026chi;\u003csup\u003e2\u003c/sup\u003e (7) = 4.459, \u003cem\u003ep\u003c/em\u003e = 0.725).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSelf-report of tinnitus\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFigure 3 shows participants\u0026rsquo; self-report of tinnitus. Twenty-four out of 60 (40%) participants reported experiencing tinnitus. Ten (42%) reported intermittent tinnitus while 14 (58%) complained of constant tinnitus. However, based on the THI, none of the participants reported that their tinnitus was bothersome. Moreover, there was no statistically significant difference between sex and the frequency of tinnitus (Chi-square test of independence: \u0026chi;\u003csup\u003e2\u003c/sup\u003e (2, 60) = 1.997, \u003cem\u003ep\u003c/em\u003e = 0.368).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study aimed to evaluate hearing loss and tinnitus as potential risk factors among dental professionals. We found that 25% of female and 61% of male ears have clinically defined hearing loss (4F-PTA of greater than 20 dB HL). More males have thresholds that exceed the 95th percentile age- and sex-based reference ranges as compared to females. 40% of the participants report experiencing either intermittent or constant tinnitus. Our findings are comparable to previous studies and suggest a compelling occupational noise concern in dental professionals.\u003c/p\u003e \u003cp\u003eThis study is the first to compare hearing thresholds of dental professionals to age- and sex-based reference ranges. The significant percentage of elevated hearing thresholds (Table\u0026nbsp;3 suggest a previously underreported risk of hearing loss for dental professionals. This indicates that noise exposure in the dental profession is more detrimental than previously recognized. Findings from this study also revealed a significant sex difference, with males exhibiting a higher prevalence of hearing loss as compared to females. This is consistent with previous studies where occupational noise exposure is more common in males than in females [\u003cspan additionalcitationids=\"CR22 CR23\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], even when accounting for noise exposure history [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. This difference may be attributed to various factors including biological susceptibility [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] and recreational noise exposure [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSeveral studies have implicated that exposure to high-intensity sounds, leading to noise-induced hearing loss, during aging causes an acceleration and worsening of age-related hearing loss [\u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Dental professionals are at a particularly high risk due to frequent exposure to loud dental equipment that can exacerbate the natural age-related auditory decline. Additionally, there are non-auditory consequences of occupational noise exposure including annoyance [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], cardiovascular disease [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], and cognitive performance [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Given that dental professionals have long careers well into their 70s and 80s, it is imperative for them to prevent the consequences of noise exposure.\u003c/p\u003e \u003cp\u003eGiven the risk for hearing loss and tinnitus among dental professionals, several recommendations can be made to mitigate these risks. Firstly, implementing the use of high-quality hearing protection in dental clinics can significantly reduce noise exposure. Additionally, routine audiologic assessments can help in early detection, prevention, and management of hearing related issues. Lastly, raising awareness and providing education on the importance of hearing protection starting in dental school can empower dental professionals to take proactive measures to preserve their hearing health.