Uso da dupla proteção auditiva na atenuação do ruído ocupacional: uma revisão sistemática / Use of double hearing protection for occupational noise attenuation: a systematic review / El uso duplo de protecctores auditivos para la reducción del ruido ocupacional: una revisión sistemática

Introdução: A Perda Auditiva Induzida por Ruído (PAIR) está associada à contínua exposição ao ruído dentro do ambiente ocupacional, é a segunda doença mais recorrente entre os trabalhadores. Objetivo: Verificar a efetividade e benefício do uso da dupla proteção auditiva na atenuação do ruído ocupacional. Método: A busca de artigos científicos foi realizada nas bases de dados MEDLINE (Pubmed), LILACS, SciELO, SCOPUS e WEB OF SCIENCE, sem restrição de idioma, período e localização. Para complementar e evitar viés de risco foi realizada uma busca por literatura cinzenta no Google Acadêmico. A revisão sistemática foi conduzida de acordo com as recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Análises (PRISMA). Estudos que pontuaram ≥ 6 pontos de acordo com o protocolo de pontuação qualitativa proposto por Pithon et al. (2015). Resultados: A dupla proteção auditiva deverá ser utilizada quando o protetor auditivo tipo concha ou plug não fornecerem atenuação suficiente para diminuir o ruído no ambiente laboral, contudo, a atenuação sonora pelos EPI auditivos pode ser um obstáculo à comunicação e localização espacial, principalmente aos trabalhadores que possuem algum grau de PAIR. Conclusão: o uso da dupla proteção auditiva pode ser uma estratégia considerável para proteção de perdas auditivas em ambientes controlados. Novos padrões sonoros para alarmes de alerta, prevendo o aviso de acidentes em ambiente ocupacional em que o uso combinado dos dispositivos auditivos utilizados em ambientes controlados e a implantação dos sinais de banda larga como sinal padrão poderão ser utilizados como estratégias de segurança coletiva. (AU)

Introduction: Noise-Induced Hearing Loss (NIHL) is associated with continuous exposure to noise within the occupational environment and is the second most common disease among workers. Objective: To verify the effectiveness and benefit of using double hearing protection in attenuating occupational noise. Search Strategy: The search for scientific articles was carried out in the MEDLINE (Pubmed), LILACS, SciELO, SCOPUS and WEB OF SCIENCE databases, without restriction of language, period and location. To complement and avoid risk bias, a search for gray literature was performed on Google Scholar. Methodology: The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Studies that scored ≥ 6 points according to the qualitative scoring protocol proposed by Pithon et al. (2015). Results: Double hearing protection should be used when the use of a shell or plug type hearing protector does not provide enough attenuation to reduce noise in the work environment, but this sound attenuation by hearing PPE can be an obstacle to communication and spatial location, especially to workers who have some degree of PAIR. Conclusion: the use of double hearing protection can be a considerable strategy for protecting against hearing loss in controlled environments. New sound patterns for warning alarms, providing for the warning of accidents in an occupational environment where the combined use of hearing devices used in controlled environments and the implementation of broadband signals as a standard signal can be used as collective safety strategies. (AU)

Introdución: La pérdida de audición inducida por el ruido es associada com la exposición continua el lo ambiente de trabajo y es la segunda enfermedad más comum em los trabajadores. Objectivo: Verificar la eficácia y beneficio del doble uso de los protectores auditivos em la atenuación del ruído. Método: La revisión sistemática se realizó de acuerdo con las recomendaciones para revisiones sistemáticas y metanálisis (PRISMA). Los estudios que obtuvieron ≥ 6 puntos según el protocolo de puntuación cualitativa propuesto por Pithon et al. (2015). Resultados: La protección auditiva doble és utilizada cuando el uso de un protector auditivo tipo concha o enchufe no proporciona la atenuación suficiente para reducir el ruido en el ambiente de trabajo, pero esta atenuación del sonido por los EPP auditivos puede ser un obstáculo para la comunicación y la ubicación espacial, especialmente para los trabajadores con perdida de audición. Conclusión: el uso de doble protección auditiva es una estrategia considerable en ambientes controlados y seguros. Nuevos padrones sonoros para alarmas de aviso de accidentes en un entorno laboral y la implementación de señales de banda ancha como señal estándar, pueden utilizarse como estrategias de seguridad colectiva.(AU)

Analysis of verification results of protective effects of hearing protectors in different industries / 中华劳动卫生职业病杂志

Objective: To get insight into the current practice of noise reduction effect of workers as they wore hearing protectors in different domestic enterprises and the possible affected factors. Methods: From October 2020 to April 2021, using a random sampling method, 1197 workers exposed to noise in petrochemical factories, textile factories, and parts manufacturing factories were selected as the study subjects. The noise reduction effect of hearing protectors worn by workers in daily use was tested using a hearing protector suitability testing system. The personal sound attenuation level (PAR) was compared among workers in three enterprises, Targeted intervention and repetitive testing were conducted for workers who did not meet the noise reduction effect required by the enterprise, and the changes in PAR of workers before and after the intervention were compared. The comparison of baseline PARs between two or more groups was performed using the Mann Whitney test, the comparison of baseline PARs with post intervention PARs was performed using the Wilcoxon signed rank sum test, and the comparison of qualitative data between two or more groups was performed using the Chi square test. Results: The median baseline PAR for all workers was 15 dB. Men, age<30 years old, education level at or above college level, working experience of 5 to 15 years, and those who used hearing protectors for 5 to 15 years had higher PARs, with statistically significant differences (P<0.05). The median difference in baseline PAR among workers from three enterprises was statistically significant (H=175.06, P<0.01). The median PAR of subjects who did not pass the baseline increased from 3 dB to 21 dB after intervention (Z=-27.92, P<0.01) . Conclusion: Some workers wearing hearing protectors do not meet the required PAR, and low PARs may be related to incorrect wearing methods and incorrect selection of hearing protectors. As a tool for testing, training, and assisting in selection, the hearing protector suitability testing system is of great significance for worker hearing protection.

