轻微及轻度听力损失儿童发育特征研究进展

轻微及轻度听力损失(MMHL)包括单侧感音神经性听力损失、双侧轻度感音神经性听力损失、高频感音神经性听力损失。这类患儿可能存在声源定位困难、容易疲劳、噪声下言语辨别困难等症状,影响其语言、心理教育、日常生活。目前普遍认为该类型听力损失程度较轻,没有引起足够重视,导致相当多的MMHL儿童未得到及时干预。本文旨在总结MMHL对儿童的听觉、语言和言语、认知、学校表现及日常生活的影响,揭示MMHL儿童的发育特征,为这类儿童的早期识别和积极干预寻找客观依据。     

甲苯致听力损失研究进展

近年来,随着苯等高毒化学品的限制使用,甲苯等替代产品的产量和消费量日益增加,甲苯的毒性作用以及健康效应引起了国内外职业卫生领域的广泛关注。现阶段甲苯的健康效应研究主要集中在高浓度甲苯暴露导致中枢神经系统功能障碍和皮肤黏膜刺激症状等,但随着医学科学的发展,越来越多的研究包括动物实验和人群研究均表明甲苯可能对听力系统产生潜在危害,本文对甲苯致听力损失的研究进展进行综述。     

噪声致听力损失机制的研究进展

噪声致听力损失(NIHL)是感音神经性聋最常见的形式之一。过去几十年,NIHL的研究一直专注于感音毛细胞的损伤导致听阈升高,而由于常规听力检查方法无法发现,听神经损失导致的隐性听力损失未引起重视。本文从耳蜗毛细胞的损伤、听神经突触病变和髓鞘病变三个方面来阐述NIHL的机制,为相应的临床防治研究提供线索。     

听力损失婴儿的听力监测

[目的]了解听力损失婴儿的听力变化趋势,为正确有效干预提高依据. [方法]对101例(173耳)3个月内初次听性脑千反应(auditory brainstem response,ABR)疑为听力损失的婴儿在3个月后进行ABR追踪复查.[结果]第1次ABR检查,平均阈值(50.91±14.46)dBnHL,第2次ABR检查,平均阈值降为(39.57±19.74)dBnHL,差异有统计学意义.有121耳周值减低,29耳不变,23耳增加,轻中度者分级程度转为正常78耳,占45.1%,8例9耳分级程度加重,极重度者阈值基本未改变.[结论]对于初次听力诊断疑为轻中度听力损失者,应进行每3个月1次的听力学监测和跟踪随访,重度以上的听力损失者3月龄的早期诊断和6月龄的早期干预是可行.     

先天畸形新生儿听力效果筛查及先天畸形对听力损失的影响

目的探讨先天畸形新生儿听力效果筛查及先天畸形对听力损失的影响,为临床提供参考。方法选择2015年1月-2016年12月河北省儿童医院收治的198例先天畸形新生儿为观察组,同期选择306例正常新生儿为对照组,对两组新生儿均采用自动听性脑干反应(a AABR)与畸变产物耳声发射法(DPOAE),对比其听力效果筛查及听力损失的情况。结果第1次筛查利用DPOAE方法共筛查出306例正常新生儿,检测耳数共612只,通过率为94.77%;共筛查出198例先天畸形新生儿,检测耳数共396只,通过率为53.54%,两组通过率比较,差异有统计学意义(χ~2=19.65,P0.01);利用DPOAE方法对198例先天畸形新生儿进行初次筛查,通过的有12例共24只耳,通过率为6.06%率,利用畸变产物耳声发射法进行复筛的通过率明显高于初筛(χ~2=18.53,P0.01)。进行第2次筛查的有378只耳,通过的共有202耳,通过率为53.44%。利用AABR方法进行第1次筛查达到标准的有23例共46只耳,通过率为11.62%;进行第2次筛查的有388只耳,通过的共有212只耳,通过率为54.64%。利用自动听性脑干反应法复筛的通过率明显高于初筛(χ~2=15.96,P0.01)。结论先天畸形新生儿听力效果筛查较差,可综合运用自动听性脑干反应与畸变产物耳声发射法以提高听力效果筛查率。     

