Effects of Coexposure to Noise and Mixture of Organic Solvents on Hearing in Dockyard Workers

Occupational health risk assessment of workplace solvents and noise in the electronics industry using three comprehensive risk assessment models

Background

Occupational hazards such as solvents and noise in the electronics industry are serious. Although various occupational health risk assessment models have been applied in the electronics industry, they have only been used to assess the risks of individual job positions. Few existing studies have focused on the total risk level of critical risk factors in enterprises.

Methods

Ten electronics enterprises were selected for this study. Information, air samples and physical factor measurements were collected from the selected enterprises through on-site investigation, and then the data were collated and samples were tested according to the requirements of Chinese standards. The Occupational Health Risk Classification and Assessment Model (referred to as the Classification Model), the Occupational Health Risk Grading and Assessment Model (referred to as the Grading Model), and the Occupational Disease Hazard Evaluation Model were used to assess the risks of the enterprises. The correlations and differences between the three models were analyzed, and the results of the models were validated by the average risk level of all of the hazard factors.

Results

Hazards with concentrations exceeding the Chinese occupational exposure limits (OELs) were methylene chloride, 1,2-dichloroethane, and noise. The exposure time of workers ranged from 1 to 11 h per day and the frequency of exposure ranged from 5 to 6 times per week. The risk ratios (RRs) of the Classification Model, the Grading Model and the Occupational Disease Hazard Evaluation Model were 0.70 ± 0.10, 0.34 ± 0.13, and 0.65 ± 0.21, respectively. The RRs for the three risk assessment models were statistically different (P < 0.001), and there were no correlations between them (P > 0.05). The average risk level of all of the hazard factors was 0.38 ± 0.18, which did not differ from the RRs of the Grading Model (P > 0.05).

Conclusions

The hazards of organic solvents and noise in the electronics industry are not negligible. The Grading Model offers a good reflection of the actual risk level of the electronics industry and has strong practicability.

Effects of coexposure to noise and mixture of toluene, ethylbenzene, xylene, and styrene (TEXS) on hearing loss in petrochemical workers of southern China

Many harmful factors existing simultaneously with noise are reported to induce hearing impairment, such as organic solvents. However, the existing hearing safety limits and current risk assessment for hearing loss rely on single noise exposure. It is urgent to clarify the combined effect of noise and other harmful factors on hearing loss. Petrochemical workers are always exposed to noise and organic solvents, mainly benzene, toluene, ethylbenzene, xylene, and styrene (BTEXS), while the combined effect of their coexposure on hearing remains unclear. Herein we conducted a cross-sectional survey, measuring pure-tone audiometry of 1496 petrochemical workers in southern China. Participants exposed to BTEXS were 569, 524, 156, 452, and 177 respectively. Individual cumulative noise exposure (CNE) levels and BTEXS exposure were assessed. The average CNE was 93.27 ± 4.92 dB(A)·years, and the concentrations of BTEXS were far below the occupational exposure limits of China. Logistic regression analyses showed that CNE was consistently positively associated with hearing loss (HL) and high-frequency hearing loss (HFHL) but not related to speech-frequency hearing loss (SFHL). Compared with participants in the lowest quartile of CNE, those in the highest quartile showed an OR of 5.229 (95% CI: 3.179, 8.598) for HFHL. Two-pollutant model analysis indicated that TEXS exposure was positively associated with HL (OR 1.679, 95%CI 1.086, 2.597), SFHL (OR 2.440, 95%CI 1.255, 4.744), and HFHL (OR 1.475, 95%CI 1.077, 2.020). However, no interactions were observed between CNE and TEXS coexposure on hearing loss. In our study, covariates including smoking and drinking status, body mass index (BMI), ear protection and personal protective equipment, and use of earphone/headphone were adjusted. In conclusion, coexposure to noise and low-level TEXS could induce more severe damage on hearing function than exposure to each alone, especially SFHL. Therefore, petrochemical workers simultaneously exposed to noise and TEXS, even at low-level, should be included in hearing protection programs.

MicroRNA expression is associated with auditory dysfunction in workers exposed to ototoxic solvents and noise

This study is part of a project on early hearing dysfunction induced by combined exposure to volatile organic compounds (VOCs) and noise in occupational settings. In a previous study, 56 microRNAs were found differentially expressed in exposed workers compared to controls. Here, we analyze the statistical association of microRNA expression with audiometric hearing level (HL) and distortion product otoacoustic emission (DPOAE) level in that subset of differentially expressed microRNAs. The highest negative correlations were found; for HL, with miR-195-5p and miR-122-5p, and, for DPOAEs, with miR-92b-5p and miR-206. The homozygous (mut) and heterozygous (het) variants of the gene hOGG1 were found disadvantaged with respect to the wild-type (wt), as regards the risk of hearing impairment due to exposure to VOCs. An unsupervised artificial neural network (auto contractive map) was also used to detect and show, using graph analysis, the hidden connections between the explored variables. These findings may contribute to the formulation of mechanistic hypotheses about hearing damage due to co-exposure to noise and ototoxic solvents.

The prevalence of occupational exposure to noise: A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury

BACKGROUND

The World Health Organization (WHO) and the International Labour Organization (ILO) are developing joint estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large network of individual experts. Evidence from mechanistic and human data suggests that occupational exposure to noise may cause cardiovascular disease. In this paper, we present a systematic review and meta-analysis of the prevalence of occupational exposure to noise for estimating (if feasible) the number of deaths and disability-adjusted life years from cardiovascular disease that are attributable to exposure to this risk factor, for the development of the WHO/ILO Joint Estimates.

OBJECTIVES

We aimed to systematically review and meta-analyse estimates of the prevalence of occupational exposure to noise.

DATA SOURCES

We searched electronic academic databases for potentially relevant records from published and unpublished studies, including Ovid Medline, PubMed, EMBASE, and CISDOC. We also searched electronic grey literature databases, Internet search engines, and organizational websites; hand-searched reference list of previous systematic reviews and included study records; and consulted additional experts.

