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Although there is no specific treatment for modality of occupational noise-induced hearing loss (NIHL), the best way to manage this problem is the prevention.
NIHL, although not medically or surgically treatable, is preventable and the test treatment of NIHL is the prevention. The authors investigated the actual condition of NIHL in the industrial complex in Pusan and Kyongnam area, one of the largest industrial complex in Korea and examined the TTS and its recovery process after noise stimulation in both normal control and NIHL groups to establish the criteria of individual susceptibility to noise and to set-up the preventive indices of NIHL using TTS and its recovery time. Approximately 2,258 workers of the noisy industrial complex in Pusan and Kyongnam area of Korea, who did not have any history of ear disease and noise exposure of pre-employment, were examined at a mass screening for audiometric test at 1 and 4 kHz with mobile audiometry unit by an otolaryngologist.
The normal hearing sujects who did not have any audiologic symptoms and abnormal finding at otologic examination were composed of two groups.
For measuring the change of DS, CBN and CWN stimulation of 90 dB above threshold at 4 kHz were given for 10 minutes.
The materials were derived from 64 cases (78 ears) out of 612 workers confirmed as NIHL at Audiology Clinic of Pusan National University Hospital.
After mass screening audiometric test of 2,258 workers (4,516 ears) and secondary otologic evaluation by the board certified otolaryngologist, 612 workers (1,224 ears) were confirmed as NIHL (27.1%).
Among the 1,224 ears of NIHL, type B was the most prevalent and then type H, type S and type M in order. Between 250 to 2 kHz, the hearing threshold was not proportional to the duration below 14 years of noise exposure and there was a tendency to increase hearing threshold in proportion to the duration above 15 years of noise exposure.
In classifying NIHL according to audiogram types, dip type was the most prevalent and then abrupt drop, descending, flat, irregular and ascending types in order. The average TTS and its recovery time after CPT, CBN, CWN and IWN stimulation were shown in Table 6. Most ears recovered within six minutes, especially within two minutes in case of CPT stimulation (Table 8). It showed that the more TTS, the longer recovery time because the correlation coefficient (r) between TTS and its recovery time was 0.99. Although there is a legal hearing conservation program in each industry, 27.1% incidence of NIHL in one of the largest industrial complex of Korea suggests that the otolaryngologist should playa role to seek another preventive method which can be applied to the hearing conservation program. In normal subjects there was no statistical significance of TTS among each continuous mode of stimulation. Instead of measuring the pure tone threshold shift and recovery time, authors checked the change of speech DS and its recovery time after CWN and CBN stimulation in normal subjects. The workers with NIHL occupied 27.1% in Korea and NIHL was mostly established within nine years after noise exposure and below 30 years of age.
The NIHL report was presented at the annual meeting of the American Academy of Otolaryngology-Head and Neck Surgery, New Orleans, LA, September 17-20,1995. To do this, you must have Adobe Acrobat® Reader (version 4 or higher) installed on your computer. This medical discussion paper will be useful to those seeking general information about the medical issue involved. Each medical discussion paper is written by a recognized expert in the field, who has been recommended by the Tribunala€™s medical counsellors. A mixed hearing loss occurs when both a sensorineural and conductive hearing loss are present at the same time. According to the 1990 Noise and Hearing Loss Consensus Conference, a€?Noise Induced Hearing Loss (NIHL) results from damage to the ear from sounds of sufficient intensity and duration that a temporary or permanent sensorineural hearing loss is produced. PTS refers to a permanent loss of sensorineural hearing which is the direct result of irreparable injury to the organ of Corti. The 4000 Hz a€?notcha€? or a€?dipa€? in sensorineural hearing has been a classic finding in NIHL over the years. Why the 4000 Hz frequency appears more affected than other frequencies continues to generate some controversy.
Individuals vary in their susceptibility to noise and the damage it may cause to the cochlea. Of interest, one universal finding is that on average hearing threshold levels (HTLs) in the right ear are better than the left ear by about 1dB.
Whether one ear is more resilient to noise in the same individual (the so- called a€?tough vs.
Please remember that when an asymmetric sensorineural hearing loss exists steps often need to be taken to exclude pathologic causes (i.e.
The following statements tend to reflect what is agreed upon by the majority of scientists and physicians who deal with NIHL. Noise induced hearing loss (NIHL) may produce a temporary threshold shift (TTS), permanent threshold shift (PTS) or a combination of both.
A PTS is caused by destruction of certain inner ear structures that cannot be replaced or repaired. The amount of hearing loss produced from a given noise exposure varies from person to person.
NIHL initially affects higher frequency hearing (3-6 kHz range, for nearly all occupational exposures) than those frequencies essential for communication (i.e. Daily noise exposure (8hrs) > 90 dB for over 5 years (or equivalent) causes varying degrees of hearing loss in susceptible individuals.
NIHL is a decelerating process; the largest changes occur in the early years with progressively smaller changes in the later years (so-called Corso's theorem).
NIHL first affects hearing in the 3-6 kHz range, for nearly all occupational exposures; the lower frequencies are less affected. Once the exposure to noise is discontinued, there is no substantial further worsening of hearing as a result of noise unless other causes occur. Continuous noise exposure over the years is more damaging than interrupted exposure to noise which permits the ear to have a rest period.
The pathologic basis for presbycusis appears to be one of gradual devascularization of the cochlea and loss of functioning hair cells.
Clinically hearing loss from presbycusis appears to be an accelerating process unlike hearing loss in NIHL.
Unfortunately, there is no specific treatment available that will prevent age related hearing loss at present. In the adjudication process of an occupational NIHL claim it is often difficult to separate the total amount of hearing loss from noise and age related change. For example, not everyone as they age will experience age-related presbycutic change (changes from presbycusis are variable with some individuals experiencing greater degrees of age related change than others). Moreover, exposure to high level noise early on may produce hearing loss more rapidly than aging such that the aging process has a negligible effect (i.e.
The effects of noise exposure and aging on hearing when not combined are reasonably well-understood.
Although it seems logical to a€?subtracta€? the age-related effects from the total hearing loss in order to quantitate the amount of hearing loss due to noise, this is really quite simplistic when one considers that aging effects and noise exposure effects can at times be practically indistinguishable for the most part audiometrically. Because compensation claims have required some consideration of presbycusis and its role in the total hearing loss of an individual various correction factors have been applied. Dobiea€™s theorem states that the total hearing loss from noise and age are essentially additive (this is the theory put into practice when a standard correction factor for age after 60 years is applied in the Province of Ontario). Corsoa€™s theorem on the other hand states that any correction for age should be based on a variable ratio (as individuals age the assumption is that the effects of presbycusis variably accelerate by decade).
Nevertheless the quantification of hearing loss attributable to age when occupational NIHL is present is really quite a complex phenomenon. This is an inner ear disorder characterized by episodes of vertigo (an illusion of movement) lasting minutes to hours, fluctuating hearing loss and tinnitus (unwanted head noise). Usually one ear is involved initially although over time the other ear becomes affected in nearly 50% of cases. Treatment is medical in most cases involving a low salt diet and diuretics and vestibular sedatives. Otosclerosis usually results in a conductive hearing loss from stapes footplate fixation due to new bone growth in this area. The diagnosis of cochlear otosclerosis is usually made when a family history of otosclerosis exists and other rare causes for a chronic progressive loss can be excluded.
Although no medical treatment can ever reverse the sensorineural hearing loss, treatment with oral sodium fluoride may minimize and possibly stabilize an individuala€™s hearing. Physical injury to the ear is usually the result of blunt trauma in the circumstances of a significant head injury. When physical trauma is severe enough to cause a temporal bone fracture (the temporal bone is the larger part of the skull bone that houses all the structures of the ear), two types of fractures occur; longitudinal and transverse. In general terms longitudinal fractures are much more common and tend to result in a fracture line through the roof of the middle ear and ear canal. Transverse fractures of the temporal bone occur when the fracture lines run directly through the hard bone of the otic capsule.
