Audiological Symptoms Experienced by Taxi Drivers at Two Taxi Ranks in Johannesburg, South Africa

Abstract

Background:

Noise-induced hearing loss (NIHL) is among the most common occupational health conditions worldwide. In South Africa, thousands of informal taxi drivers are chronically exposed to high traffic and environmental noise; however, data on their hearing health, awareness of audiology or access to hearing conservation programmes are lacking.

Objective:

This study investigated occupational noise exposure, auditory and nonauditory symptoms, knowledge of hearing risks and health-seeking behaviours among minibus taxi drivers in Johannesburg.

Methods:

A cross-sectional, quantitative design was used. Eighty-six male taxi drivers completed structured questionnaires on demographics, work history, exposure, symptoms, knowledge and health-seeking behaviour. Data were analysed using descriptive statistics, chi-square tests and logistic regression.

Results:

All participants were male. Most firstly, encountered occupational noise between the ages 20 and 30 and worked 12–16 hours daily, with 16–37 years of cumulative exposure. Tinnitus (64%) and hearing difficulties (40%) were the most common, with 78% noticing hearing changes during peak hours. Noise exposure was significantly associated with tinnitus, hearing difficulties, diabetes, perceived hearing changes and the belief that noise affects work. Logistic regression identified tinnitus [odds ratio (OR) = 1634] and hearing difficulties (OR = 166) as the strongest predictors of hearing change. Only 27% had undergone hearing testing, and over half were unaware of audiologists’ roles. Knowledge of hearing risks and audiology was linked to high testing uptake.

Conclusions:

Johannesburg taxi drivers are at high risk for NIHL because of chronic exposure, long shifts and lack of protective measures. Limited awareness of audiology and poor health-seeking behaviour further increase vulnerability.

KEY MESSAGES

• (1)Johannesburg taxi drivers face chronic exposure to high traffic noise, placing them at significant risk of auditory and nonauditory health effects, including tinnitus, fatigue and headaches.
• (2)Awareness among drivers about the long-term consequences of noise exposure and the role of audiological services is limited, with most drivers never having undergone hearing assessments.
• (3)Effective hearing conservation strategies must account for drivers’ long working hours, informal work conditions and socioeconomic challenges to ensure feasible and sustainable interventions.
• (4)Targeted occupational health measures, such as routine screenings, health education campaigns and noise mitigation, are essential to safeguard drivers’ hearing, improve overall well-being and support road safety.

INTRODUCTION

Taxi drivers are frequently exposed to elevated noise levels due to traffic congestion and the operational demands of the taxi industry. Chronic exposure to such noise significantly increases the risk of developing noise-induced hearing loss (NIHL), tinnitus and related health issues such as sleep disturbances, stress, migraines, irritability, cardiovascular problems, fatigue and concentration difficulties.[1,2,3] Audiological studies indicate that professional drivers generally exhibit higher hearing thresholds than individuals in less noisy occupations, with significant damage occurring at frequencies of 3 and 4 kHz.[4,5,6] Hearing loss severity is influenced by cumulative exposure; drivers who have long tenure and extended daily working hours demonstrating great threshold shifts, particularly at high frequencies.[7,8,9]

Globally, public transport drivers, including taxi drivers, are at high risk of NIHL because of their chronic exposure to environmental noise. Studies conducted in São Paulo (Brazil), Kolkata (India) and Kathmandu (Nepal) highlight that prolonged noise exposure leads to auditory impairment and nonauditory effects, such as increased aggression, sleep disturbances, psychological disorders and excessive fatigue.[6,10,11] These health effects are exacerbated by variables such as age, gender, occupational characteristics and years of exposure and are further compounded in developing countries where populations live and work in environments with consistently high noise levels.[8]

