Efeitos da dupla proteção auditiva na saúde do trabalhador: revisão de literatura / Effects of double hearing protection on occupational health: a literature review / Efectos de la doble protección auditiva en la salud de los trabajadores: revisión de la literatura

O uso da proteção auditiva pode representar uma série de preocupações de segurança quando considerados o treinamento e orientação, os prejuízos à comunicação e o ambiente ocupacional. O objetivo deste estudo foi verificar os benefícios da dupla proteção auditiva em risco de ruído ocupacional. Os artigos científicos de embasamento foram selecionados pelas bases de dados MEDLINE (Pubmed), Lilacs, Scielo, SCOPUS e Web of Science, sem restrição de idioma, período e localização. Foram localizados 197 artigos em que três atenderam aos critérios de admissão desta pesquisa. Os Equipamentos de Proteção Individual (EPIs) exigem controle rigoroso quanto ao seu uso adequado, que por vezes é negligenciado na rotina diária de trabalho. Conclui-se que a modernização e o uso de tecnologias mais seguras tem o intuito de diminuir o impacto da exposição ao ruído, entretanto, as barreiras entre a economia e a adesão pelos trabalhadores ainda precisam ser minimizadas.

Use of hearing protection can raise a series of safety concerns when considering training and guidance, communication impairments, and occupational environment. Hence, this study assessed the benefits of dual hearing protection in occupational noise risk. Scientific articles were selected from the MEDLINE (PubMed), LILACS, SCIELO, SCOPUS, and Web of Science databases, with no language, period, or location restrictions. A total of 197 articles were located, of which three met the inclusion criteria. Proper PPE (Personal Protective Equipment) usage requires strict monitoring, which is sometimes overlooked in the daily work routine. Modernization and use of safer technologies aim to reduce the impact of noise exposure; however, the barriers between the economy and worker adherence still need to be mitigated.

El uso de protección auditiva puede implicar una serie de preocupaciones de seguridad al considerar el entrenamiento y orientación, el daño a la comunicación y el ambiente laboral. El objetivo de este estudio fue determinar los beneficios de la doble protección auditiva en riesgo de ruido laboral. Se seleccionaron los artículos científicos de las bases de datos MEDLINE (PubMed), LILACS, SciELO, Scopus y Web of Science, sin restricciones de idioma, período y ubicación. Se encontraron 197 artículos, de los cuales tres cumplieron con los criterios de inclusión para este estudio. Los equipos de protección individual (EPI) requieren un riguroso control sobre su adecuado uso y, muchas veces, no son utilizados por los trabajadores durante su rutina laboral. Se concluye que la modernización y el uso de tecnologías más seguras pueden reducir el impacto de la exposición al ruido, sin embargo, las barreras entre la economía y el uso de estos equipos por los trabajadores aún necesitan mitigarse.

Perfil das doenças metabólicas na perda auditiva ocupacional / Profile of metabolic damages in occupational hearing loss / Perfil de enfermedades metabólicas en la pérdida auditiva ocupacional

Introdução: O diagnóstico precoce quanto às perdas auditivas é essencial para minimização do impacto social em relação à rotina laboral e na qualidade de vida. Objetivo: Caracterizar a associação entre a perda auditiva em trabalhadores com doenças metabólicas. Método: Estudo transversal retrospectivo de dados secundários de prontuário com o tratamento das doenças metabólicas, os dados foram coletados em duas clínicas de saúde ocupacional (C1 e C2) em Florianópolis - Santa Catarina (Brasil), no período de janeiro de 2020 a dezembro de 2022, considerando exames referenciais a partir do ano de 2005. Os dados foram organizados em planilhas do programa Microsoft Excel® e, posteriormente, exportados e analisados no software MedCalc® Statistical Software versão 22.006. Resultados: Foram analisados dados de 97 pacientes (71 homens e 26 mulheres), expostos ao ruído ocupacional (p = 0,0047), com diagnóstico de ao menos uma doença metabólica (41,20%) e prevalência de medicamentos da classe ATC H (p = 0,0465) e Losartana® (OR = 1,6976). Conclusão: O ruído ocupacional é o principal fator de risco auditivo nas empresas analisadas, e a presença de doença metabólica poderá influenciar em alterações dos limiares auditivos. Para reduzir a vulnerabilidade dessa população, é necessário a promoção, educação e conscientização dos trabalhadores nos aspectos de saúde. (AU)