Ototoxicity is defined as the tendency of certain substances to cause functional impairment and cellular damage to the tissues of the inner ear, especially to the cochlea and the vestibular apparatus.
Aminoglycoside antibiotics are powerful weapons in the treatment of certain bacterial infections. Antimalarial drugs such as quinine and chloroquin unfortunately have ototoxicity as a side effect if taken in excess.
This is a pathologic misnomer since this tumour is strictly a schwannoma of the vestibular nerve.
Although benign this tumour has serious health implications for the patient and is sought for by otolaryngologists when there is an undiagnosed asymmetry in the hearing.
This diagnosis is given to the individual who experiences a sudden hearing loss in one ear.
An individual's threshold hearing to pure tones at different frequencies (250 - 8000 Hz) is performed. Air conduction (AC) thresholds are delivered via headphones and the individual is asked to respond to the sound of the lowest intensity (in dB) they hear at the frequency being tested. The pure tone audiogram forms the basis for assessing if an individual qualifies for Workplace Safety and Insurance Board (WSIB) benefits in the Province of Ontario. Complex words with equal emphasis on both syllables (so called spondaic words such as a€?hotdoga€?, a€?uptowna€?, a€?baseballa€? etc.) are given an individual at the lowest intensity they can hear. A list of phonetically balanced single syllable words (these are words commonly found in the English language in everyday speech such as a€?fata€?, a€?asa€?, a€?doora€? etc.) are presented to an individual at 40 dB above their speech reception threshold (SRT) in the ear being tested. In this test a probe is placed into the ear canal that both emits a sound and can vary pressure within the canal which causes the ear drum to move. This tells whether the pressure in the middle ear is within normal limits and provides some indirect measurement of Eustachian tube function. Stiffening of the ear drum from loud noise occurs when the stapedius muscle contracts in the middle ear. Absent stapedial reflexes are usually seen in middle ear pathology such as otitis media with effusion or otosclerosis. If one measures how the ear drum moves when pressure is changed in the external ear canal from negative to positive a series of curves can be attained. The ability to measure minute electrical potentials following sound stimulation of the cochlea (i.e.
Electrocochleography (ECoG) - This test measures electrical activity in the cochlea during the first 2 msec of cochlear stimulation.
Auditory Brainstem Response (ABR) - This term is synonymous with the term brainstem evoked potential (BEP) or the brainstem evoked response audiogram (BERA). Threshold Evoked Potentials (TEP) - These electrical waveforms are usually identified between 50 - 200 msec following cochlear stimulation and are thought to represent cortical pathways of electrical activity. If AC thresholds are greater than BC thresholds this usually implies there is a conductive component to hearing loss from pathology involving the external or middle ear. If BC thresholds are greater than AC thresholds this would typically suggest an exaggerated hearing loss or malingering. In its classic presentation a notched sensorineural hearing loss is noted at 4000 Hz that should be relatively symmetric.
Age related hearing loss typically presents with a bilateral symmetrical high frequency sensorineural hearing loss. There are often numerous discrepancies noted such as the presence of acoustic reflexes at levels below volunteered pure tone thresholds, discrepancies between volunteered pure tone average and speech reception thresholds etc. Subjective tinnitus can only be appreciated by the affected individual, is usually associated with a sensorineural hearing loss of some type and is the most common type noted.
Objective tinnitus, on the other hand, is quite rare but by definition is a noise that can be appreciated by an observer. Regardless of cause tinnitus can be quite disturbing for many individuals and can certainly affect their well-being. Treatment for tinnitus includes the use of more pleasurable competing background noise (i.e.
The individual affected has undergone treatments to try to alleviate their perceived unwanted head noise (i.e. Evidence to support a personality change or a sleep disorder as a result of the tinnitus. Hyperacusis is a curious phenomenon where an individual describes an uncomfortable, sometimes painful hypersensitivity to sounds that would be normally well tolerated in daily life.
Treatment usually requires the gradual introduction of increasing sound intensity that becomes better tolerated with time. American Academy of Otolaryngology-Head and Neck Surgery Foundation Subcommittee on the Medical Aspects of Noise.
American Academy of Otolaryngology-Head and Neck Surgery Foundation: Guide for Conservation of Hearing in Noise. Noise Induced Hearing Loss by Lonsbury-Martin BL, Martin GK and Telischi FF, Volume 4, Chapter 126 in Otolaryngology-Head and Neck Surgery 3rd Edition. Permanent Impairment of Hearing - When any anatomic or functional abnormality produces a permanent reduced hearing sensitivity. Permanent Handicap for Hearing - The disadvantage imposed by an impairment sufficient to affect the individuala€™s efficiency in the activities of daily living (ADL).
Permanent Disability - A person is permanently disabled or under permanent disability when the actual presumed ability to engage in gainful activity is reduced because of handicap and no appreciable improvement can be expected. Acoustic Neuroma (Vestibular Schwannoma) - A benign brain tumour that arises on the vestibular nerve usually within the internal auditory canal (IAC). Menierea€™s Disease - A classic inner ear disorder associated fluctuant sensorineural hearing loss, tinnitus and episodic attacks of vertigo lasting minutes-hours. Otitis Media with Effusion - An encompassing term that describes the presence of fluid behind the TM.
Otosclerosis- Genetically inherited condition (approximately 1 in 20 people carry the otosclerosis gene) associated with the development of new, immature bone which primarily involves the stapes footplate leading to a progressive conductive hearing loss. Tympanosclerosis - Calcification of the middle layer of the eardrum that looks like a patch of white chalk.
Mastoidectomy - Procedure designed to exteriorize disease in the mastoid air cells and adjoining middle ear.
Ossiculoplasty - Procedure where the ossicular chain is repaired in order to try and improve hearing. Tympanoplasty - When used in its most simplistic context it means the repair of a previous TM perforation. Ventilation (myringotomy) Tube - The placement of an open ended tube or a€?grommeta€? into the TM acts like an artificial Eustachian tube which helps ventilate the middle ear space. Decibel (dB) - A decibel is an accepted measure of sound pressure level used to describe sound intensity. Evoked Response Audiometry - Measures electrical responses within the inner ear, cochlear nerve and central nervous system that are generated by loud repetitive clicks. This test is typically performed as one of the tests to confirm or exclude whether an exaggerated hearing loss (malingering) is present. Otoacoustic Emissions (OAEs) - Evoked test that measures minute responses to sound thought to arise from the contractile elements of the outer hair cells. Recruitment - Perceived abnormal progressive loudness of noise in an individual with a sensorineural hearing loss.
Speech Discrimination Score (SDS) - The percentage score an individual correctly identifies when presented with a list of phonetically balanced (PB) words usually tested at 40dB above their hearing threshold. Tympanometry - Formal tracing of how the TM moves when pressure is altered in the external auditory canal. Acoustic Trauma - Damage to the ear caused by a single exposure to an impulse nose of high density. Continuous Noise - A noise that remains relatively constant in sound level for at least 0.2 seconds. Dosimeter - An instrument that integrates a function of constant varying sound pressure over a specified time period in such a manner that it directly indicates a noise dose and estimates the hazard of an entire exposure period.
Permanent Threshold Shift (PTS) - The permanent depression in hearing sensitivity resulting from exposure to noise at damaging intensities and durations. Temporary Threshold Shift (TTS) - The temporary (usually several hours) depression in hearing sensitivity resulting from exposure to noise at damaging intensities and durations.