In South Africa, minibus taxis are the most common mode of transport, particularly for low-income populations living in townships, and are often the only accessible means of mobility.[12] The taxi industry facilitates approximately 65% of work-related journeys and serves the majority of daily commuters.[13] Thus, taxi drivers play a central role in economic activity and social mobility; however, their occupational environment exposes them to persistent auditory hazards. Prolonged exposure to traffic noise increases their susceptibility to NIHL, tinnitus and other health effects, which can compromise communication with passengers, reduce alertness and elevate stress levels. Nevertheless, research documenting taxi drivers’ self-reported audiological symptoms, knowledge of noise exposure or history of hearing assessments is limited. Existing studies primarily focused on the association between road traffic noise exposure and driving behaviour,[14] impact of working conditions on taxi drivers’ health in urban settings[15] and general working conditions and health of taxi drivers.[16] In the South African context, research largely addressed general health assessments of taxi drivers[17] and quantified traffic noise pollution levels,[18] but drivers’ awareness of noise risks, self-reported audiological symptoms or engagement with hearing assessments have never been investigated.

This gap is significant because chronic exposure to traffic noise is a known risk factor for NIHL, tinnitus and related nonauditory effects such as fatigue, stress and reduced concentration. The absence of regulated traffic noise standards, limited access to audiological services and high exposure to urban traffic noise amplify the occupational health risks faced by South African taxi drivers. Therefore, investigating their knowledge of noise exposure, documenting self-reported symptoms and recording their hearing assessment history is essential for informing targeted occupational health interventions. Evidence from such research can guide the development of hearing conservation programs, public awareness campaigns and policy initiatives, ultimately safeguarding drivers’ hearing, improving occupational safety and maintaining the essential transport services they provide.

Therefore, this study aims to explore taxi drivers’ knowledge and awareness of noise exposure, document their self-reported audiological symptoms and collect information on their history of hearing assessments.

MATERIALS AND METHODS

Study Design

This quantitative cross-sectional survey is a follow-up to the study by Moroe and Mabaso[18] which quantified traffic noise pollution at two Johannesburg taxi ranks. As the noise exposure methodology and results have been previously described, the present study focused on documenting audiological symptoms reported by taxi drivers and assessing their awareness of noise exposure risks. Eighty-six taxi drivers from two of the busiest ranks in Johannesburg participated: (1) Bree taxi rank − a closed, multilevel terminal accommodating approximately 3000–4000 taxis daily; and (2) Chris Hani Baragwanath taxi rank − an open-air, single-floor rank in Soweto serving 2000–3000 taxis daily. An equal number of participants (n = 43) were included from each rank. All were active male taxi drivers, aged over 18 years, with a minimum of 1 year’s driving experience. From 27 April to 09 July 2019, data were collected during drivers’ rest periods to minimise disruption to their work schedules. Only male drivers were included, as the taxi industry in this context is predominantly male.

Sample Size Calculation

No a priori sample size calculation was conducted because of the exploratory nature of this work. Existing literature indicates that exploratory studies typically include between 10 and 75 participants.[19] In this study, 86 participants were enrolled.

Data Collection

Data were collected using a self-developed questionnaire consisting mainly of closed-ended questions on prior hearing assessments, awareness of audiologists and knowledge of noise exposure risks, alongside open-ended items addressing work patterns, medical history, risk factors and audiological symptoms. A self-developed questionnaire was used and no standardised scales were included. Several steps were taken to ensure the questionnaire was valid and appropriate. Firstly, expert review was conducted; professionals knowledgeable in occupational noise exposure and hearing health assessed the questionnaire. They confirmed that the questions were clear, relevant and comprehensive, thereby establishing face validity (the questions measured what was intended) and content validity (all important aspects of the topic were covered). Secondly, a pilot trial was conducted with two taxi drivers at the rank who provided written consent. Both participants were able to answer all questions without difficulty, and the researcher provided translations when clarification of certain terms was needed. These steps ensured that the instrument accurately captured the relevant experiences and awareness of taxi drivers in this study. The questionnaire was self-administered; however, given the drivers’ varying literacy levels, educational backgrounds and cultural contexts, the data collector (PM), an undergraduate audiology student, was available to assist the participants whenever needed. A pilot test with two taxi drivers confirmed the questionnaire’s clarity and relevance.