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.

Investigation of protective exposure risk events in nurses against corona virus disease 2019 in Wuhan / 北京大学学报(医学版)

OBJECTIVE@#To investigate the current situation of virus exposure risk incidents of nurses against corona virus disease 2019 (COVID-19) in Wuhan, and to provide reference evidence for nursing managers to protect nursing staff who were working in the isolation ward.@*METHODS@#In the study, 308 nursing staff against COVID-19 working in the isolation ward in Wuhan were conveniently selected to participate in the investigation. The designed questionnaires including 7 kinds of protective exposure risk events were made by the team of researchers on the basis of literature review and interview with the nurses in Wuhan. All the participants recalled their working experience in the status of dressing in personal protective equipment and filled in the questionnaires online by WeChat according to the same instruction.@*RESULTS@#The questionnaires were filled in validly by a total of 304 nursing staff, of whom 88.8% received emergency training on the prevention and dealing measurement of exposure risk events. The incidence of shoe cover contamination, falling off or torn was relatively high, about 53.6%. Due to the protection of gloves, the incidence of hand or skin contamination was relatively low, about 14.1%. The most nervousness of protective exposure risk event for nurses was N95 mask contamination, falling off or shifting, with a score of 8.2±2.3, showing a higher psychiatric burden. Single factor analysis found that the number of days in Wuhan was different, the number of the types of protective risk events occurred was different (χ2=14.562, P=0.024), orderly multivariate Logistic regression found that men were the independent protective factor for the number of the types of protective exposure risk events that occurred (P=0.019).@*CONCLUSION@#Protective exposure risk events may occur in the work of nursing staff working in the isolation ward in Wuhan. It is necessary to guide nurses to prevent the occurrence of protective exposure risk events and effectively deal with them, so as to prevent virus exposure and reduce psycholo-gical burden.

Verificación de niveles de atenuación de protectores auditivos tipo copa en trabajadores del sector Hidrocarburos / Verifying the attenuation levels of earmuff hearing protectors in Oil & Gas workers / Verificando os níveis de atenuação dos protetores auditivos de abafador em trabalhadores de petróleo e gás

RESUMEN Objetivo Verificar los niveles de atenuación de dos tipos de protectores auditivos de copa bajo condiciones reales de operación. Métodos Se realizó un diseño experimental de medidas repetidas de los niveles de presión sonora al interior y exterior de los protectores auditivos, realizando mediciones de ruido bajo circunstancias habituales de trabajo para operadores de una planta de hidrocarburos. Posteriormente, se determinaron las diferencias entre los niveles de atenuación establecidos por el fabricante, los niveles de atenuación ajustados bajo el método recomendado por NIOSH y los niveles de atenuación obtenidos experimentalmente. Resultados Los valores de atenuación ofrecidos por los fabricantes difieren de los obtenidos experimentalmente, siendo estos últimos, menores en todos los casos del estudio. Los valores de atenuación de los protectores auditivos ajustados bajo el método NIOSH alcanzaron valores más cercanos a los experimentales. Conclusiones La variabilidad entre los valores de atenuación teóricos y experimentales, permiten establecer que las estimaciones de los niveles de atenuación obtenidos en condiciones controladas no consideran aspectos que en condiciones reales de uso afectan la eficiencia del protector auditivo. Este estudio plantea la necesidad de implementar programas integrales de protección auditiva, que permitan considerar variables asociadas a la eficacia del dispositivo en condiciones de uso, a través de la aplicación de pruebas de ajuste o en su defecto a través de la aplicación de los factores de ajuste sugeridos por NIOSH, con el fin de realizar una adecuada selección que permita alcanzar un control efectivo para el ruido.

ABSTRACT Objective To verify the attenuation levels of two types of earmuffs under real operating conditions. Materials and Methods A study with experimental design was carried out to obtain repeated measurements of the sound pressure levels inside and outside hearing protectors in a sample of workers of an oil and gas company working under normal process and exposure conditions. The results allowed determining differences between the attenuation levels established by the manufacturer, the adjusted attenuation levels under the NIOSH method, and the attenuation levels obtained experimentally. Results The attenuation values established by the manufacturers are lower than those ones obtained under actual use conditions in all cases evaluated. Likewise, the attenuation values of the hearing protectors, once adjusted under the NIOSH method, reached values much closer to those obtained experimentally. Conclusions The variability between theoretical attenuation values and experimental values allows concluding that the attenuation levels obtained under controlled laboratory conditions do not take into account certain characteristics that, based on their use, affect the efficiency of the hearing protection device. This study encourages the implementation of comprehensive hearing protection programs that consider variables such as hearing protection effectiveness, under real use conditions, by applying fit tests or other adjustment factors like the one suggested by NIOSH. This would ensure an adequate selection that aims at achieving an effective control of this risk factor.

