A review of the studies investigating the effects of noise exposure on humans from 2017 to 2022: Trends and knowledge gaps
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Mohammad Javad SheikhMozafari
Abstract
Background
Due to rapid urbanization and industrialization, noise pollution has become a growing global concern, with significant impacts on occupational and environmental health. Unlike earlier times when it received limited attention, its importance has increased due to mounting evidence of its health effects. Research on noise pollution highlights its consequences and helps identify gaps that require further exploration. This systematic review aims to compile and categorize the health effects associated with various sources of noise pollution.
Methodology
This review focuses on studies published from 2017 to 2022 examining the impact of noise on human health. Eligible studies were identified through comprehensive searches on PubMed and Web of Science.
Results
Out of 1,042 studies retrieved, 287 met the inclusion criteria. The health effects of noise were categorized into auditory effects (e.g., hearing loss), non-auditory effects (e.g., psychological and physiological impacts), and other effects (e.g. immune dysfunction and DNA damage).
Conclusions
While substantial research highlights the adverse effects of noise, future studies should explore its emerging impacts, especially on occupational and environmental health, such as links to cancer and genetic damage, to address existing research gaps and provide a broader understanding of its implications.
1 Introduction
Noise pollution has become a significant concern for various groups, among them acoustic experts, epidemiologists, and urban residents [1,2]. The pervasive and unwanted presence of noise has severe physical and psychological effects on human health [3,4]. The World Health Organization (WHO) ranks noise as the second most harmful environmental factor in Western Europe and a leading cause of health issues [5,6]. Rapid urbanization and industrialization have exacerbated noise pollution to hazardous levels [7]. The harmful effects of noise on both the general public and workers are substantial [8], and these negative impacts are intensifying. If not managed, they could lead to serious consequences [9]. Initially, research focused on the impact of occupational noise, primarily causing noise-induced hearing loss (NIHL). However, studies have expanded to include various noise sources and their detrimental effects beyond hearing loss. The sources of noise pollution include but are not limited to, occupational noise, traffic noise from automobiles, planes, trains, wind turbines, community noise, ambient noise, environmental noise, and so on [10,11,12,13,14,15]. The adverse effects of noise on the public and workers include noise annoyance [16], sleep disorders [17], hearing damage [18,19,20], cardiovascular problems [21,22,23], noise sensitivity [24], mental disorders [25], metabolic disorders [26], decreased concentration [27] increased blood pressure, [24] increased diabetes, [28] increased cholesterol and triglycerides [29], and impaired immune system [30,31]. It is estimated that 10% of the US population is at a heightened risk of NIHL, with 16% exposed to occupational noise as reported [32]. According to estimates, 10% of the U.S. population is at significant risk of NIHL, with 16% of them likely to be exposed to hazardous occupational noise [32]. A recent study reported that approximately 56 million people, or 54% of the European Union’s population, live in areas where annual road traffic noise averages over 55 decibels, posing a significant health risk. Moreover, around 45,000 disability-adjusted life years (DALYs) are lost annually in high-income Western European countries due to environmental noise, primarily affecting children aged 7–19 years [33]. According to a recent study, workers exposed to occupational noise exceeding 90 decibels for 8 h each day displayed a significantly higher diastolic blood pressure compared to individuals exposed to noise levels lower than 90 dB [24]. Zaresakhvidi’s research indicated that a 5 dB increase in road traffic noise heightened the risk of developing diabetes by 17% [34]. Hammer’s investigation revealed that in 2013, over 104 million people in the United States were exposed to noise levels exceeding 70 dB annually, which increases the risk of NIHL, heart disease, and other health issues [35]. A European study reported that environmental noise caused significant sleep disturbances, leading to an annual loss of 900,000 DALYs [36]. Hahad’s study found that road traffic noise alone accounted for 18,000 premature deaths, 1.7 million cases of hypertension, and 80,000 hospital admissions annually in Europe [37]. Numerous other research studies have highlighted similar negative impacts of various sound sources on human health [24,38,39,40,41,42].
Acquiring substantial information from studies on the health impacts of noise is essential for a deeper understanding of the effects of human exposure to noise. Furthermore, to the best of our knowledge, no comprehensive examination has yet explored all potential health effects arising from diverse noise sources. Therefore, this research aims to gather and classify the health effects of noise from various perspectives (auditory and non-auditory effects). Another goal of this study is to investigate the trajectory and characteristics of both field and experimental research to identify the strengths and weaknesses of existing studies and address research gaps in current knowledge. The final objective is to provide an overview of research efforts and approaches that could inform future research needs and areas of study. This research is expected to lay the groundwork for more extensive investigations into the health impacts of noise, particularly in areas where relevant studies are limited or insufficient information is available.
2 Material and methods
2.1 Study period and databases used for article search
This systematic review examined the studies conducted about noise effects on humans during 6 years (2017–2022) according to PRISMA [43]. The search for eligible studies was performed using PubMed and Web of Science, which provided comprehensive coverage of the topic by including all relevant and significant studies.
2.2 Search keywords in the database
Since this study follows the PRISMA guideline, a specific search strategy was applied to each of the databases, Web of Science and PubMed.