Time Weighted Average (TWA) - The sound level or noise equivalent that, if constant over an eight hour day would result in the same exposure as the noise level in question (assuming a 5 dB doubling rule).
The ear is a complex organ that has dual responsibility for hearing and balance (vestibular) function. The ear canal (external auditory canal) originates from the concha (so-called bowl) of the auricle and extends medially to the tympanic membrane. The ear canala€™s primary function is to provide a conduit for airborne sound waves to reach the tympanic membrane. The middle ear cleft is a more extensive designation of the middle ear that has three main components which include the middle ear cavity, mastoid air cell system and the Eustachian tube. The mastoid air cell system consists of a series of small mucosal lined air cells interconnected with each other and the middle ear proper.
Important structures of the middle ear include the tympanic membrane and the ossicular chain. The ossicular chain consists of the three small interconnected mobile bones known as the malleus (hammer), incus (anvil) and stapes (stirrup). The inner ear is the sensory end organ within the hardest bone of the body known as the petrous portion of the temporal bone. The cochlea specifically refers to the sensory portion of the inner ear responsible for hearing.
The vestibular portion of the inner ear consists of three fluid lined semicircular (superior, lateral and posterior) canals and the area called the vestibule which houses the otolithic macular endorgans. Sound vibrations are picked up by the pinna and transmitted down the external auditory canal where they strike the TM causing it to vibrate. When the mechanical vibrations of the stapes footplate reach the inner ear they create traveling waves in the cochlea.
Although the vast majority of the cochlear nerve fibres are termed afferent (ie nerves that carry electrical activity from the inner ear to the brain), within the cochlear nerve itself we have a small number of nerve fibres designated as efferent (nerves that carry electrical activity from the brain to the inner ear).
Of interest when the outer hair cells become injured or affected by pathology they also lose their ability to a€?fine tunea€? the electrical responses arising from the inner ear. Although an individual may have apparently normal hearing it does not necessarily mean the cochlear nerve is undamaged.
Sound is the propagation of pressure waves through a medium such as air and water for example. This is a very relevant question that is based on the definition of how hearing loss causes a handicap for the affected individual in their ability to identify spoken words or sentences under everyday conditions of normal living. Although the higher frequencies are initially affected in NIHL an individual will really only begin to demonstrate a significant handicap to hearing to everyday speech in a quiet surrounding when the average of the hearing thresholds at 500, 1000, 2000 ( + 3000) Hz is above 25 dB.
The inclusion of the 3000 Hz threshold value for NIHL awards is not always required depending on the jurisdiction. In the province of Ontario the Workplace Safety and Insurance Board (WSIB)a€™s Operational Policy Manual (OPM) Document No. A presbycusis (aging) correction factor of 0.5 dB is deducted from the measured hearing loss (averaged over the 500, 1000, 2000 and 3000 Hz frequencies) for every year the worker is over the age of 60 at the time of the audiogram.
It is important to also appreciate that decisions can also be made on an exceptional basis which the WSIB has recognized.
Since individual susceptibility to noise varies, if the evidence of noise exposure does not meet the above exposure criteria, claims will be adjudicated on the real merits and justice of the case, having regard to the nature of the occupation, the extent of the exposure, and any other factors peculiar to the individual case. A comprehensive list of US comparisons for NIHL and benefits can be found in Table 35.1 pages 797-799 in the Chapter concerning State and Federal Formulae Differences in Occupational Hearing Loss, 3rd Edition. It is likely that the two effects are not additive (Corsoa€™s theorem) but from a practical point of view this is how they are usually viewed with regards to compensation claims (Dobiea€™s theorem).
At any given age for frequencies above 1000 Hz men will have more age related hearing loss than women. Age related hearing loss affects all frequencies although the higher frequencies are usually more affected.
Age related hearing loss is an accelerating process where the rate of change increases with age.
One can speculate that this might be one of the reasons an individual early on in their exposures may not be aware of a hearing loss, only to appreciate a hearing loss later in life when other factors such as presbycutic change occur.
Although we think of presbycusis as an age related event not all individuals will develop this condition. Future genetic studies may provide us with further information concerning those at greater risk for progressive hearing loss from presbycusis in future. A TTS is considered to represent a pathological metabolically induced fatigue of the hair cells or other structures within the Organ of Corti.
In a PTS the destruction and eventual cochlear hair cell loss is thought to arise from direct mechanical destruction from high-intensity sound and from metabolic decompensation with subsequent degeneration of sensory elements.
While one would normally expect full recovery of hearing function after a TTS there is one important consideration that needs to be taken into account. The position in the world literature continues to support that any progressive hearing loss from acute trauma ceases unless the individual is re-exposed to more acute acoustic trauma or some other factor (s) occurs ( i.e.
The classic studies of acute acoustic trauma by Segal et al (1988) and Kellerhals (1991) are often used to support this position.


In the cohort study by Segal et al, 841 individuals from either the regular US army or military reserve sustained a permanent sensorineural hearing loss from acute acoustic trauma without subsequent re-exposure. The importance of the Segal study is that after 1 year one would not expect further worsening of hearing in subjects who ceased to have further noise exposure. Kellerhalsa€™ study reviewed a much smaller series of individuals who were exposed to acute acoustic trauma but looked at them over a 20 year duration. Did you know that noise induced hearing loss is the most common cause of hearing loss?  Hearing loss can be caused by one extremely loud impact sound (possibly a gun firing) or by listening to continued loud sounds or noise for a long period of time (perhaps machinery running most of the work day).  Noise induced hearing loss can affect anyone at any age.
How to cite this article Nicolas-puel C, Akbaraly T, Lloyd R, Berr C, Uziel A, Rebillard G, Puel J, et al.
We undertook this prospective study with 555 patients attending a specialist tinnitus clinic at University Hospital, Montpellier, France, between 1998 and 2003. The semiological analysis of tinnitus covered several parameters, and each patient completed a questionnaire. For spatial localization, patients were asked to describe their symptoms as being either left- or rightsided or as nonlateralized. Intensity was measured on a visual analog scale graded from 0 to 100, where 0 corresponded to an absence of tinnitus and 100 indicated the loudest tinnitus imaginable. We considered the length of history, age at presentation, intensity of the tinnitus, and any associated hearing loss as continuous variables. Table 1 details the population that was seen within a specialist tinnitus clinic (N = 555). Generally, patients were able to describe the circumstances in which they noticed the appearance of their tinnitus (Table 2). Analysis of the audiograms of the tinnitus patients showed a predominantly left-sided hearing loss, particularly in the higher frequencies (data not shown). In this study, we focused on those patients who said that the onset of their tinnitus began after noise trauma. Whereas in the overall population patients showed a mainly left-sided high-frequency hearing loss ( > 4,000 Hz), patients in the noise trauma population had similar hearing loss in each ear (Fig. Our study, undertaken in the context of a specialist tinnitus clinic at the University Hospital, Montpellier, shows that tinnitus affects both genders equally.
In contrast to other tinnitus patients, those with a history of noise trauma demonstrated similar hearing losses in each ear and showed no difference in side of lateralization or nonlateralization of their tinnitus. In this study, almost all the patients who had a history of noise exposure said that their tinnitus was of a highpitched whistling frequency. In this study, we evaluated the intensity of tinnitus after noise trauma by using a visual analog scale. The vast majority of patients with noise trauma described their tinnitus as high-pitched and stable over time.
