Indian J Otolaryngol Head Neck Surg (2023) 75:S278–S284

https://doi.org/10.1007/s12070-022-03432-3

ORIGINAL ARTICLE

Noise Pollution and Associated Hearing Loss in a Metropolitan

City—a Preliminary Report
Roopak Visakan Raja1 · Gurumani Sriraman2 ·
Mohan Kameswaran3

Received: 6 November 2022 / Accepted: 21 December 2022 / Published online: 29 December 2022
© Association of Otolaryngologists of India 2022

Abstract To measure the amount of noise produced in
busy parts of a metropolitan and also to assess the audiologi-
cal status of the civilians exposed to such noise. Cross-sec-
tional study for one year between June 2017 and May 2018
was conducted. Noise was measured in four busy parts of an
urban city with a digital sound level meter. People involved
in various occupations in the busy parts for more than one
year within the age range of 15–45 years were included.
Maximum noise level recorded was 106.4 dBA in Koyem-
bedu. Average noise was around 70–85 dBA in Chennai.
Totally 100 people were subjected to audiological assess-
ment (69 Males; 31 Females). Among them 93% had hearing
loss. Hearing loss was almost equal both in sexes. Sensory
hearing loss was the major type (83%). All areas were almost
equally affected with maximum (100%) being affected in
Annanagar and Koyembedu. The right ear was more affected
than the left. All age groups were affected among which the
working age group (36–45) years was most affected. The
unskilled occupation group was most affected (100%). There
was a positive relation between noise levels and hearing loss.
Duration of exposure did not have positive correlation with
hearing loss. Noise pollution and its induced hearing loss
was more prevalent and increased in all four areas. As hear-
ing loss due to noise pollution is predominant as observed
* Roopak Visakan Raja
fantazrup11@gmail.com
1 may disrupt the activity and balance of human life. There
Annai ENT and Head & Neck Center, Erode,
Tamil Nadu 638009, India
2 annoyance; like other forms of pollution, it has wide-rang-
Department of Otolaryngology and Head and Neck Surgery,
Andaman and Nicobar Islands Institute of Medical Sciences,
Port Blair, Andaman and Nicobar Islands, India
3
Madras ENT Research Foundation, Chennai, Tamil Nadu,
India
in the study, awareness about noise pollution and its effects
among the community is a necessity.
Keywords Noise pollution · Hearing loss · Metropolitan
city · Road traffic noise · Noise induced hearing loss
Introduction
Noise being a major component of dynamic space, is one
of the most invasive aspects of the urban environment.
The Environment Protection Agency in the United States
describes noise as “unwanted or disturbing sound”. Sound
becomes disturbing when it interferes with normal activities
and diminishes one’s quality of life [1]. Sensitivity to noise
varies from individual to individual and depends on various
factors such as type of noise and the hearing status of the
individual. Noise present in the natural environment such as
blowing wind, volcanic eruptions as well as other man-made
noise–from automobiles and firecrackers etc.—a byproduct
of today’s environment due to industrialization and urbani-
zation, causes annoyance and irritability.
In 1971, a World Health Organization working group
concluded that noise is a major threat to human well-being
[2]. Noise, even at levels that are not harmful to hearing, is
perceived subconsciously as a danger signal, even during
sleep [3].
Noise pollution is displeasing or excessive noise that
is growing evidence that noise pollution is not merely an
ing adverse health, social and economic effects [2, 4–13].
Noise pollution is more widespread and severe nowadays,
and it will only continue to increase in magnitude due to
population explosion, rapid urbanization. The source of most

