Occupational Hearing Loss by State: Where Are Workers Most at Risk?

California leads all 50 states with 6,600 occupational hearing loss cases. Michigan, Ohio, Pennsylvania, and Illinois form a dense industrial cluster in the Midwest. And some states you would expect to rank high — Texas, Florida — fall well short of their population-adjusted potential. Nine years of OSHA Injury Tracking Application data mapped across every state reveals a geography of hearing loss that is shaped as much by industry concentration and enforcement culture as it is by raw workforce size.

Soundtrace analyzed nine years of OSHA ITA hearing loss records across 21,120 U.S. establishments. This post is the state-level companion to our industry rate analysis — showing where the highest case volumes are concentrated and what the patterns suggest about compliance gaps nationwide.

The Top 10 States by Hearing Loss Case Volume

The following rankings are based on total hearing loss cases recorded in the OSHA ITA dataset over nine years. These are raw case counts, not rates — the same methodology limitation that applies to industry data applies here. A state with a larger manufacturing workforce will naturally generate more cases at the same per-worker risk level.

Total hearing loss cases, 9-year OSHA ITA dataset. Source: Soundtrace analysis.

California's lead is substantial but not surprising given its size and industrial diversity. What is notable is how tightly bunched Michigan, Ohio, and Pennsylvania are — three states whose manufacturing heritage is embedded in their workforce structure in a way that maps directly onto hearing loss risk. Wisconsin's appearance at #7, ahead of New York despite having roughly one-fifth the population, is the first real outlier worth examining.

The Midwest Cluster: Why Industrial Geography Matters

The concentration of hearing loss cases across Michigan, Ohio, Pennsylvania, Illinois, Wisconsin, Indiana, and Minnesota is the most structurally significant pattern in the state-level data. These seven states account for a disproportionate share of the national total despite representing a minority of the U.S. population and workforce.

The explanation is industrial geography. The manufacturing industries with the highest per-worker hearing loss rates — fabricated metal, wood products, paper and pulp, food processing, and transportation equipment — are heavily concentrated in these states. This is not a coincidence of history. The infrastructure, labor force, and supply chains that support these industries have been built over generations in this region, and the noise exposure profile that comes with them has been sustained across decades.

For hearing conservation service providers, this geography is a market map. These states represent the highest concentration of employers who need structured audiometric testing programs, and many of them — particularly mid-sized manufacturers, wood products operations, and food processing facilities — are precisely the type of company that has historically been underserved by large national vendors.

States That Underperform Relative to Expectations

The more analytically interesting story is not the states at the top — it is the states that rank lower than their size, industrial base, or noise exposure profile would predict.

Florida

Florida is the third-largest state by population and has significant construction, food processing, and manufacturing activity. Yet it appears at just 2,000 cases in the dataset — well below what its workforce size would suggest. Several factors likely contribute: Florida's workforce is more service-oriented than the Midwest, construction noise exposure is episodic rather than sustained, and Florida operates under federal OSHA rather than a State Plan, which may affect ITA submission compliance among smaller employers.

Texas

Texas generates 4,500 cases — significant in absolute terms but modest given that it is the second-largest state by both population and GDP, with major petrochemical, oil and gas, and construction industries. As we explored in our Texas hearing loss workers' compensation guide, Texas's voluntary workers' compensation system and non-subscriber framework create a different compliance incentive structure than most states. Federal OSHA enforcement covers the entire state without a State Plan backstop, and ITA submission rates among smaller Texas employers may not fully capture the actual case volume.

The Low-Volume States Worth Watching

States like Montana (84 cases), Wyoming (36 cases), and North Dakota (520 cases) show low absolute volumes that reflect genuinely small industrial workforces. But within those small totals, industries like agriculture, mining, and oil and gas extraction are present — and the per-worker rates in those sectors, as our industry rate analysis showed, are among the highest in the country. Low case counts in small states do not mean low risk for the workers who are there.

How OSHA State Plans Affect the Data

Twenty-six states and two U.S. territories operate their own OSHA-approved State Plans, which must be at least as effective as federal OSHA but may be more stringent. The remaining 24 states — including Texas, Florida, Georgia, and most of the Southeast — operate under direct federal OSHA jurisdiction.

This distinction matters for interpreting state-level hearing loss data for two reasons.

First, enforcement intensity varies. States with their own plans — California, Michigan, Washington, Minnesota, and others — generally have more active enforcement programs, more inspectors relative to their workforce, and stronger recordkeeping compliance cultures. California's OSHA (Cal/OSHA) is among the most active in the country. This almost certainly contributes to California's leading case volume: more employers are submitting complete records, and more cases are being captured.

Second, some State Plans have requirements beyond federal OSHA. California's noise regulations, for instance, have specific provisions that go beyond 29 CFR 1910.95 in certain respects. States with more stringent requirements may capture cases that would not be recordable under the federal standard alone.

What State-Level Data Means for Hearing Conservation Strategy

Whether you are an employer managing a multi-state operation, a safety consultant building a regional practice, or a hearing conservation service provider targeting new markets, the state-level data has specific strategic implications.

• Multi-state employers should benchmark by state, not just nationally. A company operating facilities in both Michigan and Florida faces very different enforcement environments, workers' compensation risk profiles, and industry peer benchmarks. A single national compliance standard applied uniformly across both states is not a risk-calibrated approach.
• Federal OSHA states may have more underreported cases — and more untapped market. States like Texas, Florida, and the broader Southeast operate under federal enforcement with lower ITA submission rates among smaller employers. These states likely have more unaddressed hearing conservation need than the data shows, making them high-opportunity markets for service providers.
• State Plan states reward program quality. In states with active enforcement — California, Michigan, Washington — the consequence of a program gap is not just a workers' compensation claim. It is an OSHA inspection finding with citation and penalty exposure on top. Employers in these states have stronger financial incentives to run well-documented programs.
• Wisconsin is a bellwether worth watching. At 4,500 cases from a state with roughly 3 million workers, Wisconsin's per-worker case rate is among the highest in the country. Its paper and pulp, wood products, and food processing industries drive this — all sectors that appear near the top of our industry rate analysis as well. Wisconsin is the state where the industry and geography risk factors converge most clearly.
• The Southeast is an emerging hearing conservation market. Georgia (3,600 cases), North Carolina (2,400), and Tennessee (2,900) represent a growing industrial base — automotive assembly, food processing, and distribution — that is receiving less hearing conservation vendor attention than the Midwest. As manufacturing continues to shift South, these states will generate increasing case volumes.

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