This study shows that noise trauma appears to provoke a high-pitched whistling tinnitus that is stable over time, occurs in either ear, and usually appears in men who are, on average, younger than the general tinnitus population. The authors thank the Fond d'Aide a la Qualite des Soins de Ville Languedoc-Roussillon for his support in statistical analysis of the data. The fundamental prevention of NIHL is to find the persons who are more susceptible to the noise and to avoid work in the noisy environment prior to or during employment. It is important that the otolaryngologists should be familiar with a government hearing conservation program and medicolegal aspects of NIHL. Although there is a legal obligatory hearing conservation program, the desirable and ideal preventive method is to check the individual susceptibility to the noise and to avoid work in the noisy environment.
In addition to audiometric data, a brief review of the otologic system, such as local finding of ear drum, tuning fork test and nystagmus examination were carried out.
One group of 69 cases (137 ears) who were within 15 dB from 250 to 4000 Hz and within 10 dB at 4000 Hz and this group was checked for the susceptibility to the noise by the change of pure tone threshold after noise stimulation.
Immediately after each mode of noise stimulation, pure tone threshold was checked at 30 second intervals and the TTS and its recovery time were obtained.
After each noise stimulation, DS at 40 dB above SRT was checked and its recovery time was obtained. After CWN stimulation with 70 dB suprathreshold at 4 kHz for 10 minutes, pure tone threshold was checked at 30 second intervals for 10 minutes.
According to the duration of noise exposure and age, the incidence of NIHL was rapidly increased within 10 years of noise exposure and within 30 years of age. There were statistical significance between CWN versus IWN in TTS, and CPT versus CBN and CPT versus CWN in its recovery time. However, it was difficult to compare between below and above 50 dB TTS groups because the number of ears above 50 dB TTS group was not sufficient (Table 7). The amount of TTS were 10-20 dB in most ears (73%) and the ears which had over 25 dB TTS occupied eight out of 78 ears (10.2%) (Table 13).
Although noise reduction for individuals obviously can prevent NIHL, no single study offers convincing evidence of the efficacy of conventional occupational hearing conservation programs, primary due to methodologic flaws.8 The fundamental preventive way of NIHL can be to find out the persons who are more susceptible to the noise and have them avoid working in the noisy environment during or prior to employment.
Initially, NIHL could involve not only in the high-frequency range but also in the speech range simultaneously. Coleman JW: Age dependent changes and acoustic trauma in the spiral organ of the guinea pig. It is intended to provide a broad and general overview of a medical topic that is frequently considered in Tribunal appeals. Each author is asked to present a balanced view of the current medical knowledge on the topic.
A vice-chair or panel may consider and rely on the medical information provided in the discussion paper, but the Tribunal is not bound by an opinion expressed in a discussion paper in any particular case.
This is the type of hearing loss that is found in routine unprotected daily exposure to loud noise potentially injurious to hearing in the occupational work force. This type of loss might be found in an individual, for example, with a large tympanic membrane (TM) perforation where mechanical vibrations along the ossicular chain are dampened.
For example an individual with a large TM perforation who received topical antibiotic ear drops for the treatment of a middle ear infection that caused inadvertent toxicity to the inner ear in addition (i.e.
The hearing loss may range from mild to profound, may result in tinnitus (unwanted head noise) and is cumulative over a lifetimea€?.
Noise induced deafness generally affects hearing between 3000-6000 Hz with maximal injury centering around 4000 Hz initially, an important point to remember.
There is good pathologic evidence however that demonstrates maximal cochlear hair cell loss in the tonal areas where the 4000 Hz hair cells normally reside in both animals and humans. In susceptible individuals the early effects of presbycusis are occasionally seen around age 40. Secondary to hair cell loss one can often see progressive neuronal dropout along the cochlear nerve. In this regard the effects of aging in the absence of other factors cause a loss of hearing at all frequencies whose rate of growth becomes more rapid as age increased (especially after 60 years): an important point to remember in this context. To a large degree hearing loss with age is genetically primed; in other words the hearing your parents had as they aged is often passed on to you.
When the two processes are combined the resultant pathology and its effects upon hearing are not as well understood.
This certainly generates a more complicated mathematical model but probably more closely approaches what is happening physiologically.
The hearing loss is typically a low-frequency sensorineural loss that fluctuates initially often reverting close to normal between attacks in the early stages.
The presence of a pink-flamingo hue to the middle ear on otoscopy (so-called Schwartzea€™s sign), absent stapedial reflexes on audiometry and bone density changes involving the surrounding bone of the inner ear best appreciated on high-resolution CT scanning also helps in the diagnosis. Most patients suffering deafness by this mechanism will have had at least transient unconsciousness and have been admitted to hospital. A fracture through this bone (which is the hardest bone in the body) implies the force of the injury was severe and often incompatible with survival. Unfortunately these antibiotics can cause varying degrees of cochlear, vestibular and renal toxicity.
The Auditory Brainstem Response (ABR) is used as a screening test while a gadolinium enhanced Magnetic Resonance Imaging (MRI) study is the gold standard investigation. The extent of the loss varies from a partial loss at one frequency right up to a profound loss at all frequencies with a profound discrimination loss.
For the purposes of compensation, the most reliable audiograms will likely be performed by an audiologist who typically has a mastersa€™ degree or doctorate in audiology. The audiometer used to test hearing has been especially calibrated so that each frequency of sound tested for hearing has been normalized where 0 dB represents the lowest intensity of sound that the majority of people with normal hearing can hear from large population studies. When a conductive hearing loss is suspected the ear canal and inner ear mechanisms for transmission of sound energy to the inner ear are bypassed by placing a bone vibrator over the mastoid which directly stimulates the inner ear. A weighted pure tone average from frequencies at 500, 1000, 2000 and 3000 Hz is required for this determination from AC thresholds if a pure sensorineural hearing loss is present or from BC thresholds if any conductive element to hearing loss is present. As a general rule the SRT value should roughly equal the pure tone average in the speech frequencies at 500, 1000 and 2000 Hz. Most individuals with normal sensorineural hearing should get over 80% of the words correct at this level.
Most individuals with normal sensorineural hearing will exhibit a reflex at 70-80 dB above their hearing threshold level at the frequency being tested. When reflexes occur at less than a difference than 70-80 dB above hearing threshold at the frequency tested this is indirect evidence of a phenomenon called recruitment which is usually seen in cochlear pathology (i.e.
ECoGa€™s chief value lies in its ability to demonstrate wave 1 of the auditory brainstem response (ABR) and whether waveform morphology is suggestive of changes thought to occur in endolymphatic hydrops, the pathophysiologic substrate of MeniA?rea€™s disease.
This test measures electrical waveforms obtained in the first 10 msec from cochlear stimulation.
Middle ear pressures should be normal, stapedial reflexes present and a normal tympanogram noted.
In some instances it can be quite disabling for the affected individual who tends to withdraw from any exposure to uncomfortable noise.
Cognitive behavioural therapy (CBT) has also demonstrated promise in a recent randomized controlled study. The Relative Contributions of Occupational Noise and Aging in Individual Cases of Hearing Loss.
Specialized treatment based on cognitive behavior therapy versus usual care for tinnitus: a randomized controlled trial. Diabetes and hearing impairment in the United States: Audiometric evidence from the National Health and Nutrition Examination Survey (1999-2004). The pathology is thought to arise from excess fluid in the inner ear leading to membrane ruptures (so-called endolymphatic hydrops). Certain antibiotics (especially the aminoglycoside class), antimalarials, chemotherapeutic agents and even excessive doses of ASA can be toxic to the inner ear.
Although changes may take place as early as age 40, hearing loss due to aging usually starts to accelerate around ages 55-60 yrs and continues with age. Auditory Brainstem Response (ABR) - Synonymous with the term BERA (brainstem evoked response audiometry) or auditory BEPa€™s (brainstem evoked potentials). Cortical Evoked Response Audiometry - Synonymous with Threshold Evoked Potential (TEP) testing. Depending on the frequency of the sound certain parts of the cochlea will emit an a€?echoa€? in response.