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Indian J Otolaryngol Head Neck Surg (2023) 75:S278–S284
outdoor noise worldwide is mainly caused by machines and
transportation systems, motor vehicles, aircrafts, and trains
[14, 15]. A recent search of the National Library of Medicine
database for adverse health effects of noise revealed over
5000 citations, many of recent vintage. Whether by accident
or incident, the accumulation of noise and unwanted distrac-
tion adds up to a negative healthcare experience [16].
Noise annoyance is seen as the major effect of noise,
which can include feelings of nuisance or disturbance [11].
Noise interferes with basic activities such as sleeping, rest-
ing, studying and communicating, it can also cause heart
disease, mental health problems and hearing damage [5, 10].
Continued or repeated exposures to high intensity sound can
cause acoustic trauma to the ear resulting in noise induced
hearing loss (NIHL), ringing in the ears, occasional dizzi-
ness [17]. Worldwide, 16% of the disabling hearing loss in
adults is attributed to occupational noise [18].
Hearing loss due to noise usually occurs in two forms,
they are (a) Noise-induced hearing loss and (b) Acoustic
trauma. Hearing loss caused by exposure to recreational
and occupational noise results in devastating disability that
is actually 100 percent preventable. Noise-induced hearing
loss is the second most common form of sensorineural hear-
ing deficit, after presbycusis (age-related hearing loss) [19].
Shearing forces caused by any sound have an impact on the
stereocilia of the hair cells of the basilar membrane of the
cochlea; when excessive, these forces can cause cell death.
But in spite of various studies being done with different
aspects of noise such as noise produced in certain indus-
tries and vehicles etc., very few studies have measured the
amount of road traffic noise produced in different parts of
the city. Even fewer have dealt with the impact on hearing
on people due this type of noise. Hence this study was done
with the sole purpose of understanding whether there was
noise pollution in a metro city and its impact on its citizens
with respect to hearing.
Aim
• To identify level of noise pollution in a metropolitan city
like Chennai and to study its effect on hearing status of
the individuals who are subjected to it.
Objectives
• To measure the level of road traffic noise in four busy
parts of the city
• To assess the audiological status of the civilians who are
exposed to such noise
• To assess effect of age, profession, gender, exposure
duration on hearing loss
S279
Methods and Material
Method of study Cross-sectional study.
Duration of study One year from June 2017 to May 2018.
Approval from ethical committee The project was carried
out after an approval from the institutional ethics committee.
Population under study People involved in various occu-
pations in and around the busy areas of an urban city within
a 1 km radius, who were exposed to road traffic noise for
more than one year, were considered for the study.
Volunteer’s recruitment process After selecting the shops/
institutions in each area based on the paper lot method, the
employees of these establishments were approached from
door to door. After explaining the procedure and its ben-
efits to the participants, those within the study criteria were
included in the study after simple randomization. Informed
consent was obtained from each participant and patient pri-
vacy was maintained.
Inclusion criteria civilians of both sexes within the age
range from 25 to 45 years, willing for the study, with no
apparent hearing loss and no previous chronic exposure to
high recreational or industrial noise (heavy machinery noise)
were included for the study.
Exclusion criteria People with drug induced hearing loss,
previous infection of the ear, history of injury and surgery
in the ear, congenital anomalies, history of metabolic dis-
orders {Diabetes, renal failure} and co-morbid conditions
were excluded.
Equipment
1. Noise levels were measured using the digital sound level
