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• 1. What is noise?
• 2. Responsibilities
• 3. Noise assessments
• 4. How should noise be managed?
• 5. What are noise control measures?
  • 5.1 Elimination - new plant and workplaces
  • 5.2 Engineering controls - existing plant and workplaces
  • 5.3 Administrative noise control measures
  • 5.4 Personal hearing protectors
• 6. Audiometric testing
• Appendix 1 - extract from the Workplace Health and Safety Regulation 1997
• Appendix 2 – Obligations under the Workplace Health and Safety Act 1995
• Appendix 3 – Noise hazard identification checklist
• Appendix 4 – Instruments for assessing noise levels
• Appendix 5 – Guidance material
• Appendix 6 – Ototoxins
• Appendix 7 – Acoustic shock
• Appendix 8 – Dictionary

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Appendix 6 – Ototoxins

Introduction
Workplace chemicals
Medication
Further information

Introduction

6.1 Exposure to certain chemical substances may result in hearing loss. These substances are calledototoxins. They may damage thecochlea in the inner ear and/or the auditory neurological pathways. Hearing damage is more likely if exposure is to a combination of substances or to a combination of the substance and noise.

6.2 Ototoxins can be divided into two general classes: workplace chemicals and medication.

Workplace chemicals

6.3 Research is still being carried out to establish human exposure response relationships for workplace ototoxins, either alone or in combination with noise. Exposure standards for chemicals and noise have not yet been altered to take account of increased risk to hearing.

6.4 Until revised standards are established it is recommended that workers exposed to any of the substances listed in Table 1 be included in audiometric testing programs and that information on ototoxins be included in training sessions. Annual audiograms are highly recommended for workers whose airborne exposures (without regard to respiratory protection worn) are at 50% or more of the NOHSC National Exposure Standard²⁴or the substance in question, regardless of the noise level.

6.5 Some potential ototoxins may be absorbed through the skin (See Table A3). If such skin exposures cannot be controlled and are chronic, annual audiograms are also recommended. Control measures should be implemented in the workplace to eliminate or reduce exposure to ototoxins. Personal protective equipment is the least preferred of these controls.

6.6 For workers currently participating in an audiometric testing program due to excessive noise, suitably trained reviewers of the audiometric data should be alert to possible additive or synergistic effects between the exposure to noise and ototoxins and, if necessary, suggest reducing exposure to one or both.

6.7 Activities where noise and ototoxins often combine include: painting; printing; boat building; construction; furniture making; manufacture of metal, leather and petroleum products; fuelling vehicles and aircraft; fire fighting and weapons firing.

6.8 Personal protective equipment may need to be supplied for the handling of ototoxins.

Medication

6.9 Some medications have been identified as ototoxins such as some anti-cancer, anti-inflammatory, anti-thrombotic, anti-malarial and anti rheumatic drugs, loop diuretics and antibiotics.

Information about the possible hearing loss effects of these drugs should be included in training programs and workers should be encouraged to discuss any concerns they may have about their own medication with their doctor or pharmacist.

Further information

Further information on the research being undertaken in this area can be found at NIOSH Safety and Health Topic: Noise and Hearing Loss Prevention

Notes:

1. Research in this area is on going. Substances have been included in this table based on the priority list given in a paper by Morata.²⁵
2. Other substances with similar molecular structures and other heavy metals should not be assumed to have no ototoxic effects simply because no clear evidence is presently available.
3. Skin absorption has been listed based on the substance having an ‘Sk’ notice in the NOHSC National Exposure Standard.²⁶

Table 1 – Potential workplace ototoxins

Type	Name	Skin absorption
Solvents	Butanol	yes
	Carbon disulphide	yes
	Ethyl benzene
	Heptane
	n-hexane
	Perchloroethylene
	Solvent mixtures and fuels	yes
	Styrene
	Toluene
	Trichloroethylene
	White spirit (Stoddard solvent)
	Xylene	yes
Metals	Arsenic
	Lead
	Manganese
	Mercury	yes
	Organic tin	yes
Others	Carbon monoxide
	Hydrogen cyanide	yes
	Organophosphates	yes
	Paraquat

²⁴ National Occupational Health and Safety Commission. Adopted National Exposure Standards for Atmospheric Contaminants in the Occupational Environment [NOHSC:1003(1995)], Australian government Publishing Service, Canberra, 1995.

²⁵ Morata, T.C., Chemical Exposure as a Risk Factor for Hearing Loss. JOEM, Vol. 45, Number 7 July 2003.

²⁶ National Occupational Health and Safety Commission. Adopted National Exposure Standards for Atmospheric Contaminants in the Occupational Environment [NOHSC:1003(1995)], Australian Government Publishing Service, Canberra, 1995.

Last updated 22 July 2008

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