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe evaluation of hearing status and presence of tinnitus among dental professionals in this study revealed a significant occupational health concern. The findings underscore the importance of preventive measures and regular auditory monitoring to mitigate the risks associated with prolonged noise exposure in dental practice. By addressing these risks, we can enhance the well-being and professional longevity of dental professionals. However, it is important to note that this study is limited by its cross-sectional design, which may not fully capture the long-term effects of noise exposure. Future studies can be executed to longitudinally investigate the impact of dental noises on the hearing acuity of dental students since they routinely have lengthy controlled practice sessions with dental handpieces.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding Declaration:\u003c/strong\u003e This research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eThis study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board at the University of the Pacific, under the approval number IRB2022-209. Informed consent was obtained from all participants prior to their involvement in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eAll authors provide consent for the publication of this manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material:\u0026nbsp;\u003c/strong\u003eThe data that support the findings of this study are available on request from the corresponding authors, \u0026nbsp;CZ and JH.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors have no competing interests.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eNo external funding was received for this study.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions:\u0026nbsp;\u003c/strong\u003eConceptualization: CZ, AY, JH; Investigation: CZ, AY, SR, KS, BS, FN, JH; Methodology: CZ, AY, SR, KS, BS, FN, JH; Data analysis: CZ; Writing \u0026ndash; original draft: CZ; Writing \u0026ndash; review and editing: CZ, AY, KS, FN, JH\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eThe authors thank the following graduate students for their assistance with the data collection: Nico Scordakis, Isabella Gantman, Cheng Zeng, Ji Yeon Chung, Emily Bernard, Lauren Hudec, and Mackenzie Hichman. The authors would also like to thank the participants for their time and effort. This research was supported by start-up funds from the University of the Pacific, Department of Audiology (CZ, JH).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDiBenedetto DV: \u003cstrong\u003eOccupational hazards of the health care industry: protecting health care workers\u003c/strong\u003e. \u003cem\u003eAAOHN J \u003c/em\u003e1995, \u003cstrong\u003e43\u003c/strong\u003e(3):131-137.\u003c/li\u003e\n\u003cli\u003eNIOSH: \u003cstrong\u003eCriteria for a recommended standard: Occupational noise exposure, revised criteria 1998\u003c/strong\u003e. In\u003cem\u003e.\u003c/em\u003e: National Institute for Occupational Safety Health (NIOSH) Cincinnati, OH; 1998.\u003c/li\u003e\n\u003cli\u003eNatarajan N, Batts S, Stankovic KM: \u003cstrong\u003eNoise-Induced Hearing Loss\u003c/strong\u003e. \u003cem\u003eJ Clin Med \u003c/em\u003e2023, \u003cstrong\u003e12\u003c/strong\u003e(6).\u003c/li\u003e\n\u003cli\u003eQsaibati ML, Ibrahim O: \u003cstrong\u003eNoise levels of dental equipment used in dental college of Damascus University\u003c/strong\u003e. \u003cem\u003eDent Res J (Isfahan) \u003c/em\u003e2014, \u003cstrong\u003e11\u003c/strong\u003e(6):624-630.\u003c/li\u003e\n\u003cli\u003eBarek S, Adam O, Motsch JF: \u003cstrong\u003eLarge band spectral analysis and harmful risks of dental turbines\u003c/strong\u003e. \u003cem\u003eClin Oral Investig \u003c/em\u003e1999, \u003cstrong\u003e3\u003c/strong\u003e(1):49-54.\u003c/li\u003e\n\u003cli\u003eTheodoroff SM, Folmer RL: \u003cstrong\u003eHearing loss associated with long-term exposure to high-speed dental handpieces\u003c/strong\u003e. \u003cem\u003eGen Dent \u003c/em\u003e2015, \u003cstrong\u003e63\u003c/strong\u003e(3):71-76.\u003c/li\u003e\n\u003cli\u003eZubick HH, Tolentino AT, Boffa J: \u003cstrong\u003eHearing loss and the high speed dental handpiece\u003c/strong\u003e. \u003cem\u003eAm J Public Health \u003c/em\u003e1980, \u003cstrong\u003e70\u003c/strong\u003e(6):633-635.