STUDY ELIGIBILITY AND CRITERIA

We included working-age (≥15 years) workers in the formal and informal economies in any WHO Member and/or ILO member State, but excluded children (<15 years) and unpaid domestic workers. We included all study types with an estimate of the prevalence of occupational exposure to noise, categorized into two levels: no (low) occupational exposure to noise (<85dBA) and any (high) occupational exposure to noise (≥85dBA).

STUDY APPRAISAL AND SYNTHESIS METHODS

At least two review authors independently screened titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. We combined prevalence estimates using random-effect meta-analysis. Two or more review authors assessed the risk of bias and the quality of evidence, using the RoB-SPEO tool and QoE-SPEO approach developed specifically for the WHO/ILO Joint Estimates.

RESULTS

Sixty-five studies (56 cross-sectional studies and nine cohort studies) met the inclusion criteria, comprising 157,370 participants (15,369 females) across 28 countries and all six WHO regions (Africa, Americas, Eastern Mediterranean, Europe, South-East Asia, and Western Pacific). For the main analyses, we prioritized the four included studies that surveyed national probability samples of general populations of workers over the 58 studies of workers in industrial sectors and/or occupations with relatively high occupational exposure to noise. The exposure was generally assessed with dosimetry, sound level meter, or official or company records; in the population-based studies, it was assessed with validated questions. Estimates of the prevalence of occupational exposure to noise are presented for all 65 included studies, by country, sex, 5-year age group, industrial sector, and occupation where feasible. The pooled prevalence of any (high) occupational exposure to noise (≥85dBA) among the general population of workers was 0.17 (95% confidence interval 0.16 to 0.19, 4 studies, 108,256 participants, 38 countries, two WHO regions, I2 98%, low quality of evidence). Subgroup analyses showed that pooled prevalence differed substantially by WHO region, sex, industrial sector, and occupation.

CONCLUSIONS

Our systematic review and meta-analysis found that occupational exposure to noise is prevalent among general populations of workers. The current body of evidence is, however, of low quality, due to serious concerns for risk of bias and indirectness. Producing estimates of occupational exposure to noise nevertheless appears evidence-based, and the pooled effect estimates presented in this systematic review are suitable as input data for the WHO/ILO Joint Estimates (if feasible). Protocol identifier: 10.1016/j.envint.2018.09.040 PROSPERO registration number: CRD42018092272.

Comparative Study of Evoked Otoacoustic Emissions in Offshore and Onshore Seafaring Workers

PURPOSE

To evaluate the cochlear function of offshore and onshore seafaring workers of a naval company in the city of Rio de Janeiro and to estimate the degree of association between occupational exposure to noise and/or chemical substances and alteration in cochlear function.

METHODS

This study evaluated seafaring workers aged 20 to 49, of both genders, without auditory symptoms, divided into two groups: the Offshore Group, operating in the high seas with occupational exposure; and the Onshore Group, operating in offices without occupational exposure. Exams were performed to evaluate cochlear function, including transient evoked otoacoustic emissions (TEOAE) and distortion product otoacoustic emissions (DPOAE).

RESULTS

The TEOAE and DPOAE responses were on average lower in the Offshore Group, for all frequencies analyzed. The proportion of failures observed was also higher in the exposure group (Offshore), for general response and specific frequency, mainly for the frequencies of 4 kHz for TEOAE and 6 kHz for DPOAE.

CONCLUSION

The results suggest that exposure to noise and/or chemical substances can contribute to alterations in cochlear function in seafarers even without manifesting auditory symptoms.

Research and Discussion on the Relationships between Noise-Induced Hearing Loss and ATP2B2 Gene Polymorphism

Long-term and continuous noise exposure can result in noise-induced hearing loss (NIHL), which is a worldwide problem resulting from the interaction of environmental and genetic factors. The ATP2B2 gene polymorphism can destroy cochlear hair cells and increase the risk of NIHL. A case-control study of 760 Chinese textile workers was conducted to investigate the relationship between ATP2B2 polymorphisms and NIHL susceptibility. Venous blood was collected and questionnaires were conducted by professional physicians. A case group and a control group which were typed by individuals' pure-tone audiometry test results were set. Three polymorphism sites of ATP2B2 were genotyped by using the PCR technique. Analysis results revealed that the C allele of rs3209637 (95%CI = 1.08-2.58, odds ratio (OR) = 1.67, P = 0.027) was a dangerous factor and could add to risks of NIHL in the Chinese employees. The data of stratified analysis revealed that individuals who are exposed to noise > 95 dB with the rs3209637 C genotype have a higher susceptibility to NIHL (OR = 1.34, 95%CI = 1.07-1.68). Multifactor dimensionality reduction analysis revealed that the interaction between rs14154 and rs3209637 is linked to increased NIHL risk, and for the interaction among rs14154, smoking and drinking had the same function (OR = 1.54 and 1.77, 95%CI = 1.15-2.07, 1.33-2.37, and P = 0.0037 and P < 0.0001, respectively). Our results suggest that genetic polymorphism rs3209637 C within ATP2B2 is a risk factor for NIHL among Chinese employees and rs3209637 C could be a potential biomarker for NIHL patients.

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.

Impact of Aging on the Auditory System and Related Cognitive Functions: A Narrative Review

Age-related hearing loss (ARHL), presbycusis, is a chronic health condition that affects approximately one-third of the world's population. The peripheral and central hearing alterations associated with age-related hearing loss have a profound impact on perception of verbal and non-verbal auditory stimuli. The high prevalence of hearing loss in the older adults corresponds to the increased frequency of dementia in this population. Therefore, researchers have focused their attention on age-related central effects that occur independent of the peripheral hearing loss as well as central effects of peripheral hearing loss and its association with cognitive decline and dementia. Here we review the current evidence for the age-related changes of the peripheral and central auditory system and the relationship between hearing loss and pathological cognitive decline and dementia. Furthermore, there is a paucity of evidence on the relationship between ARHL and established biomarkers of Alzheimer's disease, as the most common cause of dementia. Such studies are critical to be able to consider any causal relationship between dementia and ARHL. While this narrative review will examine the pathophysiological alterations in both the peripheral and central auditory system and its clinical implications, the question remains unanswered whether hearing loss causes cognitive impairment or vice versa.

