PREVENTION OF NOISE-INDUCED HEARING LOSS噪声性听力损..

NOISE-INDUCEDHEARING LOSS REPORT INFORMALCONSULTATION held WorldHealth Organization, Geneva 28-30October 1997 Number Three series:AStrategies HearingImpairment@ PREVENTION NOISE-INDUCEDHEARING LOSS Report WHO-PDHInformal Consultation, Geneva, 28-30 October 1997 CONTENTSKEY POINTS FROM CONSULTATION............................................................................4SUMMARY.................................................................................................................................5 NOISE-INDUCEDHEARING LOSS ........................................10 NOISE-INDUCEDHEARING LOSS.........................................11 REPORTSFROM REGIONS.......................................................................................14 4.1 AFRICA REGION.............................................................................................14 4.2 AMERICAS REGION .......................................................................................15 4.3 EASTERN MEDITERRANEAN REGION ........................................................16 4.4 EUROPEAN REGION......................................................................................17 4.5 SOUTH EAST ASIA REGION..........................................................................18 4.6 WESTERN PACIFIC REGION.........................................................................20 MANAGEMENTWITHIN PRIMARY HEALTH CARE................22 5.1 Introduction.......................................................................................................22 5.2 Individual strategies non-occupationalsettings .............................................................................................................22 5.3 Environmental Strategies.................................................................................23 5.4 Occupational Strategies...................................................................................24 5.5 Detection NATIONALPLAN NOISE-INDUCEDHEARING LOSS ..........................................................................................................26 6.1 Perspective from developingcountry: Kenya.........................................26 6.2 Perspective from developingcountry: Pakistan......................................27 6.3 Perspective from developedcountry ............................................................27 6.4 Legislation FUTURENEEDS ..............................................................................32 7.1 Data Collection.................................................................................................32 7.2 Research opportunities ....................................................................................34 RECOMMENDATIONS...........................................................35 ANNEX AGENDA.................................................................................................................38ANNEX PARTICIPANTS.......................................................................................39ANNEX DRR.H. HENDERSON ...................................................................42 INDEX.......................................................................................................................................43 PREVENTION NOISE-INDUCEDHEARING LOSS Report WHO-PDHInformal Consultation, Geneva, 28-30 October 1997 NOISE-INDUCEDHEARING LOSS Report WHO-PDHInformal Consultation, Geneva, 28-30 October 1997 NOISE-INDUCEDHEARING LOSS Report WHO-PDHInformal Consultation, Geneva, 28-30 October 1997 KEYPOINTS FROM excessivenoise majoravoidable cause permanenthearing impairment worldwide. Noise-inducedhearing loss importantpublic health priority because, populationslive longer industrializationspreads, NIHL addsubstantially globalburden developedcountry, excessive noise leastpartially morethan one-third hearingimpairment. manycountries, excessive noise biggestcompensatable occupational hazard. estimatedcosts developedcountries range from 0.2% GDP(gross domestic product). developedcountries, riskfrom social noise youngpeople. developingcountries, occupational noise urban,environmental noise (especially traffic noise) increasingrisk factors hearingimpairment. Developingcountries often lack both effective legislation against noise preventnoise-induced hearing loss. Where oftenpoorly enforced seriousshortage accurateepidemiological information prevalence,risk factors NIHL,especially developingcountries. NationalProgrammes noise-inducedhearing loss should allcountries PrimaryHealth Care (PHC). Elements should include environmental medicalsurveillance, noise reduction, effective legislation, inspection, enforcement, health promotion education,hearing conservation noise-inducedhearing loss must appropriate(i.e. makessense), adequate difference),acceptable (one can live widespreadignorance hazard,awareness must increasedabout harmfuleffects noise-inducedhearing loss. positiveimage hearingshould promoted,including its contribution dailyquality Researchneeds pathogenicmechanisms, technical measures noiseabatement, improving hearing protectors, lowcost medications collaborationshould strengthenedbetween developed developingcountries facilitateresearch fieldPREVENTION NOISE-INDUCEDHEARING LOSS Report WHO-PDHInformal Consultation, Geneva, 28-30 October 1997 hearingimpairment from noise-induced hearing loss (NIHL) October1997. Its task epidemiology,pathogenesis drawup recommendations futureaction PrimaryHealth Care, especially developingcountries. PROBLEM:-Exposure excessivenoise majoravoidable cause permanenthearing impairment worldwide. developedcountry, leastpartially morethan one- third hearingimpairment manycountries, biggestcompensatable occupational