Effects of lead and noise exposures on hearing ability

Occupational Lead Exposure Ototoxicity Evaluated With Distortion-Product Otoacoustic Emissions

OBJECTIVES

To evaluate the extent of hearing loss among pottery workers in Mexico exposed to lead.

DESIGN

The authors conducted a cross-sectional study including 315 adult pottery workers. Auditory function was evaluated by air conduction pure-tone audiometry (pure-tone average) and distortion-product otoacoustic emission (DPOAE) levels (amplitude and signal-to-noise ratio). Lead exposure was assessed with a single blood sample test and classified as low, medium, and high according to blood lead tertiles. Logistic regression models were calculated for the association between blood lead levels, pure-tone average, and DPOAE records.

RESULTS

Median (25th-75th) blood lead levels were 14 μg/dL (7.5-22.6 μg/dL). The audiometric pattern and DPOAE records were similar across blood lead levels groups in all frequencies, and no statistically significant differences were found. Adjusted logistic regression models showed no increase in the odds for hearing thresholds >25 dB (HL) and DPOAE absence associated with blood lead levels, and no dose-response pattern was observed ( p > 0.05).

CONCLUSIONS

Given the results from this cross-sectional study, no association was found between blood lead levels and hearing loss assessed with DPOAE. Future longitudinal work should consider chronic lead exposure estimates among underrepresented populations, which can potentially inform safer work practices to minimize the risk of ototoxicity.

Metal Exposures, Noise Exposures, and Audiometry from E-Waste Workers in Agbogbloshie, Ghana

Metals, such as lead, may be ototoxic, but this property is not well understood, especially in conjunction with noise. This cross-sectional study investigated hearing, noise, and metal biomarkers in informal electronic waste (e-waste) recycling workers in Accra, Ghana. Workers (N = 58) participated in audiometric testing, a survey, blood collection, and personal noise dosimetry. Sixty percent of participants displayed audiometric notches indicative of noise-induced hearing loss (NIHL). Most workers (86%) reported high noise while working. Daily average noise levels were in the range 74.4-90.0 dBA. Linear regression models indicated participants who lived at Agbogbloshie Market for longer periods were significantly associated with worse hearing thresholds at 4 and 6 kHz. The models did not identify blood levels of lead, mercury, or cadmium as significant predictors of worse hearing thresholds or larger noise notches, but increased levels of selenium were significantly associated with better hearing at 6 kHz. Models of thresholds at 4 and 6 kHz were improved by including an interaction term between the maximum noise exposure and the level of zinc in whole blood, suggesting that zinc may protect hearing at lower noise levels, but not at higher levels. Further study of the relationships between elements, noise, and NIHL is needed.

Exposure to lead, mercury, styrene, and toluene and hearing impairment: evaluation of dose-response relationships, regulations, and controls

The risk of hearing loss from exposure to ototoxic chemicals is not reflected in occupational exposure limits and most jurisdictions. The aims of this research were to investigate dose-response relationships between exposure to lead, mercury, toluene, and styrene and hearing impairment based on current epidemiological evidence, conduct cross-jurisdictional comparisons, and investigate control measures for exposure to ototoxic chemicals. Ovid Medline and Ovid Embase databases were used to find relevant publications. A total of 86 epidemiological studies met the eligibility criteria for final evaluation. When significant associations between exposure and outcome were identified, exposure levels were evaluated to determine whether No Observed Adverse Effect Level (NOAEL) and Lowest Observed Adverse Effect Level (LOAEL) could be identified. Cross-jurisdictional comparisons included the U.K., U.S., Canada, and Australia occupational health and safety legislations. The majority of lead (75%), styrene (74%), and toluene (77%) studies showed significantly increased risks of hearing loss from exposure to these substances, although numerous studies on toluene (70%) and styrene (16%) compared auditory function between "solvent mixture" or "noise and solvent mixture" exposed groups and controls and not necessarily on groups exposed to a single agent. Based on five studies, blood lead ranges of 1-1.99 μg/dL to 2.148-2.822 μg/dL were identified as NOAELs while blood lead levels of 2 μg/dL up to 2.823-26.507 μg/dL were identified as LOAELs for hearing loss. Except for general duty clauses, the U.S., Canadian, and Australian jurisdictions have set no enforceable regulations specific to ototoxic chemical exposures. A biological exposure index of 2 μg/dL is recommended for prevention of hearing impairment from lead exposure. Based on Safe Work Australia, noise exposure limits may be reduced to 80 dB(A) for 8 hr. Other recommendations include performing audiometric testing and controlling exposure through all routes of entry.

