Background: Workers with prolonged exposure to noise above the occupational exposure limit (OEL) of 85 dBA are at risk of developing occupational noise-induced hearing loss (ONIHL). In South Africa, ONIHL compensation in mining, metals, and construction is administered by Rand Mutual Assurance (RMA).
Objective: To describe trends of ONIHL claims, and determinants of successful claims in the South African mining industry, from 2010 to 2019.
Methods: This was a repeat cross-sectional study. Mineworkers were assigned to homogeneous exposure groups (HEGs) by occupation at claim submission. Trends in annual proportions of ONIHL claims were assessed using the chi-square test. Binary logistic regression was used to identify factors associated with successful ONIHL claims, i.e. those that met employment and medical compensation criteria.
Results: From 2010 to 2019, 12 761 ONIHL claims were submitted to RMA. Claims decreased by 7.3/10 000 mineworkers per year, and successful claims decreased from 72.6% to 43.3%. Three-quarters (n = 9 585, 75.1%) of claimants were in HEG B (85–105 dBA). The HEG was not stated for 1 374 (10.8%) claimants. Compared to claimants with < 20 years of employment, those employed for 20–29 years had a 40% greater likelihood of success (adjusted odds ratios (AOR): 1.40, 95% CI 1.25–1.56). Compared to claimants in HEG B, those in HEG C (82–85 dBA) had a 33% lower likelihood of successful claims (AOR: 0.67, 95% CI 0.57–0.78 and AOR: 0.52, 95% CI 0.45–0.60, respectively).
Conclusion: Claim data provide useful information about ONIHL and compensation. Noise exposures above the OEL were common. Successful claims were associated with higher noise exposures and longer employment. The findings from this study highlight the need for noise prevention programmes to achieve the mining industry target of zero harm, and the usefulness of routine administrative data for research and monitoring of occupational diseases.

Background: The aviation industry relies on the expertise of aircraft maintenance technicians (AMTs) to ensure aircraft airworthiness. However, the noise produced by airport maintenance activities and tools poses a potential risk of noise-induced hearing loss (NIHL) to AMTs.
Objective: The objectives of the study were to assess noise perceptions and the use of hearing protective devices (HPDs), and to measure personal occupational noise exposure levels among AMTs involved in aircraft maintenance operations in Gauteng province, South Africa.
Methods: Self-administered questionnaires were used to collect sociodemographic data and perceptions about noise exposure from 208 AMTs. The associations between participants’ perceived noise levels and some socio-demographic factors were assessed using descriptive statistics. The associations between participants’ socio-demographic characteristics and their perceptions of personal noise exposure and use of HPDs were analysed, using binary logistic regression. Personal noise exposures were measured in a subset of 30 AMTs across three maintenance areas (minor, line, and base maintenance), using a QUEST Technologies noise dosimeter. One-way analysis of variance (ANOVA) was performed on log-transformed mean personal noise exposure levels, to compare exposure across the three areas.
Results: Most of the study participants were male (n = 135, 64.9%). A large proportion (n = 171, 82.2%) perceived that they were exposed to high noise levels. The majority of participants (n = 200, 96.2%) reported being supplied with HPDs, while a smaller proportion (n = 181, 87.0%) indicated that they had received training. The logistic regression analysis showed that being an apprentice (p = 0.032) was the only significant predictor of perceiving exposure to loud noise. The AMTs employed to do line maintenance were exposed to the highest 8-hr time-weighted average (TWA) daily noise levels of 95.7 ± 7.5 dBA; both minor and base maintenance workers were also exposed to high noise levels (92.3 ± 6.0 dBA and 92.1 ± 3.8 dBA, respectively). However, there were no statistically significant differences in mean exposure levels.
Conclusion: Being an apprentice was the only socio-demographic variable associated with perception of noise exposure. Not all study participants were issued with HPDs and provided with training on their use. Aircraft maintenance workers are exposed to noise levels that exceed the 85 dBA noise rating limit and are, therefore, at risk of NIHL. A comprehensive hearing conservation programme with targeted interventions, based on tasks and work environments, is essential for AMTs.

Background: Military personnel are exposed to high noise levels during training and deployment missions. Interventions to reduce noise exposure levels and the prevalence of noise-induced hearing loss (NIHL) are necessary. When planning such interventions, workers’ knowledge should be taken into consideration.
Objective: The objective of the study was to describe knowledge about NIHL and hearing conservation practices, and referral threshold shifts (RTSs) using audiometric screening results, among members of a South African army unit.
Methods: In this cross-sectional study, 38 army unit members were purposively sampled from a study population of 631. Demographic data, NIHL knowledge, and hearing conservation practices were collected using a questionnaire, and analysed using descriptive statistics. Audiometric screening data were analysed for army unit members who had been employed for two or more years and had two audiograms (baseline and periodic). The Wilcoxon signed-rank test (WSR) was used to compare participants’ baseline and periodic hearing thresholds.
Results: Most participants were male (n = 37, 97.4%), aged 26–35 years (n = 31, 81.6%), and permanently employed (n = 33; 86.8%). Around half lacked knowledge that exposure to noise is the main risk factor associated with NIHL (n = 21, 55.3%); only two (5.3%) knew that NIHL cannot be treated with medicine. Almost half of the participants (n = 18, 47.4%) reported that they were only sometimes provided with hearing protection devices (HPDs); 10 were never or almost never provided with HPDs (26.3%). There was a significant RTS at high frequencies from the baseline and periodic screening examinations (p = 0.012 and p = 0.002 for the right and left ear, respectively).
Conclusion: The participants’ RTS from baseline serves as early indication of those at risk for NIHL. A limited understanding of the primary risk factor for NIHL highlighted knowledge gaps. Education and training about NIHL should be provided to army unit members. Provision and correct use of suitable HPDs, to prevent NIHL, should be mandatory for military personnel for the promotion of effective hearing conservation practices.

