Noise-induced hearing loss: an occupational medicine perspective

Application of the occupational health risk assessment model in predicting the risk of noise-induced hearing loss in noise-polluted manufacturers in southern China

Objective. This study aimed to evaluate the correlation between occupational noise-induced hearing loss (ONIHL) and noise exposure in different positions within manufacturing facilities that primarily produce electronic devices, wooden furniture and hardware machinery in southern China and to investigate the practical application of the risk assessment model. Methods. Noise exposure data were collected from 115 workers in 10 manufacturing industries in southern China through on-site investigation. Subsequently, sample testing was conducted in accordance with Chinese standards. The 31 job positions investigated were classified into two similar exposure groups (SEGs). The occupational health risk assessment (OHRA) model was used to evaluate the risks of ONIHL in various job positions. Results. More than half of the positions in both groups had noise levels exceeding 85 dB. In both SEGs, male workers exhibited similar risk patterns of acquiring hearing impairment, with a more pronounced and earlier risk of hearing loss compared to female workers. Age was also found to be a risk factor for hearing impairments. Conclusion. The ORHA model demonstrated a positive correlation between noise exposure levels and NIHL. This model can help employers assess job management with noise exposure and take measures to implement an effective risk management system.

Risk analysis of noise-induced hearing loss of workers in the automobile manufacturing industries based on back-propagation neural network model: a cross-sectional study in Han Chinese population

OBJECTIVES

This study aims to predict the risk of noise-induced hearing loss (NIHL) through a back-propagation neural network (BPNN) model. It provides an early, simple and accurate prediction method for NIHL.

DESIGN

Population based, a cross sectional study.

SETTING

Han, China.

PARTICIPANTS

This study selected 3266 Han male workers from three automobile manufacturing industries.

PRIMARY OUTCOME MEASURES

Information including personal life habits, occupational health test information and occupational exposure history were collected and predictive factors of NIHL were screened from these workers. BPNN and logistic regression models were constructed using these predictors.

RESULTS

The input variables of BPNN model were 20, 16 and 21 important factors screened by univariate, stepwise and lasso-logistic regression. When the BPNN model was applied to the test set, it was found to have a sensitivity (TPR) of 83.33%, a specificity (TNR) of 85.92%, an accuracy (ACC) of 85.51%, a positive predictive value (PPV) of 52.85%, a negative predictive value of 96.46% and area under the receiver operating curve (AUC) is: 0.926 (95% CI: 0.891 to 0.961), which demonstrated the better overall properties than univariate-logistic regression modelling (AUC: 0.715) (95% CI: 0.652 to 0.777). The BPNN model has better predictive performance against NIHL than the stepwise-logistic and lasso-logistic regression model in terms of TPR, TNR, ACC, PPV and NPV (p<0.05); the area under the receiver operating characteristics curve of NIHL is also higher than that of the stepwise and lasso-logistic regression model (p<0.05). It was a relatively important factor in NIHL to find cumulative noise exposure, auditory system symptoms, age, listening to music or watching video with headphones, exposure to high temperature and noise exposure time in the trained BPNN model.

CONCLUSIONS

The BPNN model was a valuable tool in dealing with the occupational risk prediction problem of NIHL. It can be used to predict the risk of an individual NIHL.

Do Surgical Smoke Evacuators Increase the Risk of Hearing Loss for Operative Personnel During Routine Adenotonsillectomy Surgery?

INTRODUCTION

Aerosol mitigation equipment implemented due to COVID-19 has increased noise levels in the operating room (OR) during otolaryngological procedures. Intraoperative sound levels may potentially place personnel at risk for occupational hearing loss. This study hypothesized that cumulative intraoperative noise exposures with aerosol mitigation equipment exceed recommended occupational noise exposure levels.

METHODS

Sound levels generated by the surgical smoke evacuator (SSE) during adenotonsillectomy were measured using a sound level meter and compared to surgery without SSE.

RESULTS

Thirteen adenotonsillectomy surgeries were recorded. Mean sound levels with the SSE were greater than the control (72 ± 3 A-weighted decibels (dBA) vs. 68 ± 2 dBA; p=0.015). Maximum noise levels during surgery with SSE reached 82 ± 3 dBA.

CONCLUSION

Surgeons performing adenotonsillectomy with aerosol mitigation equipment are exposed to significant noise levels. Intraoperative sound levels exceeded international standards for work requiring concentration. Innovation is needed to reduce cumulative OR noise exposures.

Examining the utility of near infrared light as pre-exposure therapy to mitigate temporary noise-induced hearing loss in humans

Introduction

This study sought to determine the effect of Occupational Safety and Health Administration (OSHA) compliant noise on auditory health and assess whether pre-noise near infrared (NIR) light therapy can mitigate the effects of noise exposure.

Methods

Over four visits, participants (n = 30, NCT#: 03834714) with normal hearing completed baseline hearing health assessments followed by exposure to open ear, continuous pink noise at 94 dBA for 15 min. Immediately thereafter, post-noise hearing tests at 3000, 4000, and 6000 Hz and distortion product otoacoustic emissions (DPOAEs) were conducted along with the Modified Rhyme Test (MRT), Masking Level Difference Test (MLD), and Fixed Level Frequency Tests (FLFT) [collectively referred to as the Central and Peripheral Auditory Test Battery (CPATB)] to acquire baseline noise sensitivity profiles. Participants were then randomized to either Active or Sham NIR light therapy for 30 min binaurally to conclude Visit 1. Visit 2 (≥24 and ≤ 48 h from Visit 1) began with an additional 30-min session of Active NIR light therapy or Sham followed by repeat CPATB testing and noise exposure. Post-noise testing was again conducted immediately after noise exposure to assess the effect of NIR light therapy. The remaining visits were conducted following ≥2 weeks of noise rest in a cross-over design (i.e., those who had received Active NIR light therapy in Visits 1 and 2 received Sham therapy in Visits 3 and 4).

Results

Recovery hearing tests and DPOAEs were completed at the end of each visit. Participants experienced temporary threshold shifts (TTS) immediately following noise exposure, with a mean shift of 6.79 dB HL (±6.25), 10.61 dB HL (±6.89), and 7.30 dB HL (±7.25) at 3000, 4000, and 6000 Hz, respectively, though all thresholds returned to baseline at 3000, 4000, and 6000 Hz within 75 min of noise exposure. Paradoxically, Active NIR light therapy threshold shifts were statistically higher than Sham therapy at 3000 Hz (p = 0.04), but no other differences were observed at the other frequencies tested. An age sub-analysis demonstrated that TTS among younger adults were generally larger in the Sham therapy group versus Active therapy, though this was not statistically different. There were no differences in CPATB test results across Active or Sham groups. Finally, we observed no changes in auditory function or central processing following noise exposure, suggestive of healthy and resilient inner ears.

Conclusion

In this study, locally administered NIR prior to noise exposure did not induce a significant protective effect in mitigating noise-induced TTS. Further exploration is needed to implement effective dosage and administration for this promising otoprotective therapy.

NADPH Oxidase 3: Beyond the Inner Ear

Reactive oxygen species (ROS) were formerly known as mere byproducts of metabolism with damaging effects on cellular structures. The discovery and description of NADPH oxidases (Nox) as a whole enzyme family that only produce this harmful group of molecules was surprising. After intensive research, seven Nox isoforms were discovered, described and extensively studied. Among them, the NADPH oxidase 3 is the perhaps most underrated Nox isoform, since it was firstly discovered in the inner ear. This stigma of Nox3 as "being only expressed in the inner ear" was also used by me several times. Therefore, the question arose whether this sentence is still valid or even usable. To this end, this review solely focuses on Nox3 and summarizes its discovery, the structural components, the activating and regulating factors, the expression in cells, tissues and organs, as well as the beneficial and detrimental effects of Nox3-mediated ROS production on body functions. Furthermore, the involvement of Nox3-derived ROS in diseases progression and, accordingly, as a potential target for disease treatment, will be discussed.