Ethical Considerations

Ethics approval was obtained from the University of the Witwatersrand Human Research Ethics Committee (HREC) (non-medical), Johannesburg, South Africa (Protocol Number: STA_2019-04). All study procedures adhered to the relevant guidelines and regulations of the University’s Ethics Committee. Written informed consent was obtained from all participants before data collection, and confidentiality was maintained throughout the study.

Data Analysis

Descriptive statistics, including frequencies and percentages, were used to summarise demographic variables, awareness of noise exposure risks, prior hearing assessments and reported audiological symptoms. Responses were categorised according to awareness and symptomatology to identify overall patterns within the sample. Findings were presented as tables and graphical formats. All figures were generated using Microsoft Excel (Microsoft Corporation, Armonk, NY, USA, Microsoft 365). Inferential statistical analyses were conducted to explore associations between categorical variables. Chi-square tests of independence were used to examine relationships among noise exposure, awareness and various health and work-related outcomes. When significant associations were found, effect sizes were calculated using Cramér V to quantify the strength of the relationships. For analyses involving binary or multinomial outcomes, logistic regression was performed to identify the significant predictors of reported changes in hearing over time, with effect sizes reported as odds ratios (Exp(B)). Statistical significance was set at P < 0.05 for all analyses. All analyses were conducted using IBM SPSS Statistics for Windows, Version 30.0.0 (IBM Corp.).

RESULTS

Demographic and Work Characteristics

All participants were male. Most reported that they began driving between 2001 and 2011 or between 2012 and 2016, with a small group indicating that they had started in 1990. Age at first exposure to traffic noise was most commonly between 26 and 30 years, followed by between 20 and 25 years and less frequently between 31 and 35 years. Years of exposure varied, with the largest proportion indicating between 16 and 37 years, followed by between 27 and 37 years and a small group reporting between 5 and 15 years [Table 1].

Table 1.

Participants’ demographics

Variable		Count	Column N%
Year started driving	1990	22	25.60%
	2001–2011	32	37.20%
	2012–2016	32	37.20%
Age at first exposure	20–25	33	38.40%
	26–30	40	46.50%
	31–35	13	15.10%
Years of exposure	0–15	24	27.90%
	16–25	33	38.40%
	26–37	29	33.70%
Shifts per day	1–3	23	26.70%
	4–6	53	61.60%
	7–9	10	11.60%
Shift duration	4:00 AM to 7:30 PM	16	18.60%
	4:00 AM to 8:00 PM	32	37.20%
	5:00 AM to 9:00 PM	38	44.20%
Working days per week	3 days	11	12.80%
	5 days	27	31.40%
	7 days	48	55.80%
Knowledge of audiologist	Yes	24	27.90%
	No	18	20.90%
	Not sure	44	51.20%
Hearing Tested	Yes	23	26.70%
	No	63	73.30%
Year hearing tested	2000–2005	9	10.50%
	2006–2010	8	9.03%
	2011–2012	6	7.00%
	Not tested	63	73.30%
Need hearing test	Yes	35	40.70%
	No	21	24.40%
	Maybe	30	34.90%
Rank type	Closed	43	50.00%
	Open	43	50.00%

In terms of work schedules, most participants reported working 4–6 shifts per day, followed by 1–3 shifts and a few completed 7–9 shifts daily. Reported shift durations ranged from early morning to late evening, with most working from 5:00 AM to 9:00 PM, followed by from 4:00 AM to 8:00 PM and a few from 4:00 AM to 7:30 PM. Regarding working days per week, the majority worked 7 days, followed by 5 days and a small proportion working 3 days per week.

Comparison between the Two Groups: Closed Versus Open

The data were also analysed according to the two taxi rank groups to identify any differences or similarities in their responses. Across all variables described below, no statistically significant differences were observed between the closed and open rank groups.