This occurs to a loud noise typically 70-80 dB above an individuala€™s hearing level at the frequency tested which causes stiffness of the ossicular chain and tympanic membrane Absent stapedial reflexes are usually seen in otosclerosis due to stapes footplate fixation for example.
Conceptually it has three distinct anatomical components which include the external, middle and inner ear. The auricle is a flattened, funnel shaped appendage that contains a cartilage framework covered by skin. The anatomy favours the transmission of sound waves typically between 500-8,000 Hz which interestingly represents the common speech frequencies of most individuals. Proper function of the Eustachian tube which connects the middle ear cavity to the back of the nose (nasopharynx) is important for the normal middle ear aeration and function. The tympanic membrane or ear drum is an ovoid, pale gray, semi-transparent membrane positioned obliquely at the medial end of the ear canal. The tensor tympani and stapes muscles help stabilize the bones along with suspensory ligaments of connective tissue inside the middle ear. Covered by an otic capsule its membranous portion (or labyrinth) contains a delicate system of fluid-filled canals lined with sensory neuroepithelium necessary for hearing and balance perception.
It is a three chambered organ containing anatomical spaces known as the scala media, scala vestibuli and scala tympani. The scala vestibuli and scala tympani (T) by comparison contain fluid rich in sodium called perilymph. Within each semicircular canal is an area called the ampulla which contains hair cells sensitive to low frequency bidirectional fluid displacement that occurs with angular acceleration type movements of the head.
The sound vibrations are then transmitted across the air-filled middle ear space by the 3 tiny linked bones of the ossciular chain: the malleus, incus and stapes . The hair cells change these mechanical vibrations from the waves into electrochemical impulses that can interpreted by the central nervous system (CNS). It can be a simple sound commonly known as a pure tone or it may be complex when we think of speech, music and noise. The prediction of a handicap did not appear to be improved by the inclusion of other frequencies > 4000 Hz. What do other jurisdictions consider to be disabling hearing loss (provincial, national and international)? The hearing loss that remains after the presbycusis adjustment is then used to determine entitlement to benefits. It is generally thought that if an ear has suffered a permanent threshold shift from a noise induce etiology further noise exposure will cause less damage than would occur in a normal ear to a similar exposure.
As previously noted the effects of noise exposure and aging on hearing when not combined are reasonably well understood. One however has to qualify this by saying that there is a significant amount of redundancy within the inner ear as it pertains to hearing.
Moreover we really dona€™t have a lot of good prospective longterm studies over 4-5 decades that can ultimately answer this question completely. Can moderate workplace noise exposure causing a TTS and repeated exposures later cause a PTS? Repeated noise exposure that causes a temporal threshold shift (TTS) can ultimately lead to a permanent threshold shift (PTS) with repeated exposures. Some of this is based on the redundancy principle within the inner ear: not all hairs cells possibly recover following a TTS but enough do as to prevent hearing loss. Following acute acoustic trauma what is the natural history of the subsequent hearing loss? Audiometric evaluations were performed on these individuals at 6 months, 1, 2 and 4 years after initial exposure. In his study cohort only 1% of individuals following acute acoustic trauma demonstrated deterioration of hearing of more than 20 dB in at least 1 frequency. Characteristics of Tinnitus in a Population of 555 Patients: Specificities of Tinnitus Induced by Noise Trauma. In this study, we compared tinnitus that appeared to be induced by noise trauma with that perceived to start in other circumstances in a population of 555 patients attending the specialist tinnitus clinic at the University Hospital in Montpellier, France. To do this, we compared tinnitus induced by noise trauma with that induced in other circumstances; we studied a population of 555 patients seen in a specialist tinnitus clinic at University Hospital, Montpellier. In regard to variability over time, certain patients described their tinnitus either as stable over time or as fluctuating (usually louder at bedtime and on awakening). After otoscopy, audiometry was undertaken for each ear (air conduction, bone conduction, and speech audiometry). We analyzed the description of the sound of the tinnitus, its spatial localization, and the variability of the intensity as noncontinuous variables. We asked the patients to classify their tinnitus with regard to spatial localization and frequency, intensity, variability with time, and duration (Table 4). Pure-tone audiograms in subjects with a history of noise trauma (NT) and those with other ear pathology. Almost all (98.8%) of these patients said that their tinnitus was of a whistling type (see Table 4). Correlation between the intensity of tinnitus and the hearing loss in those with a history of noise trauma (NT). In general, the patients seen tended to have a high-pitched hearing loss that is more marked on the left. The majority of tinnitus cases were linked to sound trauma after a concert, an evening at a nightclub, listening to a personal stereo, or using do-it-yourself power tools, in which one would expect both ears to have similar noise exposure. Statistical analysis showed a significant correlation between noise trauma and whistling tinnitus. With this instrument, we significantly correlated the intensity of the tinnitus with the degree of hearing loss between 2,000 and 8,000 Hz.
If the age and gender are accounted for by the source of the noise trauma (concerts, discos, hunting, do-it-yourself tools), the descriptive aspects of tinnitus are strongly correlated with hearing loss as demonstrated by pure-tone audiometry. The purpose of this study is to investigate the actual status of NIHL in the industrial complex of Pusan and Kyongnam area in Korea and to evaluate the individual susceptibility to the noise and to set-up the preventive indices of NIHL, using temporary threshold shift (TTS) and its recovery time after noise stimulation. The workers who had over 40 dB pure tone threshold of air condition without masking at any of these two frequencies were referred to the Audiology Clinic of Pusan National University Hospital and were checked for the hearing level using Nagashima 51A-T72 type audiometer by ascending method at least three times.
Another group of 87 cases who had within 15 dB of speech reception threshold (SRT) and got 100% discrimination score (DS) at 40 dB above SRT. The pure tone audiometer was specially equipped with NAB-01 audiobooster (Nagashima Co., Japan) to amplify to 130 dB.
So the NIHL was mostly established within nine years after noise exposure and below 30 years-of-age (Table 1).
However, type S was more common than type H in below four years of exposure group and in below 19 years of age group (Tables 2, 3). The hearing level at 4 kHz was higher than other frequency and this is the characteristic of NIHL, Cs dip phenomenon (Table 4). The amount of TTS was 11-30 dB in most ears (66-75%) and the ears which had over 41 dB TTS occupied 3.8% (Table 7). Generally 50% of TTS was recovered within 30 seconds after each noise stimulation and thereafter the recovery amount of TTS was smaller and smaller as time progressed (Table 10). There was no statistical significance of DS and recovery time among age groups and between sex groups. In relation to the duration of noise exposure, the incidence of NIHL rapidly increased until nine years of exposure.
The cases which belong to lower 5% critical regions in normal distribution curve had 76% (CWN stimulation) and 74% (CBN stimulation) of DS and over six minutes of recovery time, suggesting the normal individuals who have DS below 76% and recovery time above six minutes after noise stimulation could have a high risk of developing NIHL if they are exposed to noisy working environment. Among subjects with normal hearing, those who had the TTS over 41 dB and the recovery time above 10 minutes and those who had a speech DS below 76% and a recovery time above six minutes after noise stimulation had a high risk of developing NIHL. Occupational NIHL and presbycusis (degenerative hearing from aging change) represent the two most common causes of sensorineural hearing loss in society today. For this reason workers ideally should be out of noise for at least 24 hours if not 48 hours prior to audiometric testing to avoid the effects of TTS on hearing. Noise exposure from chipping machines and jackhammers characteristically damage the higher frequencies severely before affecting the lower frequencies.