Impact of Excessive Noise Generation in Orthopaedic Operating Theatres: A Comprehensive Review

Excessive noise in the orthopaedic operating theatre (OT) is an underrecognized and often neglected health hazard noticed amongst surgeons, patients and theatre and scrub practitioners. A comprehensive search strategy was conducted using databases, such as PubMed, Scopus and Web of Science, with the search words 'noise', 'NIHL' and 'orthopaedics' to retrieve the significant data and generate this narrative review. We evaluated the typical causes, potential hazards and negative effects of noise-induced impacts on OT personnel and patients. Strategies to mitigate the effects of unnecessary, disproportionate noises in the OT environment were explored. Excessive noise generated in orthopaedic OTs can produce several negative effects on patients, surgeons and staff. Noise-induced hearing loss (NIHL) is a rare and under-noticed disorder. The orthopaedic OT environment, with the ever-increasing use of power tools and surgical instruments, contributes to detrimental noise generation. NIHL is an occupational hazard. Raising awareness, appropriate training and clinical governance in collaboration with the hospital risk management team amongst all the medical and paramedical fraternities working in orthopaedic theatres can mitigate challenges faced due to the deleterious effects of excessive noise. We propose recommendations and standard operating protocols that can be incorporated into hospital policies to prevent NIHL among the orthopaedic fraternity and patients alike.

Noise exposure in pediatric otolaryngology clinic: A sound survey of a single-institution tertiary care facility

BACKGROUND

The Occupational Safety and Health Administration (OSHA) considers acoustic exposure of 90 decibels (dB) an occupational risk for noise-induced hearing loss. Pediatric healthcare clinicians are exposed to considerable noise especially during invasive procedures, predisposing them to noise-induced hearing loss, increased work-related stress, and increased complications associated with intense noise exposure. While there has been extensive research in noise exposure in dentistry, to date there has been no research on noise exposure in the pediatric otolaryngology clinic setting. The objective of this study is to quantify the degree of noise exposure that pediatric otolaryngologists encounter in the clinical setting.

METHODS

A sound survey was performed of 420 pediatric otolaryngology clinic visits within a single-institution tertiary care facility from January 2022 to March 2022, with a total of 409 visits included. At each visit, noise was measured using a calibrated National Institute for Occupational Safety and Health (NIOSH) Sound Meter application, an iPad, and a microphone. The Equivalent Continuous Sound Pressure Level (LAeq), peak sound pressure level (SPL), C-weighted peak noise level (LCpeak), and the 8-hour time-weighted average (TWA) sound level were recorded.

RESULTS

The average LAeq was 61.1 dB, the median LAeq was 60.3 dB, and the average peak SPL was 80.5 dB. Only 0.5 % of visits reached an LAeq above 80 dB, however, 51 % were above 60 dB and 99 % were above 45 dB. No clinicians were exposed to noise exceeding established limits of safety. Patients younger than ten years old (p < 0.001) and those who underwent procedures such as cerumen removal (p < 0.001) elicited higher ranges of elevated noise. Multivariate analysis confirmed that increased age decreased acoustic exposure while procedures increased acoustic exposure.

CONCLUSIONS

The results of this study suggest that pediatric otolaryngology clinicians do not exceed hazardous noise limit exposure. However, they are exposed to levels above those which have been linked to stress, poor productivity, and stress-related disorders. This analysis also reports that patients who are younger and those that undergo procedures, specifically cerumen removal, tend to expose their providers to the highest levels of noise. This is the first study examining noise exposure in pediatric otolaryngology, and further research should evaluate the risks of noise exposure in this environment.

Design and testing of a personalized noise monitoring system

Agricultural workers are more prone to noise-induced hearing loss than are many other workers. Hearing protection device use among agricultural workers is low, but training can increase hearing protection device use. This work proposes a system designed to automatically inform agricultural workers when they were exposed to noises that exceed the National Institute for Occupational Safety and Health (NIOSH) recommended exposure level. The smartphone-based system worn on the arm uses a noise dosimeter to measure noise exposures throughout the day to within ±2 A-weighted decibels of a Class 2 sound level meter. The device collects location and audio data, which are transferred to a server and presented to the worker on a locally hosted website. The website details noise exposure and helps the worker identify where exposure occurred and what specific tasks exceed NIOSH's recommended exposure limit, putting them at higher risk of noise-induced hearing loss. With this understanding, the worker is expected to adopt behavior changes and better hearing protection use at critical places and times. This pilot study evaluates the accuracy of the noise dosimeter and GPS relative to gold-standard instruments. The system was tested on a farm with outputs compared with gold-standard instruments. A-weighted, 1-sec averaged sound pressure levels and position data were collected while users were performing a variety of tasks indoors and outdoors. The smartphone's external noise dosimeter read within ±2 A-weighted decibels of the Class 2 reference dosimeter 59% of the time. The positioning devices had an average error of sub-4 m. While not perfectly matching gold-standard instruments, the device is capable of identifying and collecting information relative to loud noise events that promote noise-induced hearing loss.

Monoallelic loss of the F-actin-binding protein radixin facilitates startle reactivity and pre-pulse inhibition in mice

Hearing impairment is one of the most common disorders with a global burden and increasing prevalence in an ever-aging population. Previous research has largely focused on peripheral sensory perception, while the brain circuits of auditory processing and integration remain poorly understood. Mutations in the rdx gene, encoding the F-actin binding protein radixin (Rdx), can induce hearing loss in human patients and homozygous depletion of Rdx causes deafness in mice. However, the precise physiological function of Rdx in hearing and auditory information processing is still ill-defined. Here, we investigated consequences of rdx monoallelic loss in the mouse. Unlike the homozygous (−/−) rdx knockout, which is characterized by the degeneration of actin-based stereocilia and subsequent hearing loss, our analysis of heterozygous (+/−) mutants has revealed a different phenotype. Specifically, monoallelic loss of rdx potentiated the startle reflex in response to acoustic stimulation of increasing intensities, suggesting a gain of function relative to wildtype littermates. The monoallelic loss of the rdx gene also facilitated pre-pulse inhibition of the acoustic startle reflex induced by weak auditory pre-pulse stimuli, indicating a modification to the circuit underlying sensorimotor gating of auditory input. However, the auditory brainstem response (ABR)-based hearing thresholds revealed a mild impairment in peripheral sound perception in rdx (+/-) mice, suggesting minor aberration of stereocilia structural integrity. Taken together, our data suggest a critical role of Rdx in the top-down processing and/or integration of auditory signals, and therefore a novel perspective to uncover further Rdx-mediated mechanisms in central auditory information processing.

Synaptopathy in Guinea Pigs Induced by Noise Mimicking Human Experience and Associated Changes in Auditory Signal Processing

Noise induced synaptopathy (NIS) has been researched extensively since a large amount of synaptic loss without permanent threshold shift (PTS) was found in CBA mice after a brief noise exposure. However, efforts to translate these results to humans have met with little success—and might not be possible since noise exposure used in laboratory animals is generally different from what is experienced by human subjects in real life. An additional problem is a lack of morphological data and reliable functional methods to quantify loss of afferent synapses in humans. Based on evidence for disproportionate synaptic loss for auditory nerve fibers (ANFs) with low spontaneous rates (LSR), coding-in-noise deficits (CIND) have been speculated to be the major difficulty associated with NIS without PTS. However, no robust evidence for this is available in humans or animals. This has led to a re-examination of the role of LSR ANFs in signal coding in high-level noise. The fluctuation profile model has been proposed to support a role for high-SR ANFs in the coding of high-level noise in combination with efferent control of cochlear gain. This study aimed to induce NIS by a low-level, intermittent noise exposure mimicking what is experienced in human life and examined the impact of the NIS on temporal processing under masking. It also evaluated the role of temporal fluctuation in evoking efferent feedback and the effects of NIS on this feedback.

Animal-to-Human Translation Difficulties and Problems With Proposed Coding-in-Noise Deficits in Noise-Induced Synaptopathy and Hidden Hearing Loss

Noise induced synaptopathy (NIS) and hidden hearing loss (NIHHL) have been hot topic in hearing research since a massive synaptic loss was identified in CBA mice after a brief noise exposure that did not cause permanent threshold shift (PTS) in 2009. Based upon the amount of synaptic loss and the bias of it to synapses with a group of auditory nerve fibers (ANFs) with low spontaneous rate (LSR), coding-in-noise deficit (CIND) has been speculated as the major difficult of hearing in subjects with NIS and NIHHL. This speculation is based upon the idea that the coding of sound at high level against background noise relies mainly on the LSR ANFs. However, the translation from animal data to humans for NIS remains to be justified due to the difference in noise exposure between laboratory animals and human subjects in real life, the lack of morphological data and reliable functional methods to quantify or estimate the loss of the afferent synapses by noise. Moreover, there is no clear, robust data revealing the CIND even in animals with the synaptic loss but no PTS. In humans, both positive and negative reports are available. The difficulty in verifying CINDs has led a re-examination of the hypothesis that CIND is the major deficit associated with NIS and NIHHL, and the theoretical basis of this idea on the role of LSR ANFs. This review summarized the current status of research in NIS and NIHHL, with focus on the translational difficulty from animal data to human clinicals, the technical difficulties in quantifying NIS in humans, and the problems with the SR theory on signal coding. Temporal fluctuation profile model was discussed as a potential alternative for signal coding at high sound level against background noise, in association with the mechanisms of efferent control on the cochlea gain.