In terms of when they began driving [Figure 1a], the most common period for the closed rank group was 2001–2011 (44%), whilst the open rank group had equal representation for 1990–2000 (34.9%) and 2012–2016 (34.9%). For age at first exposure to taxi-related noise, more than half of the closed rank drivers (53%) reported initial exposure between 26 and 30 years, compared with the open rank group where the largest proportion (44%) reported exposure between 20 and 25 years [Figure 1b]. Years of exposure varied between rank types, with the closed-rank drivers most frequently having 26–37 years of exposure (37%) and the open-rank drivers likely to have 16–25 years of exposure (42%). Exposure in the 0–15 years category was equal for both groups at 28% [Figure 1c].

Figure 1.

(a) Year started driving and type of rank. (b) Age at first exposure and rank type. (c) Exposure years and rank type.

Work Patterns

Regarding work patterns, the majority of both groups reported working 7 days per week, but this trend was more pronounced in the open rank group (67%) compared with that in the closed rank group (44%) [Figure 2a]. Shift duration was longest in the 5:00 AM to 9:00 PM category for both groups (44% each) [Figure 2b]. Shifts per day were most commonly in the four to six range, and this trend was more evident among open rank drivers (70%) compared with closed rank drivers (53%) [Figure 2c].

Figure 2.

(a) Working days per week and rank type. (b) Shift duration and rank type. (c) Shifts per day and rank type.

Hearing Assessment Characteristics

In terms of hearing assessments and perceptions, most participants had never undergone a hearing test (77% in closed ranks and 70% in open ranks) [Figure 3a]. Among those tested, the most common testing period was 2006–2010 for the closed rank group (14%) and 2000–2005 for the open rank group (16%) [Figure 3b]. When asked about the need for a hearing test, 46% of closed rank drivers and 35% of open rank drivers answered ‘Yes’, and a notable proportion in both groups responded ‘Maybe’ (33% closed; 37% open) [Figure 3c]. Knowledge of audiologists was generally low, with 49% of closed rank drivers and 53% of open rank drivers indicating they were ‘Not sure’ what an audiologist was. Only 23% of closed rank drivers and 33% of open rank drivers reported knowing what an audiologist was [Figure 3c].

Figure 3.

(a) Hearing assessment. (b) Year of hearing test and rank type. (c) Needs a hearing assessment and a rank type. (d) Knows an audiologist and the rank type.

Noise Exposure and Its Effects

This study explored taxi drivers’ exposure to occupational/traffic noise and their awareness of its effects on hearing, as highlighted in Figure 4. The participants reported varying levels of noise exposure and its perceived impact on their hearing and work. The majority (70%) indicated that they were not frequently exposed to noise, 25% reported occasional exposure and 5% responded sometimes. By contrast, 62% of the participants acknowledged being exposed to noise when driving, 18% denied exposure and 20% reported occasional exposure.

Figure 4.

Noise exposure and its effect.

When asked whether they noticed any differences in their hearing during peak traffic hours, 78% responded affirmatively, 6% reported no differences and 16% responded ‘sometimes’. Mixed responses were noted regarding the impact of noise on work performance, with 22% indicating that noise affected their work, 40% reporting no effect and 38% responding ‘sometimes’.

Regarding changes in hearing since starting work at the taxi rank, 52% of the participants reported noticing changes and 48% did not. Awareness of the dangers of excessive noise exposure was relatively low. Only 26% of the participants reported being aware, and 74% were unaware. However, 58% understood that excessive noise exposure can cause hearing loss, and 42% did not acknowledge this risk. Overall, these findings highlight that whilst a significant proportion of taxi drivers recognise changes in their hearing and the potential consequences of noise exposure, awareness of specific occupational hazards remains limited.

