Verdi Technology, Inc., Reno, Nevada, USA.
Department of Medicine, Division of Occupational & Environmental Medicine, University of California, San Francisco (UCSF) School of Medicine, San Francisco, California, USA.
Am J Ind Med. 2022 May;65(5):409-424. doi: 10.1002/ajim.23343. Epub 2022 Mar 15.
Compliance with noise regulations in the past three decades has significantly reduced workplace noise exposures, particularly in the loudest industries and occupations. However, the overall effectiveness of hearing conservation programs in preventing occupational noise-induced hearing loss remains uncertain and unquantified, while the incidence and cost of occupational hearing loss remain inexplicably high. This review/commentary critically explores this paradox by examining why the billions of annual audiograms conducted worldwide have not been aggregately utilized or applied to predict early NIHL in groups of workers or to measure the efficacy of exposure controls. Principal contributory reasons include regulation of noise as a safety standard rather than as a health standard, the inherent complexity of audiometric data, and the lack of a standardized method of interpretation for audiograms. The unsuccessful history of efforts to develop and adopt methods and tools to analyze aggregate audiometric data is described. Consequently, the Standard Threshold Shift-a regulatorily defined, lagging indicator of individual, irreversible hearing loss that is not an effective preventive metric-remains the de facto standard of care. A population-based Best Practices approach is proposed to leverage the raw audiometric data already available and turn it into actionable data for effective secondary prevention to strategically manage and reduce occupational hearing loss risk. This approach entails statistical methods and information management tools necessary to transform audiometry from a compliance-driven, individual screening test with limited preventive capability into a medical surveillance process directly linked to aggregate corrective and prevention actions.
在过去的三十年中，对噪声法规的遵守大大降低了工作场所的噪声暴露，特别是在最嘈杂的行业和职业中。然而，听力保护计划预防职业性噪声聋的总体效果仍然不确定且无法量化，而职业性听力损失的发生率和成本仍然高得令人费解。本综述/评论通过检查为什么全球每年进行的数十亿次听力图检查没有被汇总利用或应用于预测工人群体中的早期噪声性听力损失，或衡量暴露控制的效果，来批判性地探讨这一悖论。主要促成原因包括将噪声作为安全标准而不是健康标准进行监管、听力数据的固有复杂性以及缺乏用于解释听力图的标准化方法。描述了为开发和采用分析汇总听力数据的方法和工具而进行的不成功努力。因此，标准阈移（一种监管定义的、滞后的个体不可逆转听力损失指标，不是有效的预防指标）仍然是事实上的护理标准。提出了一种基于人群的最佳实践方法，以利用已经可用的原始听力数据，并将其转化为可采取行动的有效二级预防数据，以战略性地管理和降低职业性听力损失风险。这种方法需要统计方法和信息管理工具，将听力测定从具有有限预防能力的合规驱动的个体筛查测试转变为与汇总纠正和预防措施直接相关的医疗监测过程。