meter- master cool company model no: 52238.
2. The hearing status was assessed using a graphic series
1 portable audiometer. It works on 230 V AC supply, as
well as 15 V DC supply. The frequency used was from
125 Hz to 8 kHz. The intensity used also ranged from
0 to 100 dBA. Calibration was done by the audiologist.
The testing was done in a soundproof room. Average of
frequencies of 500, 1000 and 2000 Hz was done and the
results were documented and also revealed to the patient
for further management.
Environmental Study
1. The 4 busy areas of the city where chosen as directed by
The Pollution Control Board Authorities (based on the
analogue readings taken by their analogue sound level
meter taken half–yearly) and the Noise level produced
by road traffic was measured and recorded in these areas
with the help of a Digital Sound Level Meter.
2. The readings were in Decibel, A-weighted (dB A)
units representing the sound level measured with the
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A-weighting network on the sound level meter. This
instrument incorporates a type-1 microphone and
records sound ranging from 30 to 130 dB A with a sen-
sitivity index of ± 0.5 dB A. Fast impulse mode was used
to record the readings. The sound meter was placed at
body level for measurements.
3. Noise level was estimated at around 9 to 10 am in the
morning, and 7 to 8 pm in the evening on 2 days a week
{a weekday and weekend} at all the 4 locations with a
maximum interval of 15 min.
4. The parameter universally used in the discussion of
noise pollution is Leq, the equivalent continuous noise
level expressed in dB (A), which is the average rate
at which energy is received by the human ear during
the period monitored. L 10 and L90 indicate the level
exceeding for 10% and 90% of the time respectively,
in a record of noise level in a given interval. The other
variables obtained were L max and L min, which are the
maximum, and minimum noise levels recorded at each
place respectively.
Sample Size
Sample size was calculated by the formula 4pq/d2
• Where p is prevalence, and p + q = 1 and d is the confi-
dence interval
• The prevalence of noise pollution in the world according
to WHO is 6%, so p = 0.06. The confidence interval will
be taken as 95%, so d = 5% (0.05)
• Hence sample size will be 4pq/d2 = 4*0.06*0.94/0.05*
0.05 = 90, considering a dropout of 10 percent of 90 i.e.
9.Total sample size will be 99
• So after rounding off a total of 100 civilians/volunteers
will be included in the study that is 25 in each of the 4
groups
to determine their hearing status. The degree of hearing loss
was categorized according to WHO criteria [20].
Statistical Methods
Data collected was entered into a MS Excel spread sheet and
was statistically analyzed with SPSS software. Chi Square
test was used since the presence or absence of hearing loss
among the participants was a non-parametric entity. The
confidence interval was taken as 95%. Hence p value < 0.05
was considered as statistically significant.
Observation and Results
Noise levels produced by road traffic was measured in the
4 selected areas of Chennai (Table 1) and 100 people were
audiologically screened i.e. 25 people in each area. Totally
69 males (69%) and 31 females (31%) were tested. The mean
age of the participants included in the study was 31.45 years.
All the participants (100%) were affected in Annanagar
and Koyembedu. Overall 93 cases (93%) of the 100 had one
or the other form of hearing disorder as seen in Table 2.
65 males (94%) and 28 females (90%) were affected
by excessive noise. There was no statistical significance
between males and females (> 0.05).
Effects of noise pollution was observed among all age
groups as shown in Table 3.The prevalence of impairment of
hearing increased with increasing age and it was significant
(p < 0.05) (Tables 4, 5 and 6).
All the participants in the study were exposed to road
traffic noise on an average of 8 h/day on all days except
Table 2  Hearing status of participants in the study areas
Place Normal Affected Total