Introduction: Early diagnosis of hearing loss is essential to minimize the social impact in relation to work routine and quality of life. Objective: Analyze the association between hearing loss in workers and metabolic diseases. Method: Retrospective cross-sectional study of secondary data on the use of medications in metabolic diseases, the data were collected in two occupational health clinics (C1 and C2) in Florianópolis - Santa Catarina (Brazil), from January 2020 to December 2022, considering references from exams from the year 2005. The data were organized in Microsoft Excel® spreadsheets and subsequently exported and analyzed using the MedCalc® statistical software version 22.006. Results: The data of 97 patients (71 men and 26 women) exposed to occupational noise (p = 0.0047), diagnosed with at least one metabolic disease (41.20%) and prevalence of ATC H class medications (p = 0.0465) and Losartan® (OR = 1.6976). Discussion andConclusion: Occupational noise is the main auditory risk factor, and the presence of metabolic disease can influence hearing thresholds. To reduce the vulnerability of this population, it is necessary to promote, raise awareness and educate, using approaches related to health aspects at work. (AU)

Introducción: El diagnóstico precoz de la pérdida auditiva es fundamental para minimizar el impacto social en la rutina laboral y la calidad de vida. Propósito: Analizar la asociación entre pérdida auditiva en trabajadores y enfermedades metabólicas. Metodología: Estudio transversal retrospectivo de datos secundarios sobre el uso de medicamentos en enfermedades metabólicas; Los datos fueron recolectados en dos clínicas de salud ocupacional (C1 y C2) en en Florianópolis - Santa Catarina (Brasil), de enero de 2020 a diciembre de 2022, considerando referencias de exámenes del año 2005. Los datos fueron organizados en hojas de cálculo Microsoft Excel®. y posteriormente exportados y analizados. utilizando el software estadístico MedCalc® versión 22.006. Resultados: Se analizaron los datos de 97 pacientes (71 hombres y 26 mujeres) expuestos a ruido ocupacional (p = 0,0047), diagnosticados con al menos una enfermedad metabólica (41,20%) y prevalencia de medicamentos clase ATC H (p = 0,0465). y Losartan® (OR = 1,6976). Discusión y Conclusión: El ruido ocupacional es el principal factor de riesgo auditivo y la presencia de enfermedad metabólica puede influir en los umbrales auditivos. Para reducir la vulnerabilidad de esta población es necesario promover, sensibilizar y educar utilizando enfoques relacionados con aspectos de salud en el trabajo. (AU)

Acesso a serviço de saúde e reabilitação auditiva de adultos e idosos durante o período inicial da pandemia COVID-19 no Brasil / Access to health service and hearing rehabilitation for adult and older adults during the initial period of the COVID-19 pandemic in Brazil / Acceso a servicios de salud yrehabilitación auditiva para adultos y ancianos durante el período inicial de la pandemia COVID-19 en Brasil

Introdução: A perda auditiva é uma deficiência comum na população mundial e contribui para dificuldade na comunicação verbal e redução da qualidade de vida, evidenciando a importância da identificação precoce, reabilitação e acompanhamento audiológico dessa deficiência para mitigar suas consequências. Durante a pandemia da COVID-19, as medidas restritivas diminuíram a capacidade de atendimento dos serviços de saúde auditiva e dificultaram a busca de auxílio para resolver problemas relacionados à adaptação aos dispositivos eletrônicos de amplificação sonora (DAES), sendo uma barreira no processo de reabilitação da perda auditiva. Objetivo: Caracterizar os usuários de DEAS e o processo inicial de reabilitação auditiva de adultos e idosos e verificar fatores associados ao retorno para a consulta de monitoramento auditivo durante o período inicial da pandemia da COVID-19.Métodos: Estudo observacional transversal com usuários adultos e idosos de um serviço ambulatorial de saúde auditiva com retorno para consulta de monitoramento auditivo agendada no período inicial da implementação das medidas restritivas da pandemia da COVID-19 no Brasil. Resultados: A maioria dos participantes conseguiu retornou para a consulta de monitoramento auditivo, sendo eles em sua maioria idosos, do sexo feminino e vacinados contra a COVID-19. Houve maior prevalência de adaptação adequada aos DAES. Não houve associação estatística entre as variáveis relacionadas à adaptação aos DAES, COVID-19 e saúde mental e o retorno à consulta de monitoramento auditivo. Conclusão: Os fatores relacionados à adaptação aos DAES, à COVID-19 ou à saúde mental não influenciaram o retorno à consulta de monitoramento auditivo na presente pesquisa. (AU)

Introduction: Hearing loss is a common disability in the world population and contributes to difficulty in verbal communication and reduced quality of life, highlighting the importance of early identification, rehabilitation and audiological monitoring of this disability to mitigate its consequences. During the COVID-19 pandemic, restrictive measures reduced the service capacity of hearing health services and made it difficult to seek help to solve problems related to adaptation to personal sound amplification products (PSAPs), being a barrier in the rehabilitation process of hearing loss. Aim: To characterize PSAPs users and the initial hearing rehabilitation process for adults and elderly people and verify the factors associated with the return to hearing monitoring consultations in the initial period of the COVID-19 pandemic. Methods: Cross-sectional observational study with adults and elderly people: elderly users of an outpatient hearing health service who return for a scheduled hearing monitoring consultation in the initial period of the implementation of restrictive measures of the COVID-19 pandemic in Brazil. Results: Most participants were able to return to the hearing monitoring clinic, the majority of whom were elderly, female and vaccinated against COVID-19. There was a higher prevalence of adequate adaptation to the PSAPs. There was no statistical association between variables related to adaptation to PSAPs, COVID-19 and mental health and return to hearing monitoring consultation. Conclusion: Factors related to adaptation to PSAPs, COVID-19 or mental health did not influence the return to hearing monitoring consultation in the present investigation. (AU)

