噪声暴露工人的听力图切迹
Audiogram notches in noise-exposed workers.
作者信息
Rabinowitz Peter M, Galusha Deron, Slade Martin D, Dixon-Ernst Christine, Sircar Kanta D, Dobie Robert A
机构信息
Yale Occupational and Environmental Medicine Program, Yale University School of Medicine, 135 College Street, Suite 392, New Haven, CT 06510, USA.
出版信息
Ear Hear. 2006 Dec;27(6):742-50. doi: 10.1097/01.aud.0000240544.79254.bc.
OBJECTIVES
Diagnostic criteria for noise-induced hearing loss include the audiometric notch, yet no standardized definition exists. This study tested whether objective notch metrics could match the clinical judgments of an expert panel.
DESIGN
A panel of occupational physicians, otolaryngologists, and audiologists reviewed audiograms of noise-exposed workers. In a two-sample process, the panel judged whether a notch was present and whether hearing loss had progressed in a notch pattern. Quantitative notch metrics were compared against expert decisions.
RESULTS
At least five of six experts agreed about notch identification in 71 and 72% of the cases in the two samples, and agreement about notch progression was 61 and 67%. Notch depth and professional specialty appeared to affect notch judgments. Despite this variability, a notch metric showed excellent agreement with expert notch consensus in each sample (94.7 and 96.6%; kappa = 0.88 and 0.92).
CONCLUSIONS
Audiogram notch metrics can agree with expert clinical consensus and assist in the surveillance of noise-exposed workers.
目的
噪声性听力损失的诊断标准包括听力图上的切迹，但尚无标准化定义。本研究测试了客观切迹指标是否能与专家小组的临床判断相匹配。
设计
一个由职业医师、耳鼻喉科医生和听力学家组成的小组对噪声暴露工人的听力图进行了审查。在一个两样本过程中，该小组判断是否存在切迹以及听力损失是否呈切迹模式进展。将定量切迹指标与专家判断进行比较。
结果
在两个样本中，至少六名专家中有五名在71%和72%的病例中就切迹识别达成一致，就切迹进展的一致率为61%和67%。切迹深度和专业领域似乎会影响切迹判断。尽管存在这种变异性，但在每个样本中，一个切迹指标与专家切迹共识显示出极好的一致性（94.7%和96.6%；kappa值分别为0.88和0.92）。
结论
听力图切迹指标可与专家临床共识一致，并有助于对噪声暴露工人进行监测。
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