Comparative study of audiometrics tests on metallurgical workers exposed to noise only as well as noise associated to the handling of chemical products

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.

The relationship between chronic exposure to arsenic through drinking water and hearing function in exposed population aged 10-49 years: A cross-sectional study

It has been documented that arsenic has a potential risk to human health and identified as a risk factor for hearing impairment. However, there are few studies that confirm the ototoxic effect of arsenic, especially on the human auditory system. Therefore, the current study was conducted to investigate the correlation between auditory thresholds at different frequencies (0.25, 0.5, 1, 2, 4 and 8 kHz) and arsenic levels in drinking water samples. A total of 240 people, divided into two equal groups: exposed and reference, were selected for the auditory tests. It should be noted that, at frequencies from 0.25 to 1 kHz, no hearing loss was observed in the both groups. Based on the results, no significant correlations (p > 0.05) were found between hearing thresholds and confounding variables including gender and BMI. However, smoking and age are known to be the main variables for hearing loss in univariate regression analysis. In the case of age, the hearing loss risk in the older participants was increased compared with the younger participants (4 kHz (OR =1.09; 95% CI: 1.04, 1.13) and 8 kHz (OR =1.12; 95% CI: 1.06, 1.18)). Smoking habits had significant associations with hearing loss risk at 4 kHz (OR = 3.48; 95% CI: 1.47, 8.22) and 8 kHz (OR = 3.01; 95% CI: 1.14, 7.95). The multivariate regression analysis showed that age, smoking status, and exposure to arsenic were significantly associated with increased risk of hearing loss. Moreover, no statistically significant correlation (p˃0.05) was observed between arsenic exposure and hearing loss in the logistic regression model compared to the reference group. These outcomes suggest that further investigation and cohort studies with a larger number of participants should be conducted to find an association between arsenic exposure and hearing loss in general population.

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.

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.

The effects of combined exposure of solvents and noise on auditory function - A systematic review and meta-analysis

BACKGROUND

 Chemical substances can negatively affect the auditory system. Chemical substances alone or combined with high-level noise have recently become a major concern as a cause of occupational hearing loss.

OBJECTIVE

 To assess the combined effect of solvents and noise versus solvents only, or noise only, on the auditory function of workers.

METHOD

 Published articles which included noise and/or solvent exposure or combined effects of solvents and noise, studies conducted on human beings only and the use of audiological tests on participants.

RESULTS

 Thirteen papers were eligible for inclusion. The participants' ages ranged from 18 to 68 years. Results revealed that 24.5% presented with hearing loss as a result of noise exposure only; 18% presented with hearing loss owing to solvent exposure only; and a total of 43.3% presented with hearing loss owing to combined noise and solvent exposure. Furthermore, the prevalence of hearing loss in the noise and solvent group was significantly (p < 0.001) higher than the other groups in 10 out of the 13 studies analysed, with a pooled odds ratio (OR) of 2.754. Of the 178 participants (total of all participants exposed to solvents), a total of 32 participants presented with auditory pathology as a result of exposure to solvents only. There was a significantly higher pooled odds of hearing loss in noise and solvent-exposed group compared to solvent-only group (pooled OR = 2.15, 95% CI: 1.24-3.72, p = 0.006).

CONCLUSION

 The findings revealed significantly higher odds of acquiring hearing loss when workers were exposed to a combination of solvents and noise as opposed to solvents only, motivating for its inclusion into hearing conservation programmes.

Cobalt toxicity in humans-A review of the potential sources and systemic health effects

Cobalt (Co) and its compounds are widely distributed in nature and are part of numerous anthropogenic activities. Although cobalt has a biologically necessary role as metal constituent of vitamin B₁₂, excessive exposure has been shown to induce various adverse health effects. This review provides an extended overview of the possible Co sources and related intake routes, the detection and quantification methods for Co intake and the interpretation thereof, and the reported health effects. The Co sources were allocated to four exposure settings: occupational, environmental, dietary and medical exposure. Oral intake of Co supplements and internal exposure through metal-on-metal (MoM) hip implants deliver the highest systemic Co concentrations. The systemic health effects are characterized by a complex clinical syndrome, mainly including neurological (e.g. hearing and visual impairment), cardiovascular and endocrine deficits. Recently, a biokinetic model has been proposed to characterize the dose-response relationship and effects of chronic exposure. According to the model, health effects are unlikely to occur at blood Co concentrations under 300μg/l (100μg/l respecting a safety factor of 3) in healthy individuals, hematological and endocrine dysfunctions are the primary health endpoints, and chronic exposure to acceptable doses is not expected to pose considerable health hazards. However, toxic reactions at lower doses have been described in several cases of malfunctioning MoM hip implants, which may be explained by certain underlying pathologies that increase the individual susceptibility for Co-induced systemic toxicity. This may be associated with a decrease in Co bound to serum proteins and an increase in free ionic Co²⁺. As the latter is believed to be the primary toxic form, monitoring of the free fraction of Co²⁺ might be advisable for future risk assessment. Furthermore, future research should focus on longitudinal studies in the clinical setting of MoM hip implant patients to further elucidate the dose-response discrepancies.