Introducción: La pérdida auditiva es una discapacidad común en la población mundial y contribuye a la dificultad en la comunicación verbal y a la reducción de la calidad de vida, destacando la importancia de la identificación temprana, rehabilitación y seguimiento audiológico de esta discapacidad para mitigar sus consecuencias. Durante la pandemia de COVID-19, las medidas restrictivas redujeron la capacidad de atención de los servicios de salud auditiva y dificultaron la búsqueda de ayuda para resolver problemas relacionados con la adaptación a dispositivos electrónicos de amplificación del sonido (DEAS), siendo una barrera en el proceso de rehabilitación de la pérdida auditiva. Objetivo: Caracterizar a los usuarios de DEAS y el proceso inicial de rehabilitación auditiva de adultos y ancianos y verificar los factores asociados al retorno a las consultas de monitorización auditiva en el período inicial de la pandemia COVID-19. Métodos: Estudio observacional transversal con adultos y ancianos: ancianos usuarios de un servicio ambulatorio de salud auditiva que regresan para consulta de monitorización auditiva programada en el período inicial de la implementación de medidas restrictivas de la pandemia de COVID-19 en Brasil. Resultados: La mayoría de los participantes pudieron regresar a la clínica de monitorización auditiva, la mayoría de los cuales eran ancianos, mujeres y estaban vacunados contra COVID-19. Hubo mayor prevalencia de adaptación adecuada a la DEAS. No hubo asociación estadística entre variables relacionadas con adaptación a DEAS, COVID-19 y salud mental y retorno a consulta de monitorización auditiva. Conclusión: Los factores relacionados con la adaptación a DEAS, el COVID-19 o la salud mental no influyeron en el retorno a la consulta de monitorización auditiva en la presente investigación. (AU)

Vestibular evaluation with video head impulse test in pediatric cochlear implant patients / Evaluación vestibular con videoimpulso cefálico en pacientes pediátricos con implante coclear

Abstract Background: The cochlear implant (CI) is effective for rehabilitating patients with severe to profound sensorineural hearing loss. However, its placement and use have been associated with various complications, such as those affecting the vestibular system. The objective of this study was to compare vestibular function using the video head impulse test (vHIT) in pediatric patients before and after CI placement. Methods: A descriptive and retrospective study was conducted. The outcomes of 11 pediatric patients of both sexes with a history of profound hearing loss were evaluated. The results of vestibular-ocular reflex (VOR) gain, saccades, asymmetry, Pérez Rey (PR) index, and VOR/saccade ratio for both ears obtained by the vHIT test before and after CI placement were compared. Results: Of the 11 patients evaluated, the VOR gain showed that 81.8% had normal function, 18.2% had hypofunction, and no patients had hyperfunction before implantation. No statistically significant differences were found when compared with post-implant off and post-implant on conditions (p > 0.05). The extracted variables, asymmetry, PR index, and the VOR/saccades ratio also showed no statistically significant differences between the pre- and post-implant conditions, whether off or on. Conclusions: The vestibular function of pediatric patients did not show significant changes before and after CI placement. The vHIT test is a valuable tool for assessing vestibular function and could be considered a criterion for surgical and rehabilitation decisions in patients undergoing CI placement.

Resumen Introducción: El implante coclear es un dispositivo eficaz para la rehabilitación de pacientes con hipoacusia neurosensorial severa a profunda. Sin embargo, su colocación y uso se ha asociado a diversas complicaciones, entre ellas a nivel del sistema vestibular. El objetivo del presente estudio fue comparar la función vestibular mediante la prueba de videoimpulso cefálico (vHIT) de pacientes pediátricos antes y después de la colocación del implante coclear. Métodos: Se llevó a cabo un estudio descriptivo y retrospectivo. Se evaluaron los resultados de 11 pacientes pediátricos de ambos sexos con antecedente de hipoacusia profunda. Se compararon los resultados de ganancia del VOR, sacadas, asimetría, índice PR así como la relación VOR/sacadas para ambos oídos obtenidos mediante la prueba vHIT antes y después de la colocación del implante coclear. Resultados: De los 11 pacientes evaluados, la ganancia del VOR mostró que el 81.8% tenía normofunción, 18.2% hipofunción y ningún paciente hiperfunción antes del implante. Al compararlo con la ganancia post implante apagado y post implante encendido no se encontraron diferencias estadísticamente significativas (p > 0.05). Las variables sacadas, asimetría, índice PR así como la relación VOR/sacadas tampoco mostraron diferencias estadísticamente significativas entre las condiciones pre y pos implante ya sea apagado o encendido. Conclusiones: La función vestibular de pacientes pediátricos no mostró cambios significativos previo y posterior a la colocación del implante coclear. La prueba vHIT es una herramienta útil que permite evaluar la función vestibular y que podría considerarse como criterio para tomar decisiones quirúrgicas en pacientes que se encuentran en protocolo para implante coclear.

