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Noise Induced Hearing Loss and the Individual Susceptibility to the Noise

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Noise Induced Hearing Loss and the Individual Susceptibility to the Noise International Tinnitus Journal 2, 73-82 (1996) Noise Induced Hearing Loss and the Individual Susceptibility to the Noise Kyong-Myong Chon, M.D., Hwan-Jung Roh, M.D., Eui-Kyung Goh, M.D., Soo-Geun Wang, M.D. Department of Otolaryngology, College of Medicine, Pusan National University, Pusan, Korea Abstract: Although there is no specific treatment for modality of occupational noise-induced hearing loss c~nHL), the best way to manage this problem is the prevention. The fundame,lltal prevention of NIHL is to find the persons who are more susceptible to the noise and to avoid work in the noisy environment prior to or during employment. The purpose of this study is to investigate .' the actual status of NIHL in the industrial complex of Pusan and Kyongnam area in Korea and to evaluate the individual susceptibility to the noise and to set-up the preventive indices of NIHL, using temporary threshold shift (TIS) and its recovery time after noise stimulation. INTRODUCTION characteristics of the middle and inner ear, such as the stiffness of the cochlear partition, thickness of the basilar he problems of occupational hearing impairment and tectorial membrane, blood supply ofthe cochlea, rate T present both a challenge and an opportunity to of oxygen metabolism and density of afferent and efferent otolaryngologists, since NIHL produced by innervation would be expected to determine how much chronic exposure to excessive sound in the work place is exposure to noise can be enough to cause NIHL. the second most common cause of acquired hearing Unfortunately one cannot measure these directly in the impairment in adults.l South Korea has been trying to intact organism, so indirect measurement could be used develop its industry in a nation-wide base since the 1960's to identify the more noise-susceptible individuals before and NIHL as an occupational disease was considered to NIHL is incurred. The validity grounds, the most likely be seriously underestimated due to the shortage of overall predictor of susceptibility to NIHL could be occupational medical specialists, even though there was auditory fatigue. However, the use of fatigue tests as a legal hearing conservation program designed to protect susceptibility predictor has not been successful and workers exposed to high levels of noise.2 However, practicable until now. 3,4 The temporary threshold shift starting from the late 1980's, the consideration and (TTS) is a temporary sensorineural hearing loss that prophylactic management about noise exposure have recovers almost completely within 24 hours after been increasing. It is important that the otolaryngologists exposure to loud noise for seconds-to-hours. Although should be familiar with a government hearing conser­ the correlation between TTS and noise-induced perma­ vation program and medicolegal aspects of NIHL. nent threshold shift (NIPTS) remains uncertain, a daily , NIHL, although not medically or surgically treatable, is exposure of noise does not cause TTS, and will not result preventable and the test treatment of NIHL is the in NIPTS over a working lifetime.5 The repeated TTS prevention. Although there is a legal obligatory hearing and its incomplete recovery have been known as a kind conservation program, the desirable and ideal preventive of essential process to cause NIPTS.6,7 method is to check the individual susceptibility to the The authors investigated the actual condition of NIHL noise and to avoid work in the noisy environment. in the industrial complex in Pusan and Kyongnam area, However, everyone is not equally susceptible to the noise. one of the largest industrial complex in Korea and Until now, it is clear that the static and dynamic examined the TTS and its recovery process after noise stimulation in both normal control and NIHL groups to Reprint requests: Kyong-Myong Chon, M.D., Depart­ establish the criteria of individual susceptibility to noise ment of Otolaryngology, Pusan National University Hos­ and to set-up the preventive indices of NIHL using ITS pital, 1-10 Ami-Dong, Seo-gu, Pusan 602-739, Korea. and its recovery time. 73 International Tinnitus Journal Vol. 2, No.1, 1996 Kyong-Myong Chon et al. MATERIALS AND METHODS discrimination score (DS) at 40 dB above SRT. This group was evaluated for the susceptibility to the noise by the Hearing tests of workers in the noisy industry change of DS after noise stimulation. For checking the change of pure tone threshold, Approximately 