Speech audiometry as a method of functional diagnosis in fitness examinations of flight personnel
Testing hearing by using speech audiometry to determine word group perception in fitness examinations of flight personnel
FLYING PERSONNEL↗
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How much have adverse occupational health outcomes among construction workers improved over time? Evidence from 25 years of medical screening
Background Construction workers have always had a high risk of occupational illnesses. We used 25 years of data from a medical screening program serving older construction workers to determine how much health outcomes have improved over the past 60 years. Methods We investigated changes in relative risk for chest radiographs consistent with pneumoconiosis, COPD by spirometry, lung cancer mortality, and audiometry-assessed hearing impairment among workers participating in a medical screening program. Results were stratified by decade of first construction employment: before 1960, 1960–1969, 1970–1979, 1980–1989, and after 1990. Poisson and Cox regression analyses assessed relative risk by decade adjusted for age, sex, smoking, and years of construction trade work. Results Subjects were 94% male and, on average, 60 years old with 25 years of construction work. When compared to workers employed before 1960, those first employed after 1990 experienced the following reductions in model-adjusted relative risks: chronic obstructive pulmonary disease, 32%; all pneumoconiosis, 68%; parenchymal abnormalities, 35%; pleural abnormalities, 71%; hearing impairment, 20%; and lung cancer mortality, 48%. Risks started to decline in the 1960s with greatest reductions among workers first employed after 1970. Conclusions This study demonstrates the positive impact that adoption of occupational health protections have had over the past 60 years. The greatest risk reductions were observed for outcomes with strong regulatory and legal incentives to reduce exposures and associated risks, such as those associated with inhalation hazards (asbestos and silica), while lowest improvement was for hearing impairment, for which little regulatory enforcement and few prevention incentives have been adopted.
60 APPLIED LIFE SCIENCES↗
The effects of noise on man
Book on noise effects on man covering audiometry, aural reflex, hearing damage risk, physiological responses, motor performance and speech communication
Kryter, K. D.↗
Using A Guided Interview to Create an Individual Exposure Profile for The Lifetime Surveillance of Astronaut Health (LSAH)
BACKGROUND To support NASA’s Lifetime Surveillance of Astronaut Health (LSAH) project, Individual Exposure Profiles (IEPs) were developed to record an astronaut’s pre-, in-, and post-NASA exposures. NASA astronauts were invited to participate in a one-time guided interview to review known hazard exposures and medical history documented in NASA records and to add new information not otherwise reported. The purpose of the IEP project was to determine if any significant information was gained from these interviews and identify potential trends in long-term health. METHODOLOGY The pre-filled exposure profile data was extracted from several sources including medical records, biographies, and LSAH records. The information that was pre-filled before the interview included occupational exposures prior to selection to the Astronaut Corps, during active astronaut career (e.g., EVA and ground-based training, on-orbit exposures), and after active career. The IEPs also contained relevant medical history (e.g., audiometry, illnesses, injuries) and significant non-occupational exposures. 189 interviews were conducted from 2012-2014. A Microsoft Access database was created to store the information collected in the IEPs before and after the interviews. The database houses the information from the IEPs to track the updates made to the original data. By analyzing which astronauts supplied additional information and which kinds of data were consistently added, potential gaps and trends in missing data may be identified. In designing the database, an efficient structure was implemented for ease of inputting data and to create variables that would generate quantifiable data. Creating standardized variables within the structure helped ease the process of inputting, organizing data, and analyzing data. Additional updates/data were denoted and were categorized by type of update. The categories identified were “Confirmed”, “Confirmed & Supplemented”, “Supplemented”, “Denied”, “Denied & Supplemented”, and “Other”. STATISTICAL ANALYSIS AND RESULTS To assess frequency of exposure updates, descriptive statistics will be generated and stratified by relevant factors such as astronaut selection decade, age at selection, and program/era. Hypothesis testing will be performed to understand the associations between updates to exposure information and population characteristics.
Astronaut health↗
A vestibular phenotype for Waardenburg syndrome?
OBJECTIVE: To investigate vestibular abnormalities in subjects with Waardenburg syndrome. STUDY DESIGN: Retrospective record review. SETTING: Tertiary referral neurotology clinic. SUBJECTS: Twenty-two adult white subjects with clinical diagnosis of Waardenburg syndrome (10 type I and 12 type II). INTERVENTIONS: Evaluation for Waardenburg phenotype, history of vestibular and auditory symptoms, tests of vestibular and auditory function. MAIN OUTCOME MEASURES: Results of phenotyping, results of vestibular and auditory symptom review (history), results of vestibular and auditory function testing. RESULTS: Seventeen subjects were women, and 5 were men. Their ages ranged from 21 to 58 years (mean, 38 years). Sixteen of the 22 subjects sought treatment for vertigo, dizziness, or imbalance. For subjects with vestibular symptoms, the results of vestibuloocular tests (calorics, vestibular autorotation, and/or pseudorandom rotation) were abnormal in 77%, and the results of vestibulospinal function tests (computerized dynamic posturography, EquiTest) were abnormal in 57%, but there were no specific patterns of abnormality. Six had objective sensorineural hearing loss. Thirteen had an elevated summating/action potential (>0.40) on electrocochleography. All subjects except those with severe hearing loss (n = 3) had normal auditory brainstem response results. CONCLUSION: Patients with Waardenburg syndrome may experience primarily vestibular symptoms without hearing loss. Electrocochleography and vestibular function tests appear to be the most sensitive measures of otologic abnormalities in such patients.