RESUMO Objetivo Verifique os níveis de atenuação de dois tipos de protetores auriculares em condições reais de operação. Métodos Foi realizado um projeto experimental de medições repetidas dos níveis de pressão sonora dentro e fora dos protetores auditivos, fazendo medições de ruído em condições normais de trabalho para operadores de uma usina de hidrocarbonetos. Posteriormente, foram determinadas as diferenças entre os níveis de atenuação estabelecidos pelo fabricante, os níveis de atenuação ajustados pelo método recomendado pelo NIOSH e os níveis de atenuação obtidos experimentalmente. Resultados Os valores de atenuação oferecidos pelos fabricantes diferem daqueles obtidos experimentalmente, sendo este último menor em todos os casos do estudo. Os valores de atenuação dos protetores auditivos ajustados pelo método NIOSH atingiram valores mais próximos aos experimentais. Conclusões A variabilidade entre os valores de atenuação teórica e experimental permite estabelecer que as estimativas dos níveis de atenuação obtidos em condições controladas não consideram aspectos que, em condições reais de uso, afetam a eficiência do protetor auditivo. Este estudo levanta a necessidade de implementar programas abrangentes de proteção auditiva que permitam considerar variáveis associadas à efetividade do dispositivo em condições de uso, através da aplicação de testes de adaptação ou, na sua falta, através da aplicação de ajuste sugerido pelo NIOSH, a fim de fazer uma seleção adequada para obter um controle eficaz do ruído.(AU)

Water protection in patients with tympanostomy tubes in tympanic membrane: a randomized clinical trial / Proteção auricular da água em pacientes com tubo de ventilação em membrana timpânica: ensaio clínico randomizado

ABSTRACT Objective To analyze the incidence of otorrhea in the postoperative period of patients submitted to tympanotomy to place ventilation tube, and who did not protect the ear when exposed to water. Methods Open, randomized-controlled trial. Eighty patients submitted to unilateral or bilateral ear grommet tympanostomy were included and divided into two groups: Auricular Protection and Non-Protection to water during bathing and activities in water. Results In the first postoperative month, the Non-Protection Group presented a significant increase in the number of patients with otorrhea and in the incidence. Four patients of the Protection Group (11%) presented at least one episode of otorrhea in this period, representing an incidence of 0.11 (standard deviation ±0.32) episode/month, whereas in the Non-Protection Group there were 12 episodes (33%; p=0.045) and incidence of 0.33 (±0.48; p=0.02). Between the 2nd and the 13th postoperative months, there was no difference between groups. Seven patients in the Protection Group (20%) had at least one episode of otorrhea, representing an incidence of 0.04 (±0.09) episodes/month, while in the Non-Protection Group there were seven episodes (22%; p=0.8) and incidence of 0.05 (±0.1; p=0.8). Conclusion Patients who underwent ear protection when exposed to water had a lower incidence of otorrhea in the first postoperative month than those who did not undergo protection. From the second month, there was no difference between groups.

RESUMO Objetivo Avaliar a incidência de otorreia no período pós-operatório em pacientes submetidos à timpanotomia para colocação de tubo de ventilação e que não realizaram proteção auricular quando expostos à água. Métodos Ensaio clínico controlado, aberto e randomizado. Foram incluídos 80 pacientes submetidos à timpanotomia para colocação de tubo de ventilação unilateral ou bilateral, divididos em dois grupos: Grupo Proteção e Grupo Não Proteção auricular da água durante o banho e as atividades aquáticas. Resultados No primeiro mês pós-operatório, o Grupo Não Proteção apresentou aumento significativo tanto no número de pacientes com otorreia quanto na incidência. Quatro pacientes do Grupo Proteção (11%) apresentaram ao menos um episódio de otorreia neste período, representando incidência de 0,11 (desvio padrão ±0,32) episódio/mês, enquanto no Grupo Não Proteção ocorreram 12 episódios (33%; p=0,045) e incidência de 0,33 (±0,48; p=0,02). Entre o 2º e o 13º meses pós-operatórios, não houve diferença entre os grupos. Sete pacientes do Grupo Proteção (20%) apresentaram ao menos um episódio de otorreia, representando incidência de 0,04 (±0,09) episódios/mês, enquanto no Grupo Não Proteção foram registrados sete episódios (22%; p=0,8) e incidência de 0,05 (±0,1; p=0,8). Conclusão Pacientes que realizaram a proteção auricular quando expostos à água apresentaram menor incidência de otorreia no primeiro mês pós-operatório do que aqueles que não a realizaram. A partir do segundo mês, não houve diferença entre os grupos.

The Effects of Music Intervention on Environmental Stress and Sleep Quality in Patients with Liver Transplantation / 기본간호학회지

PURPOSE: The purpose of this study was to examine effects of music intervention on environmental stress and sleep quality in liver transplant patients who are receiving care in one-person isolation rooms of an ICU. METHODS: The study was a quasi-experimental design pre-and-post nonequivalent control group. Participants were 37 patients (18 in the experimental group and 19 in the control group) who, after receiving liver transplant, were hospitalized in one-person isolation rooms of the ICU. The study covered patients admitted between August 2016 and December 2017. Earplugs and sleep shades were provided as ordinary care to both experimental and control groups, and music intervention was provided to the experimental group three times a day for 30 minutes each from the first day of hospitalization. RESULTS: The first hypothesis, “The experimental group who received music intervention will experience a lower environmental stress level than the control group” was supported (Z=−3.212, p<.001). The second hypothesis, “The experimental group who received music intervention will experience a higher sleep quality than the control group” was also supported (t=3.715, p=.001). CONCLUSION: Findings show that music intervention is an effective nursing intervention to reduce environmental stress and improve sleep quality in liver transplant patients in the ICU.