Web of Science Search Strategy:
TI = (“occupational noise” OR “ambient noise” OR “transportation noise” OR “traffic noise”) AND (“Oxidative stress” OR “cardiovascular disease” OR “Sleep Disorders”)
PubMed Search Strategy:
((“occupational noise”[tiab] OR “ambient noise”[tiab] OR “transportation noise”[tiab]) AND (“Oxidative stress”[tiab] OR “cardiovascular disease”[tiab] OR “Sleep Disorders”[tiab])) For the full list of keywords used in the search strategy, refer to Table 1.
Search strategy keywords used for noise types and health outcomes
| Keyword group | Keywords |
|---|---|
| Noise types | Occupational noise, Outdoor noise, Ambient noise, Environmental noise, Railway noise, Railroad noise, Aircraft noise, Airport noise, Construction site noise, Airplane noise, Traffic noise, Highway noise, Road traffic noise, Rail traffic noise, Transportation noise |
| Health outcomes | Oxidative stress, NIHL, Tinnitus, temporary threshold shift, Permanent threshold shift, Hyperacusis, Hearing impairment, Cardiovascular disease, Heart disease, Heart failure, Hypertension, Ischaemic heart disease, Stroke, Myocardial infarction, Myocardial ischemia, Atherosclerosis, Coronary heart disease, Annoyance, Sensitivity, Cognitive dysfunction, Cognitive impairment, Reading comprehension, Stress, Anxiety, Depression, Sleep disorders, Sleep disturbance, Sleep quality, Sleep problems, Insomnia, Sleep apnea, Sleep-wake disorders, Sleep deprivation, Sleep hygiene, Dyssomnias, Parasomnias |
Figure 1 shows the flowchart of the review process of obtained studies.
Flow diagram of the systematic review.
2.3 Inclusion and exclusion criteria
Studies meeting the following criteria were included in this review: the study was original, published in English, conducted on humans, examined noise as at least one of the stressors, and demonstrated a significant correlation between noise and the investigated effects. Animal and cellular studies, as well as studies where the relationship between noise and its effects was not statistically significant, were excluded.
After identifying the primary studies, additional steps were taken to ensure comprehensive results. The “related articles” and “citations” features in Google Scholar and ResearchGate were used as supplementary tools to identify and receive potentially relevant studies, particularly when the journals were not open access to direct access to the full text of the articles. In this review, data extraction was performed independently by two of our authors using a standardized table. Extracted data included the study title, authors, publication year, study type, noise type, type of effects investigated, and journal details. A third author compared the two sets of extracted data and resolved any discrepancies by referring to the original article.
Figure 1 illustrates the systematic process used for selecting studies for the research.
3 Results
3.1 Reviewed studies
An initial search using research keywords yielded 1,042 articles published between 2017 and 2022. After eliminating 152 duplicate studies, an initial title review excluded 396 irrelevant studies. Then, the abstract review excluded another 141 studies. Further in the full-text review phase, 66 documents were removed, ultimately leaving 287 studies for analysis. The cumulative frequency of these included studies, categorized by the year of publication, is illustrated in Figure 2.
The number of studies conducted each year from 2017 to 2022.
According to Figure 3, studies on noise effects have been conducted globally across 44 countries. Denmark and China have had the highest number of studies in this area. Generally, European countries have made greater contributions to the studies.
Geographical distribution of studies.
The distribution of study types analyzed has been depicted in Figure 4. This review encompassed a diverse range of studies, with the majority comprising cross-sectional (158 studies) and cohort (82 studies) designs.
Frequency distribution of study types.
As illustrated in Figure 4, the purpose of this figure is to present the distribution of studies reviewed in this research based on their study design. It highlights that the majority of the reviewed studies are cross-sectional, emphasizing the prevalence of this type of study among the articles analyzed.
3.2 Noise effects on human health
Noise effects can be broadly categorized into three primary types: auditory effects, non-auditory effects, and other adverse effects as explained in other studies too [44]. Auditory effects primarily include hearing loss and hearing damage. Non-auditory effects encompass the psychological and physiological impacts of noise exposure. The category of other adverse effects includes diseases, disorders, and other harmful consequences of noise exposure. Table 2 illustrates the frequency distribution of studies across these categories of noise effects. It shows that, within auditory effects, hearing loss has been more extensively researched compared to hearing damage. Likewise, among non-auditory effects, psychological impacts have received the most research focus. Overall, non-auditory effects constitute the largest body of research.
Classification of the health effects of noise and frequency distribution of the studies conducted in each category (2017–2022)
| Category | Noise effects | Study number | Frequency (%) |
|---|---|---|---|
| Auditory | Hearing loss | 47 | 16.38 |
| Hearing damage | 18 | 6.27 | |
| Non-auditory | Psychological | 114 | 39.72 |
| Physiological | 92 | 32.06 | |
| Other effects | 16 | 5.57 | |
3.3 Auditory effects of noise
Table 3 summarizes research on the auditory effects of noise exposure. The data indicate that sound sources producing pressure levels between 70 and 104 dB can cause hearing impairment, while sources with pressure levels ranging from 45 to 120 dB, covering a broader spectrum, may lead to hearing damage. Additionally, various sources of noise, including occupational noise, traffic from roads, air and rail transportation, environmental noise, and sounds from laboratory and musical instruments, have been identified as contributors to auditory effects.
