Cochrane method for systematic review and meta-analysis of interventions to prevent occupational noise-induced hearing loss - abridged / Revisão sistemática e metanálise Cochrane de intervenções para prevenção de perda auditiva ocupacional induzida por ruído - abreviada

ABSTRACT Purpose Assess the effect of non-pharmaceutical interventions at work on noise exposure or occupational hearing loss compared to no or alternative interventions. Research strategies Pubmed, Embase, Web of Science, OSHupdate, Cochrane Central and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched. Selection criteria Randomized Controlled Trials (RCT), Controlled Before-After studies (CBA) and Interrupted Time-Series studies (ITS) evaluating engineering controls, administrative controls, personal hearing protection devices, and hearing surveillance were included. Case studies of engineering controls were collected. Data analysis Cochrane methods for systematic reviews, including meta-analysis, were followed. Results 29 studies were included. Stricter legislation can reduce noise levels by 4.5 dB(A) (very low-quality evidence). Engineering controls can immediately reduce noise (107 cases). Eleven RCTs and CBA studies (3725 participants) were evaluated through Hearing Protection Devices (HPDs). Training of earplug insertion reduces noise exposure at short term follow-up (moderate quality evidence). Earmuffs might perform better than earplugs in high noise levels but worse in low noise levels (very low-quality evidence). HPDs might reduce hearing loss at very long-term follow-up (very low-quality evidence). Seventeen studies (84028 participants) evaluated hearing loss prevention programs. Better use of HPDs might reduce hearing loss but other components not (very low-quality evidence). Conclusion Hearing loss prevention and interventions modestly reduce noise exposure and hearing loss. Better quality studies and better implementation of noise control measures and HPDs is needed.

RESUMO Objetivo Avaliar o efeito de intervenções no trabalho sobre a exposição ao ruído ou a perda auditiva em comparação com ausência ou intervenções alternativas. Estratégia de pesquisa Buscas em Pubmed, Embase, Web of Science, OSHupdate, Cochrane Central e CINAHL. Critérios de seleção Incluídos ensaios clínicos randomizados (ECR), estudos controlados pré/pós-intervenção (ECPPI) e estudos de séries temporais interrompidas (SIT) avaliando controles de engenharia, administrativos, equipamentos de proteção auditiva (EPAs) e vigilância auditiva. Coletados estudos de caso de engenharia. Análise dos dados Cochrane para revisões sistemáticas, incluindo metanálise. Resultados Foram incluídos 29 estudos. Legislação mais rigorosa pode reduzir níveis de ruído em 4,5 dB(A) (evidência de qualidade muito baixa). Controles de engenharia podem reduzir imediatamente o ruído (107 casos). Onze ECR e ECPPI (3.725 participantes) avaliaram EPAs. Treinamento para inserção do EPA reduz a exposição ao ruído no acompanhamento de curto prazo (evidência de qualidade moderada). Protetores tipo concha podem ter desempenho melhor do que protetores de inserção em níveis altos de ruído, mas piores em níveis mais baixos (evidência de qualidade muito baixa). EPAs podem reduzir a perda auditiva no acompanhamento de muito longo prazo (evidência de qualidade muito baixa). Dezessete estudos (84.028 participantes) avaliaram programas de prevenção de perdas auditivas. Um melhor uso do EPA pode reduzir a perda auditiva, mas outros componentes não (evidência de qualidade muito baixa). Conclusão As intervenções para prevenção da perda auditiva reduzem modestamente a exposição ao ruído e a perda auditiva. Estudos de melhor qualidade e melhor implementação de medidas de controle de ruído e EPA são necessários.

Identificação da disfunção temporomandibular (DTM) em usuários de dispositivo de proteção auditiva individual (DPAI) / Identification of the temporomandibular (TMD) dysfunction in users of individual auditory protective devices (IAPD)