Association between UBAC2 gene polymorphism and the risk of noise-induced hearing loss: a cross-sectional study

The purpose of this article was to investigate the association between the ubiquitin-associated domain-containing protein 2 (UBAC2) gene polymorphism and noise-induced hearing loss (NIHL) and to further explore the role of single-nucleotide polymorphism (SNP) in UBAC2 in NIHL. A case control study involving 660 NIHL cases and 581 controls was conducted in this research. After genotyping by multiplex polymerase chain reaction (PCR) with next-generation sequencing, the correlation between SNPs and NIHL was analyzed using logistic regression analysis. Haplotype analysis was performed by Haploview 4.1 software. Then luciferase reporter assays and siRNA were used to explore the mechanism of SNPs in UBAC2 affecting NIHL susceptibility. The correlation analysis showed that rs3825427 AA genotype, rs9517701 GG genotype, rs7999348 GG genotype, and rs2296860 AA genotype were all associated with increased risk of NIHL (P < 0.05). The haplotype AGGA (rs3825427-rs9517701-rs7999348-rs2296860) also had a higher risk of NIHL (OR = 1.314; 95% CI, 1.098-1.572; P = 0.003). The results of the luciferase reporter assays showed that the fluorescence intensity of CTCF-OE + UBAC2 WT + TK was significantly higher than that of CTCF-NC + UBAC2 WT + TK and CTCF-OE + UBAC2 MT + TK (all P < 0.01). In CTCF knockdown cells, the expression of UBAC2 was also significantly downregulated (P = 0.0038), indicating that the transcription factor CTCF positively regulated the expression of UBAC2 and the rs3825427 C allele acted as an enhancer, which can promote CTCF to bind to the promoter of UBAC2, thereby promoting transcription. UBAC2 gene polymorphism is related to NIHL susceptibility. The UBAC2 rs3825427 regulates the expression level of UBAC2 by affecting the combination of CTCF and DNA, thus affecting the susceptibility of NIHL.

Audiometric data analysis for prevention of noise-induced hearing loss: A new approach

Compliance with noise regulations in the past three decades has significantly reduced workplace noise exposures, particularly in the loudest industries and occupations. However, the overall effectiveness of hearing conservation programs in preventing occupational noise-induced hearing loss remains uncertain and unquantified, while the incidence and cost of occupational hearing loss remain inexplicably high. This review/commentary critically explores this paradox by examining why the billions of annual audiograms conducted worldwide have not been aggregately utilized or applied to predict early NIHL in groups of workers or to measure the efficacy of exposure controls. Principal contributory reasons include regulation of noise as a safety standard rather than as a health standard, the inherent complexity of audiometric data, and the lack of a standardized method of interpretation for audiograms. The unsuccessful history of efforts to develop and adopt methods and tools to analyze aggregate audiometric data is described. Consequently, the Standard Threshold Shift-a regulatorily defined, lagging indicator of individual, irreversible hearing loss that is not an effective preventive metric-remains the de facto standard of care. A population-based Best Practices approach is proposed to leverage the raw audiometric data already available and turn it into actionable data for effective secondary prevention to strategically manage and reduce occupational hearing loss risk. This approach entails statistical methods and information management tools necessary to transform audiometry from a compliance-driven, individual screening test with limited preventive capability into a medical surveillance process directly linked to aggregate corrective and prevention actions.

Self Reported Hearing Impairments and Associated Risk Factors Among Metal and Woodwork Workers in Gondar Town, North West Ethiopia

BACKGROUND

The global prevalence of occupational noise-induced hearing loss ranges between 16% and 24%. The wood and metalwork industries have recently expanded in Ethiopia. This study aims to determine the level of noise exposure and the prevalence of self-reported hearing impairments and associated risk factors among metal and woodworkers in Gondar town Ethiopia.

MATERIAL AND METHODS

An institutional-based cross-sectional study was conducted on 580 metal and woodwork workers from February10 to March 25/2020. The data were collected through an interviewer-led questioner and the noise level measurement. Multivariate Poisson regression models were used. P-values less than .05 and adjusted prevalence ratios with 95%CI were used to declare the presence and strength of an association respectively.

RESULT

The mean (SD) average noise exposure level in the wood and metalworking industries was 96.9 ± 3.5 dBA and 96.2 ± 4 dBA, respectively. The overall prevalence of self-reported hearing impairment was 20.7% [95%CI: (17.4-24)]. In an adjusted Poisson regression, listening to music with earphones for more than 2 hours per day (PR = 2.95, 95%CI: 1.32, 6.21) and listening to music at maximum volume (PR = 2.24, 95%CI: 1.05, 4.79) were associated with hearing impairments.

CONCLUSION

The majority of workers are exposed to noise levels that exceed OSHA's permissible exposure limit value. A hearing conservation program should be implemented to reduce noise exposure levels in the wood and metal work industries. Workers should be aware of the duration and volume of recreational noise exposure.

Applying Kurtosis as an Indirect Metric of Noise Temporal Structure in the Assessment of Hearing Loss Associated With Occupational Complex Noise Exposure

OBJECTIVE

The association of occupational noise-induced hearing loss (NIHL) with noise energy was well documented, but the relationship between occupational noise and noise temporal structure is rarely reported. The objective of this study was to investigate the principal characteristics of the relationship between occupational NIHL and the temporal structure of noise.

METHODS

Audiometric and shift-long noise exposure data were collected from 3102 Chinese manufacturing workers from six typical industries through a cross-sectional survey. In data analysis, A-weighted 8-h equivalent SPL (LAeq.8h), peak SPL, and cumulative noise exposure (CNE) were used as noise energy indicators, while kurtosis (β) was used as the indicator of noise temporal structure. Two NIHL were defined: (1) high-frequency noise-induced hearing loss (HFNIHL) and (2) noise-induced permanent threshold shift at test frequencies of 3, 4, and 6 kHz (noise-induced permanent threshold shift [NIPTS346]). The noise characteristics of different types of work and the relationship between these characteristics and the prevalence of NIHL were analyzed.

RESULTS

The noise waveform shape, with a specific noise kurtosis, was unique to each type of work. Approximately 27.92% of manufacturing workers suffered from HFNIHL, with a mean NIPTS346 of 24.16 ± 14.13 dB HL. The Spearman correlation analysis showed that the kurtosis value was significantly correlated with the difference of peak SPL minus its LAeq.8h across different types of work (p < 0.01). For a kurtosis-adjusted CNE, the linear regression equation between HFNIHL% and CNE for complex noise almost overlapped with Gaussian noise. Binary logistic regression analysis showed that LAeq.8h, kurtosis, and exposure duration were the key factors influencing HFNIHL% (p < 0.01). The notching extent in NIPTS at 4 kHz became deeper with the increase in LAeq.8h and kurtosis. HFNIHL% increased most rapidly during the first 10 years of exposure. HFNIHL% with β ≥ 10 was significantly higher than that with β < 10 (p < 0.05), and it increased with increasing kurtosis across different CNE or LAeq.8h levels. When LAeq.8h was 80 to 85 dB(A), the HFNIHL% at β ≥ 100 was significantly higher than that at 10 ≤ β < 100 or β < 10 (p < 0.05 and p < 0.01, respectively).

CONCLUSIONS

In the evaluation of hearing loss caused by complex noise, not only noise energy but also the temporal structure of noise must be considered. Kurtosis of noise is an indirect metric that is sensitive to the presence of impulsive components in complex noise exposure, and thus, it could be useful for quantifying the risk for NIHL. It is necessary to re-evaluate the safety of permissible exposure limit of 85 dB(A) as noise with a high kurtosis value can aggravate or accelerate early NIHL.

Large-scale phenotyping of ABR P1-N1 amplitudes before and after exposure to noise in 69 strains of mice

ABR wave I amplitude represents the synapse of auditory nerve fibers with the inner hair cell and is highly correlated with synapse counts. Cochlear synaptopathy, the loss of synaptic connections between inner hair cells and auditory nerve fibers, has been well-demonstrated in animal models of noise-induced hearing loss. The peak-to-peak wave I amplitude was determined at baseline and 2 weeks after noise exposure. We determined the ABR wave I amplitude at 80 dB SPL at the frequencies of 8, 12, 16, 24, and 32 kHz. A total of 69 strains (1-8 mice/strain) were analyzed. A statistically significant post-noise reduction in wave I amplitude was observed in all the tested frequencies (p < 0.00001). We identify distinct patterns of noise susceptibility and make this complete phenotypic dataset available for general use. This data establishes a new resource for the study of NIHL in mice and we hope this database will be a useful tool to expand the research in this field.

