Modelling the risk of noise-induced hearing loss among military pilots

Noise is a significant risk factor in aviation, especially in military aviation. Even though our earlier studies have shown that the risk of noise-induced hearing loss (NIHL) among military pilots is small and the monitoring of their hearing is effective, we still need to develop methods of assessing the risk of NIHL more effectively at both the general and individual levels. In addition, many other risk factors are considered to contribute to the development of hearing impairment. The novel NoiseScan data management system enables assessment of the risk of developing hearing impairment on the basis of known risk factors. This study investigates the risk of hearing impairment among Finnish Air Force pilots using reasonably accurate noise exposure data and other risk factors for hearing impairment. This risk is also compared with that of industrial workers, whose risk followed the ISO 1999 prediction. Hearing among Finnish military pilots turned out to be better than predicted by the ISO 1999 model. The industrial workers had a larger number of risk factors than the pilots. Owing to the small number of risk factors, the hearing of pilots corresponds to approximately the 80th percentile, being 9-13 dB better than the 50th percentile obtained with the industrial population.     

High-frequency air-conduction and electric bone-conduction audiometry. Age and sex variations.

208 subjects representing both sexes and five age groups (15-70 years) were examined to obtain age-related threshold values for high-frequency (HF) electric bone-conduction (EBC) audiometry. The measurements also included conventional pure-tone audiometry and air-conduction (AC) HF (8-18 kHz) audiometry. The measured EBC thresholds were comparable to the values obtained with AC audiometers, and were equal to ISO standards at the frequencies of 0.5-6 kHz. The 15- and 20-year-old groups' EBC thresholds at 8 kHz were equivalent to thresholds of 15-year-old people from a cross-sectional material in Northern Finland. Thresholds deteriorated as a function of age, particularly in the HF range. The males had poorer thresholds than the females, especially in the age groups of 40 and 60 years. This could be attributed mainly to their greater noise exposure. The EBC method is quite practical and reliable for routine clinical measurements, but the dynamic range of the audiometer limits its use to relatively young subjects.     

The occurrence of acute otitis media in infants. A life-table analysis

A random sample of 2512 children were monitored to an average age of two years to determine the occurrence of acute otitis media (AOM). A life-table methodology was employed in the analysis. The cumulative incidence of the first episode of AOM up to 12 months of age was 42.4% (95% confidence interval 40.4-44.4) and the corresponding figure up to 24 months of age was 71.0% (68.9-73.1). The incidence rate for all acute otitis media episodes was 0.93 episodes per child per year (0.90-0.96) during the first 24 months of life increasing in the spring and autumn. The risk of experiencing an episode of acute otitis media increased at the age of 6-12 months and decreased slowly during the second year of life. The results confirm the frequent nature of acute otitis media and stress the necessity for clear, consistent definition of the criteria for acute otitis media in epidemiological research.     

Genetic boundaries of the schizophrenia spectrum: evidence from the Finnish Adoptive Family Study of Schizophrenia

OBJECTIVE: Identification of the genetically related disorders in the putative schizophrenia spectrum is an unresolved problem. Data from the Finnish Adoptive Family Study of Schizophrenia, which was designed to disentangle genetic and environmental factors influencing risk for schizophrenia, were used to examine clinical phenotypes of schizophrenia spectrum disorders in adopted-away offspring of mothers with schizophrenia spectrum disorders. METHOD: Subjects were 190 adoptees at broadly defined genetic high risk who had biological mothers with schizophrenia spectrum disorders, including a subgroup of 137 adoptees at narrowly defined high risk whose mothers had DSM-III-R schizophrenia. These high-risk groups, followed to a median age of 44 years, were compared diagnostically with 192 low-risk adoptees whose biological mothers had either a non-schizophrenia-spectrum diagnosis or no lifetime psychiatric diagnosis. RESULTS: In adoptees whose mothers had schizophrenia, the mean lifetime, age-corrected morbid risk for narrowly defined schizophrenia was 5.34% (SE=1.97%), compared to 1.74% (SE=1.00%) for low-risk adoptees, a marginally nonsignificant difference. In adoptees whose mothers had schizophrenia spectrum disorders, the mean age-corrected morbid risk for a schizophrenia spectrum disorder was 22.46% (SE=3.56%), compared with 4.36% (SE=1.51%) for low-risk adoptees, a significant difference. Within the comprehensive array of schizophrenia spectrum disorders, schizotypal personality disorder was found significantly more often in high-risk than in low-risk adoptees. The frequency of the group of nonschizophrenic nonaffective psychoses collectively differentiated high-risk and low-risk adoptees, but the frequencies of the separate disorders within this category did not. The two groups were not differentiated by the prevalence of paranoid personality disorder and of affective disorders with psychotic features. CONCLUSIONS: In adopted-away offspring of mothers with schizophrenia spectrum disorders, the genetic liability for schizophrenia-related illness (with the rearing contributions of the biological mothers disentangled) is broadly dispersed. Genetically oriented studies of schizophrenia-related disorders and studies of genotype-environment interaction should consider not only narrowly defined, typical schizophrenia but also schizotypal and schizoid personality disorders and nonschizophrenic nonaffective psychoses.     

