Department of Otolaryngology-Head and Neck Surgery, Stanford School of Medicine.
Department of Environmental Health and Safety, Stanford University, Stanford, California.
Otol Neurotol. 2018 Jul;39(6):693-699. doi: 10.1097/MAO.0000000000001851.
Noise-induced hearing loss is one of the most common occupational hazards in the United States. Several studies have described noise-induced hearing loss in patients following mastoidectomy. Although otolaryngologists care for patients with noise-induced hearing loss, few studies in the English literature have examined surgeons' occupational risk.
Noise dosimeters and sound level meters with octave band analyzers were used to assess noise exposure during drilling of temporal bones intraoperatively and in a lab setting. Frequency specific sound intensities were recorded. Sound produced using burrs of varying size and type were compared. Differences while drilling varying anatomic structures were assessed using drills from two manufacturers. Pure tone audiometry was performed on 7 to 10 otolaryngology residents before and after a temporal bone practicum to assess for threshold shifts.
Noise exposure during otologic drilling can exceed over 100 dB for short periods of time, and is especially loud using large diameter burrs > 4 mm, with cutting as compared with diamond burrs, and while drilling denser bone such as the cortex. Intensity peaks were found at 2.5, 5, and 6.3 kHz. Drilling on the tegmen and sigmoid sinus revealed peaks at 10 and 12.5 kHz. No temporary threshold shifts were found at 3 to 6 kHz, but were found at 8 to 16 kHz, though this did not reach statistical significance.
This article examines noise exposure and threshold shifts during temporal bone drilling. We were unable to find previous descriptions in the literature of measurements done while multiple people drilling simultaneously, during tranlabyrinthine surgery and a specific frequency characterization of the change in peach that appears while drilling on the tegmen. Hearing protection should be considered, which would still allow the surgeon to appreciate pitch changes associated with drilling on sensitive structures and communication with surgical team members. As professionals who specialize in promoting the restoration and preservation of hearing for others, otologic surgeons should not neglect hearing protection for themselves.
噪声性听力损失是美国最常见的职业危害之一。已有多项研究描述了乳突切除术后患者的噪声性听力损失。尽管耳鼻喉科医生会照顾噪声性听力损失患者，但英文文献中很少有研究检查外科医生的职业风险。
使用噪声剂量计和声级计与倍频程分析仪评估术中及实验室条件下颞骨钻孔时的噪声暴露情况。记录特定频率的声音强度。比较不同尺寸和类型的钻头产生的声音。使用来自两家制造商的钻头评估在钻不同解剖结构时的差异。在颞骨实习前后对 7 至 10 名耳鼻喉科住院医师进行纯音测听，以评估阈值变化。
耳科钻取过程中的噪声暴露在短时间内可能超过 100dB，尤其是使用直径大于 4mm 的大直径钻头、切割时比金刚石钻头以及在钻更密集的骨（如皮质）时声音更大。在 2.5、5 和 6.3kHz 处发现强度峰值。在鼓室盖和乙状窦处钻孔时，在 10 和 12.5kHz 处发现峰值。在 3 至 6kHz 处未发现暂时阈值变化，但在 8 至 16kHz 处发现阈值变化，尽管这并未达到统计学意义。
本文检查了颞骨钻孔过程中的噪声暴露和阈值变化。我们在文献中未找到同时多人钻孔、经迷路手术和在鼓室盖钻孔时出现的桃子特定频率特征变化时的测量描述。应考虑使用听力保护器，这仍允许外科医生感知与钻取敏感结构相关的音高变化并与手术团队成员进行交流。作为专门从事促进他人听力恢复和保护的专业人员，耳科外科医生不应忽视自身的听力保护。
