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Occupational Noise-Induced Hearing Loss L Mirza, DO, D

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Occupational Noise-Induced Hearing Loss L Mirza, DO, D ACOEM GUIDANCE STATEMENT Occupational Noise-Induced Hearing Loss Rau´l Mirza, DO, D. Bruce Kirchner, MD, Robert A. Dobie, MD, and James Crawford, MD, ACOEM Task Force on Occupational Hearing Loss College of Occupational and Environmen- CHARACTERISTICS Occupational hearing loss is preventable through tal Medicine (ACOEM) believes that OEM a hierarchy of controls, which prioritize the use The principal characteristics of physicians should understand a worker’s occupational NIHL are as follows: of engineering controls over administrative con- noise exposure history and become profi- trols and personal protective equipment. The 01/04/2019 on BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3VFjldD2uL9p7SMbj5XQFggscApMlmW/UgXNoK/5MD7Gq31Q2YQqh0A== by https://journals.lww.com/joem from Downloaded Downloaded cient in the early detection and prevention It is always sensorineural, primarily occupational and environmental medicine of NIHL. (OEM) physician plays a critical role in the affecting the cochlear hair cells in the inner ear. from prevention of occupational noise-induced hear- It is typically bilateral, since most noise https://journals.lww.com/joem ing loss (NIHL). This position statement clarifies THE OEM PHYSICIAN AS exposures affect both ears symmetri- current best practices in the diagnosis of occupa- PROFESSIONAL SUPERVISOR tional NIHL. cally. OF THE AUDIOMETRIC Its first sign is a ‘‘notching’’ of the oise-induced hearing loss (NIHL) TESTING COMPONENT OF A audiogram at the high frequencies of 3000, 4000, or 6000 Hz with recovery by N continues to be one of the most prev- HEARING CONSERVATION 5 BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3VFjldD2uL9p7SMbj5XQFggscApMlmW/UgXNoK/5MD7Gq31Q2YQqh0A== alent occupational conditions and occurs at 8000 Hz. PROGRAM This notch typically develops at one across a wide spectrum of industries. Occu- The OEM physician also plays a pational hearing loss is preventable through of these frequencies and affects adja- critical role in the prevention of occupa- cent frequencies with continued noise a hierarchy of controls, which prioritize the tional NIHL by serving as a professional use of engineering controls over adminis- exposure. This, together with the supervisor of the audiometric testing ele- effects of aging, may reduce the trative controls and personal protective ment of hearing conservation programs. equipment. The occupational and environ- prominence of the ‘‘notch.’’ There- The Occupational Safety and Health fore, in older individuals, the effects mental medicine (OEM) physician works Administration (OSHA) defines a require- with management, safety, industrial of noise may be difficult to distin- ment for professional supervisors in the guish from age-related hearing loss hygiene, engineering, and human resources 2 1983 Hearing Conservation Amendment. (presbycusis) without access to pre- to ensure that all components of hearing 6 1 The responsibilities of the professional vious audiograms. loss prevention programs are in place. The supervisor can be found in the ACOEM OEM physician should emphasize to The exact location of the notch position statement The Role of the Profes- depends on multiple factors including employers the critical importance of pre- sional Supervisor in the Audiometric Test- venting hearing loss through controls and the frequency of the damaging noise ing Component of Hearing Conservation and size of the ear canal. periodic performance audits rather than just 3 Programs. Responsibilities include inter- In early NIHL, average hearing conducting audiometric testing. Neverthe- pretation of audiograms, work-relatedness less, audiometric testing, besides docu- thresholds at the lower frequencies determinations, referral of problem cases, of 500, 1000, and 2000 Hz are better menting the permanent loss of hearing, quality oversight of audiometric testing, can be of value in the identification of than average thresholds at 3000, and determination of the effectiveness of 4000, and 6000 Hz, and the hearing hearing loss at a time when early preventive the hearing conservation program. intervention is possible. The American level at 8000 Hz is usually better This statement clarifies current best than the deepest part of the notch. practices in the diagnosis of NIHL. On the This notching is in contrast to pres- From the American College of Occupational and basis of current knowledge, it updates the bycusis, which also produces high- Environmental Medicine, Elk Grove, Illinois. previous ACOEM statement4 regarding the This position paper was developed by the ACOEM frequency hearing loss but in a Task Force on Occupational Hearing Loss under distinguishing