Color vision and contrast sensitivity in epilepsy patients treated with initial tiagabine monotherapy

The purpose of the study was to determine whether the use of a GABAergic antiepileptic drug (AED), tiagabine, affects color vision and contrast sensitivity. Twenty newly diagnosed patients with partial epilepsy (aged 19-72 years), receiving tiagabine as their initial monotherapy for 5-41 months were examined. Color vision was examined with the Standard Pseudoisochromatic Plates 2 (SPP2), with the Farnsworth-Munsell 100 Hue Test (FM100) and with the Color Vision Meter 712 (CVM) anomaloscope. Contrast sensitivity was measured with the Pelli-Robson letter chart. Three patients excluded from the color vision evaluation for congenital red-green color vision defects. Seven out of 17 patients (41%) had acquired color vision deficit examined with the FM100. The CVM anomaloscope revealed minor defects in two patients. Contrast sensitivity function was within normal ranges. The present study suggests that AED therapy with tiagabine, like with other established and newer AEDs may interfere with color perception.     

Modelling the risk of noise-induced hearing loss among military pilots

Noise is a significant risk factor in aviation, especially in military aviation. Even though our earlier studies have shown that the risk of noise-induced hearing loss (NIHL) among military pilots is small and the monitoring of their hearing is effective, we still need to develop methods of assessing the risk of NIHL more effectively at both the general and individual levels. In addition, many other risk factors are considered to contribute to the development of hearing impairment. The novel NoiseScan data management system enables assessment of the risk of developing hearing impairment on the basis of known risk factors. This study investigates the risk of hearing impairment among Finnish Air Force pilots using reasonably accurate noise exposure data and other risk factors for hearing impairment. This risk is also compared with that of industrial workers, whose risk followed the ISO 1999 prediction. Hearing among Finnish military pilots turned out to be better than predicted by the ISO 1999 model. The industrial workers had a larger number of risk factors than the pilots. Owing to the small number of risk factors, the hearing of pilots corresponds to approximately the 80th percentile, being 9-13 dB better than the 50th percentile obtained with the industrial population.     

Temporary threshold shift in military pilots measured using conventional and extended high-frequency audiometry after one flight

Noise of such a high level that it can result in hearing deterioration is an inherent characteristic of military flying. Susceptibility to hearing impairment was studied using 51 Finnish Air Force military personnel as subjects. The test persons flew missions on a British Aerospace Hawk 51 advanced jet trainer, Boeing F-18 Hornet, Mikoyan & Gurevich MiG-21bis and Saab 35 Draken interceptors, and a Valmet Redigo turboprop liaison aircraft. The duration of noise exposure was one flight mission, which varied from 30 to 60 min. Noise doses and levels were measured using a miniature microphone at the inlet of the ear canal, while a second microphone was located at the level of the subject's shoulder. Hearing thresholds were measured before each flight using conventional (0.125-8 kHz) and extended high-frequency (EHF) (8.20 kHz) audiometry. The measurements were repeated as soon as possible after the flight. The study showed that the pre-flight threshold levels of the subjects were good. Both conventional and EHF audiometry revealed statistically significant temporary threshold shifts (TTS) at several frequencies and with all aircraft types involved. The changes were, however, minor. The risk of noise-induced hearing impairment at the studied exposure levels is, in all probability, rather small. The role of extended high-frequency audiometry would be in research, and it might be performed for flying personnel upon entering service and every fifth year thereafter.     

Cochllear implants and GSM phone

Use of a telephone and GSM phones, in particular, was assessed by means of a postal interview sent to all adult Finnish implantees. The response rate was very high (87%). Fifty-one of the 61 respondents used a telephone and 27/61 also used a mobile phone, usually a digital phone. Two GSM phone models from Nokia (3110 and 6110) were tested with three different cochlear implant systems used by nine patients. Definite differences between the processors were found. Nucleus Spectra (two implantees) could not be used with any of the GSM phones under any test condition. Nucleus SPrint was incompatible with both GSM phone models in a poor field, while GSM phone model 6110 could be used in a good field. The Med-El Combi 40+ processor was compatible with both GSM models tested under any condition.     

Late hearing results after paraffinplasty or silastic sheeting

Summary The long-term hearing results are presented for 135 ears operated on radically. In 59 of the ears temporary paraffin filling of the tympanic cavity was employed after the removal of the typanic mucosa at operation. The filling material was removed, and the ossiculoplasty was performed about 6 months later. In 76 ears a one-stage operation with tympanoplasty and Silastic sheeting was employed.There were no statistical differences between the groups of ears mentioned according to hearing results early (1 year) or late (5–14 years) postoperatively or in the deterioration of the air-bone gaps after the first postoperative year (P>0.05). The late change in the air-bone gap was significant in both groups (paraffin group: 6.1 dB; Silastic sheeting group: 5.7 dB; P<0.05). The total improvement of hearing late after surgery (as compared to the preoperative hearing) was significantly better in the paraffin group than in ears with Silastic sheeting (P<0.05). Paraffinplasty seems to be a suitable way to avoid tympanic adhesions.     

The preoperative state of infection in chronic otitis media correlated with postoperative hearing results

Summary The postoperative long-term hearing results, with special reference to the state and management of the tympanic mucosa at operation, in 627 ears (574 patients) after an annual clinical follow-up period of 5–14 years are presented. The ears were operated on radically due to chronic otitis media, using the obliterative radical operation technique developed by T. Palva. The air-bone gap improved from the preoperative level significantly more in ears where the tympanic mucosa had been preserved than in ears where it had been removed at operation (p < 0.001). The improvement was also significantly better in dry ears than in ears which were moist or discharging at operation (p < 0.05). The mean late deterioration in the air-bone gap after the first follow-up year was significant in all the groups of ears (p < 0.05), and the mean long-term change in air-bone gap from pre- to late postoperative examination was the improvement of 3.0 dB in ears with, and a deterioration of 2.0 dB in ears without ossicular reconstruction.