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.

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.

Hearing loss in shipyard employees

Background:

Noise-induced hearing loss (NIHL) is one of the most prevalent occupational illnesses, with a higher incidence in the heavy industry.

Objectives of the Study:

The aim of this study is to investigate the prevalence of NIHL in Greece and explore its correlations with other job and individual-related factors.

Materials and Methods:

Questionnaires were administered, and audiograms were conducted to 757 employees of a shipyard company in Greece, both white- and blue-collar, during the period 2006–2009. A modification of the 1979' equation of the American Academy of Otolaryngology was used to calculate hearing loss. Statistical analysis was conducted by means of the SPSS v. 17.

Results:

A 27.1% of the employees were hearing handicap. Hearing loss was correlated with age, past medical history of ear disease (Meniere's disease, acoustic neuroma, otosclerosis) or injury, hyperlipidemia, job title and level of education. A few questions on subjective hearing ability and symptoms showed strong discriminatory power of hearing pathology.

Conclusions:

The results of this study emphasize the burden of disease in the shipyard industry, and the need for continuous monitoring, implementation of preventive measures and hearing conservation programs.

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.

Prevalence of workers with shifts in hearing by industry: a comparison of OSHA and NIOSH Hearing Shift Criteria

OBJECTIVE

The purpose of this study was to compare the prevalence of workers with National Institute for Occupational Safety and Health significant threshold shifts (NSTS), Occupational Safety and Health Administration standard threshold shifts (OSTS), and with OSTS with age correction (OSTS-A), by industry using North American Industry Classification System codes.

METHODS

From 2001 to 2010, worker audiograms were examined. Prevalence and adjusted prevalence ratios for NSTS were estimated by industry. NSTS, OSTS, and OSTS-A prevalences were compared by industry.

RESULTS

Twenty percent of workers had an NSTS, 14% had an OSTS, and 6% had an OSTS-A. For most industries, the OSTS and OSTS-A criteria identified 28% to 36% and 66% to 74% fewer workers than the NSTS criteria, respectively.

CONCLUSIONS

Use of NSTS criteria allowing for earlier detection of shifts in hearing is recommended for improved prevention of occupational hearing loss.

Prevalence of hearing loss in the United States by industry

BACKGROUND

Twenty-two million workers are exposed to hazardous noise in the United States. The purpose of this study is to estimate the prevalence of hearing loss among U.S. industries.

METHODS

We examined 2000-2008 audiograms for male and female workers ages 18-65, who had higher occupational noise exposures than the general population. Prevalence and adjusted prevalence ratios (PRs) for hearing loss were estimated and compared across industries.

RESULTS

In our sample, 18% of workers had hearing loss. When compared with the Couriers and Messengers industry sub-sector, workers employed in Mining (PR = 1.65, CI = 1.57-1.73), Wood Product Manufacturing (PR = 1.65, CL = 1.61-1.70), Construction of Buildings (PR = 1.52, CI = 1.45-1.59), and Real Estate and Rental and Leasing (PR = 1.61, CL = 1.51-1.71) [corrected] had higher risks for hearing loss.

CONCLUSIONS

Workers in the Mining, Manufacturing, and Construction industries need better engineering controls for noise and stronger hearing conservation strategies. More hearing loss research is also needed within traditional "low-risk" industries like Real Estate.

Ototoxic Substances at the Workplace: a Brief Update

Ototoxic chemicals can impair the sense of hearing and balance. Lately, efforts have been intensified to compile evidence-based lists of workplace agents with ototoxic properties. This article gives a rough overview of the latest relevant publications, which confirm that toluene, styrene, and lead should receive particular attention as ototoxic substances at the workplace. Moreover, there is sufficient evidence that occupational exposure to trichloroethylene, mercury, carbon monoxide, and carbon disulfide can affect the ear. Based on the existing information, industrial hygienists should make sure that occupational health professionals and the workforce are made aware of the risks posed by ototoxic substances; support their replacement or new technical measures to reduce exposure; make these substances a part of regular screening, develop tools that can early diagnose chemically induced hearing impairment, and investigate further into the ototoxic properties of these substances. Further research should focus on quantifying the combined effects of ototoxic substances and noise.