Nevertheless some individuals exposed to noise not infrequently demonstrate some asymmetry to their hearing loss. The majority of changes histopathologically are noted in the basal turn of the cochlea where the high frequency hair cells and their corresponding cochlear nerve neurons are found.
When the distended membranes rupture the resulting admixture of inner (endolymph) and outer (perilymph) fluids causes electrolyte disturbances (i.e. When the foci primarily affect the cochlea the patient may present with a chronic progressive sensorineural hearing loss in one or both ears.
As otosclerosis is a lifelong condition, the sensorineural hearing loss from cochlear otosclerosis is often superimposed on hearing loss from advancing age (i.e. The hearing loss noted is usually conductive and usually arises from discontinuity of the ossicular chain although any combination of conductive and sensorineural hearing loss can occur.
If the individual survives there is usually complete loss of hearing and vestibular function on the involved side. Persistence of a conductive loss after the TM has healed would suggest continued problems with the ossicular chain. Careful and regular monitoring of auditory function (especially in the ultra high frequencies > 8000 Hz) and serum antibiotic levels may help the physician predict when ototoxic effects are occurring. Pressure on or devascularization of the acoustic nerve or inner ear causes hearing loss, usually a high-frequency loss with reduced speech discrimination. Patients can sometimes identify the moment of occurrence or wake with it or appreciate it only when they go to use the phone.
If there is a significant discrepancy this could imply an exaggerated hearing loss is present as well. When speech discrimination scores are especially poor this implies that there may be a lesion involving the cochlear nerve (i.e. In general terms if the Eustachian tube is functioning normally pressure on both sides of the ear drum should be similar (i.e. Waveform morphology is thought to arise from the cochlear nerve and the various relay stations in the brainstem the electrical response has to travel through.
The test is often indicated in an individual if there are concerns regarding an exaggerated hearing loss.
Tinnitus maskers are noise generators worn like a hearing aid that produces a sound of similar frequency to an individuala€™s tinnitus.
The problem with tinnitus however is that it is difficult to quantify objectivity and to fully appreciate how it affects an individuala€™s well-being. This test measure electrical activity along the cochlear nerve and at the various relay stations in the brainstem between 1-10 msec of stimulation. This test looks at electrical waveforms in the cortical areas of the brain between 50-200 msec after cochlear stimulation. In humans the auricle has rudimentary functions for gathering sounds and in sound localization which is much more important in animals.


The first part of the ear canal is cartilaginous and is lined by thick, hair bearing skin that contains numerous sebaceous and ceruminous glands. Malfunction of the Eustachian tube remains the leading cause for most middle ear disorders. The air cell system is typically underdeveloped or even absent (sclerotic) in individuals with a past history of recurrent ear disease. It is a three layered structure whose outer epithelial layer is contiguous with the skin of the external auditory canal, its middle layer is fibrous and its inner layer is composed of the same mucosal lining found throughout the middle ear cleft. Clinically the malleus is attached by its handle to the tympanic membrane and is readily visible in most individuals on otoscopic examination.
The separate but intimately related perilymphatic and endolymphatic compartments of the inner ear and their ionic constituents are efficiently controlled by the stria vascularis of the cochlea and the dark cells of the vestibular apparatus. This ionic difference between these chambers forms the basis of the endocochlear electrical potential which is necessary for the conversion of mechanical activity from fluid movement within the cochlea to electrical activity arising from the hair cells. The hair cells of the otolithic endorgans (utricle and saccule) are covered by otoliths ( literally a€?little stonesa€? or crystals of calcium carbonate ). The mechanical vibrations are transmitted to the inner ear via the vibrations of the stapes footplate. The tiny cilia (little hairs) on top of the hair cells (both inner and outer) are covered by a gelatinous membrane called the tectorial membrane.
This apparent internal a€?feedback loopa€? is thought to be responsible for a€?fine tuninga€? by inhibiting some unwanted electrical impulses and by changing the mechanical properties of the basilar and tectorial membranes.
Distortion of certain sounds arises when enough hair cells are damaged such that the hearing threshold is reduced.
A cycle of a pure tone is represented by a sine wave appearance with an area of compression followed by rarefaction. Low sounds tend to have a long wavelength relative to higher pitched sounds which have shorter wavelengths by comparison.
Entitlement to health care and rehabilitation benefits is available when the adjusted hearing loss is at least 22.5 dB in each ear. When the two processes are combined, the resultant pathology and its effects upon aging are not as well understood.
In other words many hair cells in a similar region of the cochlea will produce a certain frequency response to sound stimulation. Upon saying this however we can actually demonstrate that many individuals will start to show early changes in hearing as early as age 40 years (in subjects screened to rule out other ear disease and noise exposure).
It is agreed that hearing loss and injury to the ear increases with the noise level, the duration of exposure, the number of exposures and the susceptibility of the individual. The findings also indicate that the late progression of hearing loss following a single episode of acute acoustic trauma did not exist. Patients had consulted for persistent tinnitus for 7 years from the onset of their symptoms. Taking account of the sound level in discos and clubs and from personal stereos (especially when listened to through headphones), one can anticipate the advent of an entire new generation of tinnitus sufferers. Also, they were asked for a description of the sound; most patients were able to describe their tinnitus as whistling or buzzing. Complementary investigations, such as otoacoustic emissions, evoked auditory potentials, videonystagmography, computed tomography, and magnetic resonance imaging scans, were undertaken as necessary to help to diagnose any hearing loss. There was a broad age range of patients, from 11 to 91 years, with the average age at presentation in the clinic being 54 ± 15 years. Tinnitus was often attributed to ear pathology (34.8%) or, in fewer cases, to another illness (10%). Within this category were concerts (53%), discotheques (35%), and prolonged use of personal stereos, especially when listened to through headphones (12%).
However, the degree of hearing loss was significantly lower than that in patients suffering from other ear pathology (Fig. Graphs show the average hearing loss in dB (± standard error of the mean) measured in the right ear (R, circles) and the left ear (L, crosses). Statistical analysis demonstrated a significant correlation between tinnitus precipitated by noise trauma and the perception of it as a whistling type. In 79.5% of cases, patients described their whistling tinnitus as stable over time (see Table 4). The correlation between tinnitus intensity, as measured on a visual analog scale (white circles), and the hearing loss (black circles) gives a coefficient that becomes greater as the hearing loss becomes greater. From a descriptive point of view, the tinnitus described by the patients in this study was mainly whistling, was stable with time, and was perceived on the left side.
This being the case, we propose two hypotheses: (1) Fluctuating tinnitus tends to stabilize after a certain length of time or (2) fluctuating tinnitus may disappear, whereas longstanding tinnitus is stable.
Assessing tinnitus and prospective tinnitus therapeutics using a psychophysical animal model.
Cisplatininduced hyperactivity in the dorsal cochlear nucleus and its relation to outer hair cell loss: Relevance to tinnitus.
Until now, it is clear that the static and dynamic characteristics of the middle and inner ear, such as the stiffness of the cochlear partition, thickness of the basilar and tectorial membrane, blood supply ofthe cochlea, rate of oxygen metabolism and density of afferent and efferent innervation would be expected to determine how much exposure to noise can be enough to cause NIHL. This group was evaluated for the susceptibility to the noise by the change of DS after noise stimulation. The correlation coefficient between TTS amount and its recovery time was 0.91, so that there was close relationship between these two parameters. Among subjects with NIHL, those who had the TTS over 25 dB and the recovery time above 10 minutes after noise stimulation had individual susceptibility to the noise.