\u003c/li\u003e\n\u003cli\u003eWillershausen B, Callaway A, Wolf TG, Ehlers V, Scholz L, Wolf D, Letzel S: \u003cstrong\u003eHearing assessment in dental practitioners and other academic professionals from an urban setting\u003c/strong\u003e. \u003cem\u003eHead Face Med \u003c/em\u003e2014, \u003cstrong\u003e10\u003c/strong\u003e:1.\u003c/li\u003e\n\u003cli\u003eWilson JD, Darby ML, Tolle SL, Sever JC, Jr.: \u003cstrong\u003eEffects of occupational ultrasonic noise exposure on hearing of dental hygienists: a pilot study\u003c/strong\u003e. \u003cem\u003eJ Dent Hyg \u003c/em\u003e2002, \u003cstrong\u003e76\u003c/strong\u003e(4):262-269.\u003c/li\u003e\n\u003cli\u003eHenry JA, Roberts LE, Caspary DM, Theodoroff SM, Salvi RJ: \u003cstrong\u003eUnderlying mechanisms of tinnitus: review and clinical implications\u003c/strong\u003e. \u003cem\u003eJ Am Acad Audiol \u003c/em\u003e2014, \u003cstrong\u003e25\u003c/strong\u003e(1):5-22; quiz 126.\u003c/li\u003e\n\u003cli\u003ePhoon WH, Lee HS, Chia SE: \u003cstrong\u003eTinnitus in noise-exposed workers\u003c/strong\u003e. \u003cem\u003eOccup Med (Lond) \u003c/em\u003e1993, \u003cstrong\u003e43\u003c/strong\u003e(1):35-38.\u003c/li\u003e\n\u003cli\u003eSidley CG: \u003cstrong\u003ePrevalence of tinnitus and hearing loss in South African dentists and investigation into possible connections with noise levels and frequencies in the dental environment\u003c/strong\u003e. Stellenbosch: Stellenbosch University; 2004.\u003c/li\u003e\n\u003cli\u003eElmehdi HM: \u003cstrong\u003eNoise levels in UAE dental clinics: Health impact on dental healthcare professionals\u003c/strong\u003e. \u003cem\u003eJ Public Health Front \u003c/em\u003e2013, \u003cstrong\u003e2\u003c/strong\u003e(4):189-192.\u003c/li\u003e\n\u003cli\u003eTogoo RA, Alhaider SH, Hakami RM, Alzamil NS, Alassmi AA, AlShahrani AA, Moadi RA, Ain TS: \u003cstrong\u003eImpact of Noise on the Hearing and Tinnitus among Dental Students, Interns, and Dental Practitioners: A Cross-sectional Study\u003c/strong\u003e. \u003cem\u003eWorld Journal of Dentistry \u003c/em\u003e2023.\u003c/li\u003e\n\u003cli\u003eKochKin S, Tyler R, Born J: \u003cstrong\u003eMarkeTrak VIII: The prevalence of tinnitus in the United States and the self-reported efficacy of various treatments\u003c/strong\u003e. \u003cem\u003eHear Rev \u003c/em\u003e2011, \u003cstrong\u003e18\u003c/strong\u003e(12):10-27.\u003c/li\u003e\n\u003cli\u003eMyers J, John AB, Kimball S, Fruits T: \u003cstrong\u003ePrevalence of tinnitus and noise-induced hearing loss in dentists\u003c/strong\u003e. \u003cem\u003eNoise Health \u003c/em\u003e2016, \u003cstrong\u003e18\u003c/strong\u003e(85):347-354.\u003c/li\u003e\n\u003cli\u003eHoffman HJ, Dobie RA, Losonczy KG, Themann CL, Flamme GA: \u003cstrong\u003eDeclining Prevalence of Hearing Loss in US Adults Aged 20 to 69 Years\u003c/strong\u003e. \u003cem\u003eJAMA Otolaryngol Head Neck Surg \u003c/em\u003e2017, \u003cstrong\u003e143\u003c/strong\u003e(3):274-285.\u003c/li\u003e\n\u003cli\u003eCruickshanks KJ, Wiley TL, Tweed TS, Klein BE, Klein R, Mares-Perlman JA, Nondahl DM: \u003cstrong\u003ePrevalence of hearing loss in older adults in Beaver Dam, Wisconsin. The Epidemiology of Hearing Loss Study\u003c/strong\u003e. \u003cem\u003eAm J Epidemiol \u003c/em\u003e1998, \u003cstrong\u003e148\u003c/strong\u003e(9):879-886.\u003c/li\u003e\n\u003cli\u003eNewman CW, Jacobson GP, Spitzer JB: \u003cstrong\u003eDevelopment of the Tinnitus Handicap Inventory\u003c/strong\u003e. \u003cem\u003eArch Otolaryngol Head Neck Surg \u003c/em\u003e1996, \u003cstrong\u003e122\u003c/strong\u003e(2):143-148.\u003c/li\u003e\n\u003cli\u003eISO: \u003cstrong\u003e\u003cem\u003eAcoustics \u0026ndash; Statistical Distribution of Hearing Thresholds Related to Age and Gender (ISO 7029:2017)\u003c/em\u003e\u003c/strong\u003e. In\u003cem\u003e.\u003c/em\u003e: AENOR; 2017.\u003c/li\u003e\n\u003cli\u003eWang Q, Wang X, Yang L, Han K, Huang Z, Wu H: \u003cstrong\u003eSex differences in noise-induced hearing loss: a cross-sectional study in China\u003c/strong\u003e. \u003cem\u003eBiol Sex Differ \u003c/em\u003e2021, \u003cstrong\u003e12\u003c/strong\u003e(1):24.