OBJETIVO: descrever e classificar a presença de disfunção temporomandibular em trabalhadores usuários de equipamentos de proteção auditiva individual. MÉTODO: tratou-se de um estudo transversal descritivo, com caráter observacional, desenvolvido em uma indústria de tintas. A população foi composta por 46 funcionários de ambos os sexos (com 94,44 por cento do gênero masculino) com idade entre 20 a 50 anos (idade media de 36,24 anos), expostos a ruído intenso (90 dBNA) que faziam uso de equipamento de proteção individual auditiva tipo concha. Na coleta de dados foram realizados os seguintes procedimentos: triagem fonoaudiológica das funções orais, avaliação clínica otorrinolaringológica e diagnóstico de disfunção temporomandibular ao exame clínico. Os dados foram analisados pela estatística descritiva. RESULTADOS: a queixa predominante foi dor na região que envolve a orelha e articulação temporomadibular. Observou-se que 87 por cento apresentaram diagnóstico positivo de DTM, em que 83 por cento tinham dor miofacial, 11 por cento dor miofacial com limitação de abertura oral e 6 por cento apresentaram diagnóstico de dor miofacial associada a deslocamento de disco com redução de abertura. CONCLUSÕES: a maioria dos trabalhadores apresentou disfunção de ordem muscular. Ressalta-se a importância de considerar a possibilidade da influência deste equipamento sobre o aparecimento ou intensificação do transtorno mencionado.

PURPOSE: to describe and classify the presence of temporomandibular joint disorders in workers using individual hearing protection equipment. METHOD: this is a transversal descriptive study, with observational character, developed in a paint industry. The population was composed of 46 employees of both genders (94.44 percent of which were male) aged between 20 and 50 years (average 36.24-year old), exposed to hazardous noise (90 dBNA) that had been using personal protective equipment (ear muff). In collecting the data, the following procedures were made: speech pathology screening of the oral functions, otorhinolaryngological evaluation and diagnosis of temporomandibular joint dysfunction by using a clinical examination. Data were analyzed using descriptive statistics. RESULTS: the main complaint was pain around the ear and temporomandibular joint. It was observed that 87 percent showed a positive diagnosis of TMD while 83 percent had myofacial pain, 11 percent myofacial pain with oral opening limitation and 6 percent showed myofacial pain diagnosis associated with disc displacement with reduction. CONCLUSIONS: the majority of the screened workers showed dysfunctions of muscular order. The possibility that the use of this equipment may influence the occurrence or intensification of the mentioned dysfunction must be emphasized.

Effects of Workplace Noise and Hearing Protective Devices on Worker's Speech Intelligibility / 대한산업의학회지

OBJECTIVE: The objective of this study was to evaluate the degree of intelligible speech in workers wearing hearing protective devices and the differences in background noise type. METHODS: A total 82 shipyard company employees and normal hearing volunteers were recruited as subjects from a company in Ulsan: subjects were classified to the hearing-impaired group or to the control group according to hearing status. They were tested pure tone and speech audiometry in varying test environments including signal-to-noise ratio and background noise type in a headphone and in a free field environment. RESULTS: For both groups, the attenuation of hearing protective devices was greater at high frequencies. For the hearing-impaired group, speech discrimination scores differences between the unprotected and the protected ear were not significant between background noise type, when speech was presented at 65 dBA. However speech intelligibility in white noise background was lower than in the other background noise types when speech was presented at 75 dBA. CONCLUSIONS: Workers' speech intelligibility increased with an increasing signal-to-noise ratio. Speech intelligibility was also dependent on background noise type. Workers and their colleagues were trained to pronounce words more loudly and more clearly when they wearing hearing protective devices or other communication methods that do not use sound signal should be considered.

Predictors of Hearing Protection Behavior Among Power Plant Workers

PURPOSE: This study aimed to identify factors affecting the use of the hearing protection devices (HPDs) among workers exposed to noise using the Pender Health Promotion Model. METHODS: The 222 subjects came from thermal power plants with similar noise levels, which are between 80 dB and 90 dB in South Korea. Data were collected with self-administered questionnaires designed to measure concepts from the Health Promotion Model. RESULTS: Mean percent times of using the HPDs at their most recent job site were 50.9%, and 20.3% had never the HPDs. The predictors of HPD use were social modeling (OR = 1.380), perceived benefits (OR = 1.150), and working at noisy worksites (OR = 4.925) when the outcome was based on the "non-use" versus "used at least once". However, the predictors of HPD use were social modeling (OR = 1.795) and perceived benefits (OR = 1.139) based on the "less than half-of-the-time-use" versus "more than half-of-the-time-use". CONCLUSION: Social modeling and perceived benefits of using the HPDs are important for workers to keep minimal or certain level of using the HPDs.