Abstract
Despite the National Occupational Safety and Legislation Act 2020’s implementation, reports of workplace accidents are rising in India. Various ear, nose, and throat conditions have been linked to a wide range of physico-chemical variables. Due to a lack of training, inadequate knowledge, a lack of awareness of occupational health and safety risks, or a lack of accessibility to or use of personal protective equipment (PPE), sculptors are frequently exposed to a variety of physical, compound and unplanned risks, chemical, and accidental hazards. The study aimed to assess the various ear, nose and throat manifestations like noise induced hearing loss, occupational rhinitis and non-infectious pharyngitis among the sculptors working in the southern part of Chennai. This observational study was performed in a total of 110 sculptors. Demographic data like age, education, duration of occupation, use of PPE like face mask, ear plug during work hours, whether sculpting is a family occupation or first generation sculptor. A detailed history and thorough ENT examination was performed with pure tone audiometry (PTA), diagnostic nasal endoscopy (DNE) and videolaryngoscopy (VLS). If any problem is detected they will be treated accordingly. Most of them (70%) were in the age group of 21–40 years but 71% of them are sculptors for more than 15 years which infers introduction to the occupation at an early age. The reason for this could be more than 80% of them possessed the heritage of sculpting as their family occupation. Duration of occupation was significantly associated with chronic rhinitis (P value was 0.002) and NIHL (P value was 0.002) whereas education and use of PPE like face mask or ear plugs were not associated with ENT manifestations. This study focuses on the sculptors’ working habits, their ignorance of safety precautions, and an assessment of the numerous ENT ailments. These manifestations showed a strong correlation to exposure time. To prevent the issues from becoming more severe, regular medical monitoring is required for early detection and intervention.
Keywords: Noise induced hearing loss, Occupation rhinitis, Ear plugs, Chronic pharyngitis
Introduction
Despite public and commercial occupational health and safety management measures, there are many occupational health hazards in India’s many industries, and they are growing [1]. Metal-cutting saws, power presses, drilling machines, and lathes are among the leading equipment responsible for workplace accidents [2]. Sculptors are a vulnerable occupational group because they frequently encounter a variety of physical, complex, and unexpected dangers, as well as chemical and accidental hazards [1]. Their vulnerability is primarily caused by a lack of training, inadequate knowledge, ignorance of occupational health and safety issues, or a lack of accessibility to or use of personal protective equipment (PPE) [3].
One of the most prevalent types of hearing loss in adults is noise-induced hearing loss (NIHL). According to the World Health Organisation, 10% of people worldwide are exposed to sound levels that may result in NIHL [4]. With the growth of industrialization, non-Gaussian noise, sometimes referred to as complex noise, which consists of high-energy impulsive noise transients superimposed on the steady-state background noise, has replaced Gaussian noise as the predominant noise type in industry [5]. The cumulative effects of long-term noise exposure play a substantial role in age-related hearing loss, tinnitus, and even deteriorating cognitive and learning abilities [6].
An inflammatory condition of the nose known as occupational rhinitis is characterised by sporadic or recurrent symptoms brought on by exposure to different materials that cause or precipitate upper airway symptoms at work [7]. These reactions can be divided as allergic and nonallergic depending on whether they are triggered by immunological or nonimmune causes [8]. It is crucial to avoid allergens to prevent developing occupational asthma. Intranasal or oral antihistamines, intranasal corticosteroids, or leukotriene antagonists are all examples of the pharmacotherapy [9].
Non-infectious pharyngitis has been associated with a variety of environmental factors, including indoor pollution, pollutants specific to a given industry, risk, or profession, and general air pollution [10]. Pulp mills, woodworking, cement plants, brick kilns, and manufacturing exhaust emissions are a few of the industries that have been linked to sore throats via their emissions of particles and gases [11].
The current observational study assessed the various ear, nose and throat manifestations like noise induced hearing loss, occupational rhinitis and non-infectious pharyngitis among the sculptors working the south part of Chennai, Tamilnadu.
Materials and Methodology
Study Design
A Cross sectional observational study performed in the Otorhinolaryngology department at tertiary care centre in Chengalpattu district and Camp was conducted in and around Mahabalipuram in Tamilnadu.
Study Duration
Six months.
Sample Size Calculation
The sample size was calculated using the formula 4pq/ (l2). Considering universal prevalence with 80% power and 10% allowable error, sample size is calculated to be 110 with 10% non- response rate.
Subject Selection
The patients who are working as a sculptors in and around Mahabalipuram in Tamilnadu.
Inclusion Criteria
Patient age of 19–60 years.
People working as stone carvers/ sculptors
Exclusion Criteria
Patients who are not willing to give consent for participation in the study.
Patient with pre-existing/congenital audiological problems.
