Sinclair A, Smith T A
Br J Ind Med. 1984 Aug;41(3):401-5. doi: 10.1136/oem.41.3.401.
Some form of audiometric screening forms part of any comprehensive hearing conservation programme, but because of the large numbers of workers exposed to noise, it is suggested that routine audiometry using an 8-frequency test preceded by history and examination makes undue demands on limited resources. It is proposed that a simple 3-frequency test without prior preparation of subjects is adequate for the purposes of industrial audiometry. Men whose hearing threshold was worse than 20 dB at 1, 2, or 4 kHz were considered to have failed the 3-frequency test and 150 such cases were randomly selected and subjected to a full 8-frequency audiogram. The results were then assessed for numerical accuracy and diagnostic reliability. The results of the 3-frequency test were marginally worse than the 8-frequency audiogram by 2.33 to 4.98 dB, and the comparison of the two tests as a diagnostic tool gave a concordance rate of 79%-80% (p = 0.00001) between the two physicians who examined the results and a level of interpersonal agreement of 87% for the 3-frequency test and 89% for the full audiogram. If audiometric screening is to be offered to the whole population at risk it should be simple, rapid, and accurate enough to detect hearing loss before disability develops so that those individuals may be counselled. It is suggested that the 3-frequency test fulfils this purpose, demonstrates the "reasonably practicable" approach of recent legislation, and does not unnecessarily divert resources from other key tasks in the practice of occupational medicine.
任何全面的听力保护计划都包含某种形式的听力筛查。然而，鉴于接触噪音的工人数量众多，有人认为，在进行病史询问和检查之后采用8频率测试进行常规听力测定，会对有限的资源造成不合理的需求。有人提议，对于工业听力测定而言，在不事先让受试者做准备的情况下进行简单的3频率测试就足够了。听力阈值在1、2或4千赫兹时高于20分贝的男性被视为3频率测试不合格，随机挑选出150例此类病例，并对其进行完整的8频率听力图检查。然后对结果进行数值准确性和诊断可靠性评估。3频率测试的结果比8频率听力图略差2.33至4.98分贝，将这两种测试作为诊断工具进行比较时，两位检查结果的医生之间的一致率为79%-80%（p = 0.00001），3频率测试的人际一致性水平为87%，完整听力图的人际一致性水平为89%。如果要对所有高危人群进行听力筛查，那么筛查方法应该简单、快速且准确，足以在残疾出现之前检测出听力损失，以便能够为这些个体提供咨询。有人认为，3频率测试符合这一目的，体现了近期立法中“合理可行”的方法，并且不会不必要地从职业医学实践中的其他关键任务中转移资源。