Horizontal Localization in Simulated Unilateral Hearing Loss

BACKGROUND AND OBJECTIVES: The ability to localize a sound source is one of the binaural hearing benefits in a horizontal plane based on interaural time difference and interaural intensity difference. Unilateral or bilateral asymmetric hearing loss will affect binaural hearing and lead to sound locating errors. In this cross sectional analytical descriptive study, the localization error was investigated when participants turned their heads to the sound source with closed eyes and after simulating unilateral hearing loss by placing earplugs inside the right ear canal. SUBJECTS AND METHODS: This cross sectional analytical descriptive study was carried out on 30 right-handed adults, 22 female and 8 male (average: 25 years, standard deviation: 3.16). They were selected with the available random access method. Horizontal localization was evaluated with five speakers located at 0, ±30, and ±60 degree azimuths at a 1-meter distance from the examinee. Narrow-band noise signals were delivered at 35 dB SL in two “without earplug” and “with earplug” situations and the results were compared. The study was performed between September and December 2016 in Tehran, Iran. RESULTS: Significant differences were observed in localization errors between the “with earplug” and “without earplug” situations. The localization differences were greater for left-side speakers (-30 and -60 degrees) compared with right-side speakers (+30 and +60 degrees). The differences were more apparent at 4,000 and 6,000 Hz, which confirmed the effect of unilateral simulated hearing loss on interaural latency differences. CONCLUSIONS: Simulating hearing loss by using an earplug in one ear (right) increased localization errors at all frequencies. The errors increased at higher frequencies.

Relationship Between Noise-Related Risk Perception, Knowledge, and the Use of Hearing Protection Devices Among Para Rubber Wood Sawmill Workers

BACKGROUND: The understanding of the relationship between risk perception, knowledge, and protective behaviors could play a major role in occupational risk control and management. Research exploring how workers perceive, recognize, and react to risks in different occupational settings is scarce in Thailand. The aim of this study was to assess the relationship of noise-related risk perceptions and knowledge to the use of hearing protective devices (HPDs) among sawmill workers in Thailand. METHODS: Sawmill workers (n = 540) from four factories in Trang, Southern Thailand, participated in a questionnaire interview from December 2015 to January 2016. Descriptive statistics and linear regression models were used to explore the risk factors related to HPD use. Path diagram analysis was demonstrated and used to evaluate associations. RESULTS: Risk perception was significantly correlated with HPD use (p < 0.01), HPD training (p = 0.01), and the number of years of work experience (p = 0.03). Sawmill workers were likely to use HPDs based on their risk perception and HPD training. However, HPD training was inversely correlated with age and the number of years of work experience. CONCLUSION: The study highlights the importance of risk perceptions and knowledge, and these factors should be emphasized in the design and implementation of any personal safety intervention program for sawmill workers.

¿Son los tapones auditivos eficaces para prevenir los efectos de la contaminación auditiva mediante la atenuación sonora? / Are ear plugs effective in preventing the effects of auditory contamination through sound attenuation?

Contexto: los efectos de la exposición a la contaminación sonora incluyen síntomas auditivos como hipoacusia, elevación del umbral auditivo, trauma acústico y también no auditivos de tipo psicológico, físico y social. Material y métodos: estudio descriptivo analítico y transversal para determinar la eficacia de la atenuación sonora de los protectores auditivos personalizados en un grupo de 33 pacientes hombres sin alteraciones físicas del conducto auditivo externo, mediante la comparación de las respuestas obtenidas en el oído real libre y sin amplificación (Real-Ear Unaided Response) y con el oído herméticamente ocluido por medio de un tapón de silicona hecho a la medida (Real-Ear Occluded), ante la presencia de un ruido externo estable de banda ancha de 65 dB de intensidad, utilizando para ello un equipo de precisión certificado con normas ISO (Verifit de Audioscan). Resultados: se encontró que existe mayor protección a los decibeles altos con las frecuencias: 2000 Hz, 3000 Hz y 4000 Hz, bajando de 65 a 40 decibeles que traduce una reducción del 61%; no existe diferencia significativa entre ambos oídos, lo cual se explica por las particularidades en las formas anatómicas, profundidad de la inserción y la adecuada colocación de la sonda microfónica. Los valores promedio de atenuación bilateral en dB SPL que se logra en las diferentes frecuencias con tapones personalizados de protección auditiva varían dependiendo de la misma, con 250 Hz es de 9,97 en el oído derecho y 9,36 en el oído izquierdo y con 6000 Hz 15,28 en el oído derecho y 13,64 en el oído izquierdo. Una mayor atenuación se encontró con 3000 Hz (OD: 32,11 OI: 30,69), 2000 Hz (OD: 28,33 OI: 28,47) y 4000 Hz (OD: 27,28 OI: 26,67). Conclusión: el uso de protectores auditivo logra una evidente reducción de los niveles sonoros, sobre todo con frecuencias agudas (primeras) cuyos umbrales se afectan al someterse a elevados niveles de ruido por tiempos prolongados. (AU)

Context: the effects of exposure to noise pollution include auditory symptoms: hearing loss, elevation of the auditory threshold, acoustic trauma and also non-auditory psychological, physical and social. Material and methods: a descriptive, analytical, cross-sectional study, the efficacy of the sound attenuation of the personalized hearing protectors was determined in a group of 33 male patients without physical alterations in the external auditory canal, by means of the comparison of the responses obtained in the ear Real-Ear Unaided Response, and with the ear sealed by means of a custom-made silicone plug (Real-Ear Occluded), in the presence of stable external broadband noise of 65 dB Of intensity, using a precision equipment certified with ISO standards, the Verifit of Audioscan. Results: it was found that there is a greater protection to high decibels with frequencies 2000 Hz, 3000 Hz and 4000 Hz, falling from 65 to 40 decibels, which means a reduction of 61%, there is no significant difference between both ears, Which is explained by the particularities in the anatomical forms, depth of insertion and the proper placement of the microphone probe. The average bilateral attenuation values in dB SPL that is achieved in the different frequencies with personalized ear protection plugs vary depending on the same, with 250 Hz being 9.97 in the right ear and 9.36 in the left ear and with 6000 Hz 15.28 in the right ear and 13.64 in the left ear. Greater attenuation was found with 3000 Hz (OD: 32.11 OI: 30.69), 2000 Hz (OD: 28.33 OI: 28.47) and 4000 Hz (OD: 27.28 OI: 26.67). Conclusion: the use of hearing protectors; Achieves an evident reduction of the sound levels, especially with acute frequencies, which are the first ones whose thresholds are affected when undergoing high levels of noise for prolonged times. Keywords: sound attenuation, hearing protectors, noise induced hearing loss, auditory contamination