Heavy metal blood levels and hearing loss in children of West Bengal, India

Introduction:

Heavy metals are a major environmental threat in India and there are several health risks associated with it. The aim of this study was to investigate the relationship between the blood levels of lead, cadmium, arsenic, and mercury and a sensoneurial hearing loss in children aged one to ten years.

Method:

Heavy metal blood levels were determined using inductively coupled plasma mass spectrometry, with appropriate quality control.

Results:

We found significantly higher blood lead concentration (mg/L; Mean ± SE) in children with a hearing loss (53.2 ± 4.4) compared to healthy controls (38.4 ± 4.7)/P = 0 0.03/.

Conclusion:

Children’s blood lead levels ≥ 50 mg/L compared to the levels < 10 mg/L were associated with increased probability of hearing loss (OR, 48.8; 95% CI, 41.9–55.6). The differences in the blood levels of cadmium, arsenic, and mercury between the children with a hearing loss and controls were statistically insignificant (P > 0.05).

The combined effects of occupational exposure to noise and other risk factors - a systematic review

PURPOSE

Noise-induced health effects exacerbate by many other risk factors. This systematic review aims at shedding light on the combined effects of co-exposure to occupational noise and other factors.

MATERIAL AND METHODS

A literature search in Web of Science, Scopus, PubMed, Science Direct, and Google Scholar, with appropriate keywords on combined effects of occupational noise, and co-exposure to noise and other factors, revealed 7928 articles which were screened by two researchers. A total of 775 articles were reviewed in full text. We found 149 articles that were relevant and had sufficient quality for analysis.

RESULTS

We identified 16 risk factors that exacerbate occupational noise-induced health effects. These factors were classified into four groups: chemical (carbon monoxide (CO), solvents, heavy metals, and other chemicals), physical (lighting, heat, vibration, and cold), personal (age, gender, genetics, smoking, medication, contextual diseases) and occupational (workload and shift work). Hearing loss, hypertension, reduced performance, and cardiovascular strains, are the most important risk factors combined effects due to concurrent exposure to noise and other risk factors.

CONCLUSION

Evidences of combined effects of solvents, vibration, heavy metals, CO, smoking, chemicals, aging, heat, and shiftwork were respectively stronger than for other factors. Most of the studies have investigated only the combined effects of risk factors on hearing, and the evidence for non-auditory effects is still limited, and more studies are warranted. Therefore, in the Hearing Conservation Programs, besides noise, aggravating factors of noise effects should also be taken into account.

Chronic Lead Exposure Results in Auditory Deficits and Disruption of Hair Cells in Postweaning Rats

Objective

The effects of lead exposure on cognitive function have been studied intensively over the past decade, but less attention has focused on its impact on auditory function. This study is aimed at investigating the effect of lead on the cochlea and the molecular mechanisms responsible for its actions.

Methods

0.2% lead acetate was administered to rats in drinking water for 30, 60, and 90 days. Brainstem auditory evoked responses (ABR) were recorded, and morphological changes in the hair cells were observed. We also measured glutathione (GSH) and malondialdehyde (MDA) concentrations and antioxidant enzyme activities such as catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and glutathione reductase (GR) activities in the cochlea.

Results

Lead exposure increased the ABR threshold and slightly prolonged the latencies of wave II and wave IV in rats. Abnormally shaped hair cells and loss of hair cells were found in the cochlea basilar membrane, together with degenerative changes in spiral ganglion neurons following lead exposure. The activities of some antioxidant enzymes were also reduced in association with upregulation of MDA expression. These effects may be caused by impaired catalytic function of the enzymes as a result of lead interaction.

Conclusion

The antioxidant system of the cochlea in the immature rat brain is highly vulnerable to developmental lead exposure. Oxidative stress may therefore represent a possible mechanism for lead-induced auditory deficits.