Prevalence of hearing loss and influencing factors among workers in Wuhan, China

We aimed to estimate the prevalence of hearing loss and influencing factors among workers in automobile manufacturing industry in Wuhan, China. We conducted cross-sectional analyses of 2017 through 2019 data from survey of the key occupational diseases on 17,176 workers in automobile manufacturing industry, Wuhan, China. Hearing loss was defined as a pure tone mean of 25 dB or higher in either ear at 0.5, 1, and 2 kHz for speech frequency and at 3, 4, and 6 kHz for high frequency. Among the 17,176 workers, more than a quarter of participants had high frequency hearing loss, and 6.41% had speech frequency hearing loss. The prevalence of hearing loss was higher among participants with diabetes mellitus and current smoking, temporary tinnitus, and sudden change in hearing. Compared with the controls, age (OR = 1.08, 95% CI = 1.08-1.09), male (OR = 1.40, 95% CI = 1.21-1.63), occupational noise exposure (OR = 1.19, 95% CI = 1.08-1.30), having temporary tinnitus (OR = 1.20, 95% CI = 1.08-1.33), and having sudden change in hearing (OR = 1.58, 95% CI = 1.20-2.08) were associated with higher prevalence of high frequency hearing loss; meanwhile, age (OR = 1.09, 95% CI = 1.08-1.09), male (OR = 1.38, 95% CI = 1.11-1.71), having family history of hearing loss (OR = 2.84, 95% CI = 1.35-5.97), and having sudden change in hearing (OR = 2.58, 95% CI = 1.80-3.70) were associated with higher prevalence of speech frequency hearing loss. No additive and multiplicative interaction was found between occupational noise and these factors for hearing loss. Hearing loss directly affects 25% of workers in automobile manufacturing industry in Wuhan. Measures should be implemented for the control of occupational noise and other factors simultaneously in the workplace.

Thyroid-Stimulating Hormone and Free Thyroxine Alterations in Subjects with Occupational Hearing Loss

Context and Aim:

Occupational hearing loss (OHL) is caused by exposure to industrial noise. Alterations in the thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels are related to hearing loss. The purpose of this study is to investigate the TSH and FT4 level alterations in OHL.

Methods and Material:

Among 428 subjects, 144 male workers with normal hearing (NH), noise-induced hearing loss (NIHL), and high tone loss (HTL) (N = 48 in each group) were included in this study. All the subjects had normal TSH and FT4 levels.

Results:

The TSH level is higher in the HTL and NIHL groups in comparison to NH, but it is only significant in the HTL group. The FT4 level is significantly lower in the NIHL group; however, the lower FT4 level in the HTL group is not significant when compared to the NH group.

Discussion:

The NIHL group may turn into the HTL group over time. This process could be monitored by alteration in their TSH and FT4 levels.

Conclusions:

Alterations in the TSH and FT4 levels could be considered as a pathophysiology for OHL. More research is required to investigate the electrophysiological, physiological, and histological correlations of TSH and FT4 and different types of hearing loss caused by noise exposure.

Correlation of SOD and MDA Expression in the Organ of Corti and Changes in the Function of Outer Hair Cells Measured by DPOAE Examination in Noise-Exposed Rat Cochlea

BACKGROUND

Hearing loss due to noise can cause the disturbances toward the quality of life and cause mechanical damage and metabolic decompensation. Distortion Product Otoacoustic Emission (DPOAE) is an examination to assess the sensory function of outer hair cells. Superoxide Dismutase (SOD) and Malondialdehyde (MDA) are markers of oxidative stress. The aim of this study was to identify the correlation between DPOAE examination and SOD and MDA expression in rats exposed to noise.

METHODS

This research was conducted on 27 rats which were divided into 3 groups, group 1 (control), group 2, and group 3 were groups with 100 dB and 110 dB noise exposure respectively.

RESULTS

Our findings show a decrease in SOD expression and DPOAE values as well as an increase in MDA expression in rats exposed to noise and there is a positive correlation between Signal to Noise Ratio (SNR) value with SOD expression (r= 0.733, p= 0.025) and a negative correlation between SNR value with MDA expression (r= -0.678, p= 0.045).

CONCLUSION

our study find the correlation of oxidant and antioxidant status values in the organ of corti and changes in the function of outer hair cells in noise-exposed rat models.

Single nucleotide polymorphisms in JNK1 are associated with susceptibility to noise-induced hearing loss in a Chinese population

PURPOSE

This study intended to explore the effect of C-Jun N-terminal kinases 1 (JNK1) polymorphisms on the sensitivity of individual hearing loss.

METHODS

A total of 1333 subjects, including 683 NIHL workers and 650 normal-hearing workers from east China, were included in this cross-sectional study. Genotyping of three JNK1 single nucleotide polymorphisms (rs9284, rs8428, and rs11598320) was performed. The relationship between different genotypes and noise-induced hearing loss was analyzed.

RESULTS

Results show that rs11598320 TT genotype was associated with a higher risk of NIHL (OR 1.57, 95% CI 0.91-2.70). Stratified analysis indicated that the rs11598320 AT + AA genotype was associated with a decreased risk of hearing loss in subjects exposed to noise ≤ 16 years or a noise level > 92 dB (OR 0.68, 95% CI 0.50-0.93 and OR 0.64, 95% CI 0.42-0.96, respectively). The rs8428 TT genotype was associated with an increased risk of noise-induced hearing loss when the noise level was > 92 dB (OR 1.73, 95% CI 1.11-2.70). Haplotype TCT (rs9284-rs8424-rs11598320) was associated with an increased risk of noise-induced hearing loss (OR 1.30, 95% CI 1.00-1.68).

CONCLUSION

Single nucleotide polymorphisms (rs11598320 and rs8424) in JNK1 can be used as new biomarkers of susceptibility for noise-induced hearing loss in Chinese workers.

Hearing Difficulties and Tinnitus in Construction, Agricultural, Music, and Finance Industries: Contributions of Demographic, Health, and Lifestyle Factors

High levels of occupational noise exposure increase the risk of hearing difficulties and tinnitus. However, differences in demographic, health, and lifestyle factors could also contribute to high levels of hearing difficulties and tinnitus in some industries. Data from a subsample (n = 22,936) of the U.K. Biobank were analyzed to determine to what extent differences in levels of hearing difficulties and tinnitus in high-risk industries (construction, agricultural, and music) compared with low-risk industries (finance) could be attributable to demographic, health, and lifestyle factors, rather than occupational noise exposure. Hearing difficulties were identified using a digits-in-noise speech recognition test. Tinnitus was identified based on self-report. Logistic regression analyses showed that occupational noise exposure partially accounted for higher levels of hearing difficulties in the agricultural industry compared with finance, and occupational noise exposure, older age, low socioeconomic status, and non-White ethnic background partially accounted for higher levels of hearing difficulties in the construction industry. However, the factors assessed in the model did not fully account for the increased likelihood of hearing difficulties in high-risk industries, suggesting that there are additional unknown factors which impact on hearing or that there was insufficient measurement of factors included in the model. The levels of tinnitus were greatest for music and construction industries compared with finance, and these differences were accounted for by occupational and music noise exposure, as well as older age. These findings emphasize the need to promote hearing conservation in occupational and music settings, with a particular focus on high-risk demographic subgroups.

Occupational noise-induced hearing loss in China: a systematic review and meta-analysis

OBJECTIVE

Most of the Chinese occupational population are becoming at risk of noise-induced hearing loss (NIHL). However, there is a limited number of literature reviews on occupational NIHL in China. This study aimed to analyse the prevalence and characteristics of occupational NIHL in the Chinese population using data from relevant studies.

DESIGN

Systematic review and meta-analysis.

METHODS

From December 2019 to February 2020, we searched the literature through databases, including Web of Science, PubMed, MEDLINE, Scopus, the China National Knowledge Internet, Chinese Sci-Tech Journal Database (weip.com), WanFang Database and China United Library Database, for studies on NIHL in China published in 1993-2019 and analysed the correlation between NIHL and occupational exposure to noise, including exposure to complex noise and coexposure to noise and chemicals.