Individual Fit Testing of Hearing Protection Devices Based on Microphone in Real Ear

BACKGROUND: Labeled noise reduction (NR) data presented by manufacturers are considered one of the main challenging issues for occupational experts in employing hearing protection devices (HPDs). This study aimed to determine the actual NR data of typical HPDs using the objective fit testing method with a microphone in real ear (MIRE) method. METHODS: Five available commercially earmuff protectors were investigated in 30 workers exposed to reference noise source according to the standard method, ISO 11904-1. Personal attenuation rating (PAR) of the earmuffs was measured based on the MIRE method using a noise dosimeter (SVANTEK, model SV 102). RESULTS: The results showed that means of PAR of the earmuffs are from 49% to 86% of the nominal NR rating. The PAR values of earmuffs when a typical eyewear was worn differed statistically (p 0.05). CONCLUSION: This study could provide local individual fit data. Ergonomic aspects of the earmuffs and different levels of users experience and awareness can be considered the main factors affecting individual fitting compared with the laboratory condition for acquiring the labeled NR data. Based on the obtained fit testing results, the field application of MIRE can be employed for complementary studies in real workstations while workers perform their regular work duties.

Avaliação do protetor auditivo em situação real de trabalho pelo método field Microphone-in-real-ear / Evaluation of the hearing protector in a real work situation using the field-microphone-in-real-ear method

RESUMO Objetivo Avaliar a eficácia da atenuação de um protetor auditivo em uma situação real de trabalho utilizando o método f-Microphone-in-real-ear (f-MIRE). Métodos Participaram 18 indivíduos, de ambos os gêneros (média de idade 47,17±8 anos). No local de trabalho, foi realizada a avaliação do nível pessoal de atenuação do Protetor Auditivo (PA) pelo método Field Microphone-in-Real-Ear (f-MIRE), seguido por orientações sobre a importância do uso do PA, higienização, armazenamento e treinamento para sua colocação efetiva. Resultados As análises mostraram que houve atenuação estatisticamente significante para todos os dados coletados (ruído total, por banda de frequência e dose) quando comparados os níveis de ruído no microfone lapela e no microfone sonda. Na comparação entre os valores de atenuação fornecidos pelo fabricante e os encontrados neste estudo, observou-se valores maiores para o fabricante em todas as bandas de frequência. Não houve diferença para os níveis de ruído nas diferentes atividades e horários avaliados. Conclusão Os achados do presente estudo possibilitaram conhecer o nível pessoal de atenuação do protetor auditivo durante uma situação real de trabalho, que estava dentro dos limites de tolerância. Também foi possível coletar informações sobre o ruído do ambiente em que esses trabalhadores estão expostos, onde observamos situações nas quais esse nível ultrapassava os valores de segurança, sendo assim recomendável o uso do PA. É importante que mais estudos sejam realizados utilizando o método f-MIRE, pois pode ser um aliado para avaliar a eficácia da atenuação do PA no local de trabalho.

ABSTRACT Purpose To evaluate the effectiveness of the attenuation of a hearing protector (HP) in a real work situation using the field-microphone-in-real-ear method (f-MIRE). Methods Eighteen individuals of both genders (mean age of 47.17±8 years) participated in this study. In the workplace, the personal attenuation level of the HP was assessed using the f-MIRE method, followed by orientation about the importance of using the HP, cleaning and storing the device, and training for effective placement. Results The analyses showed a significant statistic attenuation for all of the collected data (total noise, by frequency band and dose) when the noise levels in the lapel microphone and the probe microphone were compared. In the comparison of the attenuation values provided by the manufacturer and those found in this study, we observed higher values for the manufacturer in all frequency bands. No difference was observed for the noise levels in the different activities and times evaluated. Conclusion The findings of this study enabled us to know the personal level of attenuation of the HP during a real work situation, which was within the limits of tolerance. It was also possible to collect information about the environmental noise to which these workers are exposed. We noticed situations where this level exceeded the safety values, and therefore it is recommended the use of the HP. It is important that more studies are conducted using the f-MIRE method, because it may be an ally to assess the effectiveness of the HP attenuation in the workplace.