Assessing ototoxicity due to chronic lead and cadmium intake with and without noise exposure in the mature mouse

Exposure to heavy metals may lead to hearing impairment. However, experimental studies have not explored this issue with and without noise exposure in mature animals with environmentally relevant doses. The aim of this study was to investigate ototoxicity produced by lead (Pb) and cadmium (Cd) and noise, singly and in combination, in the adult CBA/CaJ mouse. Metals were delivered via drinking water (0.03 mM, 1 mM, and 3 mM Pb; or 30, 100, and 300 μM Cd) for 12 weeks, resulting in environmentally- and occupationally relevant mean (± standard deviations) blood levels of Pb (2.89 ± 0.44, 38.5 ± 4.9, and 60.1 ± 6.6 μg/dl, respectively) and Cd (1.3 ± 0.23, 6.37 ± 0.87, 27.2 ± 4.1 μg/L, respectively). Metal treatment was also combined with a noise exposure consisting of a 105 dB broadband (2-20 kHz) stimulus for 2 hr or a sham exposure. Auditory performance was determined by comparing auditory brainstem responses (ABR) and distortion product otoacoustic emissions (DPOAE) at baseline and after 11 weeks of metal treatment. Metal-exposed animals did not develop significant auditory deficits and did not exhibit morphological damage to cochlear hair cells. In contrast, noise-exposed animals, including those exposed to combinations of metals and noise, demonstrated significant hair cell loss, reduced DPOAE amplitudes, and ABR threshold shifts of 42.2 ± 13 dB at 32 kHz (105 dB noise alone). No significant potentiation or synergistic effects were found in groups exposed to multiple agents. This study establishes a highly reproducible adult mouse model that may be used to evaluate a variety of environmental exposure mixtures.

Chronic lead exposure induces cochlear oxidative stress and potentiates noise-induced hearing loss

Acquired hearing loss is caused by complex interactions of multiple environmental risk factors, such as elevated levels of lead and noise, which are prevalent in urban communities. This study delineates the mechanism underlying lead-induced auditory dysfunction and its potential interaction with noise exposure. Young-adult C57BL/6 mice were exposed to: 1) control conditions; 2) 2 mM lead acetate in drinking water for 28 days; 3) 90 dB broadband noise 2 h/day for two weeks; and 4) both lead and noise. Blood lead levels were measured by inductively coupled plasma mass spectrometry analysis (ICP-MS) lead-induced cochlear oxidative stress signaling was assessed using targeted gene arrays, and the hearing thresholds were assessed by recording auditory brainstem responses. Chronic lead exposure downregulated cochlear Sod1, Gpx1, and Gstk1, which encode critical antioxidant enzymes, and upregulated ApoE, Hspa1a, Ercc2, Prnp, Ccl5, and Sqstm1, which are indicative of cellular apoptosis. Isolated exposure to lead or noise induced 8-12 dB and 11-25 dB shifts in hearing thresholds, respectively. Combined exposure induced 18-30 dB shifts, which was significantly higher than that observed with isolated exposures. This study suggests that chronic exposure to lead induces cochlear oxidative stress and potentiates noise-induced hearing impairment, possibly through parallel pathways.

Hearing loss, lead (Pb) exposure, and noise: a sound approach to ototoxicity exploration

To determine the state of the research on ototoxic properties of Pb, evaluate possible synergistic effects with concurrent noise exposure, and identify opportunities to improve future research, we performed a review of the peer-reviewed literature to identify studies examining auditory damage due to Pb over the past 50 years. Thirty-eight studies (14 animal and 24 human) were reviewed. Of these, 24 suggested potential ototoxicity due to Pb exposure, while 14 found no evidence of ototoxicity. More animal studies are needed, especially those investigating Pb exposure levels that are occupationally and environmentally relevant to humans. Further investigations into potential interactions of Pb in the auditory system with other hazards and compounds that elicit ototoxicity are also needed in animal models. To better assess the effects of Pb exposure on the human auditory system and the possibility of a synergism with noise, future epidemiological studies need to carefully consider and address four main areas of uncertainty: (1) hearing examination and quantification of hearing loss, (2) Pb exposure evaluation, (3) noise exposure evaluation, and (4) the personal characteristics of those exposed. Two potentially confounding factors, protective factors and mixtures of ototoxicants, also warrant further exploration.

Effects of combined exposure to metals, solvents, and noise on permanent threshold shifts

BACKGROUND

Studies suggest metal and solvent exposure may damage hearing. This study evaluated the association between exposures classified as high for metals, solvents, and noise on permanent threshold shift (PTS) development.

METHODS

A total of 1,546 personnel at an industrial shipyard were divided into five exposure groups based on level of concentration: high noise, high metals/solvents, high metals/noise, high metals/solvents/noise, and a low metals/solvents/noise reference group. Hearing threshold changes were analyzed to identify development of a PTS.