Dental care in patients with periodontal disease and hearing impairment: a scoping review / Atención odontológica en pacientes con enfermedad periodontal y deficiencia auditiva: scoping review

Introduction: Literature shows that individuals with disabilities, including hearing impairment, often suffer from untreated dental caries, poor oral hygiene, and compromised periodontal health, leading to adverse effects on oral health. Objetive: This study aims to analyze current evidence concerning dental care strategies for controlling, managing, and preventing biofilm accumulation in patients with hearing impairment. Materials and Methods: A systematic search was conducted in the databases Scopus, Web of Science, SciELO and PubMed between April and May 2022 to identify articles establishing a relationship between periodontal disease and hearing disability. Full-text articles published in English or Spanish between 2012 and 2022 were included. Results: Seventeen articles met the inclusion criteria and were analyzed. These included cross-sectional studies, cohort studies, clinical trials, case reports, and case-control studies. Most studies reported fair to poor oral health status among individuals. Nine different interventions or management approaches for treating periodontal disease in patients with hearing impairment were identified. Conclusions: The current global evidence on the association between periodontal disease and hearing impairment is very limited. Dentists may need to employ various strategies to address communication barriers, as outlined in this study.

Introducción: Según la literatura, las personas en situación de discapacidad presentan caries dentales no tratadas, higiene bucal y estado periodontal deficiente, lo cual puede resultar en efectos negativos para su salud bucal. Objetivo: Analizar la evidencia existente con relación a la atención odontológica enfocada en el control, manejo y prevención de acumulación de biofilm en pacientes con deficiencia auditiva. Materiales y Métodos: Se realizó la búsqueda de artículos en las bases de datos y motor de búsqueda (Scopus, Web of Science, SciELO y PubMed) entre abril y mayo 2022, de acuerdo con la evidencia existente que relacione la enfermedad periodontal y la discapacidad auditiva en la atención odontológica. Se incluyeron artículos de texto completo en idioma inglés o español, con fecha de publicación entre 2012 a 2022. Resultado: Se seleccionó un total de 17 artículos para su análisis. Se encontró estudios transversales, estudios de cohorte, ensayos clínicos, reporte de caso y estudios de casos y controles. La salud oral fue catalogada en estado regular y deficiente en la mayoría de los estudios. Se encontró 9 tipos de intervenciones o manejos para el tratamiento de la enfermedad periodontal en pacientes con hipoacusia. Conclusión: La evidencia existente respecto a la enfermedad periodontal y la deficiencia auditiva es insuficiente a nivel global. Debido a lo anterior, el odontólogo puede abordar los obstáculos comunicativos de diferentes maneras de acuerdo a los métodos descritos en esta publicación.

Uso de auriculares y la audición en estudiantes de medicina de una universidad pública de Lima, Perú / Headphone use and hearing in medical students at a public university in Lima, Perú

RESUMEN Introducción: La pérdida auditiva afecta a millones globalmente, especialmente a jóvenes que usan auriculares frecuentemente. Objetivo: Establecer la relación entre el uso de auriculares y la audición en estudiantes de medicina en Lima, Perú. Métodos: Se realizó un estudio observacional, analítico y transversal en la Universidad Nacional Federico Villarreal. Participaron 98 estudiantes de medicina (18-32 años) que usaban auriculares regularmente. Se excluyeron aquellos con patologías auditivas previas. La recolección de datos incluyó encuestas sobre el uso de auriculares y audiometrías realizadas en una cabina silente. Los resultados se analizaron mediante estadística descriptiva e inferencial, utilizando el coeficiente de correlación de Rho de Spearman para evaluar la relación entre las variables. Resultados: El 59,2% de los estudiantes eran mujeres. El 39,2% presentó hipoacusia leve a tonos agudos, mientras que el 36,2% tenía audición normal. El 71,4% reportó disminución de la capacidad auditiva y el 56,1% experimentó otalgia. El uso de auriculares mostró una correlación positiva y significativa con la audición (Rho = 0,298, p = 0,003). El tiempo de exposición también fue significativo (Rho = 0,260, p = 0,010), pero la intensidad del sonido no lo fue (Rho = 0,193, p = 0,057). Conclusión: Existe una relación positiva entre el uso de auriculares y la pérdida auditiva en estudiantes de medicina. Se recomienda implementar programas de concienciación sobre el uso seguro de auriculares y realizar evaluaciones auditivas periódicas para prevenir el deterioro auditivo.

