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PDF access policyFull text access is free in HTML pages; however the journal allows PDF access only to subscribers. Andrew W SmithPMID:12689363The WHO Programme for Prevention of Deafness and Hearing Impairment (PDH) is especially targeted at developing countries where there is a serious lack of accurate population-based data on the prevalence and causes of deafness and hearing impairment, including noise-induced hearing loss.
A fundamental requirement for the development of a National Plan and choice of preventive strategy for a National Programme is accurate, population-based data on the prevalence and causes of the problem. The most recent meeting organised by the PDH programme at WHO, in the series on strategies for prevention, was on the prevention of noise-induced hearing loss, held in Geneva in October 1997.
Barbara Canlon, Karin Agerman, Rene Dauman, Jean-Luc PuelPMID:12689364Hearing loss induced by noise, as well as in combination with other environmental factors, is a significant health problem throughout the world.
Wolfgang BabischPMID:12689365Reviews of epidemiological studies of cardiovascular effects of occupational noise have been published regularly in the literature.
AC Davis, EA Lovell, PA Smith, MA FergusonPMID:12689366In our study of the Hearing in Young Adults (HIYA) aged 18-25 years, there appeared to be little effect of social noise on hearing thresholds (Smith et al. Anders Kjellberg, Per Muhr, Bjorn SkoldstromPMID:12689367The contribution of noise exposure to fatigue at work was studied in a survey study and three field studies. Jens OekenPMID:12689368Acute acoustic traumas are caused by exposure to extremely high noise levels ranging from milliseconds to several hours' duration. HJM SteenekenPMID:12689369Active noise reduction is a successful addition to passive eardefenders for improvement of the sound attenuation at low frequencies. A cochlear implant is an electronic device that restores partial hearing to individuals with severe to profound hearing loss who do not benefit from a conventional hearing aid. Your ear consists of three parts that play a vital role in hearing—the external ear, middle ear, and inner ear.
Conductive hearing: Sound travels along the ear canal of the external ear, causing the ear drum to vibrate. Sensorineural hearing: When the three small bones move, they start waves of fluid in the cochlea, and these waves stimulate more than 16,000 delicate hearing cells (hair cells). If you have disease or obstruction involving your ear canal, tympanic membrane (ear drum), or middle ear, your conductive hearing may be impaired. Cochlear implants bypass damaged hair cells and convert speech and environmental sounds into electrical signals and send these signals to the hearing nerve. The microphone captures sound, allowing the speech processor to translate it into distinctive electrical signals. Cochlear implants are designed only for individuals who attain almost no benefit from a hearing aid. Otolaryngologists (ear, nose, and throat specialists) perform implant surgery, although not all of them do this procedure. Ear (otologic) evaluation: The otolaryngologist examines the ear canal and middle ear to ensure that no active infection or other abnormality precludes the implant surgery. Physical examination: Your otolaryngologist also performs a physical examination to identify any potential problems with the use of general anesthesia needed for the implant procedure.
Hearing (audiologic) evaluation: The audiologist performs extensive hearing tests to find out how much you can hear with and without a hearing aid. X-ray (radiographic) evaluation: Special X-rays are taken, usually computerized tomography (CT) or magnetic resonance imaging (MRI) scans, to evaluate your inner ear anatomy. Cochlear implant surgery is usually performed as an outpatient procedure under general anesthesia. Several weeks after surgery, your cochlear implant team places the signal processor, microphone, and implant transmitter outside your ear and adjusts them. Most adult cochlear implant patients notice an immediate improvement in their communication skills. The Food and Drug Administration (FDA) regulates cochlear implant devices for both adults and children and approves them only after thorough clinical investigation. Be sure to ask your otolaryngologist for written information, including brochures provided by the implant manufacturers.
More expensive than a hearing aid, the total cost of a cochlear implant, including evaluation, surgery, device, and rehabilitation can cost as much as $100,000. However, opportunities exist for prevention of noise­induced hearing loss by primary, secondary and tertiary means and it is necessary for countries to measure the size of the problem and adopt strategies for its prevention.
They affirmed that much deafness and hearing impairment is avoidable or remediable and that the greatest needs for the problem are in developing countries.