RESULTS

A total of 71 865 workers aged 33.5±8.7 years were occupationally exposed to 98.6±7.2 dB(A) (A-weighted decibels) noise for a duration of 9.9±8.4 years in the transportation, mining and typical manufacturing industries. The prevalence of occupational NIHL in China was 21.3%, of which 30.2% was related to high-frequency NIHL (HFNIHL), 9.0% to speech-frequency NIHL and 5.8% to noise-induced deafness. Among manufacturing workers, complex noise contributed to greater HFNIHL than Gaussian noise (overall weighted OR (OR)=1.95). Coexposure to noise and chemicals such as organic solvents, welding fumes, carbon monoxide and hydrogen sulfide led to greater HFNIHL than noise exposure alone (overall weighted OR=2.36). Male workers were more likely to experience HFNIHL than female workers (overall weighted OR=2.26). Age, noise level and exposure duration were also risk factors for HFNIHL (overall weighted OR=1.35, 5.63 and 1.75, respectively).

CONCLUSIONS

The high prevalence of occupational NIHL in China was related to the wide distribution of noise in different industries as well as high-level and long-term noise exposure. The prevalence was further aggravated by exposure to complex noise or coexposure to noise and specific chemicals. Additional efforts are needed to reduce occupational noise exposure in China.

Supplementation of Taurine Insulates Against Oxidative Stress, Confers Neuroprotection and Attenuates Memory Impairment in Noise Stress Exposed Male Wistar Rats

Noise has always been an important environmental factor that induces health problems in the general population. Due to ever increasing noise pollution, humans are facing multiple auditory and non-auditory problems including neuropsychiatric disorders. In modern day life it is impossible to avoid noise due to the rapid industrialization of society. Continuous exposure to noise stress creates a disturbance in brain function which may lead to memory disorder. Therefore, it is necessary to find preventive measures to reduce the deleterious effects of noise exposure. Supplementation of taurine, a semi essential amino acid, is reported to alleviate psychiatric disorders. In this study noise-exposed (100 db; 3 h daily for 15 days) rats were supplemented with taurine at a dose of 100 mg/kg for 15 days. Spatial and recognition memory was assessed using the Morris water maze and novel object recognition task, respectively. Results of this study showed a reversal of noise-induced memory impairment in rats. The derangements of catecholaminergic and serotonergic levels in the hippocampus and altered brain antioxidant enzyme activity due to noise exposure were also restored by taurine administration. This study highlights the importance of taurine supplementation to mitigate noise-induced impaired memory via normalizing the neurochemical functions and reducing oxidative stress in rat brain.

Does occupational noise matter amongst manufacturing (small and medium enterprises) workers? Empirical evidence from Magaba, Mbare, Zimbabwe

BACKGROUND

The significance of how occupational noise can influence attitudes towards occupational noise exposure, susceptibility to hearing loss and job performance has generally been neglected in the past studies.

OBJECTIVES

The aim of this study was to determine the impact of occupational noise on attitudes towards occupational noise exposure, susceptibility to hearing loss and job performance of manufacturing small and medium enterprises (SMEs) workers in Zimbabwe.

METHOD

A survey was conducted involving 250 respondents, including manufacturing SME workers, and the hypotheses were analysed by applying structural equation modelling.

RESULTS

Occupational noise had a positive and significant effect on attitudes towards occupational noise exposure and perceived susceptibility to hearing loss amongst manufacturing SME workers. In addition, attitudes towards exposure to occupational noise and the perceived susceptibility of hearing loss have had a positive and significant impact on manufacturing SME workers' job performance.

CONCLUSION

The novelty of the research is its analysis of occupational noise as an indicator of attitudes towards occupational noise exposure and susceptibility to hearing loss as well as job performance. This study provides practitioners with beneficial implications. Collective knowledge on occupational noise could help manufacturing SME managers in recognising the perceptions of employees on occupational noise and how it ultimately affects job performance. Moreover, this study is intended to add new knowledge to the current body of African occupational noise literature - a context that has not received much research attention in developing countries.

Early hearing slope as a predictor of subsequent hearing trajectory in a noise-exposed occupational cohort

Variations in individual susceptibility to noise-induced hearing loss have been observed among workers exposed to similar ambient noise levels but the reasons for this observation are poorly understood. Many workers are exposed to hazardous levels of occupational noise throughout their entire careers. Therefore, a mechanism to identify workers at risk for accelerated hearing loss early in their career may offer a time-sensitive window for targeted intervention. Using available longitudinal data for an occupationally noise-exposed cohort of manufacturing workers, this study aims to examine whether change in an individual's high frequency hearing level during the initial years of occupational noise exposure can predict subsequent high frequency hearing loss. General linear mixed modeling was used to model later hearing slope in the worse ear for the combined frequencies of 3, 4, and 6 kHz as a function of early hearing slope in the worse ear, age at baseline, sex, race/ethnicity, mean ambient workplace noise exposure, and self-reported non-occupational noise exposure. Those with accelerated early hearing loss were more likely to experience a greater rate of subsequent hearing loss, thus offering a potentially important opportunity for meaningful intervention among those at greatest risk of future hearing loss.

Occupational Noise-Induced Hearing Loss

: Occupational hearing loss is preventable through a hierarchy of controls, which prioritize the use of engineering controls over administrative controls and personal protective equipment. The occupational and environmental medicine (OEM) physician plays a critical role in the prevention of occupational noise-induced hearing loss (NIHL). This position statement clarifies current best practices in the diagnosis of occupational NIHL.

Validation of self-reported occupational noise exposure in participants of a French case-control study on acoustic neuroma

OBJECTIVES

To validate self-reported occupational loud noise exposure against expert evaluation of noise levels in a French case-control study on acoustic neuroma and to estimate the impact of exposure misclassification on risk estimation.

METHODS

Noise levels were evaluated in 1006 jobs held by 111 cases and 217 population controls by an expert. Case-control differences in self-reporting were analyzed with logistic models. Sensitivity, specificity, positive and negative predictive values, and observed agreement of the self-reports were computed relative to the expert evaluation. They were used to calibrate the odds ratio (OR) between lifetime ever occupational loud noise exposure and the risk of acoustic neuroma, without adjustment for measurement error of the expert assessments.

RESULTS

Cases reported noise levels in individual jobs closer to the expert assessment than controls, but the case-control difference was small for lifetime exposures. For expert-rated exposure of 80 dB(A), reporting of individual jobs by cases was more sensitive (54% in cases, 37% in controls), whereas specificity (91% in cases, 93% in controls) and observed agreement (82% in cases, 81% in controls) were similar. When lifetime exposure was considered, sensitivity increased (76% in cases, 65% in controls), while cases specificity decreased (84%). When these values were used to calibrate self-reports for exposure misclassification compared to expert evaluation at 80 dB(A), the crude OR of 1.7 was reduced to 1.3.

CONCLUSIONS

Despite the relatively accurate reporting of loud noise, the impact of the calibration on the OR was non-negligible.

Bilateral high-frequency hearing loss is associated with elevated blood pressure and increased hypertension risk in occupational noise exposed workers

Objective

To investigate the association of bilateral high-frequency hearing loss (BHFHL) with blood pressure and hypertension among occupational noise exposed workers.

Methods

Occupational noise exposed workers were enrolled in 2017 from the occupational diseases survey of Chengdu. BHFHL was classified as normal, mild, or high by the bilateral high-frequency tone average. Linear regression model was used to assess the effects of occupational noise exposure time and BHFHL on blood pressure. Logistic regression model was performed to estimate hypertension risk odds ratios (ORs) associated to occupational noise exposure time and BHFHL.

Results

Increasing years of occupational noise exposure and BHFHL were significantly associated with systolic and diastolic blood pressure increase (all P<0.001). The lineal trend was only significant in males, with adjusted ORs for hypertension gradually increasing with increasing years of occupational noise exposure (P<0.001). Furthermore, subjects having mild and high BHFHL had a higher hypertension risk of 34% and 281%, respectively (both P<0.001). Dose-response relationship between BHFHL and hypertension was found in both males and females.

Conclusions

Occupational noise exposure was positively associated with blood pressure levels and hypertension risk.

Effects of D-methionine in mice with noise-induced hearing loss mice

Objective

To study the effects of D-methionine in a mouse model of noise-induced hearing loss (NIHL).

Methods

We investigated changes in auditory function and microscopic cochlear structure in a mouse model of NIHL, and carried out 4-hydroxynonenal (4-HNE) immunostaining and terminal deoxynucleotidyl transferase dUTP nick-end labeling, and examined expression levels of connexins 26 and 30 by western blot.

