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Original research
Hearing loss as a predictor for hearing protection attenuation among miners
  1. Elon D Ullman1,
  2. Lauren M Smith1,
  3. Marjorie C McCullagh2,
  4. Richard L Neitzel1
  1. 1 Department of Environmental Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
  2. 2 Department of Systems, Populations and Leadership, University of Michigan, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Richard L Neitzel, Environmental Health Sciences, University of Michigan, Ann Arbor, MI 48109, USA; rneitzel{at}


Objective This study investigated risk factors for poor earplug fit, with a focus on the association between hearing loss and personal attenuation ratings (PARs).

Methods Earplug fit was assessed by obtaining PARs using a real ear at attenuation threshold (REAT) system. Hearing loss was assessed using the unoccluded hearing thresholds measured during the REAT testing and the results of a speech-in-noise test. Potential predictors of PARs were modelled using both simple and multiple linear regression. Hearing loss was the primary predictor of interest.

Results Data were collected from 200 workers at ten above-ground mining sites in the Midwestern USA. Workers reported wearing their hearing protection on average 73.9% of the time in a high noise environment (mean 8-hour time-weighted average noise exposure 85.5 dBA, range 65–103 dBA). One-quarter (26.7%) of workers were found to have a hearing loss (hearing threshold ≥25 dB across 1–4 kHz), and 42% reported symptoms of tinnitus. Workers with a hearing loss had a significantly lower PAR than those without a hearing loss (β=−5.1, SE=1.7).

Conclusions The results of the adjusted regression models suggest that workers with hearing loss achieved significantly lower PARs than those without hearing loss. This association between hearing loss and hearing protection devices (HPD) fit brings into focus the potential benefit of fit checks to be included in hearing conservation programmes. Workers found to have hearing loss should be prioritised for fit testing, as their hearing impairment may be associated with poor HPD fit.

  • hearing
  • preventive medicine
  • noise
  • occupational health practice
  • hygiene / occupational hygiene

Data availability statement

All datasets used in this study are freely available on reasonable request from

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Data availability statement

All datasets used in this study are freely available on reasonable request from

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  • Funding This study was funded by the Alpha Foundation for the Improvement of Mine Safety and Health, grant number AFC719–20.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.