Studies evaluating the auditory effects of noise
| Auditory effects | Sound source | Noise characteristic | References | |
|---|---|---|---|---|
| Hearing loss | Occupational noise, Traffic noise, aircraft noise, Amusement Tools noise in parkas, surgical tools noise, music, ambient noise, rail noise | 70–104 dB, 3–6 kHz | [16,39,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89] | |
| Auditory system damage | Tinnitus | Occupational noise, musical instruments noise, road traffic noise | 70–120 dB, 0.5–6 kHz | [46,72,81,90,91,92,93,94,95,96] |
| Hearing Fatigue | rail noise | — | [71] | |
| Hyperacusis | Occupational noise, traffic noise (road and air, hospital noise, laboratory noise, leisure noise, ambient noise | 45–125 dB | [97,98,99,100,101,102,103,104] | |
| Cochlea Damage | Occupational noise | 95 dB | [105] | |
| Saccule Damage | Occupational noise | 95 dB, 4 kHz | [105] | |
| Vestibular Damage | Occupational noise | 85 dB, 4 kHz | [105,106] | |
3.4 Psychological effects of noise
The reviewed studies categorize the psychological effects of noise into several subgroups: sleep disorders, noise annoyance, mental health, cognitive disorders, and sleep quality. This classification is summarized in Table 4. Of the 100 studies analyzed, the majority focused on sleep disorders and noise annoyance. These two aspects are notably prominent among the psychological effects reported, particularly when sound pressure levels ranged from 16 to 85 dB.
Studies evaluating the psychological effects of noise
| Psychological effects | Sound source | Noise characteristic | References | |
|---|---|---|---|---|
| Sleep disorder | Insomnia, sleep deprivation, sleep quality reduction, sleep irritability | Traffic and transportation noise (road, rail, and air), occupational noise, wind turbine noise, background noise (hospital, neighborhoods), ambient sound, laboratory sounds | 16–85 dB | [12,14,15,24,38,45,48,51,65,66,71,78,94,100,107–158] |
| Obstructive sleep apnea | Occupational noise | — | [51] | |
| Noise annoyance | Acoustic comfort reduction | Random noise, traffic and transportation noise (road, rail, air), construction industry, wind turbine noise, Laboratory sounds, occupational noise | 21.7–85 dB, 40–400 Hz | [29,41,67,97,98,100–102,110,126,129,130,136,137,143,147,150,159–197] |
| Noise disturbance | — | Background noise (neighborhood), traffic noise | — | [198] |
| Mental health | Depression | Occupational noise, traffic and transportation noise (road, rail and air), random noise * | 35.2–88 dB | [45,100,149,183,199,200] |
| Stress and anxiety | Random noise *, road, and transportation noise | 35.2–55 dB | [45,100,132,149,183] | |
| General mental health | Road traffic and airway noise | 46.3–86.3 dB | [24,39,98,99,133,201–205] | |
| Cognitive impairment | Decreased attention | Road traffic and occupational noise | 55 dB | [128,206,207] |
| Decreased concentration | Background noise | [27,198] | ||
| Memory impact | Laboratory noise and road traffic | 34.7–52.1 dB | [101,208] | |
| cognitive function reduction | Laboratory noise and road traffic | 35–65 dB | [124,161,209,210] | |
*Those noises mentioned sporadically in the studies but without being classified into specific categories.
When assessing the physiological effects of noise, researchers have examined its impact on various human organs, as detailed in Table 5. The findings indicate that the cardiovascular system is most prominently affected by noise, with numerous studies focusing on this area. Additionally, research has investigated the effects of noise on other bodily systems, including the immune, nervous, reproductive, urinary, and endocrine systems, and has confirmed negative impacts on these organs. Recent studies have also explored the potential effects of noise, particularly industrial noise levels ranging from 80 to 97 dB, on DNA and biomarkers of oxidative stress.
