Intervention Review

Interventions to prevent occupational noise induced hearing loss

  1. Jos H Verbeek1,*,
  2. Erik Kateman2,
  3. Thais C Morata3,
  4. Wout Dreschler4,
  5. Bas Sorgdrager5

Editorial Group: Cochrane Ear, Nose and Throat Disorders Group

Published Online: 8 JUL 2009

Assessed as up-to-date: 8 MAR 2009

DOI: 10.1002/14651858.CD006396.pub2

Database Title

Additional Information

How to Cite

Verbeek JH, Kateman E, Morata TC, Dreschler W, Sorgdrager B. Interventions to prevent occupational noise induced hearing loss. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD006396. DOI: 10.1002/14651858.CD006396.pub2.

Author Information

  1. 1

    Cochrane Occupational Health Field, Finnish Institute of Occupational Health, Center of Expertise for Good Practices and Competence, Team of Knowledge Transfer in Occupational Health and Safety, Kuopio, Finland

  2. 2

    Arbounie, Center of Expertise in Hearing and Noise Problems, 7007 HC Doetinchem, Netherlands

  3. 3

    National Institute for Occupational Safety and Health (NIOSH), Cincinnati, OH, USA

  4. 4

    Academic Medical Centre, Audiology, Amsterdam, Netherlands

  5. 5

    Academic Medical Center, Netherlands Centre for Occupational Diseases, Amsterdam, Netherlands

*Jos H Verbeek, Finnish Institute of Occupational Health, Center of Expertise for Good Practices and Competence, Team of Knowledge Transfer in Occupational Health and Safety, Cochrane Occupational Health Field, PO Box 93 (Neulaniementie 4), Kuopio, 70701, Finland. jos.verbeek@ttl.fi.

Publication History

  1. Publication Status: New
  2. Published Online: 8 JUL 2009

SEARCH

ARTICLE TOOLS

View Full Article (HTML) Summary (60K)Standard (480K)Full (751K)
 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Millions of workers worldwide are exposed to noise levels that increase their risk of hearing impairment. Little is known about the effectiveness of hearing loss prevention interventions.

Objectives

To assess the effectiveness of non-pharmaceutical interventions for preventing occupational noise exposure or occupational hearing loss compared to no intervention or alternative interventions.

Search methods

We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library issue 4, 2008); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; NIOSHTIC, CISDOC and mRCT to 15 December 2008.

Selection criteria

Randomised controlled trials, controlled before-after studies and interrupted time series (ITS) of non-clinical hearing loss prevention interventions under field conditions among workers exposed to noise.

Data collection and analysis

Two authors (EK, JV) independently assessed study eligibility and trial quality and extracted data.

Main results

Twenty-one studies were included. One study evaluated a strategy to reduce noise exposure. Fourteen studies with 75,672 participants evaluated hearing loss prevention programmes (HLPPs), and six studies with 169 participants evaluated hearing protection. The overall quality of studies was low.

One ITS study evaluated the effect of new legislation in reducing noise exposure. It found that the median noise level decreased by 27.7 dB(A) (95% confidence interval (CI) -36.1 to -19.3 dB) with a change in trend in time of -2.1 dB per year (95% CI -4.9 to 0.7).

A hearing protection study in army recruits compared those exposed to impulse noise with non-exposed recruits. The odds ratio (OR) for hearing loss was 3.0 (95% CI 1.1 to 8.0) despite hearing protection. In four studies, workers in a HLPP had a 0.5 dB HL greater hearing loss at 4 kHz than non-noise exposed workers (95% CI -0.5 to 1.7). In one study, the hazard ratio of hearing loss was 3.8 (95% CI 2.7 to 5.3) for workers exposed to noise compared to non-exposed workers.

In three studies, a high quality HLPP had a lower risk of hearing loss than lower quality programmes.

Noise attenuation ratings of hearing protection under field conditions were consistently lower than the ratings provided by the manufacturers.

Authors' conclusions

There is low quality evidence that legislation can reduce noise levels in workplaces.The effectiveness of hearing protection devices depends on their proper use. There is contradictory evidence that HLPPs are effective in the long-term. Even though case studies show that substantial reductions can be achieved, there is no evidence that this is realised in practice. Better implementation and reinforcement is needed.

Better evaluations of technical interventions and long-term effects are needed. Audiometric and noise measurement data are potentially valuable for such studies.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Interventions to prevent hearing loss caused by noise at work

Millions of workers are exposed to noise levels that increase the risk of hearing loss and hearing impairment. In many countries there are mandatory hearing loss prevention programmes (HLPPs), which are considered an effective means to prevent noise induced hearing loss. However, the evidence for this assumption is unclear. 