features of occupational down-sloping pattern without recov- the auspices of the Council of Scientific Advisors. NIHL. ery at 8000 Hz.7 It was reviewed by the Committee on Policy, Although OSHA does not require on Procedures, and Public Positions, and approved 01/04/2019 by the ACOEM Board of Directors on April 28, DEFINITION audiometric testing at 8000 Hz, 2018. ACOEM requires all substantive contribu- Occupational NIHL develops gradu- inclusion of this frequency is highly tors to its documents to disclose any potential ally over time and is a function of continu- recommended to assist in the identi- competing interests, which are carefully consid- ous or intermittent noise exposure. This is fication of the noise notch as well as ered. ACOEM emphasizes that the judgments 8 expressed herein represent the best available evi- in contrast to occupational acoustic trauma age-related hearing loss. dence at the time of publication and shall be which is characterized by a sudden change Noise exposure alone usually does considered the position of ACOEM and not the in hearing as a result of a single exposure to not produce a loss greater than 75 dB individual opinions of contributing authors. The authors declare no conflicts of interest. a sudden burst of sound, such as an explo- in high frequencies and greater than Address correspondence to: Marianne Dreger, MA, sive blast. The diagnosis of NIHL is made 40 dB in lower frequencies. Neverthe- ACOEM, 25 Northwest Point Blvd, Suite 700, by the OEM physician, by first taking into less, individuals with non-NIHL, such Elk Grove Village, IL 60007 ([email protected]). account the worker’s noise exposure history as presbycusis, may have hearing Copyright 2018 American College of Occupa- ß and then by considering the following char- threshold levels in excess of these tional and Environmental Medicine 8 DOI: 10.1097/JOM.0000000000001423 acteristics. values. e498 JOEM Volume 60, Number 9, September 2018 Copyright © 2018 American College of Occupational and Environmental Medicine. Unauthorized reproduction of this article is prohibited JOEM Volume 60, Number 9, September 2018 Occupational Noise-Induced Hearing Loss Hearing loss due to continuous or inter- hazardous noise exposure continue.19 hierarchy of primary prevention controls mittent noise exposure increases most Barring an ototraumatic incident, work- should be implemented in order to miti- rapidly during the first 10 to 15 years ers will always develop temporary gate the risk of an acquired dose to of exposure, and the rate of hearing loss threshold shift before sustaining perma- workers, or others, potentially exposed then decelerates as the hearing threshold nent threshold shift.1 to ototoxic chemicals. increases.9 This is in contrast to age- Individual susceptibility to the auditory related loss, which accelerates over time. ADDITIONAL effects of noise varies widely.28 The Available evidence indicates that previ- CONSIDERATIONS IN biological basis for this remains unclear. ously noise-exposed ears are not more In addition, the contribution of comorbid sensitive to future noise exposure. EVALUATING THE WORKER conditions such as cardiovascular dis- There is insufficient evidence to con- WITH SUSPECTED NIHL ease, diabetes, and neurodegenerative clude that hearing loss due to noise will The OEM physician evaluating pos- disease to hearing loss is unclear.29 progress once the noise exposure is dis- sible cases of NIHL should consider the There are a number of other causes of continued.8 This is primarily based on a following issues: sensorineural hearing loss besides occu- National Institute of Medicine report pational noise. Of primary concern is which concluded that, on the basis of Unilateral sources of noise such as sirens non-occupational noise exposure from available human and animal data, it was and gunshots can produce asymmetric a variety of sources, especially recrea- felt unlikely that such delayed effects loss, as can situations in which the work tional noise, such as loud music, weap- occur.9,10 However, recent animal involves fixed placement of the affected ons firing, motor sports, etc. Other experiments indicate although there ear relative to the noise source. When causes include a wide variety of genetic appears to be threshold recovery and evaluating cases of asymmetric loss, disorders, infectious diseases (eg, laby- no loss of cochlear cells following noise referral to rule out a retrocochlear lesion, rinthitis, measles, mumps, syphilis), exposures to rodents, there is evidence of such as an acoustic neuroma,20 is war- pharmacologic agents (eg, aminoglyco- cochlear afferent nerve terminal damage ranted before attributing the loss to sides, diuretics, salicylates, antineoplas- and delayed degeneration of the cochlear noise. The physician should consult cri- tic agents),
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