ABSTRACT Introduction: Hearing loss affects millions globally, especially young people who frequently use headphones. Objective: To establish the relationship between headphone use and hearing among medical students in Lima, Peru. Methods: An observational, analytical, and cross-sectional study was conducted at the Universidad Nacional Federico Villarreal. Participants included 98 medical students (18-32 years) who regularly used headphones. Those with previous hearing pathologies were excluded. Data collection included surveys on headphone use and audiometries performed in a silent booth. Results were analyzed using descriptive and inferential statistics, employing the Spearman's Rho correlation coefficient to assess the relationship between variables. Results: 59.2% of the students were women. 39.2% had mild hearing loss at high tones, while 36.2% had normal hearing. 71.4% reported decreased hearing capacity, and 56.1% experienced ear pain. Headphone use showed a positive and significant correlation with hearing (Rho = 0.298, p = 0.003). Exposure time was also significant (Rho = 0.260, p = 0.010), but sound intensity was not (Rho = 0.193, p = 0.057). Conclusion: There is a positive relationship between headphone use and hearing loss in medical students. It is recommended to implement awareness programs on safe headphone use and conduct regular hearing evaluations to prevent auditory deterioration.

Asociación del resultado auditivo final, en pacientes con hipoacusia súbita, a la respuesta a glucocorticoides in vitro / Association of the final hearing result, in patients with sudden hearing loss, to the response to glucocorticoids in vitro

Introducción: La hipoacusia súbita (HS) es poco frecuente y su etiopatogenia no está definida. La terapia con corticoides es de elección en base a recomendaciones de expertos por sus efectos teóricos y no en base a utilidad clínica demostrada. Objetivo: Evaluar si existe correlación entre el resultado auditivo final, de pacientes con HS tratados con corticoides, y la respuesta in vitro de sus leucocitos a corticoides, medida como diferencias en la expresión relativa de genes blanco del receptor de glucocorticoides. Material y Método: Estudio de casos (recuperación total) y controles (no recuperados) de pacientes con HS tratados con corticoides en el Hospital Clínico de la Universidad de Chile, durante 2017-2019. Se obtuvo DNA que fue almacenado en el Biobanco de Tejidos y Fluidos de la Universidad de Chile (BTUCH). Se purificaron y cultivaron leucocitos mononucleares de sangre periférica, expuestos in vitro a hidrocortisona. Se determinó la diferencia en la expresión relativa de genes blanco (IGFBP1, CAT, HSD17B12, APOA2), por Q-RTPCR, entre ambos grupos. Resultados: Se reclutaron 35 pacientes; se incluyeron para análisis 23: 11 casos y 12 controles, con edad promedio de 54,9 y 50,8 años respectivamente, distribución homogénea de sexo. No hubo diferencia estadísticamente significativa en la expresión relativa de los genes blanco, a la exposición in vitro a corticoides, entre ambos grupos. Conclusión: En nuestro estudio, modelo, y sistema de evaluación no se evidenciaron efectos de los corticoides. No podemos descartar que, con un número mayor de pacientes, otros genes blanco u otros protocolos de estudio podrían detectarse diferencias.

Introduction: Sudden hearing loss (SHL) is rare and its etiopathogenesis is still not clear. Corticosteroid therapy is of choice based on expert recommendations due to its theoretical effects and no based on proved clinical efficacy. Objectives: To assess whether there is a correlation between the final auditory outcome of patients with SHL treated with corticosteroids and the in vitro response of their leukocytes to corticosteroids, measured as differences in the relative expression of glucocorticoid receptor target genes. Material and Method: Case-control (total recovery and not recovered respectively) study of patients with SHL treated with corticosteroids at Clinical Hospital Universidad de Chile between 2017 and 2019. DNA was obtained and stored in the Biobanco de Tejidos y Fluidos de la Universidad de Chile (BTUCH). Peripheral blood mononuclear leukocytes were purified and cultured and then exposed to hydrocortisone. The difference in the relative expression of target genes (GFBP1, CAT, HSD17B12, APOA2), by Q-RTPCR was determined. Results: Thirty-five patients were recruited, 24 were included for the analysis: 11 cases and 12 controls, with and average age of 54.9 and 50.,8 years respectively, homogeneous sex distribution. There was no statistically significant difference in the relative expression of the target genes, upon in vitro exposure to corticosteroids, between both groups. Conclusion: In our study, model and evaluation system, no effects of corticosteroids were evidenced. With a larger number of patients, other target genes or other study protocols, we cannot rule out that differences could be detected.

