Lifetime Noise Exposure and Its Interaction With Ageing: Effects on Audiometric Thresholds, Speech-In-Noise Perception, and Tinnitus for Palestinian Workers.
Adnan M Shehabi, Hannah Guest, Amal Abu Kteish and 3 others
Age was the consistent driver of hearing thresholds, speech-in-noise performance, and tinnitus risk in 98 Palestinian workers; lifetime noise exposure showed no significant effect on any primary outcome, and the age × noise interaction did not remain significant after adjusting for multiple tests.
Key findings
1Age was a significant predictor of worse standard audiometric thresholds (0.54 dB per year), extended high-frequency thresholds (1.24 dB per year), and diotic speech-in-noise thresholds (0.095 dB per year), while lifetime noise exposure was not a significant predictor of any of these three primary outcomes.
2The age × noise interaction for standard audiometric thresholds was significant before correction but did not remain significant after the Holm–Bonferroni adjustment; no significant interactions were found for extended high-frequency thresholds, diotic or antiphasic speech-in-noise, binaural unmasking, or tinnitus.
3In a post-hoc exploratory split at the median age, noise exposure was associated with an 8.1 dB higher average PTA threshold per tenfold increase in exposure energy for older participants, but not for younger participants; the authors note this was uncorrected and should be interpreted cautiously.
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What it does not show
Cross-sectional design: cannot establish whether noise exposure caused the threshold differences or whether people with worse hearing were more likely to report or recall higher exposure. Noise exposure was self-reported retrospectively via questionnaire; the authors note recall bias and exposure misclassification as concerns, and time since last hazardous exposure was not controlled, so some participants may have had residual temporary threshold shifts at testing. The age × noise interaction for PTA did not survive multiple-comparison correction; the only significant noise effect came from an uncorrected post-hoc subgroup split, which the authors themselves flag as exploratory. The sample was 83% male, reflecting the local workforce, so findings may not generalise to women or to populations with different occupational noise patterns. The median lifetime exposure (41.9 units, roughly 42 working years at 90 dBA) is high, but the distribution was wide and the relationship between age and cumulative exposure was not significant, making it harder to separate the two factors. Secondary analyses (antiphasic DIN, BILD, tinnitus) were not powered a priori and were not corrected for multiple comparisons.
Declared interests
Funded by Birzeit University Research Committee, the UK Medical Research Council (MR/V01272X/1), and the NIHR Manchester Biomedical Research Centre (NIHR203308). The authors declared no potential conflicts of interest.
The easy way to misread this
Do not read the exploratory finding that noise exposure raised PTA thresholds in older workers as proof that noise causes age-accelerated hearing loss — the primary interaction test did not survive correction for multiple comparisons, and the subgroup analysis was post-hoc, uncorrected, and explicitly flagged by the authors as requiring replication.
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