The worker's ear: a history of noise-induced hearing loss.

Hearing loss afflicts millions of people throughout the world, and many of those millions are workers who have been exposed to excessive noise. People have always been surrounded by a variety of sounds in their environments, but the invention of gunpowder and the Industrial Revolution introduced new sounds of greater intensity than ever before. It is only within the past 40 years that serious efforts to reduce excessive noise at work sites have been initiated. In the latter half of the 20th century, many governments imposed regulations to limit workers' exposure to loud sounds. Because of this recent action, some people may believe that the recognition of occupational noise-induced hearing loss (NIHL) is relatively new. However, a review of selected historical and medical manuscripts, books, and articles show that the association of hearing changes with loud noise exposure was recognized for centuries before systematic attempts were made to limit the exposure. Delays in implementing controls to limit noise exposure were due to cultural reasons, technical problems in controlling noise generation, and a lack of understanding of the mechanics of hearing loss. A historical perspective on this issue may remind health care providers that they need to continue to emphasize hearing conservation measures as occupational noise exposures change with the shift of industrial activities between countries.