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Shakhtour L, Song S, Orobello NC, Ambrose T, Rana MS, Behzadpour HK, Reilly BK. Evaluation of Noise Exposure Levels in Pediatric ENT Operating Rooms. Otolaryngol Head Neck Surg 2024. [PMID: 38881393 DOI: 10.1002/ohn.857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 05/08/2024] [Accepted: 05/27/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE Operating room (OR) sounds may surpass noise exposure thresholds and induce hearing loss. Noise intensity emitted by various surgical instruments during common pediatric otolaryngologic procedures were compared at the ear-level of the surgeon and patient to evaluate the need for quality improvement measures. STUDY DESIGN Cross-sectional study. SETTING Single tertiary care center. METHODS Noise levels were measured using the RISEPRO Sound Level Meter and SoundMeter X 10.0.4 at the ear level of surgeon and patient every 5 minutes. Operative procedure and instrument type were recorded. Measured noise levels were compared against ambient noise levels and the Apple Watch Noise application. RESULTS Two hundred forty-two total occasions of noise were recorded across 62 surgical cases. Cochlear implantation surgery produces the loudest case at the ear-level of the patient (91.8 Lq Peak dB; P < .001). The otologic drill was the loudest instrument for the patient (92.1 Lq Peak dB; P < .001), while the powered microdebrider was the loudest instrument for the surgeon (90.7 Lq Peak dB; P = .036). Noise measurements between surgeon and patient were similar (P < .05). Overall agreement between the Noise application and Sound Level Meter was excellent (intraclass correlation coefficient of 0.8, with a 95% confidence interval ranging from 0.32 to 0.92). CONCLUSION Otolaryngology OR noises can surpass normal safe thresholds. Failure to be aware of this may unwittingly expose providers to noise-related hearing loss. Mitigation strategies should be employed. Quality improvement measures, including attention to surgical instrument volume settings and periodic decibel measurements with sound applications, can promote long-term hearing conservation. DISCUSSION Otolaryngology OR noises can surpass normal safe thresholds. Failure to be aware of this may unwittingly expose providers to noise-related hearing loss. The duration, frequency of exposure, and volume levels of noise should be studied further. IMPLICATIONS FOR PRACTICE Mitigation strategies should be employed. Quality improvement measures, including attention to surgical instrument volume settings and periodic decibel measurements with sound applications, can promote long-term hearing conservation.
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Affiliation(s)
- Leyn Shakhtour
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Sophia Song
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Nicklas C Orobello
- Department of Otolaryngology, Children's National Hospital, Washington, District of Columbia, USA
| | - Tracey Ambrose
- Department of Otolaryngology, Children's National Hospital, Washington, District of Columbia, USA
| | - Md Sohel Rana
- Division of Surgery, Children's National Hospital, Washington, District of Columbia, USA
| | - Hengameh K Behzadpour
- Department of Otolaryngology, Children's National Hospital, Washington, District of Columbia, USA
| | - Brian K Reilly
- Department of Otolaryngology, Children's National Hospital, Washington, District of Columbia, USA
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Alberti G, Portelli D, Galletti C. Healthcare Professionals and Noise-Generating Tools: Challenging Assumptions about Hearing Loss Risk. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6520. [PMID: 37569060 PMCID: PMC10418966 DOI: 10.3390/ijerph20156520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/20/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023]
Abstract
Hearing loss is a significant global health concern, affecting billions of people and leading to various physical, mental, and social consequences. This paper focuses on the risk of noise-induced hearing loss (NIHL) among specific healthcare professionals, especially ear surgeons, orthopaedic surgeons, dentists, and dental hygienists, who frequently use noisy instruments in their professions. While studies on these professionals' noise exposure levels are limited, certain conditions and factors could pose a risk to their hearing. Measures such as engineering and administrative controls, regular audiometric testing, and the use of hearing protection devices are crucial in preventing NIHL. Early detection and intervention are also vital to mitigate further damage. This paper proposes the results of a modified screening protocol, including questionnaires, audiometry, and additional diagnostic tests to identify and address potential hearing disorders. Specific healthcare professionals should remain aware of the risks, prioritize hearing protection, and undergo regular monitoring to safeguard their long-term auditory well-being.
