Noise Exposure in Palestinian Workers Without a Diagnosis of Hearing Impairment: Relations to Speech-Perception-in-Noise Difficulties, Tinnitus, and Hyperacusis

Purpose: Many workers in developing countries are exposed to unsafe occupational noise due to inadequate health and safety practices. We tested the hypotheses that occupational noise exposure and aging affect speech-perception-in-noise (SPiN) thresholds, self-reported hearing ability, tinnitus presence, and hyperacusis severity among Palestinian workers. Method: Palestinian workers (N = 251, aged 18-70 years) without diagnosed hearing or memory impairments completed online instruments including a noise exposure questionnaire; forward and backward digit span tests; hyperacusis questionnaire; the short-form Speech, Spatial and Qualities of Hearing Scale (SSQ12); the Tinnitus Handicap Inventory; and a digits-in-noise (DIN) test. Hypotheses were tested via multiple linear and logistic regression models, including age and occupational noise exposure as predictors, and with sex, recreational noise exposure, cognitive ability, and academic attainment as covariates. Familywise error rate was controlled across all 16 comparisons using the Bonferroni-Holm method. Exploratory analyses evaluated effects on tinnitus handicap. A comprehensive study protocol was preregistered. Results: Nonsignificant trends of poorer SPiN performance, poorer self-reported hearing ability, greater prevalence of tinnitus, greater tinnitus handicap, and greater severity of hyperacusis as a function of higher occupational noise exposure were observed. Greater hyperacusis severity was significantly predicted by higher occupational noise exposure. Aging was significantly associated with higher DIN thresholds and lower SSQ12 scores, but not with tinnitus presence, tinnitus handicap, or hyperacusis severity. Conclusions: Workers in Palestine may suffer from auditory effects of occupational noise and aging despite no formal diagnosis. These findings highlight the importance of occupational noise monitoring and hearing-related health and safety practices in developing countries.