The PDH programme has developed a standardised Ear Disease Assessment Protocol to enable countries to conduct national surveys rapidly.
The participants concluded that exposure to excessive noise is the major avoidable cause of permanent hearing impairment worldwide.
Although most structures in the inner ear can be harmed by excessive sound exposure, the sensory cells are the most vulnerable. The survey study was based on a questionnaire covering symptoms and work place exposure answered by 50 000 state employees. In pure tone audiometry they range from the C5 dip to basomediocochlear sensorineural hearing loss.

Assessment methods are discussed, focused on subjective and objective attenuation measurements, stability, and on high noise level applications. Please use newer version of your browser or visit Internet Explorer 6 countdown page for more information. It is surgically implanted in the inner ear and activated by a device worn outside the ear.
Three small bones of the middle ear conduct this vibration from the eardrum to the cochlea (auditory chamber) of the inner ear. An internal component that consists of a small electronic device that is surgically implanted under the skin behind the ear, connected to electrodes that are inserted inside the cochlea. These signals or “codes” travel up a thin cable to the headpiece and are transmitted across the skin via radio waves to the implanted electrodes in the cochlea.
They must be 12 months of age or older (unless childhood meningitis is responsible for deafness).
An incision is made behind the ear to open the mastoid bone leading to the middle ear space.
They teach you how to look after the system and how to listen to sound through the implant.
Children require time to benefit from their cochlear implant, as the brain needs to learn to correctly interpret the electrical sound input. Before deciding whether your implant is working well, you need to understand clearly how much time you must commit. The 1995 resolution estimated that there are 120 million persons with disabling hearing difficulties worldwide and urged member states to set up National Programmes for the prevention of deafness and hearing impairment, with the technical assistance of WHO.
A National Programme will require a set of integrated strategies to prevent deafness and hearing impairment.
Noise-induced hearing loss is the most prevalent irreversible industrial disease, and the biggest compensatable occupational hazard. The second part focuses in more detail on the results of studies in which noise exposure was not assessed by objective measurements, but on the basis of subjec­tive ratings as given by the study subjects in a questionnaire.
There was however, a threefold increase in the reports of tinnitus in those subjects with significant social noise exposure (≥ 97 dB NIL). Their pathogenesis is assumed to consist of micromechanical-traumatic and biochemical-metabolic damage to the outer hair cells. The electrical signal travels through inter-connections in the brain to specific areas of the brain that recognize it as sound.
Although many auditory nerve fibers may be intact and can transmit electrical impulses to the brain, these nerve fibers are unresponsive because of hair cell damage. The electrodes’ signals stimulate the auditory nerve fibers to send information to the brain, where it is interpreted as meaningful sound.
The implant team (otolaryngologist, audiologist, nurse, and others) will determine your candidacy for a cochlear implant and review what you may expect as a result of the cochlear implant. Once the middle ear space is exposed, an opening is made in the cochlea and the implant electrodes are inserted.
There are many causes of hearing loss and some patients may take longer to fit and require more training due to individual differences.
While cochlear implants do not restore normal hearing, and benefits vary from one individual to another, most users find that cochlear implants help them communicate better through improved lip-reading. WHO-PDH addresses problems in this field of major public health importance which are amenable to intervention, giving priority to the poorest developing countries. The PDH programme has already addressed two such causes, ototoxic drugs and chronic otitis media and will shortly produce guidelines for implementation of these strategies within the context of primary health care. In developing countries, occupational noise and urban, environmental noise are increasing risk factors for hearing impairment.
Once a large number of hair cells are lost, the nerve fibres to that region also degenerate resulting in an irreversible hearing loss. Finally, the paper addresses some issues of occupational noise studies which deserve special attention from the methodological and conceptual point of view.
No other abnormality was found of hearing function for those who were exposed to the most social noise. Fatigue and headache were found to be more common among the noise exposed groups even after control for the effects of other critical variables. In order to establish the changes to the DPOAE (distortion products of otoacoustic emissions), 17 patients were examined after sustaining acute acoustic trauma.
Instead, the device bypasses damaged parts of the auditory system and directly stimulates the nerve of hearing, allowing individuals who are profoundly hearing impaired to receive sound. Since severe sensorineural hearing loss cannot be corrected with medicine, it can be treated only with a cochlear implant.