Middle ear lipoma as a mimicker of other diseases: a review of an unusual presentation / Lipoma en el oído medio como un imitador de otras enfermedades: una revisión de una presentación inusual

The finding of a lipoma in the middle ear is much rarer than its occurrence in the external auditory canal or even the inner ear, with fewer than seven cases described in the literature and none of them in Spain or South America. Despite its benign nature, the location of the lipoma may compromise structures that play a significant role in auditory preservation or balance control, necessitating surgical removal as a curative treatment. The main objective of this article is to describe the presentation of lipomas in the middle ear as a possible, although rare, etiology to consider in patients presenting with hearing loss, instability, or both symptoms concurrently, seeking otorhinolaryngological evaluation.

El hallazgo de un lipoma en el oído medio es mucho más raro que su ocurrencia en el canal auditivo externo o incluso en el oído interno, con menos de siete casos descritos en la literatura y ninguno de ellos en España o Sudamérica. A pesar de su naturaleza benigna, la ubicación del lipoma puede comprometer estructuras que desempeñan un papel significativo en la preservación auditiva o en el control del equilibrio, lo que hace necesaria la extirpación quirúrgica como tratamiento curativo. El objetivo principal de este artículo es describir la presentación de los lipomas en el oído medio como una posible, aunque rara, etiología a considerar en pacientes que presentan pérdida de audición, inestabilidad o ambos síntomas simultáneamente, buscando evaluación otorrinolaringológica.

Infección congénita por citomegalovirus, hipoacusia y tamizaje neonatal. Una actualización / Congenital cytomegalovirus infection, hearing loss and newborn screening. An update

El citomegalovirus congénito (CMVc) es la infección congénita más común y la principal causa no genética de hipoacusia congénita. Gran parte de los recién nacidos (RN) con CMVc sintomático desarrolla secuelas graves permanentes, donde la hipoacusia es la más frecuente. Sin embargo, el 90% de los casos se presenta en forma asintomática, pudiendo desarrollar secuelas auditivas tardías. El diagnóstico precoz de CMVc requiere un alto índice de sospecha. Actualmente, técnicas eficientes para su detección están disponibles, lo que facilita el diagnóstico en las primeras 3 semanas de vida. La terapia antiviral es la primera línea de tratamiento para el CMVc sintomático, logrando buenos resultados auditivos. A pesar de los avances en los métodos de detección y beneficios del tratamiento, los RN no son tamizados para CMVc. El tamizaje selectivo de CMVc en pacientes que no pasan el screening auditivo facilita la intervención precoz en los casos identificados, pero no permite detectar el número significativo de niños que presenta hipoacusia de aparición tardía. El tamizaje universal permite hacer seguimiento auditivo a los pacientes en riesgo de desarrollar hipoacusia sensorioneural (HSN) por CMVc, identificando así los casos de hipoacusia de aparición tardía, pero la costo-efectividad es aún controversial. Es necesario avanzar en una estrategia local para el tamizaje de CMVc, buscando reducir su impacto a nivel nacional.

Congenital cytomegalovirus (cCMV) is the most common congenital infection and the main non-genetic cause of congenital hearing loss. A significant number of newborns (NB) with symptomatic cCMV will develop permanent serious sequelae, being hearing loss the most frequent. However, 90% of the cases are asymptomatic and may develop late auditory sequelae. Early diagnosis of cCMV requires a high index of suspicion. Currently, efficient detection techniques for its detection are available, which facilitates diagnosis within the first 3 weeks of life. Antiviral therapy is the first line of treatment for symptomatic cCMV, achieving good hearing results. Despite advances in detection methods and the benefits of antiviral therapy, NB are not routinely screened for cCMV. Selective screening for cCMV in patients who fail newborn hearing screening facilitates early intervention in identified cases but fails to detect a significant number of children with late onset hearing loss. Universal screening allows hearing follow up in patients at risk of developing sensorineural hearing loss (SNHL) due to cCMV, thus identifying late-onset hearing loss cases, but cost-effectiveness is still controversial. It is necessary to advance in a local strategy for cCMV screening, aiming to reduce its national impact.

Educação em saúde bucal para crianças e adolescentes com deficiência auditiva: relato de experiência / Oral health education for children and adolescents with hearing impairment: experience report