Studies evaluating the physiological effects of noise
| Physiological effects | Sound sources | Noise characteristic | References | |
|---|---|---|---|---|
| Cell damage | DNA damage | Occupational noise | 80.2–96.7 dB | [160] |
| Oxidative stress | Occupational noise | 80.2–96.7 dB | [160,211,212] | |
| Hormones secretion | Cortisol | Traffic and transportation noise (road, rail and air), hospital noise | 45–76.8 dB | [38,39] |
| Insulin | Traffic noise (road and rail) | 45 dB | [26] | |
| Cardiovascular system | Increased systolic and diastolic blood pressure | Occupational noise, traffic noise (road, rail and air, random noise* | 38–102 dB | [10,21,68,69,71,97,108,126,135,142,143,155,157,160,163,213–250] |
| Arterial and coronary occlusion | Occupational noise, traffic noise (road, rail and air) | 30–85 dB | [42,95,130,251–256] | |
| Aorta Calcification | Road traffic and occupational noise | — | [257,258] | |
| Atherothrombosis | Random noise* | — | [240] | |
| Arterial inflammation | Road traffic and random noise* | — | [254,259] | |
| — | Traffic noise (road, rail and air), wind turbine noise | 40–64 dB | [10,151,236,237,260–264] | |
| Cardio-cerebrovascular | Ambient noise, vehicle noise, | 61.7 dB | [141,235,262] | |
| Fast Heart Rate | Airport noise, random noise*, road traffic noise, wind turbine noise | 31 dB | [21,94,142,242] | |
| Cardiovascular system faults | Road traffic noise, air way noise | 58.3 dB | [253,265,266] | |
| Atrial fibrillation | Traffic noise (road, rail and airway), industrial noise, construction, and random noise* | [99,104,267] | ||
| Myocardial infarction | Wind turbine noise, traffic noise (road, rail, and air), random noise* | 25–79 dB | [103,114,134,237,260,262,268–275] | |
| Stroke | Road traffic noise, occupational noise, rail noise random noise* | 44–79 dB | [65,75,254,276–278] | |
| Cardiovascular mortality | Road, rail, airway noise | 45–60 dB | [252,279,280] | |
| Ischemic heart disease | Road, rail, airway noise, vehicle noise | 24–75 dB | [16,78,95,103,109,141,163,208,262,263,281–285] | |
| Glycated hemoglobin | Road traffic noise | 55–65 dB | [214] | |
| Congestive heart failure | Road traffic noise | 50–56.3 dB | [134] | |
| Increased cholesterol and triglycerides | Road traffic noise | 55–65 dB | [190,214,241] | |
| Immune system | Immune system failure | Road traffic noise | — | [286] |
| Nervous system | Nervous system failure | Occupational noise | 85 dB | [287] |
| Stroke | Road, rail, airway noise, occupational noise | 30–85 dB | [75,147,251,252,277,281,288,289] | |
| Reproductive system and pregnancy | Time of getting pregnant | Road traffic noise | 55 dB | [290] |
| Blood pressure disorders caused by pregnancy | Road Traffic noise, random noise* | 65 dB | [291,292] | |
| Kidney and urinary tract | Renal hemodynamic disorder, decreased glomerular filtration rate | Airplane noise | 80 dB | [293,294] |
*Those noises mentioned sporadically in the studies but without being classified into specific categories.
3.5 Other noise effects
A comprehensive review of the literature indicates that noise impacts extend beyond auditory and non-auditory effects. Specifically, noise can exacerbate existing diseases and disorders and negatively affect overall health and performance. In our study, we have systematically categorized and analyzed these broader impacts, which are presented in the other effects section of our findings. Due to their complex and non-physiological nature, classifying these impacts can be challenging. Commonly observed conditions in this category include but are not limited to, the aggravation of asthma, disturbances in glucose metabolism, and obesity. Additionally, this category encompasses the potential role of noise in the development and progression of cancer. While establishing a direct causal link between noise exposure and cancer remains difficult, some studies have highlighted noise’s involvement in the development of specific cancers, particularly breast and colon cancer. Traffic noise from sources such as air, rail, and road has been identified as a significant contributor to these health outcomes (Table 6).
Studies evaluating side effects of noise
| Other effect | Sound sources | Noise characteristic | References | |
|---|---|---|---|---|
| Cancer | Prevalence/incidence of breast cancer | Traffic noise (road, rail, and airway) | 35–60 dB | [11,253,285,295] |
| Colon cancer | Road traffic noise | 57 dB | [296] | |
| Asthma | Exacerbation of asthma | Traffic noise (road, rail, and airway) | 56 dB | [40] |
| Diabetes | Glucose metabolism disorder | Traffic noise (road, rail, and airway) | 30–63 dB | [26,245,297–302] |
| Obesity | Increased cholesterol | Occupational health | 85 dB | [10,29,160] |
| Increased triglycerides | Road traffic noise, occupational health | 55–85 dB | [29,160,214] | |
| Obesity prevalence | Traffic noise (road, rail, and airway), Random noise* | 30–89 dB | [242,303–306] | |
| Increased Body mass index | Road traffic noise | 55–56.2 dB | [307,308] | |
| Headache | Traffic noise, background noise (neighborhood) | 53.7 dB | [117,198] | |
| Metabolic syndrome | Occupational health | 85–100 dB | [309] | |
| Serum pristine level | Random noise* | 85.98 dB | [70] | |
| Performance And Productivity | Educational achievements reduction | Community noise and Random noise* | 65 dB | [13,310] |
| Life quality | Life quality reduction | Traffic noise (road, rail, and airway) and airport noise | 30–65 dB | [144,145,311] |
*Those noises mentioned sporadically in the studies but without being classified into specific categories.
In Table 7, the noise exposure effects are presented by the type of sound sources. It is worth noting that this table includes only the sources that caused the most significant effects.