The electronic device at the base of the electrode array is then placed under the skin behind the ear. Your team will ask you to come back to the clinic for regular checkups and readjustment of the speech processor as needed.

Also, 90 percent of adult cochlear implant patients are able to discriminate speech without the use of visual cues.
These problems include ototoxicity, chronic otitis media, noise damage to hearing, inherited and congenital causes, and the provision of appropriate affordable hearing aid services. The meeting recommended that all countries should implement National Programmes for the Prevention of noise-induced hearing loss, integrated with Primary Health Care, and including elements on health promotion, and measures to reduce noise sources and introduce legislation and effective hearing conservation. At present, the underlying mechanism for cochlear damage induced by noise is not fully understood. These are concerned with study design, statistical inference, selection and confounding bias, overcontrolling, effect modification and exposure misclassifi­cation. In an attempt to investigate this further we invited a sub-sample of those tested in the earlier phase of the study, to conduct further examinations of their hearing function.
Study 2 compared reaction times before and after a week's work in high noise exposure and one in low exposure exposure in a group of aeroplane mechanics.
The causes included firework explosions, anti-tank rocket launchers, vehicle tyre bursting, rock concerts, hand-gun shots, sub-machine gun fire, hand grenade explosion, exploding car battery. Development of a system includes the acoustical design, the feedback amplifier, and the speech input facility.
There is an urgent need to obtain more, accurate epidemiological data on the problem, especially in developing countries.
The failure of the adult peripheral auditory system to regenerate after injury is a major clinical problem.
The three groups eventually consisted of those in the most social noise group who reported tinnitus (n=15) and those who did not (n=15), plus a group of people who had no social noise exposure but who reported tinnitus (n=8). Reaction times were prolonged after work in the noise week, whereas an opposite trend was seen in the control week. The pure tone audiogram, tympanogram, tinnitus maskability and DPOAE (both DP-gram and growth rate in various frequencies) were determined in all patients. However, a number of experimental applications have recently become available and are effective in reducing the damaging effects of noise. All the groups were retested for their hearing thresholds, using standard audiometry and also the Audioscan technique to look for notches in the audiogram.
Study 3 showed a gradual increase of reaction times during a week of noise exposure in a group of aeroplane technicians. If the event had occurred some time ago, measurements were taken only once; in acute cases measurements were repeated at different times. Finally the performance of some commercial systems and a laboratory prototype are compared.
Current experimental designs include strategies for protecting against injury and are primarily based on the fact that the metabolic state of the cochlea can determine the overall degree of hearing loss induced by noise.
Study 4 compared reaction times and subjective fatigue among naval crews on a day with low and a day with high noise exposure.
In nine patients with persistent hearing impairment, clear DPs were found in the unaffected frequencies but were completely absent in the affected frequency range. The purpose of the present article is to review the current literature dealing with strategies for protecting against noise trauma. Transient-evoked oto-acoustic emissions were measured and also suppressed with a contralateral broad-band noise. In one of the studied boat types the development of fatigue during the work day was accentuated on the day with high exposure.
Four of these patients were unilaterally and two patients were bilaterally affected; three patients had a different (not noise-induced) hearing loss on the opposite side. Some evidence has been found to suggest that those young people who reported tinnitus are affected by social noise exposure, in terms of pure tone thresholds, speech tests, oto-acoustic emissions and reported hearing problems. In eight patients with regressive hearing loss, DPs were by contrast detectable throughout the entire frequency range, their amplitudes only rising slightly as hearing recovered.
DPOAE seem to indicate the likelihood of recovery of hearing threshold after an acute acoustic trauma. Second, the presumed noise exposure was often not appropriate because even after a year it was possible for several individuals with insignificant social noise to move into the group with significant social noise exposure.
In cases with DPs completely absent in the affected frequency range, the prognosis seems to be much worse than in cases with present DPs in the frequency range of hearing. Third, there is a need for a larger multi-centre study to look at the effect of social noise in more detail using a common protocol. The results of our study will be very useful in calculating the numbers needed in such a multi-centre study.

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