新生儿听力损失的高危因素及其与听力损失的相关性研究

目的探讨影响新生儿听力损失的高危因素及其与听力损失的相关性。方法选择2013年1月-2015年12月在宝鸡市中心医院产科出生的5 930例新生儿为研究对象,根据是否有高危因素分为正常组5 356例和高危组574例,听力筛查在新生儿出生后2~3 d进行,由专业技术人员在新生儿自然睡眠或安静的状态下通过耳声发射(OAE)对其听力进行初步检查。未通过者及漏筛者于产后42 d内采用畸变产物耳声发射(DOAE)和自动听性脑干反应(AABR)对双耳进行复筛,对两组新生儿不同相关因素的听力初筛、复筛通过率进行比较分析。结果 5 930例新生儿听力初筛共有5 389例通过,通过率为90.87%。新生儿不同性别及分娩方式比较,差异无统计学意义(P0.05)。产妇18~34岁与≥35岁和新生儿不同胎龄听力初筛结果比较,差异有统计学意义(χ~2=725.464、186.007,均P0.01)。正常组与高危组新生儿听力初筛结果比较,差异有统计学意义(χ~2=427.996,P0.01);541例新生儿听力复筛共有419例通过,通过率为77.45%。新生儿不同性别及分娩方式比较,差异无统计学意义(P0.05)。产妇18~34岁与≥35岁和新生儿不同的胎龄听力初筛结果比较,差异有统计学意义(χ~2=10.973、33.009,均P0.01)。正常组与高危组新生儿听力初筛结果比较,差异有统计学意义(χ~2=69.560,P0.01)。高危组听力损失检出率(14.11%)明显高于正常新生儿组(0.7%),两组比较,差异有统计学意义(χ~2=398.390,P0.01)。结论新生儿高危因素与新生儿听力损失有一定联系,新生儿发生听力损失的主要高危因素为:有听力障碍家族史、有两种及以上高危因素、NICU住院超过5 d、新生儿窒息。     

青少年听力损失研究进展

听力损失指有不同程度声音响度感知障碍以及言语分辨障碍的生理现象[1],可分为暂时性听力损失和永久性听力损失[2].目前,听力损失已成为全世界流行最广的感觉器官残疾,负面影响居全球疾病负担排行榜前列[3].已有研究发现,糖尿病等慢性疾病、噪音、社会支持以及易感性基因等均是听力损失的危险因素[4-5].     

噪声性听力损失易感基因的研究进展

噪声性听力损失是现阶段全球最主要的职业性损伤之一.以往的研究显示,噪声的易感性存在个体差异,本文综述报道目前国内外关于基因多态性与噪声性听力损失之间关系的现有研究状况.     

隐性听力损失在职业健康监护中的研究进展

根据近年来隐性听力损失发病机制的研究发现,隐性听力损失的发生早于永久性听阈位移,可更早地发现噪声对听觉系统的损伤,对职业性噪声聋的防护具有重要意义。本文对隐性听力损失的危险因素、噪声导致隐性听力损失的发病机制、隐性听力损失的检测方法等方面进行了综述,探讨隐性听力损失在职业健康监护中的意义,为今后早期发现听力损失、噪声作...     

Noise exposure and hearing conservation practices in an industry with high incidence of workers' compensation claims for hearing loss

BACKGROUND: Washington State has experienced a striking increase in workers' compensation claims for hearing loss. METHODS: This cross-sectional study examined noise exposures and hearing conservation practices in one industry with a high rate of hearing loss claims. We evaluated 10 representative foundries with personal noise dosimetry, management interviews, employee interviews, and existing audiometry. RESULTS: Noise levels routinely exceeded 85 dBA. All companies were out of compliance with hearing conservation regulations. Most employees with important findings on audiograms were not aware of their findings. There was a significant positive correlation between management-interview scores and worksite-average employee-interview scores (r = 0.70, P = 0.02). CONCLUSIONS: Companies where more effort is put into hearing conservation program activities can achieve a greater positive impact on employee awareness. However, there were broad deficiencies even in the better programs in this sample, suggesting that workers in this industry probably face a continuing substantial risk of occupational hearing loss.     

Evaluation of noise-induced hearing loss by reference to the upper limit of hearing

We have defined the upper limit of hearing as the maximum audible frequency measured with fixed intensity and changing frequency. We have previously established the standard upper limit ageing curves from the normal age variation in the upper limit of hearing. In the present study, we sought to clarify the effects of occupational noise on the upper limit of hearing. We measured the upper limit of hearing in 239 healthy male workers (478 ears) exposed to intensive occupational noise. Their age variation in the upper limit of hearing was compared with the standard upper limit ageing curves in males. There were statistically significant deteriorations. Even if the ears that had normal hearing levels (35 dB or less) were selected, deterioration in the upper limit of hearing was noticeable. The upper limit of hearing may serve as clinically useful information on the hearing impairment that precedes noticeable hearing impairment in conventional audiometry for workers exposed to intensive occupational noise.     