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Affiliation(s)
- Giuseppe Alberti
- Department of Adult and Development Age Human Pathology “Gaetano Barresi”, Unit of Otorhinolaryngology, University of Messina, 98125 Messina, Italy;
| | - Daniele Portelli
- Department of Adult and Development Age Human Pathology “Gaetano Barresi”, Unit of Otorhinolaryngology, University of Messina, 98125 Messina, Italy;
- Policlinico G. Martino, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Cosimo Galletti
- Department of Integrated Dentistry, School of Dentistry, Universitat Internacional de Catalunya, Sant Cugat del Vallès, 08017 Barcelona, Spain;
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Vaisbuch Y, Hosseini DK, Wagner A, Hirt B, Mueller M, Ponnusamy R, Heller S, Cheng AG, Löwenheim H, Aaron KA. Surgical Approach for Rapid and Minimally Traumatic Recovery of Human Inner Ear Tissues From Deceased Organ Donors. Otol Neurotol 2022; 43:e519-e525. [PMID: 35239617 DOI: 10.1097/mao.0000000000003500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To develop a surgical approach for rapid and minimally traumatic recovery of inner ear tissue from human organ and tissue donors to provide fresh tissue for use in inner ear research. STUDY DESIGN Exploration of novel surgical methodology and evaluation of the steps necessary for obtaining specimens from donors during the procurement of organs for transplantation. SETTING Donor procurement locations across multiple local hospitals and tissue processing at the microsurgical temporal bone laboratory. PATIENTS TISSUE SOURCE Human organ and tissue donors. INTERVENTIONS Dissection and procurement of the inner ear tissue. MAIN OUTCOME MEASURES Development of rapid and minimally traumatic inner ear tissue recovery. Primarily, establishing an efficient process which includes collaboration with transplant network, implementing a consent protocol, developing and training an on-call recovery team, and designing a portable surgical kit suitable for use in a variety of settings. RESULTS The extraction procedure is described in three consecutive steps: the trans-canal exposure, the approach to the vestibule with extraction of the vestibular organs; and the approach to extract inner ear tissues from the cochlear duct. CONCLUSIONS Organ and tissue donors are a promising and underutilized resource of inner ear organs for purposes of research and future translational studies. Using our modified technique through the trans-canal/trans-otic approach, we were able to extract tissues of the vestibular and auditory end organs in a timely manner.
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Affiliation(s)
- Yona Vaisbuch
- Department of Otolaryngology - Head and Neck Surgery, Stanford University, Stanford, California, USA
- Department of Otolaryngology - Head and Neck Surgery, Rambam Medical Center, Haifa, Israel
| | - Davood K Hosseini
- Department of Otolaryngology - Head and Neck Surgery, Stanford University, Stanford, California, USA
- Department of Internal Medicine, Hackensack University Medical Center, Hackensack. New Jersey, USA
| | - Andreas Wagner
- Institute of Clinical Anatomy and Cell Analysis, University of Tübingen
| | - Bernhard Hirt
- Institute of Clinical Anatomy and Cell Analysis, University of Tübingen
| | - Marcus Mueller
- Department of Otolaryngology - Head and Neck Surgery, University of Tübingen, Tübingen, Germany
| | | | - Stefan Heller
- Department of Otolaryngology - Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Alan G Cheng
- Department of Otolaryngology - Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Hubert Löwenheim
- Department of Otolaryngology - Head and Neck Surgery, University of Tübingen, Tübingen, Germany
| | - Ksenia A Aaron
- Department of Otolaryngology - Head and Neck Surgery, Stanford University, Stanford, California, USA
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Cass ND, Perkins EL, Bennett ML, Ricketts TA. Evaluating Risk of Noise-Induced Hearing Loss in Otologic Surgery. Ann Otol Rhinol Laryngol 2022; 132:35-40. [PMID: 35109716 DOI: 10.1177/00034894221075422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate risk for noise-induced hearing damage from otologic surgery-related noise exposure, given recent research indicating that noise levels previously believed to be safe and without long-term consequence may result in cochlear synaptopathy with subsequent degeneration of spiral ganglion neurons, degradation of neural transmission in response to suprathreshold acoustic stimuli, and difficulty understanding in background noise. METHODS A prospective observational study of surgeon noise exposure during otologic and neurotologic procedures was performed in a tertiary care center. Surgeon noise exposure was recorded in A- and C-weighted decibel scales (dBA, dBC), including average equivalent (LAeq) and peak (LApeak, LCpeak) levels and noise dose. RESULTS Sound measurements taken at the ear with continuous recording equipment during cadaveric otologic surgery demonstrated LAeq 80-83 dBA, LApeaks of 105 dBA, LCpeaks of 127 dBC, with noise doses of 0.9% to 6.7%. Sound level measurements during live surgery translabyrinthine approaches yielded lower LAeq of 72 to 74 dBA and lower noise doses compared with temporal bone lab measurements. Raw sound recordings during live surgery demonstrated narrow band, high frequency, high amplitude spikes between 4 and 12 kHz. CONCLUSION Noise exposure to surgeons, staff, and patients in the operating room is acceptable per NIOSH recommendations. Temporal bone lab noise exposures are greater, possibly due to poorly maintained drill systems and lack of noise shielding from microscope bulk, yet are also within NIOSH recommended levels.