Hearing loss in workers exposed to epoxy adhesives and noise: a cross-sectional study

OBJECTIVES

Epoxy adhesives contain organic solvents and are widely used in industry. The hazardous effects of epoxy adhesives remain unclear. The objective of this study was to investigate the risk of hearing loss among workers exposed to epoxy adhesives and noise.

DESIGN

Cross-sectional study.

METHODS

For this cross-sectional study, we recruited 182 stone workers who were exposed to both epoxy adhesives and noise, 89 stone workers who were exposed to noise only, and 43 workers from the administrative staff who had not been exposed to adhesives or noise. We obtained demographic data, occupational history and medical history through face-to-face interviews and arranged physical examinations and pure-tone audiometric tests. We also conducted walk-through surveys in the stone industry. A total of 40 representative noise assessments were conducted in 15 workplaces. Air sampling was conducted at 40 workplaces, and volatile organic compounds were analysed using the Environmental Protection Agency (EPA) TO-15 method.

RESULTS

The mean sound pressure level was 87.7 dBA (SD 9.9). The prevalence of noise-induced hearing loss was considerably increased in the stone workers exposed to epoxy adhesives (42%) compared with the stone workers who were not exposed to epoxy adhesives (21%) and the administrative staff group (9.3%). A multivariate logistic regression analysis revealed that exposure to epoxy adhesives significantly increased the risk of hearing loss between 2 and 6 kHz after adjusting for age. Significant interactions between epoxy adhesives and noise and hearing impairment were observed at 3, 4 and 6 kHz.

CONCLUSIONS

Epoxy adhesives exacerbate hearing impairment in noisy environments, with the main impacts occurring in the middle and high frequencies.

Perda auditiva associada à exposição ocupacional a solventes orgânicos: uma revisão sistemática

Resumo Introdução: evidências apontam produtos químicos como agentes potencialmente otoneurotóxicos, todavia, ainda não há consenso quanto às associações entre as características das exposições e a ototoxicidade das diversas substâncias químicas presentes em ambientes laborais. Objetivo: revisar a literatura científica disponível, a fim de identificar estudos que apontem evidências de associação, ou não associação, entre dano auditivo e a exposição a solventes orgânicos. Método: revisão sistemática da literatura a partir da consulta a bases de dados eletrônicas, considerando artigos originais, publicados de janeiro de 1987 a fevereiro de 2013. Resultados: trinta e um estudos foram incluídos na revisão sistemática. Discussão: os estudos confirmaram a exposição a determinados solventes como fator de risco para perda auditiva de origem ocupacional, sobretudo na presença do ruído. Foram utilizados métodos variados de avaliação e classificação do desfecho coclear e/ou central, que contribuíram para a compreensão da extensão da perda auditiva induzida quimicamente, bem como com a identificação dos grupos populacionais susceptíveis. Contudo, dados sobre procedimentos diagnósticos adequados, níveis seguros e efeito dose-resposta da exposição química ainda não foram totalmente elucidados.

Occupational noise exposure and hearing: a systematic review

Purpose

To give a systematic review of the development of noise-induced hearing loss (NIHL) in working life.

Methods

A literature search in MEDLINE, Embase, Web of Science, Scopus, and Health and Safety Abstracts, with appropriate keywords on noise in the workplace and health, revealed 22,413 articles which were screened by six researchers. A total of 698 articles were reviewed in full text and scored with a checklist, and 187 articles were found to be relevant and of sufficient quality for further analysis.

Results

Occupational noise exposure causes between 7 and 21 % of the hearing loss among workers, lowest in the industrialized countries, where the incidence is going down, and highest in the developing countries. It is difficult to distinguish between NIHL and age-related hearing loss at an individual level. Most of the hearing loss is age related. Men lose hearing more than women do. Heredity also plays a part. Socioeconomic position, ethnicity and other factors, such as smoking, high blood pressure, diabetes, vibration and chemical substances, may also affect hearing. The use of firearms may be harmful to hearing, whereas most other sources of leisure-time noise seem to be less important. Impulse noise seems to be more deleterious to hearing than continuous noise. Occupational groups at high risk of NIHL are the military, construction workers, agriculture and others with high noise exposure.

Conclusion

The prevalence of NIHL is declining in most industrialized countries, probably due to preventive measures. Hearing loss is mainly related to increasing age.

Electronic supplementary material

The online version of this article (doi:10.1007/s00420-015-1083-5) contains supplementary material, which is available to authorized users.

Auditory effects of exposure to noise and solvents: a comparative study

Introduction Industry workers are exposed to different environmental risk agents that, when combined, may potentiate risks to hearing. Objective To evaluate the effects of the combined exposure to noise and solvents on hearing in workers. Methods A transversal retrospective cohort study was performed through documentary analysis of an industry. The sample (n = 198) was divided into four groups: the noise group (NG), exposed only to noise; the noise and solvents group (NSG), exposed to noise and solvents; the noise control group and noise and solvents control group (CNS), no exposure. Results The NG showed 16.66% of cases suggestive of bilateral noise-induced hearing loss and NSG showed 5.26%. The NG and NSG had worse thresholds than their respective control groups. Females were less susceptible to noise than males; however, when simultaneously exposed to solvents, hearing was affected in a similar way, resulting in significant differences (p < 0.05). The 40- to 49-year-old age group was significantly worse (p < 0.05) in the auditory thresholds in the NSG compared with the CNS. Conclusion The results observed in this study indicate that simultaneous exposure to noise and solvents can damage the peripheral auditory system.

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.

