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Objective Information is summarized from the overall body of published literature regarding ototoxic chemicals encountered outside of clinical exposures, largely in occupational settings. While summarizing the most common non-pharmaceutical ototoxins, this review provides clinically relevant information and recommendations such that hearing health professionals may adopt a more comprehensive and appropriate diagnostic case history, test battery, documentation scheme, and education delivery. Methods Solvents, metals, and asphyxiants literature was reviewed using PubMed, national and international agency websites, and communications with known ototoxicity experts. Results Initial intentions to summarize the existing programs for occupational ototoxicity monitoring fell short when it was discovered that such programs have not yet formalized across the major oversight agencies in the United States. Instead, recommended guidance documents and fact sheets, which highlight existing occupational exposure limits and suggest monitoring and education are discussed. Conclusions While evidence in humans is limited, potentially ototoxic substances are worthy of improved surveillance and further research to understand their ototoxic mechanisms, effects, and possible mitigation strategies. A triad approach of monitoring, protecting, and educating is recommended for effective prevention of hearing loss: the Department of Defense Hearing Center of Excellence’s Comprehensive Hearing Health Program model employs such an approach.

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The purpose of this study was to describe changes in hearing, using the permanent threshold shift metric, among United States Air Force servicemembers, including active duty, Reserve and Air National Guard components, for demographics, job categories, and career fields. In the United States Air Force, only servicemembers who are occupationally exposed routinely to hazardous noise are monitored. Audiogram records and demographic variables were analyzed for servicemembers from 2005-2011 using data from the Department of Defense system that captures occupational hearing tests worldwide. Results suggest that occupational hearing loss was larger in males than females, in officers than enlisted populations, and in Reserve and Air National Guard than in active duty. Compared to similar civilian career fields, active duty has lower prevalence rates for occupational hearing loss overall, although Reserve and Air National Guard prevalence rates were more similar to the civilian reported rates. The proportion of personnel with permanent threshold shifts varied between 4.6-16.7% within active duty career fields, which includes 76% of the population for study timeframe. Permanent threshold shift was larger in small job categories, and in jobs that are not considered exposed to hazardous noise routinely which is comparative with results from civilian data analysis of occupational hearing loss. Further investigation into testing practices for Air Force specific groups, use of the system for nonoccupational hearing testing, and challenges to follow-up compliance is warranted. Increased surveillance procedures for occupational hearing loss are needed to address concerns on the prevalence of servicemember hearing loss, the role of recreational and lifestyle factors to contribute the high reported hearing loss prevalence of veterans compared to nonveterans.