Results

The auditory brainstem response threshold was significantly increased by noise exposure. Noise exposure also damaged the inner and particularly the outer hair cells in the cochlear basement membrane, while histochemistry demonstrated only scattered loss of hair cells in the basement membrane in mice treated with D-methionine before or after noise exposure. D-methionine inhibited apoptosis in the cochlear basement membrane, stria vascularis, and spiral ligament. 4-HNE expression in the basement membrane, stria vascularis, and spiral collateral ligament was increased by noise exposure, but this increase was attenuated by D-methionine. Connexin 26 and connexin 30 expression levels were reduced by noise exposure, and this effect was similarly attenuated by D-methionine administered either before or after noise exposure.

Conclusion

D-methionine administered before or after noise exposure could rescue NIHL by protecting cochlear morphology, inhibiting apoptosis, and maintaining connexin 26 and 30 expression.

Valencia's Cathedral Church Bell Acoustics Impact on the Hearing Abilities of Bell Ringers

Studies on the effect of occupational noise have been widely performed for occupations such as construction workers, workers of factories or even musicians and workers of nightclubs. However, studies on the acoustics of church bells are very scarce and usually reported in languages other than English. In Spain, although the tradition of bell ringers is progressively getting lost, some bell ringers that continue transmitting the tradition remain. Church bells create sound with a large sound pressure level that can be heard from a great distance. However, despite the characteristics of the sound of church bells, bell ringers do not present symptoms of occupational hearing loss unlike musicians and construction workers. To determine the effects of the sound of the church bells on bell ringers, in this paper, an acoustic study of the church bells and a physiological study of the hearing abilities of bell ringers. Results show sound pressure levels reaching 120 dB inside the bell tower. The resulting hearing loss in bell ringers is small considering the great intensity of the sound produced by the bells. This is likely due to the short amount of time that bell ringers are exposed to the sound even if it reaches high sound pressure levels.

TSP1 and TSP2 Have Unique and Overlapping Roles in Protecting against Noise-Induced Auditory Synaptopathy

Thrombospondins (TSPs) are cell adhesion molecules that play an important role in the maintenance of hearing and afferent synaptic connections. Based on their reported function in restoring synaptic connections after stroke, we tested a potential role for TSP1 and TSP2 genes in repairing cochlear synapses following noise injury. We observed a tonotopic gradient in the expression of TSP1 and TSP2 mRNA in control mouse cochleae and an upregulation of these genes following noise exposure. Examining the functional sequelae of these changes revealed that afferent synaptic counts and auditory brainstem responses (ABRs) in noise-exposed TSP1 and TSP2 knockout (-/-) mice exhibited a worst recovery when compared to controls. Consistent with their tonotopic expression, TSP1-/- mice showed greater susceptibility to noise-induced hearing loss (NIHL) at 8 kHz and 16 kHz frequencies, whereas NIHL in TSP2-/- mice occurred only at mid and high frequencies. Further analysis of the ABR waveforms indicated peripheral neuronal damage in TSP2-/- but not in TSP1-/- mice. Noise trauma affecting mid to high frequencies triggered severe seizures in the TSP2-/- mice. We found that decreased susceptibility to audiogenic seizures in TSP1-/- mice was correlated with increased TSP2 protein levels in their inner ears, suggesting that TSP2 might functionally compensate for the loss of TSP1 in these mice. Our data indicate that TSP1 and TSP2 are both involved in susceptibility to NIHL, with TSP2 playing a more prominent role.

Noise levels in general pediatric facilities: A health risk for the staff?

This study was initiated to investigate noise levels in general pediatric facilities. Although occupational noise limits of 85dBA for L_Aeq,8h (daily noise exposure) and 140dBC for L_Cpeak (peak sound level) have proven to prevent hearing loss, even low levels of continuous noise (45dBA and above) can cause adverse health effects (ISO = International Organization for Standardization, A = Austrian VOLV). The sound level measurements of L_Aeq (equivalent sound level) and L_Cpeak were conducted with a decibel meter in the examination rooms (EXR) and waiting rooms (WR) of 10 general pediatric practices and outpatient clinics in the city of Vienna, Austria. L_Aeq,8h was calculated from L_Aeq, and independent variables with a potential influence on noise levels were also examined. In EXR, the random sample consisted of 5 to 11 measuring periods per facility (mean: 7.1 ± 1.9) with a total duration between 43.85 and 98.45 min. (total: 10:19:04). With L_Aeq ranging from 67.2 to 80.2dBA, specific recommended limits were exceeded considerably (ISO: 45dBA; A: 50dBA). In WR, the random sample comprised 5 to 18 measurements per facility (mean: 13.7 ± 5.0) with a total duration ranging from 25 to 90 min. (total: 11:25:00). The values for L_Aeq were between 60.6dBA and 67.0dBA. All of these significantly exceeded recommended limits of 55dBA (ISO) and 5 out of 10 exceeded 65dBA (A). L_Cpeak reached 116.1dBC in WR and 114.1dBC in EXR. The highest calculated daily noise exposure of pediatricians (L_Aeq,8h) was 79dBA. Although no significantly increased risk for hearing loss can be concluded from our findings, it must be assumed that noise levels in general pediatrics have the potential to cause stress and associated health issues. Further research is necessary to foster the recognition of noise-related health impairments of pediatric staff as occupational diseases.

An Integrative Model Accounting for the Symptom Cluster Triggered After an Acoustic Shock

Acoustic shocks and traumas sometimes result in a cluster of debilitating symptoms, including tinnitus, hyperacusis, ear fullness and tension, dizziness, and pain in and outside the ear. The mechanisms underlying this large variety of symptoms remain elusive. In this article, we elaborate on the hypothesis that the tensor tympani muscle (TTM), the trigeminal nerve (TGN), and the trigeminal cervical complex (TCC) play a central role in generating these symptoms. We argue that TTM overuse (due to the acoustic shock), TTM overload (due to muscle tension), and ultimately, TTM injury (due to hypoxia and "energy crisis") lead to inflammation, thereby activating the TGN, TCC, and cortex. The TCC is a crossroad structure integrating sensory inputs coming from the head-neck complex (including the middle ear) and projecting back to it. The multimodal integration of the TCC may then account for referred pain outside the ear when the middle ear is inflamed and activates the TGN. We believe that our model proposes a synthetic and explanatory framework to explain the phenomena occurring postacoustic shock and potentially also after other nonauditory causes. Indeed, due to the bidirectional properties of the TCC, musculoskeletal disorders in the region of the head-neck complex, including neck injury due to whiplash or temporomandibular disorders, may impact the middle ear, thereby leading to otic symptoms. This previously unavailable model type is experimentally testable and must be taken as a starting point for identifying the mechanisms responsible for this particular subtype of tinnitus and its associated symptoms.

Genetic variation in KCNQ4 gene is associated with susceptibility to noise-induced hearing loss in a Chinese population

Noise-induced hearing loss (NIHL), one of the most widespread occupational health risks worldwide, is a kind of complex disorder resulting from both genetic and environmental factors. KCNQ4 channels are crucial to the internal ear potassium recycling. To explore whether KCNQ4 polymorphism is associated with individual susceptibility to NIHL, we performed this genetic association study on 571 NIHL cases and 639 normal hearing controls selected from about 2700 Chinese noise-exposed workers. General information and audiometric data were obtained through questionnaires and pure-tone audiometry (PTA). DNA samples were collected and genotyping for three selected SNPs (rs709688, rs2769256 and rs4660468) was performed. Significant differences were observed between cases and controls for the genotype frequency and allele frequency in rs4660468, suggesting that rs4660468 CT/TT genotype and T allele may be risk factors for NIHL. In subjects exposed to noise for more than 16 years (OR = 1.23, 95% CI = 1.09-1.53) and those who exposed to noise >92 dB (OR = 1.29, 95% CI = 1.08-1.69), increased risks of NIHL were found after stratified analysis for rs4660468. Our results suggest that rs4660468 T allele of KCNQ4 involves with a higher risk of NIHL and could be one biomarker of susceptibility for Chinese noise exposed workers.

Prevalence of severe-profound hearing loss in South Korea: a nationwide population-based study to analyse a 10-year trend (2006-2015)

To estimate prevalence of severe-profound hearing loss (HL) in South Korea, and analyse a 10-year trend of HL according to age, sex, and region by using a nationwide population-based database. Retrospective review from Korean National Health Insurance Service from 2006 to 2015. The degree of severe-profound HL was classified into six grades, based mostly on HL worse than 60 dB HL for both ears. Absolute number of HL was the highest in 2011 (0.25 million; males, 0.14 million; females, 0.11 million); it decreased gradually until 2015. Total HL prevalence was the highest in 2010 (0.5%; 251,954), and decreased annually to 2015 (0.46%; 237,272). The trend of HL prevalence showed a gradual decrease from 2010 to 2015. Prevalence of severe-profound HL was always higher in the male population (1.19 times higher than female in 2015). Prevalence of HL was higher in rural areas than in urban areas (1.4 times higher in 2015). Number of severe-profound HL in South Korea decreased gradually in all age groups annually, even though some older age groups had the highest peak in 2010–2011. Prevalence of severe-profound HL decreases gradually in all age groups annually in South Korea, although the absolute number of HL cases increases rapidly among those aged over 80 years.

