Call centers and noise-induced hearing loss.

Noise is defined as unwelcome sound. It has been estimated that 16% of adult hearing loss in the world is due to noise exposure at the workplace. This report offers a case that diagnosed with hearing loss of whom working as a call center operator at home. Home agent operators should be explored.

Introduction

Noise is defined as an unwanted and disturbing sound.[1] In many workplaces, noise is regarded as a primary hazard threatening human health. While noise can lead to serious hearing-related health problems, it can also cause general health problems such as attention impairment, anxiety, sleep disorder, and depression. However, the best known of these problems is noise-induced hearing loss which is commonly studied due to its irreversible character. Approximately, 16% of adult cases of hearing loss are believed to be associated with workplace noise exposure.[2]

Although noise is a common hazard in almost all occupations and in nearly all workplaces, some sectors such as mining, metalworking, textile, agriculture, or transportation involve a higher level of noise exposure. Furthermore, certain occupations such as musicians, traffic polices, and soldiers are also deemed as high-risk groups with regard to noise exposure.[34] In recent years, new high-risk groups have emerged due to the development of new sectors. Among those, call centers are regarded as the most remarkable ones.[5]

Call centers are business units that provide product or service support to the clients, suppliers, agents, and other third persons via phone calls by way of giving instant help or referring to the related units. In 2010, call center sector has reached a market value of 340 million dollars worldwide, including 11.5 million call center operators. In Turkey, the estimated number of call center operators is around 32.000.[56]

The most common occupational health consequences can be categorized as visual problems due to working with a video display units, voice deformation due to continuous talking, and auditory problems due to intense headset use and acoustic shocks.[78] However, there is scarce research on noise-induced hearing loss among call center operators.

In this case report, we presented a case of noise-induced hearing loss in a call center operator who was evaluated in the Dokuz Eylul University (DEU), occupational disease outpatient clinic.

Case Report

M.G. 30-year-old male patient was admitted to the Department of Ear Nose Throat in DEU Hospital with the main complaint of not hearing the safety belt alarm in his car. Subsequent to his history taking, he was referred to occupational disease outpatient clinic in the hospital. He has been working as a home agent for a call center for the last 50 months. He has been working 8 h a day and 6 days a week. His work equipment consists of a monitor and a headset.

His equipments have no amplificator. The system is accessed by a password and the incoming calls are directed by team leaders to the related operators. He was mainly serving clients from mechanical maintaining and repair sector clients, thus he described frequent high pitch noise and parasite particularly at the beginning of the conversations. He said, “I have to control the noise level manually since I do not have the amplificatory device….” In his occupational history, he describes the time between high noise level and parasite and manual modification as 3-5 s. He also described ear pain after some of these exposures. A call is received every 3-5 min; 17% of the work time is passed in passive mode, waiting for a call. The breaks are managed by the operator himself or by the team leader. He also mentioned other employees with hearing problems during occupational history, but we did not have a chance to examine any other employees yet.

He reported no periodical health examinations and very limited occupational health and safety training was given to him only at the beginning of the job. Although we requested personal noise exposure and environmental noise measurements from the company, no answer was received. The audiometry test at the start of work was normal [Figure 1].

Figure 1

Initial audiometry

There was no history of smoking or alcohol use, regular drug use, autotoxic drug use, chronic diseases, and exposure to high-pitched noise such as the explosion in his personal and family history, and no particular noise exposure during his military service. There was no history of diving, shooting, or listening to music at high volumes. His daily activities do not include any high-level exposure yet we tried to categorize his daily exposure according to the national regulations.[9] He does describe a very sedentary everyday routine including limited time in traffic (daily city traffic 70 dB and automobile horns 80 dB). He describes end shift fatigue and headache so he says “I prefer to stay in a quite environment thus I do not listen high volume music or television (radio music sound 70-80 dB).”