RESULTS

Logistic regression indicated high metals/solvents and high metals/solvent/noise groups had significantly greater odds ratios of 2.4; 95%CI [1.02, 2.85] and 1.7; 95%CI [1.46, 3.94], respectively, compared to a reference group. Both groups were associated with PTSs while controlling for age, gender, and exposure duration.

CONCLUSIONS

Simultaneous exposures classified as high for metals and solvents may damage hearing. Results suggest the need for expanding hearing conservation programs to consider combinations of exposures to metals, solvents, and noise. Am. J. Ind. Med. 60:227-238, 2017. © 2017 Wiley Periodicals, Inc.

The Adverse Effects of Heavy Metals with and without Noise Exposure on the Human Peripheral and Central Auditory System: A Literature Review

Exposure to some chemicals in the workplace can lead to occupational chemical-induced hearing loss. Attention has mainly focused on the adverse auditory effects of solvents. However, other chemicals such as heavy metals have been also identified as ototoxic agents. The aim of this work was to review the current scientific knowledge about the adverse auditory effects of heavy metal exposure with and without co-exposure to noise in humans. PubMed and Medline were accessed to find suitable articles. A total of 49 articles met the inclusion criteria. Results from the review showed that no evidence about the ototoxic effects in humans of manganese is available. Contradictory results have been found for arsenic, lead and mercury as well as for the possible interaction between heavy metals and noise. All studies found in this review have found that exposure to cadmium and mixtures of heavy metals induce auditory dysfunction. Most of the studies investigating the adverse auditory effects of heavy metals in humans have investigated human populations exposed to lead. Some of these studies suggest peripheral and central auditory dysfunction induced by lead exposure. It is concluded that further evidence from human studies about the adverse auditory effects of heavy metal exposure is still required. Despite this issue, audiologists and other hearing health care professionals should be aware of the possible auditory effects of heavy metals.

The Relationship between Occupational Exposure to Lead and Hearing Loss in a Cross-Sectional Survey of Iranian Workers

OBJECTIVES

Ototoxic effect of exposure to lead has been reported by many researchers. This study was undertaken with a view to investigate the relationship between blood lead level (BLL) and hearing loss in workers in a lead-acid battery manufacturing plant in Tehran, Iran.

METHODS

In a cross-sectional study, 609 male workers were recruited from different locations in the factory. Association between BLL and hearing loss in different frequencies were measured. Relationships were analyzed by logistic regressions. Statistical significance was defined as p-value <0.05.

RESULTS

Six hundred nine male workers with mean age 40 ± 7 years and mean noise exposure level of 80 (75-85) dB were evaluated. BLLs were categorized into four quartiles, and hearing loss in each quartile was compared to the first one. In our regression models, BLL was associated significantly with high frequency hearing loss, adjusted odds ratios for the comparison of the fourth, third, and second quartiles to the first one are respectively: 3.98 (95% CI: 1.63-9.71, p < 0.00), 3.05 (95% CI: 1.28-7.26, p < 0.01), and 2.89 (95% CI: 1.11-7.51, p < 0.03).

CONCLUSION

This study showed a dose-response relationship between BLL and hearing loss, after adjusting for potential confounders (age, body mass index, work duration, smoking, and occupational noise exposure) in logistic regressions. It is concluded that periodic hearing assessment by pure tone audiometry in workers exposed to lead should be recommended. However, additional studies are required to clarify the mechanisms of lead ototoxicity.

Adverse neurodevelopmental effects and hearing loss in children associated with manganese in well water, North Carolina, USA

Aim

Heavy metals such as manganese, arsenic and lead can act as neurotoxins. There have been few human studies of neurobehavioral/neurodevelopmental effects of arsenic and manganese on children in the United States. Since 1998, North Carolina has tested all new private wells for manganese, arsenic and lead. This study was conducted to evaluate adverse neurodevelopmental effects (delayed milestones, speech/language disorders and hearing loss) in children and metal concentrations in well water.

Methods

A quasi-regression model of the number of children (0–35 months of age) with adverse neurodevelopmental effects as outcome measures and aggregate mean metal concentration (arsenic, lead, and manganese) in private well water in each county as exposures.

Results

Over 70,000 private well water samples from 1998 to 2011 were analyzed for metal content. From 2008 to 2011, an average of 17,000 children was enrolled in the Infant Toddler Program. On average, 1.7% of children in this age range in each county had a speech/language disorder, 0.24% had a diagnosis of delayed milestones, and 0.026% had a diagnosis of hearing loss. The county mean manganese concentration was significantly and positively associated with the prevalence of delayed milestones and hearing loss in the children. No association was found for metal concentrations and speech/language disorders.