Noise exposure effects by the type of sound sources
| Occupational noise | Hearing Loss, Tinnitus, Hyperacusis, Cochlea Damage, Saccule Damage, Vestibular Damage, Insomnia, sleep deprivation, sleep quality reduction, sleep irritability, obstructive sleep apnea, Noise Annoyance, depression, decreased attention, DNA damage, Oxidative stress, Increased systolic and diastolic blood pressure, Arterial and coronary occlusion, aorta Calcification, stroke, Nervous system failure, brain stroke, Increased cholesterol, Increased triglycerides, Metabolic syndrome |
| Transportation noise | Hearing Loss, Tinnitus, Hearing Fatigue, Hyperacusis, Insomnia, sleep deprivation, sleep quality reduction, sleep irritability, Noise Annoyance, Noise Disturbance, depression, Stress and anxiety, General mental health, Decreased attention, Memory impact, cognitive function reduction, Cortisol disorder, Insulin, Increased systolic and diastolic blood pressure, Arterial and coronary occlusion, aorta Calcification, arterial inflammation, Fast Heart Rate, Cardiovascular system faults, Atrial fibrillation, Myocardial infarction, stroke, Cardiovascular mortality, ischemic heart disease, Glycated hemoglobin, Congestive heart failure, Increased cholesterol, triglycerides Immune system failure, brain stroke, time of getting pregnant, Blood pressure disorders caused by pregnancy, Renal hemodynamic disorder, decreased glomerular filtration rate, Prevalence/incidence of breast cancer, Colon cancer, Exacerbation of asthma, Glucose metabolism disorder, Increased triglycerides, Obesity prevalence, Increased Body mass index, Headache, Life quality reduction, cardio-cerebrovascular |
| Environmental noise | Hearing Loss, Insomnia, sleep deprivation, sleep quality reduction, sleep irritability, Noise Annoyance, Noise Disturbance, and depression. Stress and anxiety, Decreased concentration, increased systolic and diastolic blood pressure, Atherothrombosis, arterial inflammation, cardio-cerebrovascular, Fast Heart Rate, Atrial fibrillation, Myocardial infarction, stroke, Blood pressure disorders caused by pregnancy, Obesity prevalence, Headache, Serum pristine level, educational achievements reduction |
| laboratory noise | Hyperacusis, Insomnia, sleep deprivation, sleep quality reduction, sleep irritability, Noise Annoyance, Memory impact, cognitive function reduction |
4 Discussion
This study reviews research published over the past 6 years (2017–2022) on the impact of noise – both occupational and non-occupational – on human health. While noise has long been a significant concern in workplace settings, its effects are now recognized beyond occupational environments. The WHO has identified noise pollution as the second most critical environmental health factor, following air pollution [228]. This assertion is supported by numerous studies documenting the disease burden and mortality associated with noise exposure [312–314]. Consequently, extensive research has been conducted to investigate the health effects of noise. Our review indicates that, within the specified period, 287 studies have been dedicated to examining the impact of noise on various bodily systems and organs. Analysis of the temporal distribution of the studies reveals that between 40 and 60 studies on the effects of noise on human health have been conducted annually (Figure 2). This consistent research output underscores the significance of noise as a stressor and may reflect ongoing challenges in fully concluding studies on its various impacts. Additionally, the increasing recognition of novel effects associated with noise may drive further research efforts aimed at confirming or refuting these connections. Consequently, it is anticipated that the trend of high research activity in this area will persist in the coming years. From a geographical perspective, research on occupational and environmental noise exposure has predominantly been conducted in Europe and Asia (Figure 3). However, there are notable differences in the focus and nature of these studies across various countries and continents. European nations, with their higher levels of welfare and a strong emphasis on workers’ rights and healthcare, enforce stringent regulations concerning hazardous workplace elements, including loud noise exposure. Consequently, research in these countries has expanded beyond occupational noise to include environmental noise [315], as occupational noise levels have generally been reduced to acceptable thresholds or sufficient data has been gathered. In Europe, considerable attention is given to traffic, aircraft, and train noise, as well as other everyday environmental noise, with a strong focus on assessing the associated disease burden and mortality.
In contrast, research in Asia, particularly in East Asian countries such as China, South Korea, Taiwan, and Japan, differs in both scope and focus from studies in West Asia and Africa. While the volume of studies in Eastern Asia is higher, these studies, similar to their European counterparts, often focus on environmental noise exposure. Conversely, research in West Asian, African, and Middle Eastern countries has largely concentrated on occupational noise exposure [316]. An analysis of study types conducted over a specific period reveals that more than 50% of the studies were cross-sectional, with cohort studies being the second most common type. Figure 4 illustrates the distribution of these study types. Cross-sectional studies, due to their low cost and relatively quick execution, are suitable for investigating potential effects among individuals. However, such studies cannot definitively establish causal relationships between effects and noise exposure. In contrast, cohort studies are generally more effective for this purpose.
The review of noise-related studies indicates an increase in both the number and scope of research, highlighting the relationship between noise exposure and various outcomes. However, there is considerable heterogeneity among these studies regarding the number of participants exposed to noise – ranging from millions to smaller groups – and the duration of exposure, which varies from several months to several years. Although this variability in environmental, cultural, racial, and religious contexts can be advantageous in certain respects, it may also complicate comparisons and affect the consistency of study results [317].