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Affiliation(s)
- Nathan D Cass
- The Otology Group of Vanderbilt, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elizabeth L Perkins
- The Otology Group of Vanderbilt, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marc L Bennett
- The Otology Group of Vanderbilt, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Todd A Ricketts
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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Sampieri G, Namavarian A, Levin M, Philteos J, Lee JW, Koskinen A, Lin V, Lee J. Noise in Otolaryngology - Head and Neck Surgery operating rooms: a systematic review. J Otolaryngol Head Neck Surg 2021; 50:8. [PMID: 33573705 PMCID: PMC7879658 DOI: 10.1186/s40463-020-00487-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 12/21/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Noise in operating rooms (OR) can have negative effects on both patients and surgical care workers. Noise can also impact surgical performance, team communication, and patient outcomes. Such implications of noise have been studied in orthopedics, neurosurgery, and urology. High noise levels have also been demonstrated in Otolaryngology-Head and Neck Surgery (OHNS) procedures. Despite this, no previous study has amalgamated the data on noise across all OHNS ORs to determine how much noise is present during OHNS surgeries. This study aims to review all the literature on noise associated with OHNS ORs and procedures. METHODS Ovid Medline, EMBASE Classic, Pubmed, SCOPUS and Cochrane databases were searched following PRISMA guidelines. Data was collected on noise measurement location and surgery type. Descriptive results and statistical analysis were completed using Stata. RESULTS This search identified 2914 articles. Final inclusion consisted of 22 studies. The majority of articles analyzed noise level exposures during mastoid surgery (18/22, 82%). The maximum noise level across all OHNS ORs and OHNS cadaver studies were 95.5 a-weighted decibels (dBA) and 106.6 c-weighted decibels (dBC), respectively (P = 0.2068). The mean noise level across all studies was significantly higher in OHNS cadaver labs (96.9 dBA) compared to OHNS ORs (70.1 dBA) (P = 0.0038). When analyzed together, the mean noise levels were 84.9 dBA. CONCLUSIONS This systematic review demonstrates that noise exposure in OHNS surgery exceeds safety thresholds. Further research is needed to understand how noise may affect team communication, surgical performance and patient outcomes in OHNS ORs.
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Affiliation(s)
| | | | - Marc Levin
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Justine Philteos
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Jong Wook Lee
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Anni Koskinen
- Department of Otorhinolaryngology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Vincent Lin
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - John Lee
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, ON, Canada.
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Knewitz AP, Simpson MC, Harris DA, Sappington JM, Osazuwa-Peters N. Sociodemographic correlates of occupational, recreational and firearm noise exposure among adults in the USA. J Laryngol Otol 2020; 134:1-7. [PMID: 32014072 DOI: 10.1017/s0022215120000134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine sociodemographic factors associated with occupational, recreational and firearm-related noise exposure. METHODS This nationally representative, multistage, stratified, cluster cross-sectional study sampled eligible National Health and Nutrition Examination Survey participants aged 20-69 years (n = 4675) about exposure to occupational and recreational noise and recurrent firearm usage, using a weighted multivariate logistic regression analysis. RESULTS Thirty-four per cent of participants had exposure to occupational noise and 12 per cent to recreational noise, and 13 per cent repeatedly used firearms. Males were more likely than females to have exposure to all three noise types (adjusted odds ratio range = 2.63-14.09). Hispanics and Asians were less likely to have exposure to the three noise types than Whites. Blacks were less likely than Whites to have occupational and recurrent firearm noise exposure. Those with insurance were 26 per cent less likely to have exposure to occupational noise than those without insurance (adjusted odds ratio = 0.74, 95 per cent confidence interval = 0.60-0.93). CONCLUSION Whites, males and uninsured people are more likely to have exposure to potentially hazardous loud noise.