Method
All patients will be selected based on inclusion and exclusion criteria after getting approval from the Institutional human ethical committee. After obtaining an informed consent, a detailed history and through clinical examination will be done. Pretested semi structured questionnaire was used to collect data pertaining to socio demographic characteristics like age, gender, education, duration of occupation, use of PPE like face mask, ear plug during work hours, whether sculpting is a family occupation or first gen sculptor, history of symptoms of NIHL, rhinitis, pharyngitis (Fig. 1). Those individuals with ear complaints will be examined otoscope and hearing will be assessed by a test called pure tone audiometry (PTA). Those individuals with nasal complaints will be tested by diagnostic nasal endoscopy (DNE). Those individuals with throat complaints will be tested by videolaryngoscopy (VLS). If any problem is detected they will be treated accordingly.
Fig. 1.
Collection of demographic data and practice of safety measures
Statistical Analysis
For the statistical analysis, Statistical Package for Social Sciences (SPSS)-Version 21 was used to evaluate the data, which was put into an Excel spreadsheet. Qualitative data were expressed in percentage and quantitative data expressed in mean and standard deviation. Chi square test or fischer’s exact test was used to test the association between ENT manifestations and risk factors.
Ethical Consideration
The study was performed after the approval from Institutional Human Ethical Committee. Confdentiality of the study subjects was maintained throughout the study.
Results
Mean age is 37.1 years ± 10.5 years. All the 110 study participants were men who were uniformly working for 8 h a day using modern power tools to make sculptures. None of them were using manual tools like chisels, mallets or hammers in the recent years. None of them had history of bronchial asthma or ENT morbidities prior to the occupational exposure. Nasal and oral cleansing was practiced by most of them. Only 4.5% (N = 5) of the study population had the habit of wearing facemask during work hours and 6.3% (N = 7) of them wore ear plugs. Most of them (70%) were in the age group of 21 to 40 years but 71% of them are sculptors for more than 15 years (Table. 1).
Table 1.
Characteristics of the study population (N = 110)
| Study characteristics | N | % |
|---|---|---|
| Age | ||
| 21 to 40 years | 77 | 70 |
| 41 to 60 years | 33 | 30 |
| Education | ||
| Literate | 93 | 84.5 |
| Illiterate | 17 | 15.5 |
| Duration of occupation | ||
| < 15 years | 32 | 29.1 |
| ≥ 15 years | 78 | 70.9 |
| Use of face mask | ||
| Yes | 5 | 4.5 |
| No | 105 | 95.5 |
| Use of ear plugs | ||
| Yes | 7 | 6.3 |
| No | 103 | 92.7 |
| Family occupation | ||
| Sculpting | 96 | 87.3 |
| Others | 14 | 12.7 |
ENT manifestations in the study population
A thorough ENT examination include otoscopy, nasal speculum and oropharynx examination was followed (Table. 2). Duration of occupation was found to be associated with chronic rhinitis by Fischer’s exact test with P value 0.002 (< 0.05) (Table.3). Age was found to be significantly associated with NIHL, chi-square value of 13.866 and P < 0.0001 (Table. 4). Duration of occupation was also found to be significantly associated with NIHL by Fischer’s exact test with P value of 0.002. Duration of occupation was found to be not associated with chronic pharyngitis by Fischer’s exact test with P value 0. 483 (Table.5).
Table 2.
Ear, Nose and Throat Examination findings (N = 110)
| Study characteristics | N | % |
|---|---|---|
| Otoscopic findings | ||
| Normal | 92 | 83.6 |
| Retracted TM | 15 | 13.6 |
| Perforated TM | 3 | 2.7 |
| Nasal speculum findings | ||
| Normal | 53 | 48.2 |
| Allergic mucosa | 38 | 34.5 |
| Polypoidal growth | 19 | 17.3 |
| Examination of oropharynx | ||
| Normal | 64 | 58.2 |
| Granular | 46 | 41.8 |
Table 3.
Risk factors of Chronic rhinitis in Sculptors (N = 110)
| Study characteristics | Chronic rhinitis | χ2 value | P value | |
|---|---|---|---|---|
| Present | Absent | |||
| Age | ||||
| 21 to 40 years | 28 | 49 | 0.375 | 0.540 |
| 41 to 60 years | 10 | 23 | ||
| Education | ||||
| Literate | 30 | 63 | 1.392 | 0.238 |
| Illiterate | 8 | 9 | ||
| Duration of occupation | ||||
| < 15 years | 4 | 28 | 9.7 | 0.002 |
| ≥ 15 years | 34 | 44 | ||
| Use of face mask | ||||
| Yes | 1 | 4 | 0.49 | 0.484 |
| No | 37 | 68 | ||
| Family occupation | ||||
| Sculpting | 31 | 65 | 1.694 | 0.193 |
| Others | 7 | 7 | ||
Table 4.