In a broad classification, the effects of noise exposure can be divided into two primary categories: auditory and non-auditory effects. Auditory effects refer to the impacts of noise on the human auditory system, which can lead to temporary or permanent hearing impairment. Historically, research on auditory effects has concentrated on high sound pressure levels, particularly within occupational settings. Recently, however, there has been a growing body of research investigating the auditory effects of environmental noise. Additionally, there is increasing concern about the impact of different types of noise, such as Gaussian noise, on hearing in occupational environments [318].
Our analysis indicates that over 53 studies have investigated the adverse effects of noise exposure on hearing within the specified period. Among these, some studies focused on occupational and non-occupational settings. Potential auditory effects of noise exposure include hearing loss, tinnitus, fatigue, and physical trauma to the auditory system (as summarized in Table 2).
Non-auditory effects encompass a broader range of impacts associated with noise exposure, and the number of studies exploring these effects continues to grow. These effects can be categorized into psychological effects (such as sleep disorders, noise annoyance, cognitive disorders, depression, stress and anxiety, and general mental health), physiological disorders (including cardiovascular issues, cellular damage, gland and hormonal disturbances, immune system problems, nervous system disorders, reproductive issues, and kidney and urinary tract disorders), and other adverse effects (such as cancer, asthma, diabetes, obesity, headaches, metabolic syndrome, and reduced quality of life) (Tables 3, 4, and 5). The findings of this study reveal that non-auditory effects, particularly cancer and physiological anomalies, have received significant attention from researchers in recent years. Despite the valuable insights provided by existing studies on the health impacts of noise, there remain unresolved gaps that require further investigation. The following section will discuss critical information and research gaps related to this topic.
Regarding the study and research gaps, one of the most notable gaps in research on the health effects of noise lies in the methodologies and study designs employed within this field. The variability in research methods – such as differences in statistical populations, types of noise sources, settings (occupational versus non-occupational), study designs, periods, duration of evaluations, intervention strategies, and research variables – has created challenges in comparing results, analyzing complex statistics, and drawing coherent conclusions. As a result, adverse effects and statistical relationships associated with noise exposure have often been attributed to either environmental or occupational factors.
Moreover, the lack of methodological diversity and limited evidence specific to individual cases has further compromised the certainty of findings in noise health research and has impeded researchers from establishing definitive health outcomes. For instance, despite substantial evidence linking noise exposure to cardiovascular disorders, methodological inconsistencies among studies indicate a need for additional research in some areas. Another significant gap is related to gender differences. Many of the reviewed studies have not investigated how gender influences cardiovascular risks and blood pressure changes, leaving the impact of gender on these health risks poorly understood [25]. Research on the impact of occupational noise exposure on blood pressure has yielded inconsistent results. Some studies have found a significant correlation between noise exposure and increased blood pressure, while others have not observed such an association. This inconsistency highlights the need for extensive cohort and case–control studies to further investigate this issue. Notably, none of the studies exploring the relationship between noise exposure and blood pressure elevation have assessed 24-h blood pressure monitoring, a factor that could introduce potential bias and uncertainty in the results [319]. Similarly, research into the effects of noise on the immune system reveals a critical gap: there are far fewer human studies compared to animal studies. Generalizing findings from animal research to humans is often challenging. Therefore, advancing to more comprehensive human studies or developing methods to more accurately translate animal model results to human contexts could help bridge existing information gaps in this field. Despite growing interest, few studies have investigated the effects of noise on the human immune system. The limitations of these studies include inadequate consideration of exposure duration and sound frequency, reliance on constant sound intensity, and the omission of various immunological markers. Given this context, there is a pressing need for more clinical and experimental studies to elucidate both the direct and indirect effects of noise on the human immune system [31]. As previously noted, establishing the relationship between noise exposure and non-auditory health effects is complex. This complexity arises from the necessity of conducting thorough and well-designed studies that require high levels of expertise and scientific rigor for selecting appropriate methodologies, analyzing data, measuring correlations, and interpreting results. Moreover, the reversibility or permanence of non-auditory effects resulting from noise exposure remains unclear. Addressing this gap involves identifying which non-auditory effects are reversible upon cessation of noise exposure, determining the permanence of specific effects, and establishing the time frame required for the reversal of these health effects [320].