Conclusion

This ecological study indicates that further investigation of manganese in well water and associated neurodevelopmental health outcomes in children is needed.

Hearing

The main hazard for hearing in the workplace is noise. Organic solvents and heavy metals may increase the danger of developing occupational hearing loss, particularly in the case of co-exposure with noise. While noise produces damage predominantly to the cochlea, chemicals may be responsible for pathologic changes in both peripheral and central parts of the auditory pathway. Noise-induced hearing loss develops slowly over the years, although its progression is most dynamic during the first 10-15 years of exposure. Pure-tone audiometry indicates a bilateral sensorineural hearing loss, affecting predominantly high frequencies, with typical notch at 3-6 kHz in the early stages of the disease. Where there is co-exposure to noise and chemicals, the noise effect on hearing threshold shifts is dominant; however chemicals seem to increase the vulnerability of the cochlea to the damage by noise, particularly at its low and moderate levels. According to European Directive 2003/10/EC, the employer is obliged to implement hearing prevention programs when the A-weighted equivalent 8-hour level of noise (LAEX8 hr) exceeds 80 dB. Since chemicals may impair intelligibility of speech despite a lack of audiometric hearing threshold shift, implementation of speech audiometry, particularly speech in noise tests, is recommended in prevention programs.

Brainstem auditory evoked potentials in children with lead exposure

Introduction

Earlier studies have demonstrated an auditory effect of lead exposure in children, but information on the effects of low chronic exposures needs to be further elucidated.

Objective

To investigate the effect of low chronic exposures of the auditory system in children with a history of low blood lead levels, using an auditory electrophysiological test.

Methods

Contemporary cross-sectional cohort. Study participants underwent tympanometry, pure tone and speech audiometry, transient evoked otoacoustic emissions, and brainstem auditory evoked potentials, with blood lead monitoring over a period of 35.5 months. The study included 130 children, with ages ranging from 18 months to 14 years, 5 months (mean age 6 years, 8 months ± 3 years, 2 months).

Results

The mean time-integrated cumulative blood lead index was 12 μg/dL (SD ± 5.7, range: 2.433). All participants had hearing thresholds equal to or below 20 dBHL and normal amplitudes of transient evoked otoacoustic emissions. No association was found between the absolute latencies of waves I, III, and V, the interpeak latencies I–III, III–V, and I–V, and the cumulative lead values.

Conclusion

No evidence of toxic effects from chronic low lead exposures was observed on the auditory function of children living in a lead contaminated area.

Hearing loss and heavy metal toxicity in a Nicaraguan mining community: audiological results and case reports

We measured fingernail metal levels, Békésy-type pure-tone thresholds and distortion product otoacoustic emission (DPOAE) levels in 59 subjects residing in the gold mining community of Bonanza, Nicaragua. Auditory testing revealed widespread hearing loss in the cohort. Nail metal concentrations (mercury, lead, aluminum, manganese and arsenic) far exceeded reference levels. No relationship was found between metal levels and auditory test results for the group as a whole. Statistically significant relationships were found between DPOAE response amplitudes and metal concentrations in a subgroup with less than 40 h per week of significant noise exposure; however, conclusions regarding these relationships should be tempered by the large number of analyses performed. Several young individuals with high metal levels reported neurological symptoms and had poor hearing. The data suggest that metal levels in artisanal mining communities present a significant public health problem and may affect hearing.

Avaliação audiológica em crianças com baixo nível de exposição cumulativa ao chumbo

Objetivo verificar a ocorrência de perda auditiva sensorioneural em crianças com baixo nível de exposição cumulativa ao chumbo. Métodos 156 crianças intoxicadas por chumbo, 94 do sexo masculino e 62 do sexo feminino, na faixa etária entre 18 meses a 14 anos e 5 meses, foram submetidas a análise longitudinal do nível de Plumbemia em sangue, bem como audiometria tonal liminar e emissões otoacústicas evocadas por estímulo transiente. Resultados a população pesquisada apresentou um valor médio de Plumbemia estimada de 12,2±5,7mg/dL (faixa entre 2,4-33mg/dL); todas as crianças apresentaram resposta normal na audiometria tonal liminar em 20 dBNA nas frequências testadas, 0,5; 1; 2 e 4 kHz, para ambas as orelhas; as emissões otoacústicas evocadas por estímulo transiente estiveram presentes para todas as frequências bilateralmente, nas 79 crianças pesquisadas. Conclusão não foi constatada perda auditiva sensorioneural em crianças com histórico de baixo nível de exposição cumulativa por chumbo, assim como não foi encontrada lesão de células ciliadas externas na cóclea, mesmo que subclínicas.