Evaluation de la protection auditive des travailleurs d'une usine de transformation de fèves de cacao de 2010 à 2011 en Côte d'Ivoire

En raison de la gravité de l'impact du bruit sur la santé des travailleurs exposés, la prévention apparaît comme l'alternative essentielle pouvant en supprimer ou en limiter l'impact.Objectif : Evaluer l'efficacité des mesures de protection auditive des opérateurs.Matériel et méthodes : Une étude descriptive et transversale d'une durée de 8 mois a été conduite dans une entreprise de transformation de fèves de cacao. L'étude comportait une étude de poste avec mesurage des niveaux sonores au moyen d'un sonomètre intégrateur conforme à la norme IEC 61672 : 2003 calibré, une analyse des équipements de protection auditive et un examen ORL avec des tests audiométriques.Résultats : L'échantillon était composé de 235 opérateurs dont 212 hommes (90%) et 23 femmes. La moyenne d'âge était de 37 ans (IC variant de 37,5 ± 17,5). Dans l'atelier de torréfaction, le bruit émis atteignait jusqu'à une intensité de 101,3 Lex, d (dB) en 2008. Le broyeur et la plate-forme produisaient une intensité sonore de 99,7 Lex, d (dB) en 2010. Les niveaux sonores variaient de 80,3 à 101,3dB. Cinq formations et 6 réunions du CHSCT ont été organisées de 2006 à 2012. Les casques 3M™ 1435 avaient un degré d'atténuation plus élevé (25dB). Les bouchons d'oreilles Ear Tracer™ présentaient un degré d'atténuation plus élevé.L'audition était normale chez 142 opérateurs dont deux groupes de 3 et de 6 personnes présentaient respectivement une surdité de perception et une surdité de transmission. Deux autres travailleurs étaient atteints d'une surdité de transmission.Conclusion : Le bruit est une nuisance professionnelle grave en raison de son impact négatif sur la santé des travailleurs. Elle est omniprésente en milieu industriel. Cependant l'observation rigoureuse des mesures de prévention permettent d'éviter ce risque ou d'en réduire la gravité

Training on hearing protector insertion improves noise attenuation / Atenuação do protetor auditivo após treinamento para colocação

ABSTRACT Purpose: To determine the efficacy of hearing protector insertion by comparing attenuation values measured by objective (MIRE) and subjective (REAT) methods in groups with and without training. Methods: The study included 80 male subjects assigned to experimental (with training) and control (without training) groups. The following procedures were performed: occupational history, objective and subjective assessment of hearing protectors. Only subjects in the experimental group received training and guidance on proper hearing protector insertion. Results: Attenuation values were significantly higher in the experimental group than in the control group at all frequencies (500, 1000, 2000, and 4000 Hz) investigated through the objective (MIRE) and subjective (REAT) methods. In addition, attenuation values in the control group were lower than those provided by the hearing protector manufacturer. Conclusion: Both objective and subjective attenuation tests demonstrated the efficacy of training on insertion of hearing protectors because the group that received training on proper hearing protection insertion exhibited higher attenuation values than the untrained group.

RESUMO Objetivo: Determinar a eficácia da colocação do protetor auditivo comparando os valores de atenuação obtidos pelos métodos objetivo (MIRE) e subjetivo (REAT) em grupos com e sem treinamento. Métodos: Participaram do estudo 80 indivíduos do sexo masculino, separados em grupo pesquisa (com treinamento) e controle (sem treinamento). Os procedimentos realizados foram: anamnese e avaliações objetiva e subjetiva do protetor auditivo. Apenas os indivíduos do grupo pesquisa receberam treinamento e orientações para colocar corretamente o protetor auditivo. Resultados: Os valores de atenuação no grupo pesquisa foram maiores com diferenças estatisticamente significantes em relação ao grupo controle em todas as frequências (500, 1000, 2000 e 4000 Hz) investigadas por meio dos métodos objetivo (MIRE) e subjetivo (REAT). Além disso, os valores de atenuação no grupo controle foram menores do que as previstas pelo fabricante do protetor auditivo. Conclusão: Ambos os métodos de avaliação da atenuação (objetivo e subjetivo) demonstraram a eficácia da colocação do protetor auditivo. Entretanto, o grupo que recebeu treinamento para colocação adequada do protetor auditivo apresentou valores de atenuação maiores do que o grupo sem treinamento.

Perception of hearing protectors by workers that participate in hearing preservation programs: a preliminary study / A percepção sobre protetores auriculares por trabalhadores participantes de programas de preservação auditiva: estudo preliminar

PURPOSE: To evaluate and compare the workers' perception of comfort and use aspects regarding two types of hearing protectors (shell and earplug), in three units from a lumbering company, with different implantation times for Hearing Preservation Programs.METHODS: This is a cross-sectional study comparing 440 workers' perception of hearing protectors, from three companies in Paraná State (Brazil), with different times for Hearing Preservation Programs. Two closed questionnaires were applied (9 and 10 questions, respectively), with a scale of answers varying from 1 to 5 (Likert's scale) regarding the perception of the comfort of hearing protectors. Then, audiometry results were analyzed.RESULTS: About 17.5% presented audiogram examinations with alterations. With regard to the questionnaire about the comfort perception, the importance of noise attenuation (mean of 4.25) was the most relevant aspect, followed by communication possibility (mean of 4.15). In the protector assessment, Unit A with more Hearing Preservation Program time presented better scores for both the worker's perception of important aspects regarding hearing protector and for the assessment of the used hearing protector. There was a significant difference on communication difficulty with the use of a hearing protector among workers with normal and altered audiograms (p=0.0371). With regard to the global comfort in the comparison of workers using the shell-type hearing protector with those using insert-type hearing protectors, there was no difference (p=0.2264), irrespective of the type of the unit.CONCLUSION: In general, the unit workers presented a good perception of the important aspects about the hearing protection use of both types of hearing protectors.