Os autores relatama experiência de uma ação de educação em saúde bucal voltada a crianças e adolescentes com deficiência auditiva, matriculados em uma escola referência para o ensino à comunidade surda de uma cidade de grande porte populacional localizada no estado da Paraíba, Nordeste brasileiro. Os alunos participantes de um projeto de Extensão Universitária conduziram a ação com o auxílio de três intérpretes da Língua Brasileira de Sinais (Libras), disponibilizados pela instituição. Destaca-se a divisão da ação em dois momentos: o primeiro, inicialmente destinado às crianças do primeiro ao quinto ano do Ensino Fundamental, por meiode dinâmicas que objetivaram trabalhar a importância da alimentação saudável, bem como orientações sobre a escovação e o uso do fio dental; eum segundo momento, realizado com os adolescentes do sexto ao nono ano do Ensino Fundamental, por meio de uma dinâmica de mitos e verdades sobre a saúde bucal, a fim de esclarecer sobre as principais dúvidas dos alunos. Ambos os momentos foram exitosos e garantiram a participação efetiva dos estudantes que se engajaram e partilharam muito conhecimento com os extensionistas. Desta forma, é notório o quanto a Extensão Universitária é uma atividade importante na formação acadêmica e humana dos futuros cirurgiões-dentistase, principalmente, na devolutiva à comunidade de conhecimentos gerados na academia, oportunizando momentos ricos de educação em saúde (AU).

Los autores relatan la experiencia de una acción de educación en salud bucal dirigida a niños y adolescentes con discapacidad auditiva, matriculados en una escuela de referencia para la enseñanza de la comunidad sorda en una ciudad con gran población ubicada en el estado de Paraíba, Nordeste brasileño. Los estudiantes que participan de un proyecto de Extensión Universitaria realizaron la acción con la ayuda de tres intérpretes de Lengua de Señas Brasileña (Libras), proporcionados por la institución. Se destaca la división de la acción en dos momentos: el primero, inicialmente dirigido a niños de primero a quinto año de educación primaria, a través de dinámicas que tuvieron como objetivo trabajar la importancia de una alimentación saludable, así como orientaciones sobre el cepillado y el uso de hilo dental; y un segundo momento, realizado con adolescentes de sexto a noveno año de educación primaria, a través de una dinámica de mitos y verdades sobre la salud bucal, con el fin de aclarar las principales dudas de los estudiantes. Ambos momentos fueron exitosos y garantizaron la participación efectiva de los estudiantes que involucraron y compartieron muchos conocimientos con los extensionistas. De esta manera, se evidencia cuánto la Extensión Universitaria es una actividad importante en la formación académica y humana de los futuros cirujanos dentistas y, principalmente, en devolver a la comunidad el conocimiento generado en la academia, brindando oportunidades para momentos ricos de educación en salud (AU).

The authors report the experience of an oral health education action directed at children and adolescents with hearing impairment enrolled in a reference school for the hearing impaired in a large city in the state of Paraíba in Northeast Brazil. University students participating in an extension project conducted the action with the assistance of three interpreters of Brazilian sign language. The action involved two interventions, the first with children in the first to fifth year of primary school, who received information on the importance of a healthy diet and orientations on toothbrushing and the use of dental floss. The second involved adolescents from the sixth to ninth year, who received clarifications on myths and truths about oral health to address the main questions of the students. Both interventions were successful and ensured the effective participation of the students, who engaged in the activities and shared knowledge with the children and adolescents. University extension programs constitute an important aspect of academic education and the humanist formation of future dentists, enabling them to share with the community knowledge acquired during their university education and providing rich health education opportunities (AU).

Characteristics and influencing factors of hearing loss among noise-exposed workers in a large machinery maintenance enterprise / 环境与职业医学

Background The current increasing trend of new cases of occupational noise-induced deafness indicates that the hearing loss of occupational population has not been effectively controlled in China. It is of great significance to study the characteristics of hearing loss among noise-exposed workers and its related factors. Objective To investigate characteristics and influencing factors of hearing loss among occupational noise-exposed workers in a large machinery maintenance enterprise, and to provide a scientific basis to prevent and control noise-induced hearing loss. Methods A cross-sectional survey was conducted to investigate male Han occupational noise-exposed workers in a large mechanical maintenance enterprise. We acquired demographic characteristics, occupational exposure history, and individual life behavior characteristics of the workers through questionnaires, collected occupational exposure level data from annual occupational disease hazard factor surveillance reports, obtained pure tone hearing threshold test data through occupational health examinations, and estimated individual noise exposure levels using cumulative noise exposure (CNE). According to the results of pure tone air conduction hearing threshold test, the workers were divided into a hearing loss group and a normal hearing group. The chi-square test was employed to compare the occupational exposure characteristics and individual life behavior characteristics between the two groups. Additionally, the trend chi-square test was utilized to analyze the changing trends of age, length of service, CNE, and hearing loss rate within the two groups. The relationship between high-frequency hearing loss in both ears and its related influencing factors was assessed by a multiple logistic regression model. Results The M (P25, P75) of CNE for the 2531 occupational noise-exposed workers was 97.51 (95.39, 99.96) dB(A)·year. The incidence of hearing anomaly, binaural high-frequency hearing anomaly, random ear high-frequency hearing anomaly, binaural low-frequency hearing anomaly, and random ear low-frequency hearing anomaly were 22.48%, 16.59%, 22.13%, 2.77%, and 3.52%, respectively. High-frequency hearing threshold increase was the main reason for hearing anomaly (98.42%). In comparison to the CNE ≤ 97 dB(A)·year group, the 97 dB(A)·year<CNE≤ 100 dB(A)·year group and the CNE>100 dB(A)·year group experienced a 36.4% and 52.3% increase in the risk of bilateral high-frequency hearing loss, respectively. The smoking group exhibited a 43.5% elevated risk of bilateral high-frequency hearing loss when compared to the non-smoking group. Conversely, the group frequently wearing hearing protection equipment demonstrated a 23.6% lower risk of bilateral high-frequency hearing loss in comparison to the group occasionally wearing protective equipment. The data suggested that CNE＞97 dB(A)·year and smoking might be independent risk factors for bilateral high-frequency hearing loss, and frequently wearing hearing protection equipment might be an important protective factor. Conclusion Increased CNE and smoking can elevate the risk of high-frequency hearing loss, while personal hearing protection can effectively reduce the risk of hearing loss.