A Pilot Assessment of Occupational Health Hazards in the US Electronic Scrap Recycling Industry

The National Institute for Occupational Safety and Health (NIOSH) surveyed a randomly selected sample of electronic scrap (e-scrap) recycling facilities nationwide to characterize work processes, exposures, and controls. Despite multiple attempts to contact 278 facilities, only 47 responded (17% response rate). Surveyed facilities reported recycling a wide variety of electronics. The most common recycling processes were manual dismantling and sorting. Other processes included shredding, crushing, and automated separation. Many facilities reported that they had health and safety programs in place. However, some facilities reported the use of compressed air for cleaning, a practice that can lead to increased employee dust exposures, and some facilities allowed food and drinks in the production areas, a practice that can lead to ingestion of contaminants. Although our results may not be generalizable to all US e-scrap recycling facilities, they are informative regarding health and safety programs in the industry. We concluded that e-scrap recycling has the potential for a wide variety of occupational exposures particularly because of the frequent use of manual processes. On-site evaluations of e-scrap recyclers are needed to determine if reported work processes, practices, and controls are effective and meet current standards and guidelines. Educating the e-scrap recycling industry about health and safety best practices, specifically related to safe handling of metal dust, would help protect employees.

Control of workers' exposure to xylene in a pesticide production factory

BACKGROUND

Acute and chronic exposure to xylene can result in a range of negative health effects. However, xylene is widely used and emitted in the air of workplaces.

OBJECTIVES

To evaluate xylene vapor concentrations to guide the design and evaluation of a local exhaust ventilation (LEV) system to reduce exposure in a pesticide production factory.

METHOD

A real time volatile organic compound (VOC) monitor was used to determine the workers' time-weighted average (TWA) exposure. A LEV system was designed, and then, workers' exposure to xylene vapor was evaluated.

RESULTS

We found that worker's exposure to xylene (4·7±5·5 ppm) was lower than the standards recommended by the American Conference of Governmental Industrial Hygienists (ACGIH) and the Occupational safety and health administration (OSHA). Despite the low TWA exposures, the short-term exposures for some workers were higher than STEL levels. Three canopy hoods were designed and installed with capture velocities of 0·508 m second(-1) and duct velocity of 10·16 m second(-1).

CONCLUSION

We found that an exhaust ventilation system had a significantly reduced occupational exposure to xylene vapor.

Noise-induced hearing loss in Korean workers: co-exposure to organic solvents and heavy metals in nationwide industries

Background

Noise exposure is a well-known contributor to work-related hearing loss. Recent biological evidence suggests that exposure to ototoxic chemicals such as organic solvents and heavy metals may be additional contributors to hearing loss. However, in industrial settings, it is difficult to determine the risks of hearing loss due to these chemicals in workplaces accompanied by excessive noise exposure. A few studies suggest that the effect of noise may be enhanced by ototoxic chemicals. Therefore, this study investigated whether co-exposure to organic solvents and/or heavy metals in the workplace modifies the risk of noise exposure on hearing loss in a background of excessive noise.

Methods

We examined 30,072 workers nationwide in a wide range of industries from the Korea National Occupational Health Surveillance 2009. Data on industry-based exposure (e.g., occupational noise, heavy metals, and organic solvents) and subject-specific health outcomes (e.g., audiometric examination) were collected. Noise was measured as the daily 8-h time-weighted average level. Air conduction hearing thresholds were measured from 0.5 to 6 kHz, and pure-tone averages (PTA) (i.e., means of 2, 3, and 4 kHz) were computed.

Results

In the multivariate linear model, PTA increment with occupational noise were 1.64-fold and 2.15-fold higher in individuals exposed to heavy metals and organic solvents than in unexposed individuals, respectively.

Conclusion

This study provides nationwide evidence that co-exposure to heavy metals and/or organic solvents may exacerbate the effect of noise exposure on hearing loss in workplaces. These findings suggest that workers in industries dealing with heavy metals or organic solvents are susceptible to such risks.

A functional Ser326Cys polymorphism in hOGG1 is associated with noise-induced hearing loss in a Chinese population

DNA damage to cochlear hair cells caused by 8-oxoguanine (8-oxoG) is essential for the development of noise-induced hearing loss (NIHL). Human 8-oxoG DNA glycosylase1 (hOGG1) is a key enzyme in the base excision repair (BER) pathway that eliminates 8-oxoG. Many epidemiological and functional studies have suggested that the hOGG1 Ser326Cys polymorphism (rs1052133) is associated with many diseases. The purpose of this investigation was to investigate whether the hOGG1 Ser326Cys polymorphism in the human BER pathway is associated with genetic susceptibility to NIHL in a Chinese population. This polymorphism was genotyped among 612 workers with NIHL and 615 workers with normal hearing. We found that individuals with the hOGG1 Cys/Cys genotype had a statistically significantly increased risk of NIHL compared with those who carried the hOGG1 Ser/Ser genotype (adjusted OR=1.59, 95% CI=1.13-2.25) and this increased risk was more pronounced among the workers in the 15- to 25- and >25-year noise exposure time, 85-92 dB(A) noise exposure level, ever smoking, and ever drinking groups, similar effects were also observed in a recessive model. In summary, our data suggested that the hOGG1 Cys/Cys genotype may be a genetic susceptibility marker for NIHL in the Chinese Han population.

Challenges and Successes in Recruiting Firefighters for Hearing Loss Prevention Research

Noise-induced hearing loss (NIHL) is a significant occupational health problem in the United States, affecting more than 1 million firefighters. Noise hazards include vehicles, sirens, and power tools. Additionally, firefighters are commonly exposed to ototoxic chemicals. Because the use of hearing protection is not universally required for firefighters, firefighters must be educated about NIHL to ensure they take personal responsibility for hearing loss prevention. This study discusses challenges associated with recruiting firefighters to participate in a randomized, controlled trial testing a web-based hearing protection training program. Successful recruitment strategies included collaboration with key stakeholders, a flexible and convenient computer-based intervention, expansion to multiple recruitment sites, and interactive outreach to potential participants. Future research should use quantitative methods to evaluate and compare the effectiveness of specific recruitment strategies to facilitate firefighter enrollment in research studies. Developing and testing effective hearing protection interventions for firefighters is a crucial first step toward preventing NIHL in this population.