Participants’ Audiological and Medical Symptoms

A considerable proportion of the participants reported experiencing medical and audiological symptoms (Figure 5a and b), with tinnitus being the most prevalent (64%), followed by blocked ears (48%) and fatigue (43%). Hearing difficulties were reported by 40% of the participants, indicating a substantial level of perceived hearing problems within the group. Headaches were experienced by 35% of the participants, with 32% experiencing them intermittently. Intermittent occurrences were also notable for blocked ears (27%) and fatigue (28%). Ear infections and allergies were each reported by 22% of the participants. Discharge (28%) and pain (25%) were less common but still present in a quarter of the participants. Low rates of ear surgery (3%), family history of hearing loss (6%) and diabetes (18%) suggest minimal contribution from these factors to the overall symptom profile. ‘No’ responses predominated for ear surgery (97%), family history (94%), ear infections (78%) and allergies (76%), highlighting that these conditions were uncommon among the participants. Overall, the high prevalence of tinnitus, blocked ears and hearing difficulties points towards potential occupational or environmental noise exposure as a contributing factor, whilst the variable nature of headaches and fatigue suggests intermittent triggers. The participants who reported symptoms suggestive of hearing loss or suspected hearing loss related to their work environment at the taxi rank and who consented to further evaluation were referred to the University’s Speech and Hearing Clinic. However, most of these individuals expressed reluctance to undergo a comprehensive audiological assessment, citing time constraints as a primary barrier. Time away from the rank directly translates to lost income, making them hesitant to commit to lengthy testing procedures.

Figure 5.

(a) Medical symptoms. (b) Audiological symptoms.

Tinnitus and Its Characteristics

The participants were asked about the presence of tinnitus and its characteristics. Overall, 64% of the participants reported being bothered by tinnitus, 26% indicated they were not affected and 10% reported experiencing it only sometimes [Figure 6a]. Regarding the type of tinnitus reported, 20% of the participants described it as resembling the sound of running water, 54% reported it as similar to the hum of a fridge and 26% described it as a hairdryer-like sound [Figure 6b]. These results indicate variation in the auditory perception of tinnitus among the participants. The frequency of tinnitus was also assessed. Among the participants, 26% experienced tinnitus every morning, 62% reported noticing it only at night and 12% indicated that it was present all the time [Figure 6c]. These findings highlight that tinnitus is a common experience in this population, with variation in the perceived type of sound and the frequency of occurrence. The data show that whilst the majority of the participants reported intermittent or nighttime tinnitus, a small proportion experienced continuous or morning-specific symptoms.

Figure 6.

(a) Tinnitus presence. (b) Tinnitus sound type. (c) Tinnitus frequency.

Hearing Assessment History and Awareness of Audiology

Over a quarter of the participants (27%) reported having had their hearing tested, and the majority (73%) indicated no prior assessment. Among those who had been tested, the first assessment most commonly took place between 2000 and 2005 (11%), followed by 2006–2010 (9%) and 2012–2017 (7%). Regarding the perceived need for a hearing test, 41% expressed a definite need, 35% were unsure and 24% felt it was unnecessary. Awareness of the role of an audiologist was limited, with over half of the participants (51%) reporting uncertainty, 28% indicating awareness and 21% stating they had no knowledge. The data were evenly divided between those working at closed and open taxi ranks.

Inferential Statistics

Chi-square analyses revealed significant associations between noise exposure and several health and work-related outcomes [Table 2]. Specifically, noise exposure was significantly associated with hearing difficulties (Cramér V = 0.25, P = 0.004), changes in hearing over time (Cramér V = 0.32, P = 0.001), tinnitus (Cramér V = 0.46, P = 0.001), diabetes (Cramér V = 0.21, P = 0.020) and work performance (Cramér V = 0.22, P = 0.003). A particularly strong association was observed between awareness of noise exposure dangers and reported changes in hearing over time (Cramér V = 0.60, P = 0.001).

Table 2.