Inhibition of ROS elevation and damage to mitochondrial function prevents lead-induced neurotoxic effects on structures and functions of AFD neurons in Caenorhabditis elegans

Here we investigated the possible roles of oxidative stress in the formation of decreased thermotaxis to cultivation temperature in lead (Pb)-exposed nematodes Caenorhabditis elagans. Exposure to Pb at the examined concentrations decreased thermotaxis behaviors, and induced severe deficits in the structural properties of AFD sensory neurons. Meanwhile, Pb exposure caused the induction of severe oxidative damage, reactive oxygen species (ROS) production, and mitochondrial dysfunction in young adults. Moreover, pre-treatment with the antioxidants dimethyl sulfoxide (DMSO), ascorbate and N-acetyl-L-cysteine (NAC), used to inhibit both the ROS elevation and the mitochondrial dysfunction caused by Pb exposure, at the L2-larval stage prevented the induction of oxidative damage and the formation of severe deficits in thermotaxis and structural properties of AFD sensory neurons in Pb-exposed young adults. Therefore, the formation of oxidative stress caused by Pb exposure may be due to both the induction of ROS elevation and damage to mitochondrial function, and oxidative stress may play a key role in inducing the neurotoxic effects on the structures and function of AFD sensory neurons in Pb-exposed nematodes.

A weight of evidence approach for the assessment of the ototoxic potential of industrial chemicals

There is accumulating epidemiological evidence that exposure to some solvents, metals, asphyxiants and other substances in humans is associated with an increased risk of acquiring hearing loss. Furthermore, simultaneous and successive exposure to certain chemicals along with noise can increase the susceptibility to noise-induced hearing loss. There are no regulations that require hearing monitoring of workers who are employed at locations in which occupational exposure to potentially ototoxic chemicals occurs in the absence of noise exposure. This project was undertaken to develop a toxicological database allowing the identification of possible ototoxic substances present in the work environment alone or in combination with noise exposure. Critical toxicological data were compiled for chemical substances included in the Quebec occupational health regulation. The data were evaluated only for noise exposure levels that can be encountered in the workplace and for realistic exposure concentrations up to the short-term exposure limit or ceiling value (CV) or 5 times the 8-h time-weighted average occupational exposure limit (TWA OEL) for human data and up to 100 times the 8-h TWA OEL or CV for animal studies. In total, 224 studies (in 150 articles of which 44 evaluated the combined exposure to noise and a chemical) covering 29 substances were evaluated using a weight of evidence approach. For the majority of cases where potential ototoxicity was previously proposed, there is a paucity of toxicological data in the primary literature. Human and animal studies indicate that lead, styrene, toluene and trichloroethylene are ototoxic and ethyl benzene, n-hexane and p-xylene are possibly ototoxic at concentrations that are relevant to the occupational setting. Carbon monoxide appears to exacerbate noise-induced hearing dysfunction. Toluene interacts with noise to induce more severe hearing losses than the noise alone.

Environmental lead exposure and otoacoustic emissions in Andean children

Studies relating sensory hearing impairment to lead (Pb) exposure in children have presented inconsistent results. The objective of this study was to measure distortion product otoacoustic emissions (DPOAE), sounds emanating from the outer hair cells of the inner ear, in Pb-exposed children to determine the effects of Pb poisoning on the inner ear. DPOAE were recorded for 9 f(2) frequencies from 1187 to 7625 Hz on 102 ears of 53 Pb-exposed children (aged 6-16 yr) residing in Pb-contaminated environments in the Andes Mountains of Ecuador where Pb glazing of ceramics is the primary livelihood. Blood lead (PbB) levels ranged from 4.2 to 94.3 μg/dl (mean: 37.7; SD: 25.7; median: 36.4). The median PbB level was markedly higher than the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) 10-μg/dl action level. Spearman rho correlation analyses of the relation between PbB level and DPOAE amplitude and between PbB level and DPOAE signal-to-noise ratio revealed no significant associations at any of the f(2) frequencies tested. In addition, no significant correlation (Spearman rho) between PbB level and hearing sensitivity for 6 pure-tone test frequencies from 1000 to 8000 Hz was found. Although the study group was found to have abnormally elevated PbB levels, in contrast to some earlier reports, the results of the current study showed no consistent Pb-induced sensory effects on the cochlea of Pb-intoxicated children.