Condição auditiva de frentistas

OBJETIVO: avaliar os limiares auditivos nas frequências convencionais e altas frequências, e ainda a integridade do arco reflexo, em frentistas. MÉTODO: foram avaliados frentistas de três postos de gasolina da cidade de Santa Maria/RS. Após adequação aos critérios de inclusão, a amostra ficou composta por 24 frentistas expostos a combustíveis, 21 do gênero masculino e três do gênero feminino, com faixa etária entre 20 e 40 anos. Os exames utilizados foram audiometria tonal liminar, audiometria de altas frequências e imitanciometria. O tempo de exposição variou de um a 17 anos. O grupo controle foi composto por 24 sujeitos não expostos a qualquer agente nocivo à audição. RESULTADOS: a média dos limiares da audiometria tonal liminar e da audiometria de altas frequências foi superior no grupo estudo em todas as frequências testadas. Verificou-se diferença de limiar estatisticamente significante nas frequências de 0,5 (p=0,004), 2 (p=0,001) e 3 kHz (p=0,025), e nas frequências de 9 (p=0,007) e 10 kHz (p=0,026). Os limiares das frequências de 12,5 e 14 kHz não diferiram estatisticamente (p>0,05). Em 16, 18 e 20 kHz foi observada maior ausência de respostas no grupo estudo (p>0,05). Também se observou maior ausência de reflexos acústicos (ipsi e contralateral) no grupo estudo, na orelha direita. Na orelha esquerda, não houve diferença entre os grupos, para a ocorrência do reflexo ipsilateral. A ausência de reflexo contralateral foi maior no grupo estudo em todas as frequências testadas. CONCLUSÃO: frentistas com limiares auditivos normais podem apresentar alterações cocleares e centrais.

An Internet-Based Tailored Hearing Protection Intervention for Firefighters

Background. Noise-induced hearing loss is a significant occupational injury for firefighters exposed to intermittent noise on the job. It is important to educate firefighters about using hearing protection devices whenever they are exposed to loud noise. Computer technology is a relatively new health education approach and can be useful for tailoring specific aspects of behavioral change training. The purpose of this study is to present the development process of an Internet-based tailored intervention program and to assess its efficacy. Method. The intervention programs were implemented for 372 firefighters (mean age = 44 years, Caucasian = 82%, male = 95%) in three states (California, Illinois, and Indiana). The efficacy was assessed from firefighters’ feedback through an Internet-based survey. Results. A multimedia Internet-based training program was developed through (a) determining program content and writing scripts, (b) developing decision-making algorithms for tailoring, (c) graphic design and audio and video productions, (d) creating computer software and a database, and (e) postproduction quality control and pilot testing. Participant feedback regarding the training has been very positive. Participants reported that they liked completing the training via computer (83%) and also that the Internet-based training program was well organized (97%), easy to use (97%), and effective (98%) and held their interest (79%). Almost all (95%) would recommend this Internet training program to other firefighters. Conclusion. Interactive multimedia computer technology using the Internet was a feasible mode of delivery for a hearing protection intervention among firefighters. Participants’ favorable feedback strongly supports the continued utilization of this approach for designing and developing interventions to promote healthy behaviors.

Effects of Exposure to Mixed Organic Solvents on Blood Pressure in Non-Smoking Women Working in a Pharmaceutical Company

Some studies suggest that exposure to industrial solvents can affect blood pressure. The objective of this study was to investigate the effect of a mixture of organic solvents on blood pressure in women working in a pharmaceutical company in Iran. Four hundred and thirty-three women were included in the study. Women working in packing units (group 1) were not exposed to the mixture of organic solvents, women in new laboratory units (group 2) were exposed to the mixture within the permitted range and women working in old laboratory units (group 3) were exposed to the mixture above the permitted limit. We compared systolic and diastolic blood pressures (SBP & DBP) and prevalence of hypertension and pre-hypertension among groups. The results revealed a significant difference in SBP and pre-hypertension (p<0.001) and hypertension (p<0.05) prevalence between the exposed and the control group, but DBP did not differ significantly. Logistic regression analysis showed a significant association between hypertension and exposure to mixed solvents. Odds ratio for hypertension in the group 2 and group 3 (exposed) workers was 2.36 and 3, respectively, compared to controls. Our results suggest that exposure to a mixture of organic solvents may increase SBP and hypertension and pre-hypertension prevalence in drug manufacture workers. Therefore, more attention should be paid to workers that work in such settings by periodically measuring blood pressure and implementing accurate and comprehensive programs to reduce exposure to organic solvents.

Combined effects of ototoxic solvents and noise on hearing in automobile plant workers in Iran

Exposure of workers to mixtures of organic solvents and to occupational noise is frequent in a number of industries. Recent studies suggest that exposure to both can cause a more severe hearing loss than exposure to noise alone. Our cross-sectional study included 411 workers of a large automobile plant divided in three groups. The first group included assembly workers exposed to noise alone; the second included workers in a new paint shop, who were exposed to a mixture of organic solvents at a permissible level; and the third group included paint shop workers exposed to both noise and higher than permissible levels of organic solvents in an old paint shop. These groups were compared in terms of low-frequency hearing loss (model 1; average hearing threshold >25 dB at 0.5 kHz, 1 kHz, and 2 kHz) and high-frequency hearing loss (model 2; average hearing threshold >25 dB at 3 kHz, 4 kHz, 6 kHz, and 8 kHz). High-frequency hearing loss was more common in workers exposed to a combination of noise and mixed organic solvents even at permissible levels than in workers exposed to noise alone even after correction for confounding variables. This study shows that combined exposure to mixed organic solvents and occupational noise can exacerbate hearing loss in workers. Therefore, an appropriate hearing protection programme is recommended, that would include short-interval audiometric examinations and efficient hearing protectors.