A significant gap in the methodology of assessing the health impacts of noise pertains to the characteristics of sound sources that have captured researchers’ attention. This issue deserves a separate and detailed examination due to its importance. While most research on noise effects has focused on sound pressure levels, other critical factors, such as sound frequency and Gaussian distribution, have received less attention. Sound pressure levels are commonly used to assess occupational noise exposure, with higher levels regarded as hazardous. However, recent studies emphasize the importance of frequency and Gaussian distribution in shaping auditory outcomes. The influence of Gaussian distribution on auditory impairment remains under-researched, and its significance compared to sound pressure levels is not yet fully understood [321]. Consequently, there is ongoing uncertainty about whether lower sound pressure levels might still pose auditory risks due to their Gaussian or non-Gaussian properties. This issue extends to non-occupational noise research as well. In studies evaluating the effects of environmental noise, various methodologies are employed, including the use of average sound pressure level, maximum sound pressure level, or maximum nighttime sound level as indicators. Consequently, the question of whether Gaussian or non-Gaussian characteristics of noise should be considered remains a critical concern across both occupational and non-occupational noise research. The lack of clarity regarding the appropriate exposure index complicates the attribution of many observed effects to environmental noise. For instance, the potential link between aircraft noise and stroke remains uncertain. This uncertainty arises because many studies rely solely on average noise levels for assessment, which some researchers argue is insufficient [322]. In addition to gaps related to noise characteristics, there are significant deficiencies in studies focusing on the effects of different sound sources. While there has been substantial research on occupational, environmental, and traffic noise, less attention has been given to other sources such as anthropogenic noise and the associated physiological and demographic responses. Anthropogenic noise is likely to affect various biological systems, ranging from cellular processes to broader population dynamics [323], in other words, anthropogenic (Human-made) noise has the potential to interfere with processes, on scales – from the microscopic level of cells to broader ecological systems – impacting everything from the behavior of individual cells to the interactions among species in ecosystems, as a whole. A notable gap is the lack of comprehensive, long-term experimental studies on both the duration of exposure and the subsequent post-exposure effects. Long-term studies are crucial as short-term assessments may provide misleading or inaccurate results. Moreover, there is a concerning lack of research comparing the effects of different types of sounds and noise levels on human health [323,324].
An examination of the literature on the health implications of noise reveals a focus on both the direct and indirect effects of noise exposure. These indirect effects are often referred to as secondary effects of noise, the effects of the second stage of noise exposure, or the effects caused by noise effects. These terms encompass outcomes such as noise annoyance, tinnitus, and noise sensitivity. Despite the considerable body of research on these phenomena, there remains ambiguity about whether they are direct consequences of noise exposure or if they are exacerbated by the presence of noise. Moreover, secondary effects can further impact human health, manifesting as relationships between noise annoyance and elevated blood pressure, noise annoyance and stress, anxiety, and sleep disorders, tinnitus and depressive symptoms, noise sensitivity and reduced quality of life, and noise sensitivity with mental health disorders. Additionally, the interplay between noise sensitivity, cortisol secretion, and immune system responses is a critical area of concern.
Identifying these secondary effects and delineating them clearly from primary noise-induced effects constitutes a significant research gap that warrants further investigation. Although numerous studies address these topics, they often fall short of exploring all established effects of noise exposure comprehensively. This limitation hinders effective comparison and conclusive interpretation. Consequently, future research should focus on the secondary effects of noise. For example, the mental and psychological impacts of noise exposure remain poorly understood. The complex relationships among mental disorders, genetic differences, environmental factors, and social influences, as well as the mechanisms underlying these conditions, are still unclear. It remains uncertain whether these disorders are primary effects of noise or secondary effects, such as noise sensitivity and irritation [325]. Further investigation is needed into the relationship between cerebrocardiovascular disorders, mental health issues, and noise exposure [326]. The association between an individual’s mental well-being and the level of noise annoyance remains unclear, particularly regarding its connection to psychological conditions such as depression and anxiety [327]. Additionally, there is concern regarding the impact of noise on performance and productivity. Some studies suggest that noise exposure can impair memory and reduce mental productivity, particularly during tasks requiring sustained visual focus. However, the evidence regarding the impact of occupational noise on workplace productivity is inconclusive [328]. The relationship between sound pressure levels and job productivity lacks definitive proof, and studies have reported inconsistent findings. This issue also extends to non-occupational noise, highlighting the need for further research in this area.
Despite advancements in diagnosing and treating noise-induced hearing disorders, several gaps remain in this field. One notable gap is the need for further investigation into the causes of tinnitus. While tinnitus is commonly assumed to originate from auditory sources, this assumption may not always hold true [329]. It is essential to explore potential non-auditory causes of tinnitus as well. Additionally, there is a need for research into the prevalence of tinnitus among non-adult populations and its correlations with factors such as gender, race, weather, and seasons. Most studies to date have focused on hearing impairment and related sound sources in the context of non-occupational noise, but occupational noise can also contribute to or exacerbate this condition [330]. Therefore, it would be prudent to include this disorder in future research involving employees exposed to occupational noise.