Cumulative lead exposure and age-related hearing loss: the VA Normative Aging Study

Although lead has been associated with hearing loss in occupational settings and in children, little epidemiologic research has been conducted on the impact of cumulative lead exposure on age-related hearing loss in the general population. We determined whether bone lead levels, a marker of cumulative lead exposure, are associated with decreased hearing ability in 448 men from the Normative Aging Study, seen between 1962 and 1996 (2264 total observations). Air conduction hearing thresholds were measured at 0.25-8 kHz and pure-tone averages (PTA) (mean of 0.5, 1, 2 and 4 kHz) were computed. Tibia and patella lead levels were measured using K X-ray fluorescence between 1991 and 1996. In cross-sectional analyses, after adjusting for potential confounders including occupational noise, patella lead levels were significantly associated with poorer hearing thresholds at 2, 3, 4, 6 and 8 kHz and PTA. The odds of hearing loss significantly increased with patella lead levels. We also found significant positive associations between tibia lead and the rate change in hearing thresholds at 1, 2, and 8 kHz and PTA in longitudinal analyses. Our results suggest that chronic low-level lead exposure may be an important risk factor for age-related hearing loss and reduction of lead exposure could help prevent or delay development of age-related hearing loss.

The association between low levels of lead in blood and occupational noise-induced hearing loss in steel workers

As the use of leaded gasoline has ceased in the last decade, background lead exposure has generally been reduced. The aim of this study was to examine the effect of low-level lead exposure on human hearing loss. This study was conducted in a steel plant and 412 workers were recruited from all over the plant. Personal information such as demographics and work history was obtained through a questionnaire. All subjects took part in an audiometric examination of hearing thresholds, for both ears, with air-conducted pure tones at frequencies of 500, 1000, 2000, 3000, 4000, 6000 and 8000 Hz. Subjects' blood samples were collected and analyzed for levels of manganese, copper, zinc, arsenic, cadmium and lead with inductive couple plasma-mass spectrometry. Meanwhile, noise levels in different working zones were determined using a sound level meter with A-weighting network. Only subjects with hearing loss difference of no more than 15 dB between both ears and had no congenital abnormalities were included in further data analysis. Lead was the only metal in blood found significantly correlated with hearing loss for most tested sound frequencies (p<0.05 to p<0.0001). After adjustment for age and noise level, the logistic regression model analysis indicated that elevated blood lead over 7 microg/dL was significantly associated with hearing loss at the sound frequencies of 3000 through 8000 Hz with odds ratios raging from 3.06 to 6.26 (p<0.05-p<0.005). We concluded that elevated blood lead at level below 10 microg/dL might enhance the noise-induced hearing loss. Future research needs to further explore the detailed mechanism.

Exposure to metals induces morphological and functional alteration of AFD neurons in nematode Caenorhabditis elegans

Previous studies have revealed that metal exposure will cause severe deficits in perception behaviors. Here we investigated the effects of metal (Hg, Cu, Ag, and Cr) exposure on thermotaxis to cultivation temperature in Caenorhabditis elegans. Our data suggest that exposure to higher concentrations of examined metals induced severe deficits in thermotaxis, and a significant reduction in thermotaxis could be even observed in nematodes exposed to 2.5μM of Hg. Moreover, exposure to higher concentrations of examined metals and 2.5μM of Hg induced significant decreases in relative intensities and relative sizes of fluorescent puncta of cell bodies in AFD thermosensory neurons. In addition, exposure to higher concentrations of examined metals resulted in a significant reduction in relative intensities and relative lengths of sensory endings in AFD neurons. Furthermore, the relative transcript levels of ttx-1, which functions in specifying the fate of AFD neuron, were significantly decreased in nematodes exposed to 2.5μM of Hg, and 50 and 100μM of examined metals. Thus, metal exposure at high concentrations will induce the severe deficits in thermotaxis to cultivation temperature possibly by altering the morphology or development of AFD neuron and damaging the molecular basis for function of AFD neuron in nematodes.

An assessment of the effects of increased regulatory enforcement and legislative reform on occupational hearing loss workers' compensation claims: Oregon 1984-1998

BACKGROUND

Hearing loss from occupational exposures is a serious and widespread problem. This study measured the outcomes that increased enforcement of regulations and legislative interventions had on hearing loss workers' compensation claims.

