Objective: This study aimed to investigate the epidemiological characteristics of occupational noise-induced hearing loss (NIHL) among manufacturing workers, and to provide evidence for diagnosing and preventing occupational hearing loss caused by complex noise, which is different from Gaussian noise in temporal structure. Methods: One thousand and fifty manufacturing workers exposed to occupational noise were recruited in a cross-sectional survey. Exposure characteristics and epidemiological distribution of hearing loss and noise exposure metrics (noise energy and kurtosis) were investigated, and the relationship between noise exposure and hearing loss was analyzed. The effects of kurtosis on hearing threshold shift across different frequencies and on NIHL development with exposure duration and noise intensity were also investigated. Results: Each type of work had specific noise exposure metrics. Noise intensity and kurtosis were independent parameters (r = -0.004, p = 0.885). The prevalence of NIHL and the hearing threshold level had a specific distribution in different types of work. Kurtosis deepened the hearing notch at high frequencies and accelerated the formation of early hearing loss. The effect of exposure duration and noise intensity on the prevalence of high-frequency NIHL (i.e., at 3, 4, 6, and 8 kHz) for manufacturing workers increased with kurtosis in workers with noise exposure duration of less than 10 years and with L_Aeq.8h between 80 and 90 dB(A). Male (OR = 1.557, 95%CI = 1.141-2.124), age (OR = 1.033, 95%CI = 1.014-1.052), exposure duration (OR = 1.072, 95%CI = 1.038-1.107), kurtosis (OR = 1.002, 95%CI = 1.001-1.003), and noise intensity (L_Aeq.8h; OR = 1.064, 95%CI = 1.044-1.084) were risk factors for high-frequency NIHL. The speech-frequency NIHL (i.e., at 0.5, 1, and 2 kHz) risk of workers exposed to manufacturing noise was related to age (OR = 1.071, 95%CI = 1.043-1.100). There were no statistically significant associations between speech-frequency NIHL and sex, noise exposure duration, kurtosis, and noise intensity (L_Aeq.8h). Conclusion: The high-frequency NIHL prevalence among manufacturing workers is associated with sex, age, exposure duration, noise intensity, and temporal structure of noise, while the speech-frequency NIHL prevalence is associated with age. Kurtosis strengthens the association of noise exposure duration and noise intensity with high-frequency hearing loss. The influence of noise temporal structure should be considered in the diagnosis and early prevention of occupational hearing loss caused by complex noise.

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