One important consideration is that organizations dedicated to addressing auditory health issues often develop and disseminate guidelines and legal documents based on existing research findings. These guidelines are typically intended for adherence by individuals and groups. However, due to the slow pace at which organizations can update their protocols in response to rapidly advancing research, these documents may not always reflect the most current findings. For instance, while the WHO and some other studies have stated that airplane noise is more disruptive than road or rail traffic noise [331–333], some experimental studies suggest that airplane noise might have a lesser impact on physiological sleep compared to the other two sources [334]. Therefore, further research is needed to evaluate the relative effects of different types of transportation noise on well-being, and guidelines should be revised to incorporate the latest evidence. Numerous research efforts have been dedicated to examining the effects of noise exposure in conjunction with other stressors in workplace environments. Despite the substantial evidence already available, investigations in this area are ongoing. However, there is a notable lack of comprehensive data regarding the simultaneous exposure to environmental stressors such as heat, air pollutants, and light, alongside environmental noise. To address this knowledge gap, further research is required to explore the combined effects of these environmental stressors. Another significant research gap in understanding the health effects of noise pertains to oxidative stress and the generation of free radicals. This indicates that more research is needed to understand how noise exposure might contribute to oxidative stress and the creation of free radicals, which could have serious health implications, such as increasing the risk of chronic diseases, cardiovascular problems, or even cancer. Reactive oxygen species (ROS), which are byproducts of cellular respiration, play a crucial role in various cellular processes when present at normal levels. However, excessive ROS can lead to oxidative damage to DNA, lipids, and proteins, ultimately resulting in cell death. Several studies have demonstrated that exposure to unsafe noise levels increases ROS production in the cochlea, leading to cellular damage in this area [335]. While the involvement of ROS in the exacerbation of NIHL is well-documented, the mechanisms by which these free radicals are generated through occupational noise and their potential generation through non-occupational noise remain unclear. Further research is needed to elucidate these processes and their implications for both types of noise exposure.
The health impacts of noise on human beings have often overlooked the role of genetics, which is a crucial aspect of this issue. Although some studies have investigated gene polymorphisms that might heighten susceptibility to hearing loss [336,337], the full extent of this genetic relationship remains unclear. Identifying specific genes that predispose individuals to adverse effects from noise exposure could substantially mitigate the incidence of noise-induced disorders and diseases. This approach could be integrated into pre-employment screenings or periodic health assessments, particularly for conditions like NIHL. Insights gained from such genetic research could also advance personalized medicine by tailoring preventative measures and treatments to individual genetic profiles.
Biomarkers are becoming increasingly relevant in assessing the health impacts of noise exposure. Despite the limited number of biomarkers available for evaluating auditory health, research efforts, such as those by Parham et al., have explored the potential of prestin protein biomarkers for indicating hearing loss. Their findings suggest that prestin levels in the bloodstream could serve as an alternative biomarker for NIHL. This research highlights the potential for developing more specific biomarkers to investigate the effects of noise exposure on human health, addressing existing gaps in the field. Additionally, the relationship between noise exposure and cancer warrants further examination. Although some studies have suggested a possible link between noise exposure and an increased risk of certain cancers, conclusive evidence is lacking. Thus, additional epidemiological research is needed to clarify the fundamental and biological mechanisms through which noise exposure may contribute to cancer development, especially in occupational settings [338,339].
In summary, future research should place special emphasis on the following areas:
First, standardizing methodologies and study designs is crucial for enabling more consistent comparisons and reliable conclusions across studies. This should include addressing the variability in statistical populations, noise sources, and research variables. Secondly, it is important to investigate the gender-specific impacts of noise, particularly on cardiovascular health and blood pressure, as these effects are currently underexplored. Additionally, research on the impact of noise on the human immune system, especially through more comprehensive human studies, is needed to bridge the gap between animal models and human health outcomes. Lastly, further investigation into the impact of noise characteristics, such as Gaussian distribution and frequency, on auditory and non-auditory health outcomes is warranted, particularly given the current focus on sound pressure levels alone. These areas offer substantial opportunities to advance our understanding of noise-related health risks.
5 Conclusion
In conclusion, this investigation underscores the varied consequences of noise exposure, which can be categorized into three key areas. First, established effects such as hearing impairment, oxidative stress, and elevated blood pressure should continue to be addressed through mitigation efforts, while exploring less understood secondary impacts. Second, for effects with ambiguous links – like memory impairment and nervous disorders – future research should prioritize cohort studies to provide clearer evidence, rather than relying on cross-sectional or laboratory approaches. Finally, emerging associations with conditions such as cancer and diabetes call for preliminary laboratory and cross-sectional research to build foundational evidence, followed by cohort studies for more definitive conclusions. Addressing these areas will advance our understanding of noise exposure’s health impacts and support more effective mitigation strategies.
Acknowledgements
We would like to thank those who helped us in conducting this research.
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Funding information: The authors state no funding involved.
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Author contributions: Mohammad Javad SheikhMozafari: investigation, methodology, writing – original draft, review, and editing. Mohammad Reza Monazzam Esmaeelpour: conceptualization, project administration, writing – review and editing. Soqrat Omari Shekaftik: investigation, writing – original draft, writing – review. Jamal Biganeh: investigation, methodology, writing – original draft. Fatameh Fasih Ramandi: methodology, formal analysis.
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Conflict of interest: The authors state no conflict of interest.
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Disclosure statement: No potential conflict of interest was reported by the author(s).
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Ethics approval and consent to participate: Not applicable.
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Data availability statement: The data sets used and/or analyzed in this study are given, and more details are available from the corresponding authors at reasonable request.
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- Sound event detection by intermittency ratio criterium and source classification by deep learning techniques
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- Review Article
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