OBJETIVO: avaliar e comparar a percepção de trabalhadores sobre aspectos de conforto e uso de dois tipos de protetores auriculares (tipo concha e inserção) em três unidades de uma empresa madeireira com tempos diferentes de implantação de Programas de Preservação Auditiva (PPA).MÉTODOS: trata-se de um estudo transversal, que comparou a percepção de 440 trabalhadores de três unidades de empresa do estado do Paraná, com tempos diferentes de Programa de Preservação Auditiva, sobre protetores auriculares. Foram aplicados dois questionários fechados (9 e 10 questões) com escala de respostas de 1 a 5 (escala Likert) sobre percepção de conforto de protetores auriculares e analisadas as audiometrias.RESULTADOS: 17,5% apresentaram audiogramas alterados. Em relação ao questionário de percepção de conforto, a importância da atenuação do ruído (média 4,25) foi o aspecto mais relevante, seguido da possibilidade de comunicação (média 4,15). Na avaliação do protetor utilizado, a Unidade A com mais tempo de PPA apresentou pontuações melhores tanto para a percepção dos aspectos importantes do protetor auricular pelos trabalhadores quanto na avaliação do protetor auricular utilizado. Houve diferença significativa sobre a dificuldade de comunicação com o uso de protetor auricular entre trabalhadores com audiogramas normais e alterados (p=0,0371). Quanto ao conforto global na comparação dos trabalhadores usuários do protetor auricular do tipo concha com os do tipo inserção, não houve diferença (p=0,2264) independente da Unidade.CONCLUSÃO: Em geral, os trabalhadores das unidades apresentaram uma boa percepção de aspectos importantes da proteção auditiva para a utilização de ambos os tipos de protetores auriculares.

Gender and other factors associated with the use of hearing protection devices at work / Gênero e fatores associados ao uso de equipamento de proteção auditiva no trabalho

OBJECTIVE To analyze whether sociodemographic, occupational, and health-related data are associated with the use of hearing protection devices at work, according to gender. METHODS A cross-sectional study was conducted in 2006, using a random sample of 2,429 workers, aged between 18 and 65 years old, from residential sub-areas in Salvador, BA, Northeastern Brazil. Questionnaires were used to obtain sociodemographic, occupational, and health-related data. Workers who reported that they worked in places where they needed to shout in order to be heard were considered to be exposed to noise. Exposed workers were asked whether they used hearing protection devices, and if so, how frequently. Analyses were conducted according to gender, with estimates made about prevalence of the use of hearing protection devices, prevalence ratios, and their respective 95% confidence intervals. RESULTS Twelve percent (12.3%) of study subjects reported that they were exposed to noise while working. Prevalence of the use of hearing protection devices was 59.3% for men and 21.4% for women. Men from higher socioeconomic levels (PR = 1.47; 95%CI 1.14;1.90) and who had previous audiometric tests (PR = 1.47; 95%CI 1.15;1.88) were more likely to use hearing protection devices. For women, greater perceived safety was associated with the use of protection devices (PR = 2.92; 95%CI 1.34;6.34). This perception was specifically related to the presence of supervisors committed to safety (PR = 2.09; 95%CI 1.04;4.21), the existence of clear rules to prevent workplace injuries (PR = 2.81; 95%CI 1.41;5.59), and whether they were informed about workplace safety (PR = 2.42; 95%CI 1.23;4.76). CONCLUSIONS There is a gender bias regarding the use of hearing protection devices that is less favorable to women. The use of such devices among women is positively influenced by their perception of a safe workplace, suggesting that gender should be considered as a factor in hearing conservation programs.

OBJETIVO Analisar se dados sociodemográficos, ocupacionais e de saúde estão associados ao uso de equipamento de proteção auditiva no trabalho, segundo gênero. MÉTODOS Estudo transversal com amostra aleatória de 2.429 trabalhadores de 18 a 65 anos de subáreas de base domiciliar em Salvador, BA, no ano de 2006. Foram aplicados questionários para obtenção de dados sociodemográficos, ocupacionais e de saúde. Foram considerados expostos ao ruído aqueles que relataram trabalhar em local onde era necessário gritar para ser ouvido. Os trabalhadores expostos foram questionados sobre uso e regularidade do uso de equipamento de proteção auditiva. A análise foi conduzida por gênero, estimando-se a prevalência do uso do equipamento de proteção auditiva, razões de prevalência e os respectivos intervalos de 95% de confiança. RESULTADOS Entre os participantes do estudo, 12,3% referiram trabalhar expostos ao ruído. A prevalência do uso do equipamento de proteção auditiva foi 59,3% e 21,4%, para homens e mulheres, respectivamente. Entre os homens, maior nível socioeconômico (RP = 1,47; IC95% 1,14;1,90) e ter realizado audiometria (RP = 1,47; IC95% 1,15;1,88) foram fatores associados ao uso do equipamento. Entre as mulheres, a percepção de maior segurança associou-se ao uso do equipamento (RP = 2,92; IC95% 1,34;6,34). Essa percepção deveu-se, especialmente, à presença de supervisores comprometidos com a segurança (RP = 2,09; IC95% 1,04;4,21), à existência de regras claras para evitar acidentes de trabalho (RP = 2,81; IC95% 1,41;5,59) e ao recebimento de informações sobre segurança no trabalho (RP = 2,42; IC95% 1,23;4,76). CONCLUSÕES Há um viés de gênero em relação ao uso do equipamento de proteção auditiva menos favorável às mulheres em comparação com os homens. O uso do equipamento entre mulheres é influenciado positivamente pela percepção de um ambiente de trabalho seguro, sugerindo que o gênero precisa ser considerado nos programas de conservação auditiva.