Associations among noise exposure, health outcomes and hearing health-seeking behaviours

Dependent variable	Independent variable	Effect size (Cramér V)	P-value	Significance
Hearing difficulties	Noise exposure	0.25	0.004	Significant
Changes in hearing	Noise exposure	0.32	0.001	Significant
Tinnitus	Noise exposure	0.46	0.001	Significant
Diabetes	Noise exposure	0.21	0.02	Significant
Work performance	Noise exposure	0.22	0.003	Significant
Changes in hearing over time	Awareness of noise dangers	0.60	0.001	Significant
Hearing assessment	Knowledge of audiologist	0.04	0.875	Not significant
Need for hearing assessment	Knowledge of hearing loss	0.11	0.433	Not significant
Hearing assessment	Noise exposure	0.09	0.432	Not significant

Note: Cramér V values of 0.1, 0.3 and 0.5 are conventionally interpreted as small, medium and large effect sizes, respectively (Cohen, 1988).[20]

Additional analyses examining the relationship among knowledge of audiologists, awareness of noise exposure dangers and hearing-related practices were conducted to further explore hearing health-seeking behaviours. No significant associations were found between knowledge of audiologists and having undergone a hearing assessment (Cramér V = 0.04, P = 0.875), between knowledge of hearing loss and perceived need for hearing assessment (Cramér V = 0.11, P = 0.433) or between noise exposure and having undergone a hearing assessment (Cramér V = 0.09, P = 0.432). All effect sizes for these associations were negligible, indicating that awareness and knowledge did not translate into proactive hearing health-seeking behaviours in this population [Table 2].

Logistic regression further clarified these relationships by examining the predictors of reported changes in hearing [Table 3]. The results indicated that hearing difficulties (OR = 166.1, P = 0.001) and tinnitus (OR = 1634.2, P = 0.013) were significant positive predictors, suggesting that the participants reporting these conditions were likely to also report changes in hearing. The odds ratio for tinnitus was exceptionally high and should be interpreted cautiously, as it may reflect small cell counts or quasi-complete separation in the data rather than a precise estimate of effect size. In this case, the number of participants reporting tinnitus and changes in hearing over time was relatively small, which may have contributed to the inflated estimate. Factors such as blocked ears, headache, pain, fatigue and diabetes were not significant predictors. Some predictors had negative coefficients (e.g., pain and blocked ears). This finding indicates that after the adjustment for other variables, these factors were associated with a low likelihood of reporting changes in hearing; however, these effects were not statistically significant (all P > 0.05). Although bivariate analyses suggested multiple associations, multivariate regression revealed that only hearing difficulties and tinnitus uniquely contributed to the likelihood of self-reported hearing change.

Table 3.

Predictors of reported changes in hearing over time

Predictor variable	Effect size (odds ratio, Exp(B))	P-value	Significance
Tinnitus	1634.2	0.013	Significant
Hearing difficulties	166.1	0.001	Significant
Pain	0.41	0.578	Not significant
Blocked ears	0.97	0.982	Not significant
Fatigue	8.54	0.213	Not significant
Knowledge of audiologist	0.88	0.837	Not significant
Exposure when driving	0.78	0.584	Not significant
Diabetes	2.35	0.762	Not significant
Noise affects work	0.00	1.000	Not significant

DISCUSSION

The study population consisted exclusively of male drivers, reflecting entrenched gender dynamics in South Africa’s taxi industry, where sociocultural norms and economic pressures contribute to male predominance.[21,22] This demographic profile affects occupational health interventions, as men in this sector are often primary breadwinners. Therefore, hearing loss can impact household income and stability. Malcolm et al.[23] similarly noted the socioeconomic consequences of hearing loss, including reduced employability and increased financial strain, which resonates in the South African context of widespread unemployment and informal work.

Most participants reported driving between 2001 and 2016, with their first occupational noise exposure between ages 26 and 30 years, and many working for over a decade. Early and prolonged exposure combined with 16–37 years of driving increases the risk of progressive NIHL.[8] Anil and Arunima[5] and Stansfeld et al.[24] found that drivers exposed to urban traffic noise for over 8 hours daily exhibited higher hearing threshold shifts than nonexposed populations.

