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Audiological Tests Used in the Evaluation of the Effects of Solvents on the Human Auditory System: A Mixed Methods Review

This study aimed to scope the literature, identify knowledge gaps, appraise results, and synthesize the evidence on the audiological evaluation of workers exposed to solvents. We searched Medline, PubMed, Embase, CINAHL, and NIOSHTIC-2 up to March 22, 2021. Using Covidence, two authors independently assessed study eligibility, risk of bias, and extracted data. National Institute of Health Quality Assessment Tools was used in the quality evaluation of included studies; the Downs and Black checklist was used to assess the risk of bias. Of 454 located references, 37 were included. Twenty-five tests were studied: two tests to measure hearing thresholds, one test to measure word recognition in quiet, six electroacoustic procedures, four electrophysiological tests, and twelve behavioral tests to assess auditory processing skills. Two studies used the Amsterdam Inventory for Auditory Disability and Handicap. The quality of individual studies was mostly considered moderate, but the overall quality of evidence was considered low. The discrepancies between studies and differences in the methodologies/outcomes prevent recommending a specific test battery to assess the auditory effects of occupational solvents. Decisions on audiological tests for patients with a history of solvent exposures require the integration of the most current research evidence with clinical expertise and stakeholder perspectives.

Temporary and Permanent Auditory Effects Associated with Occupational Coexposure to Low Levels of Noise and Solvents

This study aimed to assess temporary and permanent auditory effects associated with occupational coexposure to low levels of noise and solvents. Cross-sectional study with 25 printing industry workers simultaneously exposed to low noise (<80 dBA TWA) and low levels of solvents. The control group consisted of 29 industry workers without the selected exposures. Participants answered a questionnaire and underwent auditory tests. Auditory fatigue was measured by comparing the acoustic reflex threshold before and after the workday. Workers coexposed to solvents and noise showed significantly worse results in auditory tests in comparison with the participants in the control group. Auditory brainstem response results showed differences in III−V interpeak intervals (p = 0.046 in right ear; p = 0.039 in left ear). Mean dichotic digits scores (exposed = 89.5 ± 13.33; controls = 96.40 ± 4.46) were only different in the left ear (p = 0.054). The comparison of pre and postacoustic reflex testing indicated mean differences (p = 0.032) between the exposed (4.58 ± 6.8) and controls (0 ± 4.62) groups. This study provides evidence of a possible temporary effect (hearing fatigue) at the level of the acoustic reflex of the stapedius muscle. The permanent effects were identified mainly at the level of the high brainstem and in the auditory ability of binaural integration.

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

BACKGROUND

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSION

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

Auditory system dysfunction in Brazilian gasoline station workers

Objective: To examine the auditory system of Brazilian gasoline station workers using an extensive audiological test battery. Design: This was a cross-sectional study. The audiological evaluation included a questionnaire, pure-tone audiometry, acoustic immittance tests, transient-evoked otoacoustic emissions (TEOAEs), distortion product otoacoustic emissions (DPOAEs), auditory brainstem response (ABR) and P300 auditory-evoked potentials. Study sample: A total of 77 Brazilian gasoline station workers were evaluated, and their results were compared with those of 36 participants who were not exposed to chemicals or noise at work. The gasoline station employees worked in 18 different gas stations, and the noise area measurements from all gas stations revealed time-weighted averages below 85 dBA. Results: Of the 77 gasoline station workers evaluated, 67.5% had audiometric results within the normal range, but 59.7% reported difficulties in communication in noisy places. Gasoline station workers showed significantly poorer results than non-exposed control participants in one or more conditions of each of the audiological tests used, except P300. Conclusions: The results suggest that the gasoline station workers have both peripheral and central auditory dysfunctions that could be partly explained by their exposure to gasoline.

Classificação clínico-laboratorial para manejo clínico de trabalhadores expostos ao benzeno em postos de revenda de combustíveis

Resumo Introdução: trabalhadores de postos de revenda de combustíveis estão expostos a compostos orgânicos voláteis, dos quais se destaca o benzeno. O manejo clínico do amplo espectro de sinais e sintomas desses trabalhadores ainda é um desafio para assistência em saúde. Objetivo: apresentar proposta de classificação clínico-laboratorial baseada na análise de hemograma e na avaliação clínica dos trabalhadores, para orientar a conduta dos profissionais de saúde. Métodos: a classificação clínico-laboratorial foi definida a partir de critérios de hierarquização dos resultados das avaliações clínicas e de vigilância à saúde de modo a possibilitar a organização dos procedimentos e fluxos de atenção à saúde. Resultados: a proposta define o manejo clínico com base na classificação dos expostos ao benzeno em quatro níveis de alterações clínico-laboratoriais que determinam os procedimentos compatíveis com o grau da exposição e de seus efeitos à saúde: 1) sem alterações significativas; 2) alterações inespecíficas ou incompletas, 3) alterações clínicas e/ou laboratoriais; 4) alterações sugestivas de benzenismo. Conclusão: a proposta de classificação dos achados clínico-laboratoriais é potencialmente capaz de orientar a conduta médica na avaliação das condições de saúde e dos riscos da exposição ao benzeno e de subsidiar o monitoramento sistemático e contínuo necessário para a definição de rotinas assistenciais para os coletivos de trabalhadores.

O ruído e a qualidade de vida na perspectiva de trabalhadores de postos de combustíveis

RESUMO Objetivo: avaliar a compreensão sobre o ruído e a percepção sobre a qualidade de vida de trabalhadores de postos de combustíveis. Métodos: trata-se de um estudo exploratório, com amostra de 32 trabalhadores, de ambos os sexos, de três postos de combustíveis de um município do interior do Rio Grande do Sul. A coleta foi realizada durante as atividades alusivas ao Dia Internacional de Conscientização sobre o Ruído, em abril de 2015, por um questionário sobre ruído e saúde auditiva e pelo World Heath Organization Quality of Life (WHOQOL-Bref). Resultados: a maioria dos trabalhadores relatou não apresentar perda auditiva, incômodo ou dor quando submetida a ruídos. No entanto, acreditam que a exposição ao ruído pode levar ao comprometimento auditivo, assim como ao zumbido e à tontura. O ambiente de trabalho foi indicado como ruidoso, porém os trabalhadores não se percebem produtores de ruído e não adotam medidas preventivas. Quanto à qualidade de vida, o menor score foi relativo ao domínio ambiental, em ambos os sexos e na faixa etária igual e inferior a 30 anos. Conclusão: o estudo permitiu compreender que a maioria dos trabalhadores ainda não possui conhecimento suficientemente significante sobre a necessidade de medidas de proteção contra o ruído; também evidenciou que o domínio ambiental foi o mais comprometido na percepção dos trabalhadores sobre qualidade de vida.