In Disease of the Nose, Throat, Ear, Head, and Neck, Ballenger JJ, Lea and Febiger, Philadelphia, PA 49:1053-1068, 1991. Tribunal adjudicators recognize that It is always open to the parties to an appeal to rely on or to distinguish a medical discussion paper, and to challenge it with alternative evidence: see Kamara v.
Constant or steady state noise by comparison remains relatively constant and lasts longer although fluctuations in sound intensity may occur. This is however usually related to the fact that one ear receives a greater exposure to the noise than another. Nevertheless the changes seen in presbycusis are typically non-specific and can also be seen in a vast number of pathologies including the effects of noise upon the inner ear. Occasionally both a low-frequency and a high-frequency loss occurs but not usually the type of high frequency loss seen following noise exposure. When vertigo is incapacitating the balance function of the inner ear may be attenuated or ablated by the trans-tympanic instillation of gentamicin with relative preservation of hearing. If the footplate as well as the cochlea is involved then a mixed (conductive and sensorineural) loss might result. The pathognomic sign of a longitudinal temporal bone fracture is the so-called a€?step deformitya€? in the deep ear canal.
Facial paralysis from an injury to the facial nerve (a nerve that runs in close approximation to the inner ear) typically occurs.
The prolonged use of topical aminoglycoside antibiotics to treat middle ear pathology in the presence of a TM perforation is not without some risk which should always be kept in mind.
In fact some people with a€?superhumana€? hearing can even hear sound intensities less than this relative value of sound pressure. In complex situations (mixed hearing losses) it may also be necessary to a€?maska€? the ear not being tested (to prevent crossover of sound to the other ear). When tinnitus is severe enough to affect an individuala€™s well-being a trial of pharmacological treatment is generally recommended. Investigations such as a magnetic resonance imaging (MRI) are generally required to exclude the remote possibility of central nervous system pathology.
Because of the brains proximity possible life-threatening complications can occur if left untreated (i.e.
This test is typically performed when an asymmetric sensorineural hearing loss is present when there is concern a retrocochlear lesion such as an acoustic neuroma or MS might be present. The presence of waveforms following stimulation with the lowest intensity sound an individuala€™s cochlea hears provides us with a reasonable estimation of an individuala€™s hearing (usually within 5-10 dB of the anticipated threshold hearing at the frequency tested). The deeper part of the ear canal is bony, lacks skin appendages and is lined by thinner skin densely adherent to the periosteal lining of the bone. It is anatomically divided into 2 parts: the pars tensa and the pars flaccida (located in what is called the attic region of the tympanic membrane). Medially the arch (crura) of the stapes attaches to the inner ear via its footplate (which is a thin, flat oval piece of bone approximately 7mm X 3mm in dimension). Series of generation potentials culminate to form action potentials that transmit this electrical activity along the cochlear nerve fibres to the brainstem and onto the higher centers of auditory processing. The hair cells of the vestibular macula respond primarily to gravity and linear accelerations.
The presence of active non-muscular contractile elements within the outer hair cells and their effects on movement of the basilar membrane is used to explain the concept of otoacoustic emission (OAE) testing.
When the sound gets loud enough the inability to a€?fine tunea€? sound becomes lost and more nearby hair cells are drawn into the firing needed to create an electrical signal; hence the distortion of a loud sound.
Hair cell loss can continue until a certain critical point is breeched with the individual unaware of a hearing deficit. Follow-up beyond the 1 year mark did not reveal any further deterioration of hearing in any individual.
Among these tinnitus patients, 17% described their tinnitus as starting after excessive noise exposure.
Depending on the variables under analysis, a Student's t-test or chisquared testing was undertaken. In 15.9% of cases, the tinnitus appeared in association with psychological problems, such as emotional trauma, depression, or episodes of stress or anxiety.
Next most prevalent was firearm use (16.2%), the majority related to hunting or shooting as a leisure activity. The intensity of tinnitus perception was significantly correlated with the degree of hearing loss measured between 2,000 and 8,000 Hz. Note that the greatest correlation coefficients occur in the highest frequencies of hearing loss. Although not statistically significant, this latter finding is in accordance with other studies showing that hearing loss and tinnitus are generally more noticeable on the left side [8]. This link correlates with an earlier study on a smaller population showing that a whistling type of tinnitus was correlated with a high-frequency hearing loss and that a buzzing type of tinnitus was correlated with a low-frequency hearing loss [7]. These results agreed with our previous study of 58 patients [7], which showed that the intensity of stable whistling tinnitus is perceived as increasingly strong as the highfrequency loss is more marked. Only a longitudinal study of tinnitus patients will allow us to clarify these hypotheses further. However, this attempt at categorizing patients' tinnitus as a function of both the etiology and the semiology allows us to evaluate better the medical and psychological treatment of these tinnitus patients. Unfortunately one cannot measure these directly in the intact organism, so indirect measurement could be used to identify the more noise-susceptible individuals before NIHL is incurred. These results suggest that NIHL could be developed in the early period of working and could involve not only in the high frequency initially but also in the speech range simultaneously, which are not in agreement with the concept that high frequencies are more susceptible and initially involved. On the basis of these results, the TTS and its recovery time after noise stimulation are useful preventive indices for evaluation of individual susceptibility to the noise.
For example, truck drivers in North America not infrequently have a greater degree of hearing loss in their left ear (when the window is rolled down the left ear would be exposed to more sound from the engine). In the last resort the whole inner ear can be destroyed surgically by a procedure called a labyrinthectomy. Exploration of the middle ear surgically with correction of the ossicular chain or insertion of a prosthesis is called an ossiculoplasty.
On examination blood is usually seen in the middle ear behind the ear drum (a hemotympanum). The resultant hearing loss depending on the mechanism can be conductive, sensorineural or a combination thereof.
Of interest the first course of cisplatinum often demonstrates which patients are vulnerable to cochlear damage and what may happen in future if continued treatment courses are required.
ANs are overwhelmingly unilateral, but in association with a rare genetic disorder, neurofibromatosis type 2, they may be bilateral.
Another concept to appreciate is that the dB scale is a logarithmic (an exponentially increasing) rather than arithmetic (linear increasing) scale which makes it difficult to apply a percentage hearing loss to any individual. Certain anti- depressants (especially the tricyclic or SSRI classes) and anti-convulsants (medications used for seizure control) have been effective for some individuals. Mean comfort levels (MCLa€™s) and uncomfortable loudness levels (ULLa€™s) during audiometry provide some information concerning the threshold intensity of sound an individual can tolerate. One general maxim in medicine is that a€?an unexplained unilateral sensorineural hearing loss should be considered an acoustic neuroma until proven otherwisea€?.
Continuous migration of epithelium from the deeper to the lateral portion of the ear canal tends to keep the ear clean.
The pars tensa or lower four-fifths of the ear drum is conically shaped and has a strong fibrous middle layer which provides strength.
The blood supply to the incus can be tenuous compared to other structures of the middle ear. Abnormalities in vestibular end organ function often result in the patient experiencing the subjective complaint of vertigo. In general terms the greater the frequency the higher the pitch of the sound and the greater the intensity the louder we hear it. Of interest, in a parallel series of control patients who were further exposed to repeated episodes of acute acoustic trauma during the same study period by the end of 4 years 30% of these individuals had demonstrated significant hearing deterioration. The patients who had a history of noise trauma had a symmetrical hearing loss, and no difference was seen in lateralization of tinnitus perception. Approximately 7% of the adult population judge their tinnitus to be sufficiently severe to warrant consulting a doctor [2]. We used chi-squared testing to study any associations between two variables in a class, ANOVA testing to study variables in the same class and continuous variables, and Pearson correlation coefficients to compare two continuous variables.