We found one study that showed that noise levels decreased after a change in legislation in the mining industry. 

In six studies with 169 workers, hearing protection reduced noise exposure of workers. However, one high quality study showed that if workers lack proper instructions in the use of earplugs, hearing protection is insufficient. 

We found 15 studies with 75,672 participants that evaluated the long-term effects of protection against noise exposure. Six studies compared the effects of prevention programmes on workers' hearing loss to hearing levels in non-exposed workers. One of these studies showed that army recruits are at a three-fold increased risk of hearing loss compared to non-exposed controls. Another study found a four-fold increase in hearing loss among workers that were exposed but protected compared to non-exposed workers. In the remaining four studies, there was no difference in hearing loss between protected and non-exposed workers but there is still considerable uncertainty about the validity of this result. In four studies the risk reduction depended on the quality of hearing loss prevention programmes. 

There is contradictory evidence on the effectiveness of hearing protection and hearing loss prevention programmes. Higher quality prevention programmes and better implementation of legislation are needed.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

如何預防職業性噪音聽力損傷

全世界約有數百萬的工作者暴露在噪音之中，也因此增加聽力損傷的機會，目前對於預防噪音聽損的方法所知有限

目標

評估比較在無預防及非藥物方式預防噪音或職業性聽損之間的效果

搜尋策略

我們搜尋以下資料庫(至2008年12月15日止)： Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library issue 4, 2008); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; NIOSHTIC, CISDOC and mRCT.

選擇標準

噪音工作者在聽力保護介入前後及interrupted time series(ITS)的Randomised controlled trials, controlled研究

資料收集與分析

2位作者(EK、JV)獨立評估研究資格和試驗質量和數據提取

主要結論

21項研究被納入統計，其中一項研究是評估減少噪音暴露的政策，包含75672參與者的14項研究利用Hearing loss prevention programmes(HLPPs)來做探討，另外包含169參與者的6項研究評估聽力保護的效果。所有的研究品質都是比較差的。其中一項ITS的研究主要是評估新法律對於減少噪音的成效，他們發現平均噪音減少的程度約27.7db(95% confidence interval (CI) −36.1 to −19.3 dB)，每年約減少2.1分貝(95% CI −4.9 to 0.7)。某一項在軍隊中的研究發現，儘管有做保護措施，和沒有噪音暴露的人員相比，聽力損失的odds ratio(OR)為3.0 (95% CI 1.1 to 8.0)。在另外4項研究中，利用HLPP做保護的工作者，比起非暴露在噪音的工作者，約有0.5dB的聽力損失，特別是在4kHz的地方。此外，一項研究發現，噪音暴露工作者造成聽力損害的比例，比起非噪音暴露者為3.8倍。另外3項研究發現，高品質的HLPP比起低品質的HLPP，能有較低的聽損機率。利用控制環境來減少噪音比起特別的減噪工具效果來的差

作者結論

利用法律減少工作場所的噪音，目前缺少比較強有力的証據可以証明有效。聽力保護器具的有效與否得看是否正確的使用防具。HLPPs長時間的追蹤下，有效與否的結果目前仍是不確定的，雖然某些研究認為可有效降低噪音，但仍需更好、更長期、及更技術性的証實其效用。不過某些研究的聽力及噪音數據是有其價值的

翻譯人

本摘要由國泰綜合醫院林建佑翻譯

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

數百萬的噪音工作者正處在聽力損失的危險中，許多國家有強制的HLPPs政策，他們認為這是一個有效防止聽力傷害的方法。然而，並未有研究証實這一點。其中一項研究讓我們了解，利用法律限制礦工業，可讓噪音的層級降低。在包含169位工作者的六項研究發現，聽力保護可以讓工作者的噪音暴露減少，但是，在某一項高品質的研究中發現若是工作者未適當的使用防具，聽力保護的效果是不夠的。包含75672參與者的15項研究是在探查長期聽力保護的成效。6項研究比較無噪音暴露與利用防治計畫，兩者之間的效果。其中一項在軍隊中的研究發現和未暴露在噪音中的人相比，其聽力損傷的機率高了3倍，而另一項研究發現，和未暴露在噪音中的人相比，即使有聽力保護的措施，聽力損傷的機率高了4倍；剩下的四項研究，認為有聽力保護的工作者與未噪音暴露者相比是沒有差別的，不過這之中還有一些不確定及正確性有待商確。有四項研究認為聽損的好壞與保護措施的品質好壞有關。對於聽力保護的效果好壞仍是看法不一致的，但完善的保護措施及法律限制仍是有需要的

View Full Article (HTML) Summary (60K)Standard (480K)Full (751K)