2,258 workers of the noisy industrial continuous pure tone (CPT), continuous band noise complex in Pusan and Kyongnam area of Korea, who (CBN), continuous white noise (CWN) stimulation of did not have any history of ear disease and noise exposure 90 dB above threshold at 4 kHz were given for of pre-employment, were examined at a mass screening 10 minutes, and intermittent while noise (lWN) stimula­ for audiometric test at 1 and 4 kHz with mobile audio­ tion was given for 30 seconds and then rest for 30 seconds, metry unit by an otolaryngologist. In addition to audio­ repeating 20 times. Immediately after each mode of noise metric data, a brief review of the otologic system, such stimulation, pure tone threshold was checked at as local finding of ear drum, tuning fork test and 30 second intervals and the TTS and its recovery time nystagmus examination were carried out. The workers were obtained. who had over 40 dB pure tone threshold of air condition For measuring the change of DS, CBN and CWN without masking at any of these two frequencies were stimulation of90 dB above threshold at4 kHz were given referred to the Audiology Clinic of Pusan National for 10 minutes. After each noise stimulation, DS at University Hospital and were checked for the hearing 40 dB above SRT was checked and its recovery time level using Nagashima 51A-T72 type audiometer by was obtained. ascending method at least three times. The average hearing level was divided into two ranges, speech range Tests for susceptibility to the noise: (SR), 500 Hz + 2 x 1000 Hz + 2000 Hz / 4 and high Subject with NIHL frequency range (HFR), 4000 Hz + 8000 Hz / 2. The hearing loss was classified according to hearing level The materials were derived from 64 cases (78 ears) out and frequencies as follows: of 612 workers confirmed as NIHL at Audiology Clinic 1) Mild deafness (M), 15-20 dB in SR and HFR. of Pusan National University Hospital. After CWN 2) Speech range deafness (S), over 20 dB in SR. stimulation with 70 dB suprathreshold at 4 kHz for 3) High tone deafness (H), over 20 dB in HFR. 10 minutes, pure tone threshold was checked at 4) Both range deafness (B), over 20 dB in SR and HFR. 30 second intervals for 10 minutes. The pure tone audiometer was specially equipped with NAB-Ol Tests for susceptibility to the noise: audiobooster (Nagashima Co., Japan) to amplify to Subjects with normal hearing 130 dB. The normal hearing sujects who did not have any RESULTS audiologic symptoms and abnormal finding at otologic examination were composed of two groups. One group Hearing tests of workers in the noisy industry of 69 cases (137 ears) who were within 15 dB from 250 to 4000 Hz and within 10 dB at 4000 Hz and this group 1. The incidence of N1HL was checked for the susceptibility to the noise by the After mass screening audiometric test of 2,258 workers change of pure tone threshold after noise stimulation. (4,516 ears) and secondary otologic evaluation by the Another group of 87 cases who had within 15 dB of board certified otolaryngologist, 612 workers (1,224 ears) speech reception threshold (SRT) and got 100% were confirmed as NIHL (27.1 %). According to the Table 1. The incidence of NIHL related to the duration of noise exposure and age Durat- ion -4 5-9 10-14 15-19 20- total (yrs) Age Exam NIHL , Exam NIHL \ Exam NIHL , Exam NIHL \ Exam NIH , Exam NIHL , L (yrs) Ear Ear Ear Ear Ear Ear -19 1,~36 202 14 .1 12 2 16.7 1,448 204 14 .1 20-29 1,172 356 30.4 238 70 29 4 58 14 24.1 1,468 440 30 . 0 30-39 398 112 43.2 530 164 30.9 206 66 32.0 50 16 32.0 1,184 418 35.3 40-49 98 42 42.9 112 44 39.3 108 40 37.0 40 14 35.0 12 4 33.3 310 144 38.9 50- 14 6 42.9 6 2 33.3 6 2 33.3 10 4 40.0 10 4 40.0 46 18 39.1 Total 3, ll8 178 25.0 898 282 31. 4 378 122 32.3 100 34 34.0 22 8 36 4 4,516 1,224 27.1 74 Noise Induced Hearing Loss International Tinnitus Journal Vol. 2, No.1, 1996 duration of noise exposure and age, the incidence of exposure and there was a tendency to increase hearing NIHL was rapidly increased within 10 years of noise threshold in proportion to the duration above IS years of exposure and within 30 years of age. So the NIHL was noise exposure. Between 4-8 kHz, the hearing loss was mostly established within nine years after noise expo­ proportional to the duration of noise exposure. The sure and below 30 years-of-age (Table 1). hearing level at 4 kHz was higher than other frequency and this is the characteristic ofNIHL, Cs dip phenomenon 2. The incidence of NIHL: (Table 4). relation of each hearing type Among the 1,224 ears of NIHL, type B was the most 4. Audiogram types of NIHL: prevalent and then type H, type S and type M in order.
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