The Antioxidant Effect of Rosmarinic Acid by Different Delivery Routes in the Animal Model of Noise-Induced Hearing Loss

HYPOTHESIS

Trans-tympanic Rosmarinic Acid (RA), as compared with the systemic administration, protects against noise-induced auditory hair cell and hearing losses in rats in vivo.

BACKGROUND

ROS production, lipoperoxidative damage, and an imbalance of antioxidant defences play a significant role in noise-induced hearing loss. Several molecules with antioxidant properties have been tested to restore redox homeostasis; however, drug delivery system represents a challenge for their effectiveness. In our model, acute and intense noise exposure induces hearing loss, hair cell death, and oxidative stress, with an increase in superoxide production and over-expression of lipid peroxidation in cochlear structures.

METHODS

RA was administrated in male Wistar rats by trans-tympanic (20 μl) and systemic (10 mg/kg) modality. In systemic administration, RA was injected 1 hour before noise exposure and once daily for the following 3 days. ABRs were measured before and at days 1, 3, 7, and 30 after noise exposure. Rhodamine-phalloidin staining, dihydroethidium and 8-isoprostane immunostainings were performed to assess and quantify outer hair cells loss, superoxide production, and lipid peroxidation in the different experimental groups.

RESULTS

Systemic RA administration significantly decreased noise-induced hearing loss and the improvement of auditory function was paralleled by a significant reduction in cochlear oxidative stress. The trans-tympanic modality of drug administration showed a similar degree of protection both at the functional and morphological levels.

CONCLUSION

The effectiveness of RA given via trans-tympanic injection could be interesting for the future application of this minimally-invasive procedure in the treatment of ROS-induced hearing loss.

Noise-Induced Hearing Loss - A Preventable Disease? Results of a 10-Year Longitudinal Study of Workers Exposed to Occupational Noise

Aims:

To survey current, Danish industrial noise levels and the use of hearing protection devices (HPD) over a 10-year period and to characterise the association between occupational noise and hearing threshold shift in the same period. Furthermore, the risk of hearing loss among the baseline and the follow-up populations according to first year of occupational noise exposure is evaluated.

Materials and Methods:

In 2001–2003, we conducted a baseline survey of noise- and hearing-related disorders in 11 industries with suspected high noise levels. In 2009–2010, we were able to follow up on 271 out of the 554 baseline workers (49%). Mean noise levels per industry and self-reported HPD use are described at baseline and follow-up. The association between cumulative occupational noise exposure and hearing threshold shift over the 10-year period was assessed using linear regression, and the risk of hearing loss according to year of first occupational noise exposure was evaluated with logistic regression.

Results:

Over the 10-year period, mean noise levels declined from 83.9 dB(A) to 82.8 dB(A), and for workers exposed >85 dB(A), the use of HPD increased from 70.1 to 76.1%. We found a weak, statistically insignificant, inverse association between higher ambient cumulative noise exposure and poorer hearing (−0.10 dB hearing threshold shift per dB-year (95% confidence interval (CI): −0.36; 0.16)). The risk of hearing loss seemed to increase with earlier first year of noise exposure, but odds ratios were only statistically significant among baseline participants with first exposure before the 1980s (odds ratio: 1.90, 95% CI: 1.11; 3.22).

Conclusions:

We observed declining industrial noise levels, increased use of HPD and no significant impact on hearing thresholds from current ambient industrial noise levels, which indicated a successful implementation of Danish hearing conservation programs.

Fluvastatin protects cochleae from damage by high-level noise

Exposure to noise and ototoxic drugs are responsible for much of the debilitating hearing loss experienced by about 350 million people worldwide. Beyond hearing aids and cochlear implants, there have been no other FDA approved drug interventions established in the clinic that would either protect or reverse the effects of hearing loss. Using Auditory Brainstem Responses (ABR) in a guinea pig model, we demonstrate that fluvastatin, an inhibitor of HMG-CoA reductase, the rate-limiting enzyme of the mevalonate pathway, protects against loss of cochlear function initiated by high intensity noise. A novel synchrotron radiation based X-ray tomographic method that imaged soft tissues at micrometer resolution in unsectioned cochleae, allowed an efficient, qualitative evaluation of the three-dimensional internal structure of the intact organ. For quantitative measures, plastic embedded cochleae were sectioned followed by hair cell counting. Protection in noise-exposed cochleae is associated with retention of inner and outer hair cells. This study demonstrates the potential of HMG-CoA reductase inhibitors, already vetted in human medicine for other purposes, to protect against noise induced hearing loss.

A Protocol for Decellularizing Mouse Cochleae for Inner Ear Tissue Engineering

In mammals, mechanosensory hair cells that facilitate hearing lack the ability to regenerate, which has limited treatments for hearing loss. Current regenerative medicine strategies have focused on transplanting stem cells or genetic manipulation of surrounding support cells in the inner ear to encourage replacement of damaged stem cells to correct hearing loss. Yet, the extracellular matrix (ECM) may play a vital role in inducing and maintaining function of hair cells, and has not been well investigated. Using the cochlear ECM as a scaffold to grow adult stem cells may provide unique insights into how the composition and architecture of the extracellular environment aids cells in sustaining hearing function. Here we present a method for isolating and decellularizing cochleae from mice to use as scaffolds accepting perfused adult stem cells. In the current protocol, cochleae are isolated from euthanized mice, decellularized, and decalcified. Afterward, human Wharton's jelly cells (hWJCs) that were isolated from the umbilical cord were carefully perfused into each cochlea. The cochleae were used as bioreactors, and cells were cultured for 30 days before undergoing processing for analysis. Decellularized cochleae retained identifiable extracellular structures, but did not reveal the presence of cells or noticeable fragments of DNA. Cells perfused into the cochlea invaded most of the interior and exterior of the cochlea and grew without incident over a duration of 30 days. Thus, the current method can be used to study how cochlear ECM affects cell development and behavior.

Spatiotemporal expression patterns of clusterin in the mouse inner ear

Clusterin (CLU) is an extracellular chaperone protein that is implicated in diverse physiological and pathophysiological cellular processes. CLU expression is upregulated in response to cellular stress and under certain conditions, such as neurodegenerative disease and cancer. CLU primarily functions as a chaperone that exerts cytoprotective effects by removing cellular debris and misfolded proteins and also acts as a signaling molecule that regulates pro-survival pathways. Deafness is caused by genetic factors and various extrinsic insults, including ototoxic drugs, exposure to loud sounds and aging. Considering its cytoprotectivity, CLU may also mediate cellular defense mechanisms against hearing loss due to cellular stresses. To understand the function of CLU in the inner ear, we analyze CLU expression patterns in the mouse inner ear during development and in the adult stage. Results of quantitative real-time polymerase chain reaction analysis showed that Clu mRNA levels in the inner ear were increased during embryogenesis and were constantly expressed in the adult. Detailed spatial expression patterns of Clu both in the mRNA and protein levels were analyzed throughout various developmental stages via in situ hybridization and immunofluorescence staining. Clu expression was found in specific domains of developing inner ear starting from the otocyst stage, mainly adjacent to the prosensory domain of the cochlear epithelium. In the mature inner ear, Clu expression was observed in Deiter's cells and pillar cells of the organ of Corti, outer sulcus and in basal cells of the stria vascularis in the cochlea. These specific spatiotemporal expression patterns suggest the possible roles of CLU in inner ear development and in maintaining proper hearing function.

Association of the C47T polymorphism in superoxide dismutase gene 2 with noise-induced hearing loss: a meta-analysis

Introduction

Currently, there is limited information about the relationship between manganese superoxide dismutase (sod2) c47t polymorphism and susceptibility to noise-induced hearing loss (NIHL).

Objective

The aim of this meta-analysis was to clarify the association between SOD2 C47T polymorphism and NIHL.

Methods

A search in PubMed and Web of Science was performed to collect data. All full-text, English-written studies containing sufficient and complete case-and-control data about the relationship between SOD2 C47T polymorphism and NIHL were included. Three eligible studies, comprising 1094 subjects, were identified. pooled odds ratios (ORs) and 95% confidence intervals (CI) were calculated to evaluate the strength of the association between SOD2 C47T polymorphism and NIHL.