Prolonged exposure reduces auditory recovery opportunities and raises the risk of permanent hearing damage. In this study, drivers were exposed to noise for 15 hours daily, up to 7 days a week. Narciso and Mello[25] reported that Brazilian professional drivers working irregular hours often spend more than 18 hours on the road, reducing their performance and alertness.[26] In Johannesburg, severe traffic congestion and extended, unregulated work hours intensify NIHL risk. The absence of formal occupational health protections in the informal sector further increases vulnerability.

Comparisons between closed-rank and open-rank drivers showed minor differences in exposure onset, years of work, hearing test uptake and audiology awareness, none statistically significant. This finding suggests that interventions for preventing ONIHL and improving audiological awareness must be applied uniformly. Similar patterns have been reported internationally. Manar et al.[27] found minimal differences in hearing loss between taxi and agency drivers. Research in Brazil (motorcycle taxi drivers) and Pakistan (public transport drivers) also highlighted widespread auditory effects regardless of driver type.[28,29] These studies reinforce that occupational noise exposure and auditory consequences are pervasive, with rank or work patterns having limited influence.

A striking 78% of drivers reported hearing changes during peak traffic hours, and 52% since beginning work at taxi ranks. These self-reports align with the findings of Brown and van Kamp,[30] who documented that urban transport hub noise frequently exceeds the 85 dB(A) threshold recommended by the World Health Organisation. In South Africa, limited enforcement of occupational noise regulations in informal sectors leaves chronic exposure largely unmitigated.[18] Moroe and Mabaso[18] reported noise levels at the two taxi ranks ranging from 70.3 to 110.2 dB(A), exceeding commercial and NIOSH standards. Peak levels occur during morning (06:00–08:30) and afternoon (16:30–18:30) rush hours. Elevated exposure can impair drivers’ ability to detect critical environmental cues (sirens, horns and passenger instructions), increasing accident risk and compromising commuter safety.[31]

Tinnitus, reported by 64% of the participants, emerged as a prominent symptom and early indicator of cochlear damage, consistent with international findings.[32,33,34] Chi-square analyses confirmed significant associations of noise exposure with tinnitus, hearing difficulties, perceived hearing changes and perception that noise affects work. Logistic regression identified tinnitus and hearing difficulties as the strongest independent predictors of self-reported hearing changes. The participants with tinnitus and were over 1600 and 166 times more likely to report hearing changes, respectively. These findings are supported by Umashankar et al.[35] and Dillard and Humes.[36] In South Africa, uneven distribution of audiological services[37] means tinnitus among taxi drivers may go unrecognised or untreated, leading to progressive hearing loss. Other symptoms include blocked ears, which can mask underlying sensorineural deficits and delay diagnosis.[38,39] Difficulty hearing passengers and environmental sounds suggest progressive auditory decline. Nonauditory symptoms, including fatigue and headaches, are also prevalent, consistent with research linking chronic noise exposure to stress, cognitive fatigue and reduced concentration.[24,40,41] These symptoms affect individual well-being and driving performance, increasing traffic risks. Without protection, this dual burden may cause early auditory disability, affecting occupational performance and quality of life. Drivers often adapt by relying on nonverbal communication strategies which may be ineffective in high-pressure traffic, increasing miscommunication and accidents.

Despite the high prevalence of auditory symptoms, only 27% of drivers had undergone a hearing assessment, consistent with the findings of Ramukumba and Mathikhi.[17] Alarmingly, 51% were unsure what audiologists do. Knowledge of audiologists or noise risks was not significantly associated with proactive hearing health behaviours. This disconnect suggests awareness alone is insufficient to motivate preventive audiological care, contrasting with the health belief model.[42] Some participants expressed willingness to attend hearing tests but cited work hours, lack of time and absence of nearby services as obstacles, compounded by systemic inequities in healthcare delivery.