\u003c/li\u003e\n\u003cli\u003eLie A, Skogstad M, Johnsen TS, Engdahl B, Tambs K: \u003cstrong\u003eThe prevalence of notched audiograms in a cross-sectional study of 12,055 railway workers\u003c/strong\u003e. \u003cem\u003eEar Hear \u003c/em\u003e2015, \u003cstrong\u003e36\u003c/strong\u003e(3):e86-92.\u003c/li\u003e\n\u003cli\u003eMasterson EA: \u003cstrong\u003eHearing impairment among noise-exposed workers\u0026mdash;United States, 2003\u0026ndash;2012\u003c/strong\u003e. \u003cem\u003eMMWR Morbidity and mortality weekly report \u003c/em\u003e2016, \u003cstrong\u003e65\u003c/strong\u003e.\u003c/li\u003e\n\u003cli\u003eHelzner EP, Cauley JA, Pratt SR, Wisniewski SR, Zmuda JM, Talbott EO, de Rekeneire N, Harris TB, Rubin SM, Simonsick EM\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eRace and sex differences in age-related hearing loss: the Health, Aging and Body Composition Study\u003c/strong\u003e. \u003cem\u003eJ Am Geriatr Soc \u003c/em\u003e2005, \u003cstrong\u003e53\u003c/strong\u003e(12):2119-2127.\u003c/li\u003e\n\u003cli\u003eAgrawal Y, Platz EA, Niparko JK: \u003cstrong\u003ePrevalence of hearing loss and differences by demographic characteristics among US adults: data from the National Health and Nutrition Examination Survey, 1999-2004\u003c/strong\u003e. \u003cem\u003eArch Intern Med \u003c/em\u003e2008, \u003cstrong\u003e168\u003c/strong\u003e(14):1522-1530.\u003c/li\u003e\n\u003cli\u003eMcFadden D: \u003cstrong\u003eSex differences in the auditory system\u003c/strong\u003e. \u003cem\u003eDevelopmental Neuropsychology \u003c/em\u003e1998, \u003cstrong\u003e14\u003c/strong\u003e(2-3):261-298.\u003c/li\u003e\n\u003cli\u003eKujawa SG, Liberman MC: \u003cstrong\u003eAcceleration of age-related hearing loss by early noise exposure: evidence of a misspent youth\u003c/strong\u003e. \u003cem\u003eJ Neurosci \u003c/em\u003e2006, \u003cstrong\u003e26\u003c/strong\u003e(7):2115-2123.\u003c/li\u003e\n\u003cli\u003eBielefeld EC, Tanaka C, Chen GD, Henderson D: \u003cstrong\u003eAge-related hearing loss: is it a preventable condition?\u003c/strong\u003e \u003cem\u003eHear Res \u003c/em\u003e2010, \u003cstrong\u003e264\u003c/strong\u003e(1-2):98-107.\u003c/li\u003e\n\u003cli\u003eCampo P, Venet T, Rumeau C, Thomas A, Rieger B, Cour C, Cosnier F, Parietti-Winkler C: \u003cstrong\u003eImpact of noise or styrene exposure on the kinetics of presbycusis\u003c/strong\u003e. \u003cem\u003eHear Res \u003c/em\u003e2011, \u003cstrong\u003e280\u003c/strong\u003e(1-2):122-132.\u003c/li\u003e\n\u003cli\u003eFredriksson S, Li H, Soderberg M, Gyllensten K, Widen S, Persson Waye K: \u003cstrong\u003eOccupational noise exposure, noise annoyance, hearing-related symptoms, and emotional exhaustion - a participatory-based intervention study in preschool and obstetrics care\u003c/strong\u003e. \u003cem\u003eArch Environ Occup Health \u003c/em\u003e2023, \u003cstrong\u003e78\u003c/strong\u003e(7-8):423-434.\u003c/li\u003e\n\u003cli\u003eLi X, Dong Q, Wang B, Song H, Wang S, Zhu B: \u003cstrong\u003eThe Influence of Occupational Noise Exposure on Cardiovascular and Hearing Conditions among Industrial Workers\u003c/strong\u003e. \u003cem\u003eScientific Reports \u003c/em\u003e2019, \u003cstrong\u003e9\u003c/strong\u003e(1):11524.\u003c/li\u003e\n\u003cli\u003eYang Y, Zhang E, Zhang J, Chen S, Yu G, Liu X, Peng C, Lavin MF, Du Z, Shao H: \u003cstrong\u003eRelationship between occupational noise exposure and the risk factors of cardiovascular disease in China: A meta-analysis\u003c/strong\u003e. \u003cem\u003eMedicine (Baltimore) \u003c/em\u003e2018, \u003cstrong\u003e97\u003c/strong\u003e(30):e11720.\u003c/li\u003e\n\u003cli\u003eVasudevamurthy S, Kumar UA: \u003cstrong\u003eEffect of Occupational Noise Exposure on Cognition and Suprathreshold Auditory Skills in Normal-Hearing Individuals\u003c/strong\u003e. \u003cem\u003eAm J Audiol \u003c/em\u003e2022, \u003cstrong\u003e31\u003c/strong\u003e(4):1098-1115.