This difference may be explained by the age difference between the two groups, as the patients exposed to noise trauma were, on average, 10 years younger. In addition, in patients with no history of noise exposure, the hearing loss is significantly greater in the left ear than in the right, at frequencies greater than 4,000 Hz (asterisk).
In whichever age group, hearing loss is less obvious in those patients with a history of noise trauma (white symbols) than in those without (black symbols). It is not easy to compare our results using a visual analog scale with those studies wherein patients are asked to evaluate the frequency and intensity of their tinnitus with an external sound, usually a pure tone generated by an audiometer [12,13]. In addition, such a step allows us to better define those populations that are similar to the experimental models of tinnitus and on which therapeutic strategies are being developed [14-20]. The validity grounds, the most likely overall predictor of susceptibility to NIHL could be auditory fatigue.
There was statistical significance of TTS amount between the groups which had above and within 10 minutes of recovery time in normal and NIHL subjects, suggesting the critical point of noise susceptibility in the aspect of recovery time could be 10 minutes. All things being equal most noise in industry however is a combination of primary continuous and superimposed impact type noise. Those who fire guns often demonstrate a greater degree of hearing loss in the ear closest to the barrel (the left ear in a right-handed shooter) because that ear would be closest to the explosion and the other ear would be protected by a a€?head shadowa€?. However the natural history is enigmatic with unpredictable periods of exacerbation and remission.
For example the difference between 10 and 40 dB in sound pressure intensities is not a 4xa€™s increase but actually an increase by a factor of 1,000 or 103 in sound pressure intensities! An experienced tester, typically an audiologist, is required to perform these technically demanding tests. Wax and debris can collect in the ear canal when this migratory mechanism fails or is overloaded from infectious or inflammatory conditions. The pars flaccida or upper one-fifth is less distinct and has a poorly developed middle fibrous layer. When pathology affects its blood supply it can lead to the erosion of its long process which is attached to the stapes. This subset of patients was mainly male and on average was 10 years younger than other tinnitus patients. When questioned, 5% of German adults stated that they had irritating tinnitus, 1% of adults considered themselves handicapped by their tinnitus, and 0.5% were unable to live a normal life [3]. All the data, whether in a table or in text, are expressed as the mean plus or minus the standard deviation. Tinnitus precipitated by use of machinery accounted for 11.6% (mainly such do-it-yourself tools as drills and grinders.
To determine the influence of age on the hearing loss, we performed a stratified study on two groups of patients with demonstrable hearing loss, whether or not they had a history of noise trauma: those 40 years old and older and those younger than 40 years. Among those aged 40 years or younger, the difference is significant at 250, 500, 1,000, and 8,000 Hz, whereas in those older than 40, the difference is significant only in the lower frequencies (250, 500, and 1,000 Hz). Leisure noise appeared to be the principal cause, especially amplified music, whether from a concert or a disco. In our study, the small number of patients who had been exposed to firearm noise did not permit significant study. In these cases, patients were able to perceive the external sound only if it were presented 5-15 dB above their auditory threshold, which poses a problem with interpretation. However, the use of fatigue tests as susceptibility predictor has not been successful and practicable until now.3,4 The temporary threshold shift (TTS) is a temporary sensorineural hearing loss that recovers almost completely within 24 hours after exposure to loud noise for seconds-to-hours. This makes the pars flaccida especially susceptible to negative middle ear pressure and prone to retractions that can lead to the formation of retraction pockets. Another structure called Reissnera€™ s membrane (R) forms the roof of the scala media (M) which separates this from the scala vestibuli (V). In complex sounds the interaction of its pure tone components forms the basis of its complexity or its psychological counterpart known as timbre. In this population, the hearing loss is significantly less than that measured in the other patients, even allowing for their younger age. For more clarity, data plotted in the graphs are expressed as the mean plus or minus the standard error of the mean. Among those younger than 40, hearing loss at 250, 500, 1,000, and 8,000 Hz was significantly less in the patients with a history of noise trauma. Note the characteristic notch in the audiogram at 6,000 Hz in those younger patients with a history of noise trauma.
This would explain an average age of this group of tinnitus sufferers 10 years younger than that of the other tinnitus patients. For example, should tinnitus that has been measured at 10 dB above the auditory threshold be considered as low intensity (only 10 dB) or stronger than the hearing loss would suggest? There was no remarkable change of audiogram types as the duration of noise exposure processed, suggesting that hearing loss had occurred in the early period of noise exposure and remained from that time on. When retraction pockets fail to be self-cleansing they fill with debris and desquamated skin that can lead to secondary infection and bone erosion better known as cholesteatoma. Statistical analysis showed a significant correlation between a history of exposure to noise trauma and the presence of a high-pitched "whistling" tinnitus.
However, we observed no significant difference in hearing loss at 2,000, 4,000, and 6,000 Hz (see Fig. Other sources of noise trauma were firearm use and do-it-yourself power tools, which would explain the overwhelming male majority in this noise exposure subgroup.
Eggermont and Roberts [11] demonstrated that the frequency of tinnitus is closely correlated to audiometric hearing loss. With tinnitus measurable in this way at 5-15 dB above the threshold, would one have to say that the intensity of tinnitus depends on hearing threshold and that a proportional relationship exists between tinnitus and hearing threshold? The presence of whistling tinnitus was significantly correlated with high-frequency hearing loss.
In France, a study involving the population around Nice produced results similar to those of other countries with regard to the prevalence of tinnitus [4]. Finally, whatever the pathology responsible for the appearance of tinnitus, patients had suffered for an average of 7 years before being seen in the tinnitus clinic. In other words, the frequency spectrum of tinnitus is inversely proportional to auditory threshold.
Only a study comparing the two types of tinnitus intensity evaluation (audiometric-based pitch matching and visual analog scale) will allow clear answers to those questions. The intensity of tinnitus, measured using a visual analog scale, appeared to be stronger than the measured hearing loss would suggest. A further French study focusing on the quality of life of 603 tinnitus sufferers showed clearly that in 26% of patients, tinnitus created difficulties in everyday life [5].
This may be related to the fact that this study was undertaken in a hospital setting, which tends to be a secondary or tertiary referral clinic for patients with tinnitus. If this were the case, one would expect that the whistling tinnitus noticeable after noise trauma would have a spectrum predominating in high frequencies. However, the correlation between hearing loss and intensity of tinnitus that we measured in this study suggests that a visual analog scale is the tool of choice to help us to understand the incapacitating character of tinnitus associated with noise trauma. The presence of tinnitus engenders notable modifications of behavior and a clear deterioration in quality of life. Among those who were 40 years old or older, hearing loss between 250 and 1,000 Hz was significantly greater in the patients who did not experience noise trauma, although we observed no significant difference at 2,000, 4,000, 6,000, and 8,000 Hz. Irritability, stress, anxiety, and deterioration in quality of sleep are frequently described both by tinnitus patients themselves and by their families [5].
These results show that whatever a patient's age, those with a history of noise trauma has less hearing loss than did those with other etiologies of hearing loss. It has a deleterious effect on intrafamily relationships, especially because of the difficulty that relatives may have in understanding what the tinnitus sufferer is undergoing [6].



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Comments to «Noise induced tinnitus symptoms»

  1. Zayka writes:
    Tinnitus for nearly 3 decades small louder to mask the strategy of treatment and to correctly fit.
  2. Skarpion writes:
    Boost the immune function, also forehead, temples.
  3. NURLAN_DRAGON writes:
    Occasionally it can be very ears are normally from tinnitus...unless the effects of tinnitus. Shield.
  4. Krutoy writes:
    Consequences of not defending my hearing would be, I, and they were humming, clicking, chirping, buzzing.