Annanagar 0 25(100%) 25
Collection of data Participants with no apparent hearing
Kilpauk 4 (16%) 21(84%) 25
loss were accepted into the study by simple randomization.
Koyembedu 0 25(100%) 25
A complete detailed history was collected from the partici-
Mogappair 3 (12%) 22(88%) 25
pants and then they were subjected to a basic ENT exami-
Total 7 93 100
nation including basic otoscopic examination. Following
which they were asked to undergo an audiometric analysis Chi square value—7.032 i.e. p value < 0.05

Table 3  Age distribution among the study population

Table 1  The noise levels in the selected parts of Chennai
Age group (years) Total cases Affected cases Normal
Place Maximum(dB) Minimum (dB) Average(dB)
≤ 25 23 19 (82%) 4 (18%)
Annanagar 105 68 86.5 26–35 37 34 (91.8%) 3(8.2%)
Kilpauk 104 62 83 ≥ 36 40 40 (100%) 0
Koyembedu 106.4 58.7 82.55 Total 100 93 7
Mogappair 92 52.4 72.2
Chi square value—6.857 i.e. p value < 0.05

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Table 4  Duration of noise exposure of the people in study area Discussion

Duration of Total Normal Affected
exposure(years) Maximum noise was measured in Koyembedu (106.4 dBA).
The highest average noise level was 86.5 dBA in Annanagar.
≤5 64 7(15%) 57(85%)
The above findings were surprising because more average
6–10 27 0 27(100%)
noise was produced in a commercial/residential zone like
11–15 7 0 7(100%)
Annanagar than in a busy bus stand like Koyembedu–prob-
16–20 2 0 2(100%)
ably due to the adequate ventilation in infrastructure which
Total 100 7(7%) 93(93%)
led to dispersion of noise in the bus-stand. The large number
Chi square value—3.692 i.e. p value > 0.05 of houses and congestion of traffic was the contributing fac-
tor for more noise to be retained in Annanagar and Kilpuk.
Comparatively the urbanization drive and traffic were lower
Table 5  Distribution of hearing loss in relation to occupations In Mogappair, though steadily increasing.
Occupation Total Normal Affected An average of 75–80 dB A was produced at anytime at the
four spots, which is quite high according to the Central Pol-
Highly skilled 19 4(21.1%) 15(78.9%) lution Control Board of India, where the permissible sound
Skilled 48 1(2.1%) 47(97.9%) levels in a commercial resident area is around 45–65 dB
Semi—skilled 23 2(8.7%) 21(91.3%) [21]. The noise levels measured in Curitiba, Brazil [22],
Unskilled 10 0 10(100%) average of 65 dB, were lower when compared to our study.
Total 100 7 93 Whereas in India these findings were very much consistent
Chi square value—6.692 i.e. p value < 0.05 with other studies such as Goswami et al. [23] and Vinoth-
kumaraaditya et al.[24] A recent study done in Vishaka-
pattinam by Vidya Sagar [25] and Kolhapur [26] was also
Sundays. Around 85% of the people with noise exposure of consistent with the above findings. This study shows that
about 5 years developed hearing loss and when the exposure high levels of Noise are being produced in and around an
increased to > 5 years the ratio changed to 100% (Table 4) urban city. The surprising revelation was that high noise
The right ear was more affected among the study group levels were also produced in various sub urban regions of
irrespective of the area and overall 93% compared to 90% India. The noise levels produced in India were much higher
on the left. In the cases with hearing loss, sensory neural compared to the other countries in the world which is on
hearing loss was the most common type in both ears with similar lines to the recent findings by Agarwal and Swami
83 cases (92%) in left ear and (89%) in right ear (Table 6) [27] in 2011.
Around 93% people had one or the other form of hearing
impairment which is higher than Kumar et al.[28]. These
findings were in correlation with the noise levels in the cor-
responding areas i.e. more the noise produced more the num-
ber of people affected.

Table 6  Distribution of type of Place Annanagar Kilpauk Koyem- Mogappair Total

hearing loss in relation to study bedu
site and laterality
R L R L R L R L R L

n=7 Normal 0 0 4 5 0 0 3 5 7 10
n=6 High frequency 0 1 4 2 1 1 1 0 6 4
SNHL n = 83 Minimal Sensory 13 15 12 14 12 17 18 16 55 62
Mild Sensory 10 8 4 3 9 4 1 2 24 17
Moderate Sensory 0 0 1 0 3 2 0 0 4 2
Severe sensory 0 0 0 1 0 1 0 0 0 2
Profound sensory 0 0 0 0 0 0 0 0 0 0
CHL n = 3 Mild conductive 2 1 0 0 0 0 1 1 3 2
Moderate conductive 0 0 0 0 0 0 0 1 0 1
MHL n = 1 Mixed loss 0 0 0 0 0 0 1 0 1 0
Total 25 25 25 25 25 25 25 25 100 100