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 3 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-occupational-medicine-and-toxicology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jmet","sideBox":"Learn more about [Journal of Occupational Medicine and Toxicology](http://occup-med.biomedcentral.com/)","snPcode":"12995","submissionUrl":"https://submission.nature.com/new-submission/12995/3","title":"Journal of Occupational Medicine and Toxicology","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Noise-induced hearing loss (NIHL), Tinnitus, Dental professionals, Noise exposure, Occupational noise","lastPublishedDoi":"10.21203/rs.3.rs-5112767/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5112767/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHazardous noise exposure is an important health concern in many workplaces and is one of the most common work-related injuries in the United States. Dental professionals are frequently exposed to high levels of occupational noise in their daily work environment. This noise is generated by various dental handpieces such as drills, suctions, and ultrasonic scalers. Prolonged exposure to such noise levels is known to have adverse effects on hearing health. Despite the prevalence of occupational noise in dentistry, there is a paucity of comprehensive research specifically examining the prevalence of hearing loss and tinnitus in dental professionals.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e To evaluate the prevalence of hearing loss and tinnitus, data were collected from 60 dental professionals including participant demographics and audiometric thresholds. Thresholds were compared to the age- and sex-based reference ranges from the International Standards Organization (ISO 7029:2017).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eResults showed that 15\u0026ndash;25% of males and 13\u0026ndash;18% of females had hearing thresholds that exceeded 95th percentile limits based on the ISO normative age- and sex-distributions. Tinnitus was reported in 40% of the participants.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study is the first to offer a comprehensive examination of the characteristics and prevalence of auditory dysfuncions in dental professionals, when compared to the ISO normative age and sex distributions of hearing status. Findings from this study highlight the need for increasing the awareness of occupational noise hazards among dental professionals and the importance of routine audiologic monitoring.\u003c/p\u003e","manuscriptTitle":"Impacts of Hazardous Noise Levels on Hearing Loss and Tinnitus in Dental Professionals: A Comprehensive Study ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-20 00:44:11","doi":"10.21203/rs.3.rs-5112767/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-20T17:57:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-09-20T17:51:59+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-09-19T09:37:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Occupational Medicine and Toxicology","date":"2024-09-18T23:35:10+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-occupational-medicine-and-toxicology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jmet","sideBox":"Learn more about [Journal of Occupational Medicine and Toxicology](http://occup-med.biomedcentral.com/)","snPcode":"12995","submissionUrl":"https://submission.nature.com/new-submission/12995/3","title":"Journal of Occupational Medicine and Toxicology","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2ae305e5-b3b8-4446-977b-1d15accb2fba","owner":[],"postedDate":"December 20th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-01-06T16:20:51+00:00","versionOfRecord":{"articleIdentity":"rs-5112767","link":"https://doi.org/10.1186/s12995-024-00447-0","journal":{"identity":"journal-of-occupational-medicine-and-toxicology","isVorOnly":false,"title":"Journal of Occupational Medicine and Toxicology"},"publishedOn":"2025-01-03 15:57:26","publishedOnDateReadable":"January 3rd, 2025"},"versionCreatedAt":"2024-12-20 00:44:11","video":"","vorDoi":"10.1186/s12995-024-00447-0","vorDoiUrl":"https://doi.org/10.1186/s12995-024-00447-0","workflowStages":[]},"version":"v1","identity":"rs-5112767","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5112767","identity":"rs-5112767","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}