Results

No significant association between C47T polymorphism and risk of NIHL was found with the following combinations: T vs. C (OR = 0.83; 95% CI = 0.63–1.09); TT vs. CC (OR = 0.49; 95% CI = 0.22–1.09); CT vs. CC (OR = 0.54; 95% CI = 0.25–1.17); TT vs. CC + CT (OR = 0.82; 95% CI = 0.50–1.32); CC vs. TT + TC (OR = 0.49; 95% CI = 0.23–1.04). However, in subgroup analysis, a significant association was found for TT vs. CC + CT (OR = 0.77; 95% CI = 0.42–1.41) in the Chinese population.

Conclusion

The present meta-analysis suggests that SOD2 C47T polymorphism is significantly associated with increased risk of NIHL in the Chinese population. Further large and well-designed studies are needed to confirm this association.

Determination of the level of noise in nurseries and pre-schools and the teachers' level of annoyance

Objective:

The aim of this article is to determine the level of noise in nurseries and pre-schools and also to compare measured levels with standard levels and evaluate the teachers’ level of annoyance.

Materials and Methods:

The level of noise was measured in three different schools. A total of 162 students, whose ages were between 3 and 6 years, and 12 teachers were included the study. Every age groups’ level of noise was measured during sleeping, gaming, and eating activity. In addition, teachers’ annoyance was assessed in different age groups.

Results:

The 4- to 6-year-old groups were found to have higher level of sounds than 3-year-old group. Eating period was found to be the highest level of sound whereas sleeping was found the lowest. Furthermore, teachers’ annoyance was found higher as the age decreased.

Conclusion:

Nurseries and pre-schools have noisy environment both for the students and the teachers. High level of noise, which has bad effects on health, is a public health problem. Both the students’ families and teachers must be aware of this annoying situation.

Is Hearing Impairment Associated with Rheumatoid Arthritis? A Review

Background:

Rheumatoid arthritis (RA) is a systemic, inflammatory disease that affects 1% of the population. The auditory system may be involved during the course of disease; however the association of RA and hearing impairment has not been clearly defined.

Objective:

The objective of this review is to evaluate published clinical reports related to hearing impairment in patients with RA. Furthermore, we discuss possible pathologies and associated factors as well as new treatment modalities.

Method:

A thorough literature search was performed using available databases including Pubmed, Embase, Cochrane and ComDisDome to cover all relative reports. The following keywords were used: hearing loss, hearing difficulties, hearing disorders, hearing impairment, sensorineural hearing loss, conductive hearing loss, mixed hearing loss, autoimmune hearing loss, drug ototoxicity, drug-induced hearing loss, hearing test, audiometry, auditory dysfunction and rheumatoid arthritis.

Conclusion:

Based on our review it can be postulated that patients with RA are at higher risk of hearing impairment compared to healthy subjects in their course of the disease. The hearing impairment in RA seems to be a multifactorial condition; however the mechanisms of injury, as well as the relative risk factors, are not completely clear. This review can aid to clarify this condition and is a guide for further evaluation. To the best of our knowledge, this is the first review of hearing impairment in RA.

Noise-induced damage to ribbon synapses without permanent threshold shifts in neonatal mice

Recently, ribbon synapses to the hair cells (HCs) in the cochlea have become a novel site of interest in the investigation of noise-induced cochlear lesions in adult rodents (Kujawa and Liberman, 2009; Lin et al., 2011; Liu et al., 2012; Shi et al., 2013). Permanent noise-induced damage to this type of synapse can result in subsequent degeneration of spiral ganglion neurons (SGNs) in the absence of permanent changes to hearing sensitivity. To verify whether noise exposure during an early developmental period produces a similar impact on ribbon synapses, the present study examined the damaging effects of noise exposure in neonatal Kunming mice. The animals received exposure to broadband noise at 105-decibel (dB) sound pressure level (SPL) for 2h on either postnatal day 10 (P10d) or postnatal day 14 (P14d), and then hearing function (based on the auditory brainstem response (ABR)) and cochlear morphology were evaluated during either postnatal weeks 3-4 (P4w) or postnatal weeks 7-8 (P8w). There were no significant differences in the hearing threshold between noise-exposed and control animals, which suggests that noise did not cause permanent loss of hearing sensitivity. However, noise exposure did produce a significant loss of ribbon synapses, particularly in P14d mice, which continued to increase from P4w to P8w. Additionally, a corresponding reduction in the amplitude of compound action potential (CAP) was observed in the noise-exposed groups at P4w and P8w, and the CAP latency was elongated, indicating a change in synaptic function.

Occupational Hearing Loss among Chinese Municipal Solid Waste Landfill Workers: A Cross-Sectional Study

Background

Occupational hearing loss is an increasingly prevalent occupational condition worldwide, and has been reported to occur in a wide range of workplaces; however, its prevalence among workers from municipal solid waste landfills (MSWLs) remains less clear. This study aimed to investigate the occupational hearing loss among Chinese MSWL workers.

Methods

A cross-sectional study of 247 workers from 4 Chinese MSWLs was conducted. Noise and total volatile organic compounds (TVOCs) levels at worksites were determined. We conducted hearing examinations to determine hearing thresholds. A worker was identified as having hearing loss if the mean threshold at 2000, 3000 and 4000 Hz in either ear was equal to or greater than 25 dB. Prevalence of occupational hearing loss was then evaluated. Using unconditional Logistic regression models, we estimated the odds ratios (ORs) of MSWL work associated with hearing loss.

Results

According to the job title for each worker, the study subjects were divided into 3 groups, including group 1 of 63 workers without MSWL occupational hazards exposure (control group), group 2 of 84 workers with a few or short-period MSWL occupational hazards exposure, and group 3 of 100 workers with continuous MSWL occupational hazards exposure. Both noise and TVOCs levels were significantly higher at worksites for group 3. Significantly poorer hearing thresholds at frequencies of 2000, 3000 and 4000 Hz were found in group 3, compared with that in group 1 and group 2. The overall prevalence rate of hearing loss was 23. 5%, with the highest in group 3 (36.0%). The OR of MSWL work associated with hearing loss was 3.39 (95% confidence interval [CI]: 1.28-8.96).

Conclusion

The results of this study suggest significantly higher prevalence of hearing loss among MSWL workers. Further studies are needed to explore possible exposure-response relationship between MSWL occupational hazards exposure and hearing loss.

Genome-wide association study identifies nox3 as a critical gene for susceptibility to noise-induced hearing loss

In the United States, roughly 10% of the population is exposed daily to hazardous levels of noise in the workplace. Twin studies estimate heritability for noise-induced hearing loss (NIHL) of approximately 36%, and strain specific variation in sensitivity has been demonstrated in mice. Based upon the difficulties inherent to the study of NIHL in humans, we have turned to the study of this complex trait in mice. We exposed 5 week-old mice from the Hybrid Mouse Diversity Panel (HMDP) to a 10 kHz octave band noise at 108 dB for 2 hours and assessed the permanent threshold shift 2 weeks post exposure using frequency specific stimuli. These data were then used in a genome-wide association study (GWAS) using the Efficient Mixed Model Analysis (EMMA) to control for population structure. In this manuscript we describe our GWAS, with an emphasis on a significant peak for susceptibility to NIHL on chromosome 17 within a haplotype block containing NADPH oxidase-3 (Nox3). Our peak was detected after an 8 kHz tone burst stimulus. Nox3 mutants and heterozygotes were then tested to validate our GWAS. The mutants and heterozygotes demonstrated a greater susceptibility to NIHL specifically at 8 kHz both on measures of distortion product otoacoustic emissions (DPOAE) and on auditory brainstem response (ABR). We demonstrate that this sensitivity resides within the synaptic ribbons of the cochlea in the mutant animals specifically at 8 kHz. Our work is the first GWAS for NIHL in mice and elucidates the power of our approach to identify tonotopic genetic susceptibility to NIHL.

Noise-induced hearing loss (NIHL) is the most common work-related disease in the world and the second cause of hearing loss. Although several candidate gene association studies for NIHL in humans have been conducted, each are underpowered, un-replicated, and account for only a fraction of the genetic risk. Buoyed by the prospects and successes of human association studies, several groups have proposed mouse genome-wide association studies. The environment can be carefully controlled, facilitating the study of complex traits like NIHL. In this manuscript, we describe, for the first time, an association analysis with correction for population structure for the mapping of several loci for susceptibility to NIHL in inbred strains of mice. We identify Nox3 as the associated gene for susceptibility to NIHL that the genetic susceptibility is frequency specific and that it occurs at the level of the cochlear synaptic ribbon.