hazard. riskfrom occupational noise begins developedcountries, fromsocial noise youngpeople. developingcountries, occupational noise urban,environmental noise increasingrisk factors hearingimpairment. populationslive longer industrializationspreads, NIHL addsubstantially globalburden hencehas highpublic health priority. Excessive sound damages haircells bloodsupply cochlea,initially frequencyaround thresholdshift highersound dose becomes permanent. Hair cells transducing higherfrequencies mostsensitive noisedamage; speechperception experienced NIHL.Hearing losses from different causes interactioncan occur between noise exposure elderly,NIHL may add hearingloss hearinghandicap sooner worsethan would occur from age alone. REPORTSFROM WHOREGIONS increasingexcessive noise exposure everywhere, especially developingcountries. highnoise exposure levels formal(eg manufacturing, mining) informaloccupational sector (small industries vehiclerepairing, metal-working, milling), non-occupationalsector (urban, environmental leisure).Awareness hazardamongst employers, employees low.Most countries regiondo haveeffective programmes NorthAmerica recent studies environmentalnoise have shown childrenmay receive more noise schoolthan workers from 8-hourwork day regularattendees professionalsporting events exceedmost federal guidelines. USNational Institute OccupationalSafety Health(NIOSH) 1998recommended 85dBA recommended exposure level (REL)with dBexchange rate, defined hearingloss prevention programme, redefined significantthreshold shift hearingprotector noise reduction ratings. Some Canadian provinces use similar recommendations. LatinAmerica havebeen problems assessing problem,(which poorenforcement poorlyimplemented hearing conservation programmes. Recently improvements have occurred increasedworker participation. Noise importantcause environmentalpollution EasternMediterranean, especially urbancentres. Industry (eg textile factories, forge-hammering plants), traffic noise, leisurenoise importantsources manycases give rise NOISE-INDUCEDHEARING LOSS Report WHO-PDHInformal Consultation, Geneva, 28-30 October 1997 significantNIHL. Legislation seldomenforced; compensation may Europe,directives industryhave improved noise emission levels over lasttwo decades providinghearing protection workers.However, improvements industrialnoise have been offset increasingenvironmental noise including fromtraffic recreationalactivities, especially amongst young people. estimatedcosts society,especially transport noise, range from 0.2% GDP.Countries South-EastAsia generally have NIHL prevention programmes oftenpoorly implemented onecountry regiondemonstrated between one-fifth certainoccupations have NIHL. Japannumerous studies have been conducted noisecontrol hearingconservation. Administrative guidelines have recently been issued workplaceswhere noiselevel lessthan 85 dB. Pure-tone audiometry principleevery six months. Education supervisors.Noise-induced hearing loss seenlargely manufacturingindustry, particularly shipbuilding, where most compensation has been paid. consultationdefined noise-induced hearing loss, surveypurposes only, according Noiseexposure history: 100 dB (NI) 83dBA 50year lifetime (equivalent exposure), Audiometriccriteria: sensorineural unilateral,0.5 kHz threshold less than 50 dBHL, 15dB difference between high lowfrequency threshold averages under50 year-olds. WHATNEEDS seriousshortage accurateepidemiological information relating NIHL,especially developingcountries. Priorities shouldinclude synthesis existingdata, new prevalence longitudinalsurveys significantnoise exposure effectivescreening methods enableearly identification interventionagainst NIHL, economicconsequences NIHL.National Programmes should allcountries PrimaryHealth Care (PHC). shouldaddress general educational needs particularrisk situations. However developing countries face severe constraints NIHL.Consequently, collaboration concernedNGOs otherinterested parties should supportprevention communitylevel. greatneed increasingawareness about harmfuleffects NIHL,including hearing conservation legislation.Key messages topicsshould widelydisseminated multiplemethods coordinatedprogramme, generalpublic, healtheducation, PHCworkers, localcommunity. positiveimage hearingshould promoted,including its contribution dailyquality life.However, present,our knowledge bestways influenceattitudes about noise recreationalhabits quitepoor. donethrough specially trained Anoise educators@. Occupational Noise majorproblem particularly developingcountries. Some countries do haveeffective legislation Legislationshould allcountries together effectiveinspectorate. noisesource should NOISE-INDUCEDHEARING LOSS Report WHO-PDHInformal Consultation, Geneva, 28-30 October 1997 reducedwhere possible hearingconservation programmes, including audiometry workers=education protection,should introduced.Personnel may need carryout noise surveys audiometrictesting. Workers compensation schemes alsoneeded preventionthrough noise reduction may soalso compensation.Detection occupationalnoise should include environmental medicalsurveillance. Different approaches complianceapproach sees regulations exposedworkers reactsonly when certain levels preventionapproach sees regulations minimumstandards, involves programme,monitors all employees, utilisescustomised intervention strategies. Rapid urbanization manydeveloping countries trafficnoise levelswhich causehearing impairment. Traffic noise needs example,devising enforcingregulations, promoting proper use silencers,effective land use planning, usingquieter technology. Firearms provensource noise-inducedhearing impairment peoplewho fire weapon(professionally leisure)should madeaware

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