新生儿听力损失的高危因素研究

【目的】 分析听力筛查未通过的新生儿听力损失的高危因素,为今后的防治工作提供依据。 【方法】 对复筛未通过的新生儿在出生后3月内用脑干听觉诱发电位仪、声导抗、诊断型耳声发射进行听力障碍的诊断。 【结果】 43 568例新生儿复筛未通过者802例,进行初次诊断者660例,其中256人出现不同程度的听力损失(含分泌性中耳炎导致的传导性听力损失),重度聋在听力筛查儿中的发生率为1.45‰。分泌性中耳炎发生率在听力损失组与听力正常组间差异统计学意义(χ²=57.18,P<0.001)。1∶1配对的病例对照多因素分析显示听力损失家族史是听力损失的独立危险因素。 【结论】 听力筛查未通过的新生儿中,约一半听力损失伴有分泌性中耳炎,听力损失家族史是新生儿听力损失高危因素,应加强妇幼保健宣教。     

Noise and hearing loss: a review

BACKGROUND: Noise-induced hearing loss is a major cause of deafness and hearing impairment in the United States. Though genetics and advanced age are major risk factors, temporary and permanent hearing impairments are becoming more common among young adults and children especially with the increased exposure to portable music players. Though treatment options are limited for most people with noise-related hearing loss, several modifiable health behaviors that should begin in childhood might prevent or delay the onset of hearing impairment. The purpose of this article is to review modifiable and non-modifiable risk factors, comorbidity, and the role of health education in the prevention of noise-induced hearing loss. METHODS: Review of current literature in the etiology, prevention, and treatment of noise-induced hearing loss as well as the role of health education. RESULTS: Non-modifiable risk factors related to noise-related hearing loss include increasing age, genetics, male gender, and race. Modifiable risk factors are voluntary exposure to loud noise, nonuse of hearing protection, smoking, lack of exercise, poor diet, tooth loss, and the presence of diabetes and cardiovascular disease. CONCLUSIONS: As hearing impairment among children and teenagers rises due to mostly voluntary exposure to loud noise, there are many implications for health education. Health educators need to address barriers to the use of hearing protection, deliberate exposure to loud music, and other modifiable risk factors, which cause and exacerbate hearing loss among those exposed to loud noise.     

个体噪声防护的职业接触人群听力损失的剂量-反应关系研究

目的准确评价工作场所中使用个体听力防护的噪声接触人群的听力损失。方法对50家企业的3 432名接触噪声工人进行纯音听力测试并对50家接触噪声企业进行职业卫生调查。结果50家噪声接触企业进行职业流行病调查显示噪声强度(92.1±4.9)dB,累积噪声暴露量(CNE)为(103.43±6.66)dB(A).年;在3 432名接触噪声作业人员的听阈检查中,高频损失1 272人(37.06%),语频损失133人(3.88%);高频和语频损失的发生率随累积噪声强度的增大而增大,其发生率与CNE存在剂量-反应关系(P<0.01)。结论高频和语频的发生率随累积噪声强度的增大而增大,呈剂量-反应关系。     

噪声性听力损伤影响因素的研究进展

噪声性听力损伤通常是由噪声引起的,但噪声并不是唯一的因素,很多因素比如职业危害因素的联合作用、形态测量学因素、吸烟、饮酒、医学危险因素、药物影响和基因等,对听力也有影响。其中,噪声与其他职业危害因素联合作用对劳动者健康的影响已有很多报道,涉及噪声和毒物、物理因素的联合作用。作者从职业危害因素的联合作用,形态测量学、吸烟、饮酒、医学危险因素,药物影响和基因7个方面对噪声性听力损伤的影响进行了综述。     

Noise exposure and hearing loss prevention programmes after 20 years of regulations in the United States

Objectives

To evaluate noise exposures and hearing loss prevention efforts in industries with relatively high rates of workers'' compensation claims for hearing loss.

Methods

Washington State workers'' compensation records were used to identify up to 10 companies in each of eight industries. Each company (n = 76) was evaluated by a management interview, employee personal noise dosimetry (n = 983), and employee interviews (n = 1557).

Results

Full‐shift average exposures were ⩾85 dBA for 50% of monitored employees, using Occupational Safety and Health Administration (OSHA) parameters with a 5 dB exchange rate (L_ave), but 74% were ⩾85 dBA using a 3 dB exchange rate (L_eq). Only 14% had L_ave ⩾90 dBA, but 42% had L_eq ⩾90 dBA. Most companies conducted noise measurements, but most kept no records, and consideration of noise controls was low in all industries. Hearing loss prevention programmes were commonly incomplete. Management interview scores (higher score = more complete programme) showed significant associations with percentage of employees having L_ave ⩾85 dBA and presence of a union (multiple linear regression; R² = 0.24). Overall, 62% of interviewed employees reported always using hearing protection when exposed. Protector use showed significant associations with percentage of employees specifically required to use protection, management score, and average employee time spent ⩾95 dBA (R² = 0.65).

Conclusions

The findings raise serious concerns about the adequacy of prevention, regulation, and enforcement strategies in the United States. The percentage of workers with excessive exposure was 1.5–3 times higher using a 3 dB exchange rate instead of the OSHA specified 5 dB exchange rate. Most companies gave limited or no attention to noise controls and relied primarily on hearing protection to prevent hearing loss; yet 38% of employees did not use protectors routinely. Protector use was highest when hearing loss prevention programmes were most complete, indicating that under‐use of protection was, in some substantial part, attributable to incomplete or inadequate company efforts.