Dobie Robert A
Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, CA 95817, USA.
Ear Hear. 2008 Aug;29(4):565-77. doi: 10.1097/AUD.0b013e31817349ec.
Aging and noise are generally considered the most common causes of adult hearing loss in developed countries. This study estimates the contributions of aging and occupational noise in the United States.
A model of hearing loss burden in American adults was constructed using data from the Census Bureau, from an international standard that predicts age-related and noise-induced hearing loss (ISO-1999), from the American Medical Association method of determining hearing impairment, and from sources estimating the distribution of occupational noise exposure in different age and sex groups.
Occupational noise exposure probably accounts for less than 10% of the burden of adult hearing loss in the United States; most of the rest is age-related. Most of the occupational noise burden is attributable to unprotected exposures above 95 dBA, and becomes apparent in middle age, when occupational noise exposure has ceased but age-related threshold shifts are added to prior noise-induced shifts, resulting in clinically significant impairment.
In our current state of knowledge, noise-induced hearing loss is still the most important preventable cause of hearing loss in the United States. The burden of occupational noise-induced hearing loss could probably be reduced by stricter enforcement of existing regulations. Longer lifespans in developed countries and migration of manufacturing jobs to developing countries will continue to reduce the relative contribution of occupational hearing loss in countries like the United States. Preventive interventions for age-related hearing loss, even if only partially effective, could potentially reduce the burden of adult hearing loss more than elimination of occupational noise.
在发达国家，衰老和噪音通常被认为是成人听力损失最常见的原因。本研究估算了衰老和职业噪音在美国造成的影响。
利用人口普查局的数据、一项预测年龄相关和噪音诱发听力损失的国际标准（ISO - 1999）、美国医学协会确定听力障碍的方法以及估算不同年龄和性别组职业噪音暴露分布的资料，构建了美国成年人听力损失负担模型。
职业噪音暴露可能占美国成人听力损失负担的比例不到10%；其余大部分是与年龄相关的。大部分职业噪音负担归因于95分贝以上的无防护暴露，并且在中年时变得明显，此时职业噪音暴露已经停止，但年龄相关的阈值变化叠加在先前噪音诱发的变化之上，导致临床上显著的损伤。
就我们目前的知识水平而言，噪音诱发的听力损失仍然是美国听力损失最重要的可预防原因。通过更严格执行现有法规，职业噪音诱发的听力损失负担可能会降低。发达国家寿命延长以及制造业工作岗位向发展中国家转移，将继续降低职业听力损失在美国等国家的相对影响。针对年龄相关听力损失的预防性干预措施，即使只是部分有效，可能比消除职业噪音更能减轻成人听力损失的负担。