The case was evaluated in consultation with the Department of Ear Nose and Throat. The physical examination revealed normal autoscopic results in both ears, the Weber was lateralized to the right, and the Rinne test was pathologically positive in both ears. A pure sound audiogram showed a mean pure sound of 27 dB loss in the right and a mean pure sound of 35 dB loss in the left ear, while there was a sensorineural hearing loss manifesting a sudden decline after 1000 Hz [Figure 2]. The other physical examination findings were usual.

Figure 2

Control audiometry

In accordance to the history, physical examination, and audiometric results along with the initial audiometric test, other reasons were excluded, and the patient has been diagnosed as noise-induced occupational hearing loss. He was recommended to reduce the noise exposure and put under yearly follow-up by the committee of occupational diseases.

Discussion

Call center activities (NACE code: 82.20.01) is regarded as hazardous according to the Workplace Hazard Classes of the Work Health and Safety regulation issued by the Ministry of Labor and Social Security in Turkey. Exposure limit and exposure threshold are set to 87 dB (A) and to 85 dB (A), respectively, in the legislation.[10]

According to the widely recognized definition, a value higher than 25 dB at hearing thresholds of 1, 2, 3, and 4 kHz is regarded as hearing loss.[11] Occupational hearing loss requires having worked at least 2 years in a noisy workplace or having worked in a workplace emitting a noise higher than 85 dB (A) at least for 30 days.[12] However, despite values stated in the laws, in 2010, Verbeek et al. reported that prolonged noise exposure to a noise of 80 dB (A) may constitute a risk for hearing loss. They also reviewed the suggestions aiming to prevent noise-induced hearing loss and the efficacy of programs built to prevent hearing loss were found to have a very little effect, highlighting the need for more efficient legal regulations.[11]

The results of personal noise exposure and environmental noise measurements could not be obtained in our case. The company did not let us to measure but in a study performed among 150 call center operators in an office environment in Britain, personal noise exposure level varied between 68 and 77 dB. Authors particularly highlighted the importance of in-house training and emphasized the necessity of accurate headset use along with taking the required precautions.[13] Trompette and Chatillon evaluated 117 operators from 21 different call centers revealing that personal noise exposure level was 60-90 dB (A) and the environmental noise level was 50-62 dB (A).[14] However, these studies and similar ones in the literature have been performed on call center operators in an office environment. Therefore, since noise sources such as fax machine, printer, and air conditioner are not present at home, background noise may be lower among home agents. However, there was no study focusing on home-office agents in the literature.

Another major risk other than the average noise exposure was acoustic shock defined as exposure to a sudden and disturbing loud sound. A study in Australia evaluated acoustic shock in 103 call center operators and noted the presence of symptoms such as headache, dizziness, tinnitus, and hearing loss after work hours.[15] Similarly, Trompette and Chatillon underscored the significance of equipment selection, noting that many pathologies such as acoustic shock can be eliminated by using correct and safe headsets. They also reported the importance of employee training and recommended repeated trainings until the employees are completely adapted to the headset.[14] Our case had no amplificator in the headset, and he had not received adequate training on occupational health issues which were related as the possible causes of acoustic shock.

Conclusion

There were no recruitment and follow-up examinations and yet there were neither engineering noise control nor sufficient training for hearing protection in our case. Furthermore, the flexible and precarious nature of home-based jobs is still out of standard occupational health and safety inspection mechanisms. Therefore, our case is provided a clear evidence for the need of comprehensive occupational health and safety services for call center workers. Most of the home office workers are not willing to speak out about their work-related health problems since the sector has a high employee turnover rate. When they are out of a particular job, it is very hard to trace such workers for work-related health problems. NIHL and other effects of noise should be monitored closely. Regardless of the work environment, noise control programs should be developed and applied in order to prevent hearing loss at home and in call centers. Moreover, it should be borne in mind that noise may lead to NIHL and other health problems even at values not surpassing the predetermined limits.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.