METHODS

Workers' compensation claim data from Oregon was analyzed for the period of 1984-1998 to examine trends and severity of hearing loss claims. In 1987 and 1990, Oregon enacted legislative reforms to improve enforcement and promulgation of safety standards in the state. This study examined hearing loss claims between the periods of pre- and post-legislative reforms.

RESULTS

It was found that hearing loss claims decreased significantly following the legislative reforms, although the average cost per claim increased. Age and tenure effects, and evidence of moral hazard were also discovered.

CONCLUSIONS

Increased enforcement of regulations and legislative interventions by Oregon improved working conditions leading to occupational hearing loss. Nevertheless, hearing loss remains problematic, and continued efforts are required to improve worker safety.

Occupational exposure to chemicals and sensory organs: a neglected research field

The effect of industrial chemicals on the sensory perception of exposed workers has received scant attention from the medical community to date, and the scientific literature is mainly limited to some case-reports or isolated studies. Possible explanations for this include the complexity of sensory perception, and the lack of agreement among researchers on methods for testing large groups of subjects. Nevertheless, some published studies showed that vision, hearing and olfactory function can be affected by various industrial metals and solvents, and some data exist also for touch and taste. This review discusses the main industrial chemicals involved. The pathogenesis of the toxicity of chemicals to sensory perception may be related to an action on receptors, nerve fibers, and/or the brain; probably, different pathogenetic mechanisms are involved. One of the main problems in this research field is that most of the studies to date evaluated the effect of a single industrial chemical on a single sense: as an example, we know that styrene exposure can impair smell and also hearing and vision but we have little idea whether different senses are impaired in the same worker, or whether each impairment is independent. In addition, workers are frequently exposed to different chemicals: co-exposure may have no effect, or result in both an increase or a decrease of the effect, as was observed for hearing loss, but studies on this aspect are largely insufficient. Research shows that both occupational and environmental exposure to industrial chemicals can affect sense organs, and suggests that the decline of perception with age may be, at least partly, related to this exposure. Nevertheless, available evidence is incomplete, and is largely inadequate for an estimation of a "safe" threshold of exposure. Good quality further research in this field is needed. This is certainly complex and demands adequate resources, but is justified by the ultimate result: the possibility to prevent an avoidable part of the decline in sensory function with age.

Lead induced increase of blood pressure in female lead workers

AIMS

Although lead exposure has, in the absence of mathematical modelling, been believed to elevate blood pressure in females, it is necessary to clarify the relation between lead and blood pressure by eliminating confounding factors in the analysis.

METHODS

Blood lead was measured in 193 female workers, including 123 lead exposed workers. Possible confounding factors were controlled by multiple regression analyses.

RESULTS AND CONCLUSIONS

Blood lead above 40 micro g/dl was found to be the most potent factor for elevating systolic/diastolic blood pressure. Aging, urine protein, and plasma triglyceride also contributed to systolic/diastolic/pulse pressure increase, but hypertensive heredity did not. Data suggested that lead induced changes in lipoprotein metabolism may play an important role in the lead induced blood pressure increase in female workers.

Neuro-ototoxicity in andean adults with chronic lead and noise exposure

Brainstem auditory evoked responses and audiological thresholds were used as biomarkers for neuro-ototoxicity in adults with chronic lead (Pb) intoxication from long-term Pb exposure in ceramic-glazing work. Venous blood samples collected from 30 adults (15 men and 15 women) indicated a mean blood Pb level of 45.1 micrograms/dL (SD, 19.5; range, 11.2 to 80.0 micrograms/dL) and in excess of the World Health Organization health-based biological limits (men, 46.2 micrograms/dL; SD, 19.6; range, 18.3 to 80.0 micrograms/dL; women, 44.0 micrograms/dL; SD, 20.1; range, 11.2 to 74.2 micrograms/dL). Mean auditory thresholds at frequencies susceptible to ototoxicity (2.0, 3.0, 4.0, 6.0, and 8.0 kHz) revealed sensory-neural hearing loss in men, which may be attributable to occupational noise exposure in combination with Pb intoxication. Bilateral brainstem auditory evoked response tests on participants with elevated blood Pb levels (mean, 47.0 micrograms/dL) showed delayed wave latencies consistent with sensory-neural hearing impairment. The results suggest that environmental noise exposure must be considered an important factor in determining sensory-neural hearing status in occupationally Pb-exposed adults.