Heritability of audiometric shape parameters and familial aggregation of presbycusis in an elderly Flemish population

This study describes the heritability of audiometric shape parameters and the familial aggregation of different types of presbycusis in a healthy, otologically screened population between 50 and 75 years old. About 342 siblings of 64 families (average family-size: 5.3) were recruited through population registries. Audiometric shape was mathematically quantified by objective parameters developed to measure size, slope, concavity, percentage of frequency-dependent and frequency-independent hearing loss and Bulge Depth. The heritability of each parameter was calculated using a variance components model. Logistic regression models were used to estimate the odds ratios (ORs). Estimates of sibling recurrence risk ratios (lambda(s)) are also provided. Heritability estimates were generally higher compared to previous studies. ORs and lambda(s) for the parameters Total Hearing Loss (size), Uniform Hearing Loss (percentage of frequency-dependent hearing loss) and Bulge Depth suggest a higher heredity for severe types of presbycusis compared to moderate or mild types. Our results suggest that the separation of the parameter 'Total Hearing Loss' into the two parameters 'Uniform Hearing Loss' and 'Non-uniform Hearing Loss' could lead to the discovery of different genetic subtypes of presbycusis. The parameter 'Bulge Depth', instead of 'Concavity', seemed to be an important parameter for classifying subjects into 'susceptible' or 'resistant' to societal or intensive environmental exposure.

Prevalence and risk factors of noise-induced hearing loss among liquefied petroleum gas (LPG) cylinder infusion workers in Taiwan

We assessed the exposure levels of noise, estimated prevalence, and identify risk factors of noise-induced hearing loss (NIHL) among male workers with a cross-sectional study in a liquefied petroleum gas cylinder infusion factory in Taipei City. Male in-field workers exposed to noise and administrative controls were enrolled in 2006 and 2007. Face-to-face interviews were applied for demographics, employment history, and drinking/smoking habit. We then performed the measurements on noise levels in field and administration area, and hearing thresholds on study subjects with standard apparatus and protocols. Existence of hearing loss > 25 dBHL for the average of 500 Hz, 1 kHz, and 2 kHz was accordingly determined for NIHL. The effects from noise exposure, predisposing characteristics, employment-related factors, and personal habits to NIHL were estimated by univariate and multivariate logistic regressions. A total of 75 subjects were involved in research and 56.8% of in-field workers had NIHL. Between the in-field and administration groups, hearing thresholds on the worse ear showed significant differences at frequencies of 4 k, 6 k, and 8 kHz with aging considered. Adjusted odds ratio for field noise exposure (OR=99.57, 95% CI: 3.53, 2,808.74) and frequent tea or coffee consumption (OR=0.03, 95% CI: 0.01, 0.51) were found significant. Current study addressed NIHL in a specific industry in Taiwan. Further efforts in minimizing its impact are still in need.

Organic solvents and hearing loss: The challenge for audiology

Organic solvents have been reported to adversely affect human health, including hearing health. Animal models have demonstrated that solvents may induce auditory damage, especially to the outer hair cells. Research on workers exposed to solvents has suggested that these chemicals may also induce auditory damage through effects on the central auditory pathways. Studies conducted with both animals and humans demonstrate that the hearing frequencies affected by solvent exposure are different to those affected by noise, and that solvents may interact synergistically with noise. The present article aims to review the contemporary literature of solvent-induced hearing loss, and consider the implications of solvent-induced auditory damage for clinical audiologists. Possible audiological tests that may be used when auditory damage due to solvent exposure is suspected are discussed.

Audiometric shape and presbycusis

The aim of this study was to describe the prevalence of specific audiogram configurations in a healthy, otologically screened population between 55 and 65 years old. The audiograms of 1147 subjects (549 males and 598 females between 55 and 65 years old) were collected through population registries and classified according to the configuration of hearing loss. Gender and noise/solvent-exposure effects on the prevalence of the different audiogram shapes were determined statistically. In our population 'Flat' audiograms were most dominantly represented (37%) followed by 'High frequency Gently sloping' audiograms (35%) and 'High frequency Steeply sloping' audiograms (27%). 'Low frequency Ascending' audiograms, 'Mid frequency U-shape' audiograms and 'Mid frequency Reverse U-shape' audiograms were very rare (together less than 1%). The 'Flat'-configuration was significantly more common in females, whereas the 'High frequency Steeply sloping'-configuration was more common in males. Exposure to noise and/or solvents did not change this finding. In addition, females with a 'Flat' audiogram had a significantly larger amount of overall hearing loss compared to males. Furthermore, our data reveal a significant association between the prevalence of 'High frequency Steeply sloping' audiograms and the degree of noise/solvent exposure, despite a relatively high proportion of non-exposed subjects showing a 'High frequency Steeply sloping' audiogram as well.

Effects of co-exposure to noise and mixture of organic solvents on blood pressure

OBJECTIVES

Independent exposure to noise or organic solvents is reported to be associated with cardiovascular effects, but the effect of joint exposure is unclear. The present study aimed to investigate effects of noise, a mixture of organic solvents (N,N-dimethylformamide (DMF) and toluene) and their interaction on hypertension.

METHODS

We recruited 59 volunteers working in a synthetic leather manufacturing company during 2005-2006. Both personal noise exposure and airborne co-exposure to DMF and toluene at work were measured and used to calculate the mixed hazard index (HI). Multivariate logistic regressions were conducted to estimate between-group differences of hypertension by controlling for potential confounders.

RESULTS

We found that 18 co-exposure workers (82.22 +/- 2.70 dBA and a mixed HI of 0.53 +/- 0.20) had the highest prevalence of hypertension (55.6%) compared to 15 solvent-exposure workers (a mixed HI of 0.32 +/- 0.18; 46.7%), 9 noise-exposure workers (84.13 +/- 2.30 dBA; 44.4%) and 17 low-exposure workers (11.8%). The adjusted odds ratio (OR) of hypertension compared to low-exposure workers increased from 7.9 times (95% confidence interval (CI)=0.9-66.3; p=0.06) in solvent-exposure workers and 9.1 times (OR=9.1, 95% CI=1.0-81.1; p<0.05) in noise-exposure workers to 13.5 times (95% CI=1.5-117.8; p<0.05) in co-exposure workers.