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This proves that the higher noise levels produced in the
areas studied are directly responsible for the hearing loss.
Thus establishing causal relationship between noise pollu-
tion and hearing loss as proved in other such studies done
in textile industries [29–31]. A Study done by V K Singh
[32] among policemen showed a higher percentage of hear-
ing impairment almost similar to our study, around 81%.
Shrestha et al. [33] claims that the affected percentage
among Nepal police is about 66% which is in stark contrast
to the percentage in India. Studies by May et al. [34] and
Gomez et al. [35] reported 65% NIHL among dairy farmers
and 47% NIHL among farmers in New York. These above
findings show that noise induced hearing impairment is quite
high in India compared to foreign nations. This is probably
to due increased population leading to increase in road traffic
noise as seen in this study. But our results were significantly
higher than previous studies—Indian or foreign. This may
be due to the fact that a variety of occupations were involved
in our study.
There was no statistical significance between males and
females in case of hearing impairment (p > 0.05).This was
similar to the study done by Ayele Belachew et al. [36],
where gender distribution had no significant impact on
the study outcome, though the proportion of females was
slightly higher in that study.
The mean age and the range of age included were also
similar in other studies both in India [28] & abroad [33,
37]. Effects of noise pollution were observed among all age
groups. The highest hearing impairment was noticed in the
age group 36–45 years. These findings are consistent with
other studies [38, 39] where maximum proportion of hear-
ing loss was noticed in the age group > 35 years. The preva-
lence of impairment of hearing increased with increasing
age, which was significant (p < 0.05) and similar to Ayele
Belachew et al.[36]. This finding may reflect the well-known
phenomena of presbycusis, the "normal" deterioration of
hearing with age, and/or sociocusis, the "normal" deterio-
ration of hearing loss due to noise generated from the "nor-
mal" living environment such as from music, car, and train
noise [31, 40].
Least hearing loss developed in people who were mini-
mally exposed to noise i.e. ≤ 5 years of exposure. Greater the
duration of exposure, greater was the incidence of hearing
loss. But the above findings were not statistically signifi-
cant because of the less number of cases in each category
(p > 0.05). Narlawar et al.[41] who did a study between hear-
ing loss and hypertension prevalence due to noise exposure
established the relationship between duration of exposure
and hearing loss. Other studies both in and around India also
had the same conclusion [42, 43]
Since a variety of occupations were included, they
were categorized into four groups as seen in Table 5. The
unskilled group was most affected (100%) which was
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Indian J Otolaryngol Head Neck Surg (2023) 75:S278–S284
statistically significant (p < 0.05).The kind of work included
in this category were watchmen, field workers and daily
laborers who were constantly exposed to noise on a daily
basis. This was followed by the skilled group (97.9%), here
the drivers and mechanics were the most affected occupa-
tion. About 91.3% people were affected in the semi-skilled
group. The hearing impairment was the least in the highly
skilled group of occupation which was 78.9% maybe due to
their reduced exposure to environmental noise. It was very
difficult to compare our results with other studies because
majority of literature deals with one or two specific occu-
pation like industrial workers [44], police [32, 33], airport
workers [45], farmers [28], factory workers [38] and even in
students [46]. But all studies have reported hearing loss on
exposure to excess noise.
Bilateral hearing loss was noticed in 90% in our study.
Among the patients with unilateral hearing loss (3%) all
were on the right side. The right ear was more affected,
irrespective of the area. Overall 93% were affected on the
right compared to 90% on the left but was not statistically
significant (p > 0.05). A study among operating engineers by
Rop et al. and Oi Saeng Hong showed left sided predomi-
nance [47, 48]. Nagaris et al. also showed approximately
half had bilaterally symmetric NIHL but 34.2% had left side
predominance which does not coincide with our findings.
Right sided hearing loss was predominant in a study done by
Nair et al.[42] The left sided asymmetry may be secondary
to biological difference of a less active acoustic reflex on the
left ear or may be the higher otoacoustic emission amplitude
on the right side due to its more intense auditory efferent
system [49, 50]. Or maybe be due to predominant usage of
phones and other noise producing devices on the right side.
In the cases with hearing loss sensory neural hearing loss
was the most common type in both ears with 83 cases (92%)
in left ear and (84%) in right ear followed by high frequency
hearing loss which developed in 6 cases in right ear (6.45%)
in 4 cases in left ear (4.4%).
Conclusion
• Noise pollution was present and prevalent in all four
areas of the metropolitan city with the highest noise level
measured in Koyembedu (106.4 dB A) and the highest
average noise level measured in Annanagar (86.5 dBA)
with Hearing loss present among the people in all 4
areas.
• About 93% of the participants involved in the study suf-
fered from hearing loss in one form or the other
• Sensory neural type of hearing loss was most common
(83%)
• A positive relationship was noticed between intensity of
noise and severity of hearing loss
Indian J Otolaryngol Head Neck Surg (2023) 75:S278–S284
• Males and females were equally affected
• Participants of all age groups were affected with the
working class i.e. (age group > 35 years) having the
maximum number of affected individuals
Limitations
• Study was conducted only in 4 areas of the city
• Attitude and awareness of participants not evaluated
• Seasonal variation of Noise levels not studied
• Specific occupations were not studied
• Effect of portable noise producing devices like cell
phones not studied
Acknowledgements The Madras ENT Research foundation (MERF)
was very instrumental in conducting and completing this study. The
authors would like to thank the institution at this juncture. The authors
would also like to thank Dr. Sowmya for her contribution towards edit-
ing the article.
Funding Not applicable.
Data Availability Data available with Medical records depaetment
of Shri Sathya Sai Medical College and Research Institute, Sri Balaji
Vidyapeeth University, Thiruporur, Kancheepuram, Tamil Nadu.
Code Availability Not applicable.
Declarations
Conflict of interest Authors declare no conflict of interest.
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