[Noise-induced hearing loss--factors affecting worker's decision to submit a disability claim]

Noise-induced hearing loss is recognized worldwide as a prevalent work-related morbidity and is the most common compensated occupational disease in Israel. Despite extended legislation, hearing conservation programs, surveillance and biological monitoring (by audiometry) of work sites and workers, the burden of this injury remains high. As a rule, afflicted workers refrain from filing compensation claims and do so only at later stages when both subjective and objective evidence of advanced hearing loss is present. We have evaluated the determinants that seem to influence the decision of an individual worker to file a claim. We found that the major determinants are subjective perception of the level of hearing disability and clinical symptoms such as: tinnitus (OR = 3.3 with CI 95% = 2.1 5.2), verbal communication disturbances (OR = 2.7, 95% CI = 1.9-3.8), complaints of dizziness (OR = 1.9, 95% CI = 1.4-2.5), severity of hearing impairment (by audiometry with OR = 1.04, 955 CI = 1.02-1.06) and musculoskeletal complaints (OR = 1.6, 95% CI = 1.2-2.2). These findings attest to the relatively late stage in the development of noise-induced hearing loss at which workers file a claim for compensation and rehabilitation. In order to alleviate the burden of this injury in the future and encourage workers to approach the National Insurance Institute at an earlier stage, we suggest several ways of intervention and improving the awareness of all parties concerned.