Background: Occupational noise-induced hearing loss (ONIHL) is a major public health concern in Africa, particularly in high-risk industries such as mining, manufacturing, and construction. While hearing conservation programmes (HCPs) exist, their effectiveness is often limited by poor enforcement, inadequate infrastructure, and low adoption of emerging technologies. Advancements in fourth industrial revolution (4IR) technologies – such as artificial intelligence (AI), tele-audiology, mobile health (mHealth), and the internet of things (IoT) – offer new opportunities for ONIHL prevention. However, their integration into occupational hearing healthcare in Africa remains limited.
Objective: To explore technology-driven approaches to ONIHL management and HCPs in Africa, highlighting advancements, barriers, and opportunities for integrating digital solutions into occupational health frameworks.
Methods: For this narrative review, PubMed, Scopus, Web of Science, ScienceDirect, Google Scholar, and African Journals Online (AJOL) were searched for relevant articles. The selected studies were categorised as highly or moderately relevant. Thematic analysis was conducted to synthesise key findings on AI-driven audiology, tele-audiology and mHealth, IoT-integrated hearing conservation, and regulatory challenges.
Results: A total of 1 147 publications were identified, of which 55 were evaluated for relevance; 22 were included in the review. Ten were considered to be highly relevant and 12 to be moderately relevant. AIbased solutions show promise for early detection and predictive analytics in ONIHL management, but face barriers such as high costs and limited digital infrastructure. Tele-audiology and mHealth interventions can improve access to hearing healthcare in underserved areas, yet connectivity and data security challenges persist. IoT-enabled hearing protection devices enhance real-time noise monitoring, but remain underutilised due to high costs and policy gaps. Moderately relevant studies further highlight implementation barriers, including reliance on paper-based systems, low digital literacy, and limited funding for technological innovation. Weak regulatory enforcement further limits technology adoption in HCPs.
Conclusion: While 4IR technologies present significant opportunities for ONIHL prevention, their implementation in Africa requires investment, regulatory reform, and multi-sectoral collaboration. Policy updates, financial incentives, and workforce training are crucial to integrating these innovations into occupational health strategies. The African experience offers lessons for other low- and middle-income countries, and future research should prioritise examining real-world industry adoption of these technologies.

Background: Occupational noise-induced hearing loss (ONIHL) is preventable, particularly in low- and middle-income countries (LMICs). Middle ear disorders frequently co-occur with ONIHL, but remain neglected in hearing conservation programmes (HCPs). These conditions can complicate diagnosis, impair workers’ ability to use hearing protection devices (HPDs), and exacerbate functional hearing deficits.
Objective: The objectives of this review were to: 1) describe the prevalence and impact of middle ear disorders among noise-exposed workers, 2) examine the interplay between ONIHL and middle ear pathology in occupational settings, 3) explore the influence of systemic health factors, such as human immunodeficiency virus (HIV), on conductive hearing loss, and 4) identify gaps in current HCPs in African LMICs.
Methods: This narrative review included peer-reviewed articles, policy documents, and occupational health reports published from 2000 to 2024. PubMed, Scopus, Web of Science, Google Scholar, and African Journals Online (AJOL) databases were searched for relevant literature. Articles were included if they discussed HCPs, workplace safety regulations, and audiological health in Africa, or provided comparative insights from LMICs outside Africa. Thematic analysis was conducted to identify patterns, gaps, and policy implications.
Results: Eighteen of the 1 417 articles identified were included in the final synthesis. Most studies originated from LMICs, particularly in southern Africa, while several provided global comparative insights. The studies predominantly focused on workers in mining, manufacturing, and construction sectors. Thematic analysis revealed four core themes: 1) underdiagnosis of middle ear pathologies in occupational settings, 2) lack of enforcement of noise exposure regulations, 3) low compliance with HPDs, and 4) inadequate integration of audiological assessments in HCPs. Limited research addressing the dual burden of sensorineural and conductive hearing loss was noted, complicating intervention design in African LMICs.
Conclusion: The review demonstrated a clear disconnect between HCP implementation and the dual burden of sensorineural and conductive hearing loss. Addressing this gap requires an integrated approach that incorporates middle ear assessments, context-sensitive policy reforms, and feasible interventions such as mobile screening and task-shifting. Strengthening both the clinical and policy frameworks for occupational hearing health is essential for effective, inclusive, and sustainable prevention strategies in resource-constrained environments.

The accuracy, ethics, and legal defensibility of workplace drug and alcohol testing have become increasingly significant in contemporary occupational settings. As drug use legislation evolves and the principle of procedural fairness gains prominence, testing protocols must be scientifically justified and contextually appropriate. This paper explores the rationale behind testing, the relevance of pharmacokinetics and biological matrices, the importance of measurement uncertainty, and lessons from recent South African case law. It advocates for a rational, evidence-based framework that aligns scientific validity with legal and ethical workplace requirements.