Dobie R A
West J Med. 1982 Dec;137(6):499-505.
Noise-induced hearing loss is a major and entirely preventable public health problem. Effective prevention of this disorder has yet to be achieved in the United States but would improve the overall hearing health of the population more than the treatment of all other otologic disorders combined. Losses that are mild to moderately severe and maximal at 3, 4 or 6 kHz are typical but not pathognomonic. Individual differences in susceptibility are substantial but unpredictable. Hearing conservation programs are now required by the Occupational Safety and Health Administration for almost all employees whose daily exposure to noise exceeds a time-weighted average of 85 dBA (A-weighted sound pressure level). The permitted exposure level is 90 dBA time-weighted average, above which engineering or administrative controls or hearing protectors are required. Workers with lesser exposures (85 to 90 dBA time-weighted average) who have hearing changes must be similarly protected. Many, but not all, elements of required hearing conservation programs have been specified recently by the Occupational Safety and Health Administration. Medical supervision and otologic referral are important components of hearing conservation programs because otologic problems other than noise-induced hearing loss are common in industrial populations. Compensation for noise-induced hearing loss, which is awarded through state workers' compensation boards, as well as certain federal sources, varies widely.
噪声性听力损失是一个重大且完全可预防的公共卫生问题。在美国,尚未实现对这种疾病的有效预防,但这将比综合治疗所有其他耳科疾病更能改善总体人群的听力健康。轻度至中度严重且在3、4或6千赫兹处达到最大值的听力损失很典型,但并非特征性表现。个体易感性差异很大且不可预测。职业安全与健康管理局现在要求几乎所有日常接触噪声超过时间加权平均85分贝(A加权声压级)的员工参加听力保护计划。允许的接触水平是90分贝时间加权平均,超过此水平则需要工程或行政控制措施或听力保护器。接触水平较低(85至90分贝时间加权平均)但听力有变化的工人也必须得到同样的保护。职业安全与健康管理局最近规定了所需听力保护计划的许多(但并非全部)要素。医学监督和耳科转诊是听力保护计划的重要组成部分,因为除噪声性听力损失外的耳科问题在工业人群中很常见。通过州工人赔偿委员会以及某些联邦渠道获得的噪声性听力损失赔偿差异很大。