Risk factors of NIHL in Sculptors (N = 110)
| Study characteristics | NIHL | χ2 value | P value | |
|---|---|---|---|---|
| Present | Absent | |||
| Age | ||||
| 21 to 40 years | 10 | 67 | 13.866 | 0.0001 |
| 41 to 60 years | 15 | 18 | ||
| Education | ||||
| Literate | 19 | 74 | 1.808 | 0.179 |
| Illiterate | 6 | 11 | ||
| Duration of occupation | ||||
| < 15 years | 1 | 31 | 9.874 | 0.002 |
| ≥ 15 years | 24 | 54 | ||
| Use of ear plugs | ||||
| Yes | 1 | 6 | 0.303 | 0.582 |
| No | 24 | 79 | ||
Table 5.
Risk factors of Chronic pharyngitis in Sculptors (N = 110)
| Study characteristics | Chronic pharyngitis | χ2 value | P value | |
|---|---|---|---|---|
| Present | Absent | |||
| Age | ||||
| 21 to 40 years | 16 | 61 | 3.657 | 0.056 |
| 41 to 60 years | 2 | 31 | ||
| Education | ||||
| Literate | 17 | 76 | 1.614 | 0.204 |
| Illiterate | 1 | 16 | ||
| Duration of occupation | ||||
| < 15 years | 4 | 28 | 0.492 | 0.483 |
| ≥ 15 years | 14 | 64 | ||
| Use of face mask | ||||
| Yes | 2 | 3 | 2.138 | 0.144 |
| No | 16 | 89 | ||
| Family occupation | ||||
| Sculpting | 15 | 81 | 0.301 | 0.583 |
| Others | 3 | 11 | ||
Discussion
Sculptors are routinely exposed to a variety of physically, chemically, biologically, and socially hazardous substances, and prolonged contact to these elements without using personal protection equipment can result in occupational diseases (Fig. 2). Pre-medical exams and frequent periodic monitoring can find many occupational disorders early on, allowing for proper treatment [12].
Fig. 2.
Sculptor working without any protective devices.
In 2021, Asher T. et al. evaluated the knowledge and safety methods among 50 sculptors and discovered that they demonstrated a moderate degree of practice for workplace safety and had a reasonable level of knowledge on occupational health. Additionally, it was said that the workplace lacked basic amenities for the employees. It is important to regularly monitor and inspect work locations to protect the employees from negative health impacts [1].
In 2022, Zhang, Meibian, and colleagues evaluated the contribution of complex noise to noise-induced hearing loss among 2601 workers and came to the conclusion that non-Gaussian complex noise is present in a variety of industries and that exposure to noise is greater than 70 dB, making it crucial to take preventative action [5].
In 2009, Castano et al. evaluated the presence of occupational rhinitis in 43 workers who had occupational asthma and found that the condition frequently coexists with occupational rhinitis but can also exist without occupational asthma [13].
In 2012, Bertold Renner et al. analysed a number of articles on non-infectious and environmental pharyngitis caused by various aetiologies and came to the conclusion that persistent non-infectious sore throats are caused by a mix of physico-chemical and environmental factors. Non-infectious aetiologies of the sore throat seem to be accompanied with inflammatory processes (of diverse causes, including neurogenic inflammation) [10].
Most of them (70%) were in the age group of 21 to 40 years but 71% of them are sculptors for more than 15 years which infers introduction to the occupation at an early age. The reason for this could be more than 80% of them possessed the heritage of sculpting as their family occupation. Duration of occupation was significantly associated with chronic rhinitis and NIHL whereas education and use of PPE like face mask or ear plugs were not associated with ENT manifestations.
Conclusion
In India, the prevalence of occupational health hazards is rising over time despite recent public and commercial investments in occupational health and safety management. Machine-related injuries seem to be common in the mechanical industry throughout different countries. In addition to unintentional injuries, prolonged exposure to airway allergens and noise by industrial employees causes a variety of ear, nose, and throat illnesses.
This study focuses on the sculptors’ working habits, their ignorance of safety precautions, and an assessment of the numerous ENT ailments. The most prevalent ENT conditions among sculptors included noise-induced hearing loss, occupational rhinitis, and non-infectious pharyngitis. These manifestations showed a strong correlation to exposure time. Regular medical monitoring for early identification and intervention is necessary to prevent further complications.
Limitation and Recommendations
This study could not compare and quantify the ENT hazards among the sculptors who were using safety measures routinely like usage of ear plugs and face mask with those who were not following the safety measures. The study further gives future recommendation towards the need for improving workplace environment and enforce the use of safety devices to prevent longterm ENT manifestations apart from accidental injuries.
Declarations
Confict of interest
The authors declare that they have no confict of interest.
Ethical Approval
The approval for the study was obtained from the Human ethical committee of the Chettinad University, Chennai.
Informed Consent
Written and informed consent was taken from all patient for participation in the study. Confdentiality of patients maintained.
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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