El Dib Regina P, Mathew Joseph L, Martins Regina Hg
Department of Surgery, Paulista State University/Unesp, Botucatu Medical School, Distrito de Rubião Júnior, s/n, Botucatu, São Paulo, Brazil, 18603-970.
Cochrane Database Syst Rev. 2011 Sep 7(9):CD005234. doi: 10.1002/14651858.CD005234.pub4.
This is an update of a Cochrane Review first published in The Cochrane Library in Issue 2, 2006 and previously updated in 2009.Noise-induced hearing loss can be prevented by eliminating or lowering noise exposure levels. Where the source of the noise cannot be eliminated, workers have to rely on hearing protection equipment. Several trials have been conducted to study the effectiveness of interventions to influence the wearing of hearing protection.
To evaluate the effectiveness of interventions to enhance the wearing of hearing protection among persons regularly exposed to high noise levels.
We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 1); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 8 April 2011.
We included studies if they had a randomised design, if they were among noise exposed (> 80 dB(A)) persons, if they included an intervention to promote the wearing of hearing protection (compared to another intervention or no intervention), and if the outcome measured was the amount of use of hearing protection or a proxy measure thereof.
Two authors selected relevant trials, assessed risk of bias and extracted data.
Seven studies, involving 4670 participants, were included.A computer-based intervention lasting 30 minutes, tailored to the risk of an individual worker, was not found to be more effective than a video providing general information among workers, around 80% of whom already used hearing protection.A four-year school-based hearing loss prevention programme found that the intervention group was twice as likely to wear some kind of hearing protection as the control group that received a baseline hearing test and two additional tests at years two and three.We conducted two meta-analyses for the comparisons 'tailored strategy (the use of communication or other types of interventions that are specific to an individual or a group and aim to change behaviour) versus non-tailored strategy' and 'tailored strategy versus a commercial video on the use of hearing protection' to look at mean percentage use of hearing protective devices (HPDs), that showed improvement in the mean use of HPDs for the tailored group. A meta-analysis of the comparison 'mixed interventions' (classroom instruction, distribution of HPDs, mailings, noise level assessments and audiometric testing) versus control (audiometric testing alone) also showed improvement in self reported use of HPDs when shooting firearms.Tailored education showed an improvement in HPD use of 8.3% versus targeted education (6.1%).
AUTHORS' CONCLUSIONS: The evidence found in this review shows that some interventions improve the mean use of hearing protection devices compared to non-intervention. Future trials should have standard outcomes and interventions to allow the combining of results in meta-analysis.
这是一篇Cochrane系统评价的更新版，该评价首次发表于《Cochrane图书馆》2006年第2期，此前于2009年进行过更新。通过消除或降低噪声暴露水平可预防噪声性听力损失。若无法消除噪声源，工人则必须依靠听力保护设备。已开展多项试验来研究影响听力保护设备佩戴情况的干预措施的有效性。
评估在经常暴露于高噪声水平的人群中，提高听力保护设备佩戴率的干预措施的有效性。
我们检索了Cochrane耳、鼻、喉疾病组试验注册库；Cochrane对照试验中心注册库（CENTRAL）（《Cochrane图书馆》2011年第1期）；PubMed；EMBASE；CINAHL；科学引文索引；BIOSIS预评文摘；剑桥科学文摘；国际临床试验注册平台及其他已发表和未发表试验的来源。最近一次检索日期为2011年4月8日。
若研究为随机设计；研究对象为噪声暴露（>80 dB(A)）人群；研究包含促进听力保护设备佩戴的干预措施（与另一干预措施或无干预措施相比）；且测量的结局为听力保护设备的使用量或其替代指标，则纳入该研究。
两位作者选择相关试验，评估偏倚风险并提取数据。
纳入7项研究，涉及4670名参与者。未发现针对个体工人风险量身定制的30分钟计算机化干预措施比向工人提供一般信息的视频更有效，这些工人中约80%已在使用听力保护设备。一项为期四年的学校听力损失预防项目发现，干预组佩戴某种听力保护设备的可能性是对照组的两倍，对照组在基线时接受听力测试，并在第二年和第三年额外接受两次测试。我们针对“量身定制策略（使用针对个体或群体的沟通或其他类型干预措施以改变行为）与非量身定制策略”以及“量身定制策略与关于听力保护设备使用的商业视频”的比较进行了两项Meta分析，以观察听力保护设备（HPD）的平均使用百分比，结果显示量身定制组HPD的平均使用情况有所改善。对“混合干预措施”（课堂教学、HPD分发邮寄、噪声水平评估和听力测试）与对照组（仅听力测试）的比较进行的Meta分析也显示，在射击枪支时自我报告的HPD使用情况有所改善。量身定制教育使HPD的使用提高了8.3%，而目标教育提高了6.1%。
本评价发现的证据表明，与无干预措施相比，一些干预措施可改善听力保护设备的平均使用情况。未来的试验应采用标准化结局和干预措施，以便在Meta分析中合并结果。