CONCLUSIONS

Our findings suggest that co-exposure to noise, DMF and toluene is associated with hypertension in synthetic leather workers. Simultaneous exposure to noise and a mixture of organic solvents may have a sub-additive effect on the risk of hypertension.

Potentiation of Chemical Ototoxicity by Noise

High-intensity and/or prolonged exposure to noise causes temporary or permanent threshold shifts in auditory perception. Occupational exposure to solvents or administration of clinically important drugs, such as aminoglycoside antibiotics and cisplatin, also can induce permanent hearing loss. The mechanisms by which these ototoxic insults cause auditory dysfunction are still being unraveled, yet they share common sequelae, particularly generation of reactive oxygen species, that ultimately lead to hearing loss and deafness. Individuals are frequently exposed to ototoxic chemical contaminants (e.g., fuel) and noise simultaneously in a variety of work and recreational environments. Does simultaneous exposure to chemical ototoxins and noise potentiate auditory dysfunction? Exposure to solvent vapor in noisy environments potentiates the permanent threshold shifts induced by noise alone. Moderate noise levels potentiate both aminoglycoside- and cisplatin-induced ototoxicity in both rate of onset and in severity of auditory dysfunction. Thus, simultaneous exposure to chemical ototoxins and moderate levels of noise can potentiate auditory dysfunction. Preventing the ototoxic synergy of noise and chemical ototoxins requires removing exposure to ototoxins and/or attenuating noise exposure levels when chemical ototoxins are present.

Candidate gene association study for noise-induced hearing loss in two independent noise-exposed populations

Millions of people are daily exposed to high levels of noise. Consequently, noise-induced hearing loss (NIHL) is one of the most important occupational health hazards worldwide. In this study, we performed an association study for NIHL based on a candidate gene approach. 644 Single Nucleotide Polymorphisms (SNPs) in 53 candidate genes were analyzed in two independent NIHL sample sets, a Swedish set and part of a Polish set. Eight SNPs with promising results were selected and analysed in the remaining part of the Polish samples. One SNP in PCDH15 (rs7095441), resulted in significant associations in both sample sets while two SNPs in MYH14 (rs667907 and rs588035), resulted in significant associations in the Polish sample set and significant interactions with noise exposure level in the Swedish sample set. Calculation of odds ratios revealed a significant association of rs588035 with NIHL in the Swedish high noise exposure level group. Our studies suggest that PCDH15 and MYH14 may be NIHL susceptibility genes, but further replication in independent sample sets is mandatory.

Variations in HSP70 genes associated with noise-induced hearing loss in two independent populations

Noise-induced hearing loss (NIHL) is one of the most important occupational health hazards. Millions of people worldwide are exposed daily to harmful levels of noise. NIHL is a complex disease resulting from an interaction between genetic and environmental factors. Although the environmental risk factors have been studied extensively, little is known about the genetic factors. Heat-shock proteins (HSPs) are induced after exposure to severe noise. When first induced by exposure to moderate sound levels, they can protect the ear from damage from excessive noise exposure. This protection is highly variable between individuals. An association of HSP70 genes with NIHL has been described by Yang et al (2006) in a Chinese sample set of noise-exposed workers. In this study, three polymorphisms (rs1043618, rs1061581 and rs2227956) in HSP70-1, HSP70-2 and HSP70-hom, respectively, were genotyped in 206 Swedish and 238 Polish DNA samples of noise-exposed subjects and analyzed. One SNP, rs2227956 in HSP70-hom, resulted in a significant association with NIHL in both sample sets. In addition, rs1043618 and rs1061581 were significant in the Swedish sample set. Analysis of the haplotypes composed of the three SNPs revealed significant associations between NIHL and haplotype GAC in both sample sets and with haplotype CGT in the Swedish sample set. In conclusion, this study replicated the association of HSP70 genes with NIHL in a second and third independent noise-exposed sample set, hereby adding to the evidence that HSP70 genes may be NIHL susceptibility genes.

Occupational noise, smoking, and a high body mass index are risk factors for age-related hearing impairment and moderate alcohol consumption is protective: a European population-based multicenter study

A multicenter study was set up to elucidate the environmental and medical risk factors contributing to age-related hearing impairment (ARHI). Nine subsamples, collected by nine audiological centers across Europe, added up to a total of 4,083 subjects between 53 and 67 years. Audiometric data (pure-tone average [PTA]) were collected and the participants filled out a questionnaire on environmental risk factors and medical history. People with a history of disease that could affect hearing were excluded. PTAs were adjusted for age and sex and tested for association with exposure to risk factors. Noise exposure was associated with a significant loss of hearing at high sound frequencies (>1 kHz). Smoking significantly increased high-frequency hearing loss, and the effect was dose-dependent. The effect of smoking remained significant when accounting for cardiovascular disease events. Taller people had better hearing on average with a more pronounced effect at low sound frequencies (<2 kHz). A high body mass index (BMI) correlated with hearing loss across the frequency range tested. Moderate alcohol consumption was inversely correlated with hearing loss. Significant associations were found in the high as well as in the low frequencies. The results suggest that a healthy lifestyle can protect against age-related hearing impairment.