Overall, the findings highlight the urgent need for targeted occupational health interventions in Johannesburg’s informal transport sector. Addressing NIHL and related symptoms requires a multifaceted approach involving workplace noise mitigation, routine hearing screenings, audiology awareness campaigns and improved hearing healthcare accessibility. Without such measures, chronic noise exposure will continue to undermine drivers’ health, safety and socioeconomic stability, affecting passengers and the broader community.

Implications of the Study

The findings reveal critical public health and occupational safety concerns for taxi drivers in Johannesburg’s informal transport sector. With prolonged daily exposure to noise exceeding 85 dB(A), often peaking well above recommended limits, drivers face a high risk of NIHL and related conditions, including tinnitus. Many drivers reported hearing changes but had limited awareness of chronic noise risks or the role of audiologists, highlighting the urgent need for targeted awareness campaigns.

The implications extend beyond individual health, affecting road safety and community well-being. Impaired hearing may reduce drivers’ ability to detect essential auditory cues, increasing accident risk and endangering passengers. Raising awareness about NIHL, implementing hearing conservation programs and improving access to audiological services could mitigate these risks.

The lack of familiarity with audiology services underscores the need for community-based education initiatives. Audiologists can play a key role in clinical NIHL management and proactive occupational hearing health promotion. Partnerships with taxi associations could provide effective channels for disseminating information, organising screenings and delivering interventions tailored to drivers’ working conditions and time constraints.

Limitations

This study relied on self-reported data from structured questionnaires, which may have limited the depth of participants’ responses. This approach might have restricted opportunities to explore personal narratives and contextual factors influencing drivers’ experiences with noise exposure and hearing health. The cross-sectional design prevents establishing causal links between noise exposure and reported symptoms. The small sample size and basic statistical analyses further limit generalisability. Therefore, results should be interpreted cautiously and are mainly exploratory, providing preliminary insights into taxi drivers’ experiences and awareness of occupational noise exposure. Future studies with large samples and advanced statistical analyses are needed to confirm these findings and provide strong evidence for practice and policy.

Recommendations for Future Studies

The sample size must be expanded and participants from diverse geographical locations must be included to improve the generalisability of findings. The use of qualitative methods, such as in-depth interviews or focus groups, could provide a deep understanding of taxi drivers’ perceptions and experiences with occupational noise exposure. Longitudinal studies would allow monitoring of hearing changes over time, helping establish causal links between noise exposure and hearing loss. Including objective audiological assessments, such as pure-tone audiometry, alongside self-reports would strengthen result reliability. Finally, evaluating the effectiveness of hearing conservation interventions at taxi ranks and the impact of policy enforcement and workplace regulations could provide practical insights for prevention and health promotion.

CONCLUSION

This study shows that taxi drivers in Johannesburg are exposed to harmful noise levels, putting them at high risk for NIHL, tinnitus and other auditory and nonauditory health effects. Many drivers notice changes in their hearing but remain unaware of the risks of chronic noise exposure and available audiology services. Limited hearing healthcare access, long work hours and lack of formal occupational protections further worsen the problem.

Addressing these challenges requires coordinated action by public health authorities, audiologists and transport sector stakeholders. Interventions should include noise mitigation, routine hearing screenings, targeted health education and improved access to audiological care. Without such measures, prolonged noise exposure will likely continue to harm drivers’ occupational performance, road safety and long-term quality of life.

Availability of Data and Materials

All data generated and analysed in this study are provided within this published article.

Author Contributions

The author contributed to all aspects of the manuscript, from conceptualisation to reviewing the final draft.

Ethics Approval and Consent to Participate

Ethics approval was obtained from the University of the Witwatersrand Human Research Ethics Committee (HREC) (non-medical), Johannesburg, South Africa (Protocol Number: STA_2019-04). Informed consent was obtained from all participants, assuring their voluntary involvement and confidentiality of the data.

Financial Support and Sponsorship

Not applicable.

Conflicts of Interest

The authors declare no conflicts of interest.