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Affiliation(s)
- A P Knewitz
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, Missouri, USA
| | - M C Simpson
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, Missouri, USA
| | - D A Harris
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, Missouri, USA
| | - J M Sappington
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, Missouri, USA
| | - N Osazuwa-Peters
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, Missouri, USA
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Lee C, Valenzuela CV, Goodman SS, Kallogjeri D, Buchman CA, Lichtenhan JT. Early Detection of Endolymphatic Hydrops using the Auditory Nerve Overlapped Waveform (ANOW). Neuroscience 2020; 425:251-266. [PMID: 31809731 PMCID: PMC6935415 DOI: 10.1016/j.neuroscience.2019.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/30/2019] [Accepted: 11/04/2019] [Indexed: 01/14/2023]
Abstract
Endolymphatic hydrops is associated with low-frequency sensorineural hearing loss, with a large body of research dedicated to examining its putative causal role in low-frequency hearing loss. Investigations have been thwarted by the fact that hearing loss is measured in intact ears, but gold standard assessments of endolymphatic hydrops are made postmortem only; and that no objective low-frequency hearing measure has existed. Yet the association of endolymphatic hydrops with low-frequency hearing loss is so strong that it has been established as one of the important defining features for Ménière's disease, rendering it critical to detect endolymphatic hydrops early, regardless of whether it serves a causal role or is the result of other disease mechanisms. We surgically induced endolymphatic hydrops in guinea pigs and employed our recently developed objective neural measure of low-frequency hearing, the Auditory Nerve Overlapped Waveform (ANOW). Hearing loss and endolymphatic hydrops were assessed at various time points after surgery. The ANOW detected low-frequency hearing loss as early as the first day after surgery, well before endolymphatic hydrops was found histologically. The ANOW detected low-frequency hearing loss with perfect sensitivity and specificity in all ears after endolymphatic hydrops developed, where there was a strong linear relationship between degree of endolymphatic hydrops and severity of low-frequency hearing loss. Further, histological data demonstrated that endolymphatic hydrops is seen first in the high-frequency cochlear base, though the ANOW demonstrated that dysfunction begins in the low-frequency apical cochlear half. The results lay the groundwork for future investigations of the causal role of endolymphatic hydrops in low-frequency hearing loss.
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Affiliation(s)
- C Lee
- Washington University School of Medicine in St. Louis, Department of Otolaryngology, Saint Louis, MO, USA
| | - C V Valenzuela
- Washington University School of Medicine in St. Louis, Department of Otolaryngology, Saint Louis, MO, USA
| | - S S Goodman
- University of Iowa, Department of Communication Sciences and Disorders, Iowa City, IA, USA
| | - D Kallogjeri
- Washington University School of Medicine in St. Louis, Department of Otolaryngology, Saint Louis, MO, USA
| | - C A Buchman
- Washington University School of Medicine in St. Louis, Department of Otolaryngology, Saint Louis, MO, USA
| | - J T Lichtenhan
- Washington University School of Medicine in St. Louis, Department of Otolaryngology, Saint Louis, MO, USA.
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Predicting and Weighting the Factors Affecting Workers' Hearing Loss Based on Audiometric Data Using C5 Algorithm. Ann Glob Health 2019; 85. [PMID: 31225964 PMCID: PMC6634330 DOI: 10.5334/aogh.2522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Introduction: With the extensively spread of industrialization in the world, noise exposure is becoming more prevalent in the industrial settings. The most important and definite harmful effects of sound include hearing loss, both permanent and temporary. Objective: This study was designed aimed to use the C5 algorithm to determine the weight of factors affecting the workers’ hearing loss based on the audiometric data. Methods: This cross-sectional, descriptive, analytical study was conducted in 2018 in a mining industry in southeastern Iran. In this study, workers were divided into three exposed groups with different sound pressure levels (one control group and two case groups). Audiometry was conducted for each group of 50 persons; hence, the total number of subjects was 150. The stages of this study include: 1) selecting factors (predictive) to check and weigh them; 2) conducting the audiometry for both ears; 3) calculating the permanent hearing loss in each ear and permanent hearing loss of both ears; 4) classifying the types of hearing loss; and 5) investigating and determining the weight of factors affecting the hearing loss and their classification based on the C5 algorithm and determining the error and accuracy rate of each model. To assess and determine the factors affecting the hearing loss of workers, the C5 algorithm and IBM SPSS Modeler 18.0 were used. SPSS V.18 was used to analyze the linear regression and paired t-test tests, too. Results: The results showed that in the first model (SPL <70 dBA), the 8KHz frequency with the weight of 31% had the highest effect, the factors of work experience and the frequency of 250Hz each with the weight of 3%, had the least effect, and the accuracy of the model was 100%. In the second model (SPL 70–80 dBA) the frequency of 8KHz with the weight of 21% had the highest effect, the frequency of 250Hz and the working experience each had the lowest effect with the weight of 7% and the accuracy of the model was calculated as 100%. In the third model (SPL >85 dBA), the 4KHz frequency with the weight of 31% had the highest effect, and the work experience with a weight of 1% had the lowest effect, and the accuracy of the model was 94%. In the fourth model, the 4KHz frequency with the weight of 22% had the highest effect and 250Hz and age each with the weight of 8% had the lowest effects; the accuracy of this model was calculated to be 99.05%. Conclusions: During investigating and determining the weight of the factors affecting hearing loss by the C5 algorithm, the high weight and effect of the 4KHz frequency were predicted in hearing loss changes. Considering the high accuracy obtained in this modeling, this algorithm is a suitable and powerful tool for predicting and modeling the hearing loss.
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