NASA Discipline Neuroscience↗
Hearing impairment and tinnitus among older construction workers employed at DOE facilities
Few studies have defined the risk of hearing impairment and tinnitus after retirement. This report measures hearing impairment and tinnitus prevalence among older construction trades workers. The study cohort included 21,340 participants in a national medical screening program. Audiometric hearing impairment was classified according to the Global Burden of Disease Study. Tinnitus was determined by self-report. An internal subcohort of nonconstruction trades workers served as a reference group. Stratified analyses and multivariate analyses were used to measure the prevalence of hearing impairment and tinnitus by age, sex, and job category. Prevalence of any hearing impairment was 55.2% (males, 57.7%; females, 26.8%) and increased rapidly with age. Construction trades workers were 40% more likely to have hearing impairment than the reference group. The overall prevalence of tinnitus was 46.52% and followed patterns similar to hearing impairment. Workers with hearing impairment were more likely to also have tinnitus, but tinnitus was frequently reported in the absence of measured hearing impairment. Hearing impairment and tinnitus prevalence were much higher in this study than in previous research. A significant reason for the difference is that BTMed follows participants after they have retired. To draw conclusions about the risk for work-related chronic diseases and disorders it is important to monitor workers through their lifetimes. Also, tinnitus by itself should be given greater significance. We report the findings reinforce the need to promote noise reduction and hearing conservation in construction.
60 APPLIED LIFE SCIENCES↗
Assessment methods for determining small changes in hearing performance over time
Although the behavioral pure-tone threshold audiogram is considered the gold standard for quantifying hearing loss, assessment of speech understanding, especially in noise, is more relevant to quality of life but is only partly related to the audiogram. Metrics of speech understanding in noise are therefore an attractive target for assessing hearing over time. However, speech-in-noise assessments have more potential sources of variability than pure-tone threshold measures, making it a challenge to obtain results reliable enough to detect small changes in performance. Here, this review examines the benefits and limitations of speech-understanding metrics and their application to longitudinal hearing assessment, and identifies potential sources of variability, including learning effects, differences in item difficulty, and between- and within-individual variations in effort and motivation. We conclude by recommending the integration of non-speech auditory tests, which provide information about aspects of auditory health that have reduced variability and fewer central influences than speech tests, in parallel with the traditional audiogram and speech-based assessments.
60 APPLIED LIFE SCIENCES↗
Hearing loss in space
BACKGROUND: Temporary and, in some cases, permanent hearing loss has been documented after long-duration spaceflights. METHODS: We examined all existing published data on hearing loss after space missions to characterize the losses. RESULTS: Data from Russian missions suggest that the hearing loss, when it occurs, affects mainly mid to high frequencies and that using hearing protection often might prevent the loss. Several significant questions remain about hearing loss in space. While the hearing loss has been presumed to be noise-induced, no clear link has been established between noise exposure and hearing loss during spaceflight. In one documented case of temporary hearing loss from the Shuttle-Mir program, the pattern of loss was atypical for a noise-induced loss. Continuous noise levels that have been measured on the Mir and previous space stations, while above engineering standards, are not at levels usually associated with hearing loss in ground-based studies (which have usually been limited to 8-10 h exposure periods). Attempts to measure hearing in space using threshold-based audiograms have been unsuccessful in both the American and Russian programs due to noise interference with the measurements. CONCLUSIONS: The existing data highlight the need for reliable monitoring of both hearing and noise in long-duration spaceflight.
manned↗
Preservation of auditory and vestibular function after surgical removal of bilateral vestibular schwannomas in a patient with neurofibromatosis type 2
The outcome of acoustic neuroma (vestibular schwannoma) surgery continues to improve rapidly. Advances can be attributed to several fields, but the most important contributions have arisen from the identification of the genes responsible for the dominant inheritance of neurofibromatosis types 1 (NF1) and 2 (NF2) and the development of magnetic resonance imaging with gadolinium enhancement for the early anatomic confirmation of the pathognomonic, bilateral vestibular schwannomas in NF2. These advances enable early diagnosis and treatment when the tumors are small in virtually all subjects at risk for NF2. The authors suggest that advising young NF2 patients to wait until complications develop, especially hearing loss, before diagnosing and operating for bilateral eighth nerve schwannomas may not always be in the best interest of the patient. To the authors' knowledge, this is the first reported case of preservation of both auditory and vestibular function in a patient after bilateral vestibular schwannoma excision.
Case Reports↗