Perception and attitudes of firefighters on noise exposure and hearing loss

Noise exposure of firefighters results in increased risk of hearing loss. Noise-induced hearing loss (NIHL) can be prevented by the consistent use of hearing protection devices (HPDs). However, little is known about firefighters' perceptions and attitudes on NIHL and HPD use. The purposes of the study were (1) to identify common noise sources of fire fighting equipment and activities; and (2) to describe the attitudes and beliefs of firefighters concerning the importance of their hearing, occupational noise exposure, NIHL, and HPD use. A nonexperimental, descriptive focus group design was used to gather qualitative data from firefighters at two fire houses in southeast Michigan. The study identified sources of noise unique to fire fighting, such as driving fire/emergency trucks with sirens on; operating water pumps, saws, and other equipment; and shouting to communicate with civilians and fellow firefighters. Firefighters acknowledged the significance of good hearing in fire fighting service but perceived NIHL was unavoidable on the job and viewed it as a small risk compared with other hazards. HPDs were not used regularly because firefighters believed they interfered with the ability to hear commands during emergency conditions, interfered with other required safety equipment, and were generally forgotten when gearing up. Firefighters recognized the importance of hearing health and the benefit of a hearing conservation program, including annual training, and identified several topics that should be included in a training program. These findings will provide critical information in planning what type of program should be developed and carried out for the fire fighting population.

Occupationally-acquired noise-induced hearing loss: a senseless workplace hazard

OBJECTIVES

Occupational noise-induced hearing loss (ONIHL) describes an acquired hearing deficiency directly attributable to excessive workplace noise exposure. Data suggest that excessive noise attributes to approximately 37% of all adult causes of hearing loss and remains a significant contributor to employment-related morbidity internationally. Typically insidiously-acquired, often without frank progressive symptomatology, regional medical agencies continue to struggle with this potentially debilitating condition. The aim of the study was to provide a synopsis of the current understanding of ONIHL, its impact on individual workers and the wider international community, and to identify barriers to more uniform adoption of personal hearing protection.

MATERIALS AND METHODS

A review of the contemporary literature was performed using defined keyword searches and OVID, PubMed, and Google Scholar as primary electronic search engines.

RESULTS

A number of published works were identified, describing aspects of the relationship between workplace-related noise exposure and subsequent development of employee hearing impairment, which demonstrate an overwhelming gender imbalance, with up to 97% of affected individuals being male. Industry-specific associations (e.g., mining, manufacturing and heavy construction) were well documented, as were links to toxin-specific exposures, in the recognized development of hearing loss. However, evidence of integration of appraisal of the topically-current area of genetic susceptibility was often lacking. Much discordance still exists among international agencies in the prescriptive regulation and enforcement of "safe" exposure limits.

CONCLUSIONS

Despite a high level of public awareness regarding the importance of hearing preservation and increasingly stringent international occupational health, safety and welfare requirements mandating provision of safer work environments, ONIHL continues to be a significant occupational hazard. ONIHL is permanent and may cause significant disability, for which there currently exists no cure, but is largely overtly-preventable. The impact of ONIHL on the global transition toward dominant communication-rich white-collar employment roles is difficult to quantitate, but is likely to be substantive upon the afflicted individual. In the mainstream setting, exposure-avoidance strategies aimed to reduce the incidence of ONIHL remain the focus of public health and occupational medicine approaches.

Ototoxicity of organic solvents - from scientific evidence to health policy

The scientific workshop, organized under the 6th European Framework Programme, the Marie Curie Host Fellowship for the Transfer of Knowledge "NoiseHear" Project, by the Nofer Institute of Occupational Medicine (Łódź, Poland, 15-16 November 2006), gathered world specialists in noise, chemicals, and ototoxicity, including hearing researchers, toxicologists, otolaryngologists, audiologists and occupational health physicians.The workshop examined the evidence and the links between isolated exposure to organic solvents, combined exposure to noise and solvents, and effects on the auditory system. Its main purpose was to review the key scientific evidence to gather the necessary knowledge for developing adequate occupational health policies. This paper summarizes the workshop sessions and subsequent discussions.

Hazardous decibels: hearing health of firefighters

Noise-induced hearing loss ranks among the most significant occupational health problems. In the United States, more than 1 million firefighters are at risk for noise-induced hearing loss due to exposure to hazardous levels of intermittent noise from sirens, air horns, and engines of emergency vehicles and fire trucks. Although irreversible, noise-induced hearing loss is entirely preventable through both engineering controls and personal protective equipment. This article describes occupational noise exposure, hearing loss, and strategies to prevent noise-induced hearing loss among firefighters.

The complexity of age-related hearing impairment: contributing environmental and genetic factors

Age-related hearing impairment (ARHI) is the most common sensory impairment seen in the elderly. It is a complex disorder, with both environmental as well as genetic factors contributing to the impairment. The involvement of several environmental factors has been partially elucidated. A first step towards the identification of the genetic factors has been made, which will result in the identification of susceptibility genes, and will provide possible targets for the future treatment and/or prevention of ARHI. This paper aims to give a broad overview of the scientific findings related to ARHI, focusing mainly on environmental and genetic data in humans and in animal models. In addition, methods for the identification of contributing genetic factors as well as possible future therapeutic strategies are discussed.

Association between variations in CAT and noise-induced hearing loss in two independent noise-exposed populations

Noise-induced hearing loss (NIHL) is an important occupational hazard that results from an interaction between genetic and environmental factors. Although the environmental risk factors have been studied quite extensively, little is known about the genetic factors. On the basis of multiple studies, it was proposed that oxidative stress plays an important role in the development of NIHL. Here, we investigated whether variations (single nucleotide polymorphisms; SNPs) in the catalase gene (CAT), one of the genes involved in oxidative stress, influence noise susceptibility. Audiometric data from 1261 Swedish and 4500 Polish noise-exposed labourers were analysed. DNA samples were collected from the 10% most susceptible and the 10% most resistant individuals. Twelve SNPs were selected and genotyped. Subsequently, the interaction between noise exposure and genotypes and their effect on NIHL were analysed using logistic regression. Significant interactions were observed between noise exposure levels and genotypes of two SNPs for the Swedish population and of five SNPs for the Polish population. Two of these SNPs were significant in both populations. The interaction between predictor haplotypes and tagSNP haplotypes and noise exposure levels and their effect on NIHL were also analysed, resulting in several significant associations. In conclusion, this study identified significant associations between catalase SNPs and haplotypes and susceptibility to development of NIHL. These results indicate that catalase is a NIHL susceptibility gene, but that the effect of CAT polymorphisms can only be detected when noise exposure levels are taken into account.