Noise-Induced Hearing Loss in the Police Force

BACKGROUND: Noise-induced hearing loss (NIHL) is a major preventable occupational health problem with 250 million people worldwide known to have disabling impairment of moderate to greater severity. The aims of the study are to estimate the prevalence of NIHL in the police force; and study its association with age, sex, duration of service (years), smoking and alcohol habits, use of hearing protective devices, as well as preexisting chronic diseases. METHODS: A cross-sectional study was conducted on 543 police personnel who had undergone periodic medical examination over a 12-month period. The diagnostic criteria for NIHL were (1) history of occupational noise exposure, (2) bilateral hearing loss, (3) hearing loss of > or = 25 dBA at 4,000 Hz in two consecutive audiograms, and (4) no significant medical history affecting hearing. Severity of NIHL was based on the World Health Organization grading. RESULTS: Males (74.8%) made up the majority of the police force. The mean age for police personnel was 35.55 +/- 9.57 years, and the mean duration of service was 14.75 +/- 9.39 years. Compliance with the usage of hearing protective devices was seen in 64.4%. The prevalence of NIHL in this study population was 34.2%, with a higher prevalence in males (37.7%) than in females (23.9%). The study also showed strong associations between NIHL and male sex (odds ratio, 1.9; P < 0.05), and hypertension (odds ratio, 3.3; P < 0.001). Overall, 93% were found to have mild NIHL, 3.5% had moderate NIHL, and 3.5% had severe NIHL. No police personnel were found to have profound hearing loss. CONCLUSION: The prevalence of NIHL in this study is high compared to other similar studies among police personnel. This study shows that increasing age, male, presence of hypertension, diabetes, and longer duration of service are significant associated factors for NIHL. Preventative strategies include health surveillance, implementation of a hearing conservation program, and legislation.

The Prevalence and Risk Factors of Tinnitus in Korean Adolescents / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tinnitus is the perception of sound in the absence of any outside acoustic stimulus with high prevalence. Multiple risk factors for tinnitus have been identified. So far, most of studies have concentrated on prevalence and associated chronic disease of tinnitus in adults. In the present study, we focused on tinnitus in adolescents which has not been adequately evaluated. The main goal of this study was to assess the prevalence and associated risk factors of tinnitus in adolescents. SUBJECTS AND METHOD: This study was a retrospectively designed analysis of data from the 5th Korea National Health and Nutrition Examination Survey conducted in 2011-2012. We used tinnitus related interview data, the results of physical and audiological evaluation by ENT specialists, the results of daily intake of vitamin using a 24-hour dietary recall method, and blood samples in 1370 subjects. RESULTS: The prevalence of tinnitus was 22.2% in the age range of 12 and 19 years old. Logistic regression is a statistical method used to assess the association between tinnitus and independent variables. The following factors were independently and positively associated with tinnitus; sex (adjusted OR=1.531, CI=1.097-2.137), excessive earphone use (adjusted OR=1.422, CI=1.026-1.970), Non-occupational noise (adjusted OR=4.096, CI=1.702-9.859), explosive noise (adjusted OR=4.100, CI=1.703-9.872), niacin intake (adjusted OR=0.966, CI=0.940-0.993), vitamin (vit.). D serum concentration (adjusted OR=0.959, CI=0.925-0.994). CONCLUSION: This study showed an association between tinnitus prevalence in adolescents and gender, noise exposure, and vit. D supplement. Tinnitic patients are recommended to reduce excessive noise and use hearing protection devices such as earplugs or earmuffs; they are also recommended to obtain a supply vit. D from adequate sun exposure and outside activities.

Evaluation of hearing protection used by police officers in the shooting range / Avaliação da proteção auditiva utilizada por policiais em estande de tiros

Introduction: Impact noise is characterized by acoustic energy peaks that last less than a second, at intervals of more than 1 s. Objective: To quantify the levels of impact noise to which police officers are exposed during activities at the shooting range and to evaluate the attenuation of the hearing protector. Methods: Measurements were performed in the shooting range of a military police department. An SV 102 audiodosimeter (Svantek) was used to measure sound pressure levels. Two microphones were used simultaneously: one external and one insertion type; the firearm used was a 0.40 Taurus® rimless pistol. Results: The values obtained with the external microphone were 146 dBC (peak), and a maximum sound level of 129.4 dBC (fast). The results obtained with the insertion microphone were 138.7dBC (peak), and a maximum sound level of 121.6 dBC (fast). Conclusion: The findings showed high levels of sound pressure in the shooting range, which exceeded the maximum recommended noise (120 dBC), even when measured through the insertion microphone. Therefore, alternatives to improve the performance of hearing protection should be considered. .

Introdução: O ruído de impacto é caracterizado por apresentar picos de energia acústica de duração inferior a um segundo, em intervalos superiores a um segundo. Objetivo: Quantificar os níveis de ruído de impacto a que o policial militar fica exposto durante atividades de tiro com armas de fogo e analisar a atenuação do protetor auricular utilizado. Método: As medições foram realizadas no estande de tiros de um Batalhão da Polícia Militar. Para a medição dos níveis de pressão sonora foi utilizado um audiodosímetro modelo SV 102 (Svantek). Foram utilizados dois microfones simultaneamente: um externo e outro tipo inserção, e a arma utilizada foi a pistola calibre 40, da marca Taurus®. Resultados: Os valores obtidos no microfone externo foram de 146 dBC (pico) e ruído máximo de 129,4 dBC (fast). Os resultados obtidos no microfone de inserção foram de 138,7 dBC (pico) e ruído máximo de 121,6 dBC (fast). Conclusão: Nossos achados evidenciaram elevados níveis de pressão sonora no estande de tiros, que ultrapassaram os limites máximos recomendados (120 dBC), mesmo em medição com microfone de inserção. Portanto, alternativas para melhorar o desempenho da proteção auditiva devem ser consideradas pela equipe de segurança da corporação. .