The effectiveness of salvage treatment with intratympanic dexamethasone or hyperbaric oxygen therapy in addition to systemic steroids on idiopathic sudden sensorineural hearing loss / 中国药师

Objective To investigate the clinical efficacy of intratympanic corticosteroids(ITS)and hyperbaric oxygen therapy(HBOT)in patients with idiopathic sudden sensorineural hearing loss(ISSNHL)who had failed systemic corticosteroid(SS)treatment.Methods ISSNHL patients admitted to the Department of Otolaryngology,First People's Hospital of Linping District of Hangzhou city from January 2020 to January 2023 were retrospectively collected.According to the treatment plan,patients with ISSNHL were divided into SS group,HBOT group,and ITS group.The changes in hearing level[purity hearing threshold mean(PTA)]and hearing gain of ISSNHL patients before treatment(T0),day 5(T1)and after 3 months of treatment(T2)were observed and compared,and the total effective rate of treatment in different groups was compared.Univariate analysis was used to explore the influencing factors of the efficacy of patients with different treatment modalities of ISSNHL.Results A total of 156 ISSNHL patients were included,including 70 in the SS group,33 in the HBOT group and 53 in the ITS group.At T0,there was no significant difference in PTA among the three groups of patients(P>0.05).At T2,the level of PTA in the three groups of ISSNHL patients was significantly lower than that before treatment(P<0.05).The levels of PTA in the HBOT group and ITS group were significantly lower than those in the SS group(P<0.05).The level of PTA in the HBOT group was significantly lower than that in the ITS group(P<0.05).The hearing gain of the HBOT group and the ITS group was significantly higher than that of the SS group(P<0.05),and the hearing gain of the HBOT group was significantly higher than that of the ITS group(P<0.05).The total effective rate of HBOT group was significantly higher than that of ITS group(P<0.05),and the total effective rate of ITS group was significantly higher than that of SS group(P<0.05).In addition,vertigo was an influencing factor for poor hearing recovery in ISSNHL patients regardless of treatment regimen(P<0.05).Conclusion Both ITS and HBOT can improve the treatment efficiency of ISSNHL patients who have failed SS treatment and promote hearing recovery in ISSNHL.Compared with IST,HBOT has more significant efficacy,and it is recommended that clinical treatment be prioritized.Vertigo is an influencing factor for poor hearing recovery in patients with ISSNHL who have failed SS treatment,and should be focused on in clinical practice.

Discussion on Differentiation and Treatment of Sudden Hearing Loss by Traditional Chinese Medicine Based on the Classification of Hearing Curve / 中医杂志

Pure-tone audiometry can be performed to evaluate the type and degree of hearing loss， whose results can be divided into four types including low-frequency descending， high-frequency descending， flat descending and total deafness. The low-frequency descending type of sudden hearing loss （SHL） is more likely to be spleen deficiency and dampness exuberance， the high-frequency descending type is often due to yin deficiency of liver and kidney， the flat descending type is commonly associated with qi and blood depletion， and the type of total deafness is often linked to blood stasis. Our team has further developed a comprehensive diagnostic and therapeutic approach for SHL， emphasizing "the integration of disease and syndrome， the combination of acupuncture and herbal medicine， and dynamically administering treatment". Firstly， it advocates integrating disease diagnosis with syndrome differentiation. Secondly， it recommends combining acupuncture and herbal medicine， with local acupoints such as Ermen （TE 21）， Tinggong （SI 19）， Tinghui （GB 2）， and Yifeng （TE 17） used to unblock the auditory orifice， and herbal prescriptions tailored to the hearing curve patterns. For the low-frequency descending type， it is recommended to fortify the spleen and percolate dampness by taking distal points of spleen channel and stomach channel and using Shenling Baizhu Powder （参苓白术散）. For the high-frequency descending type， the method of nourishing kidney and calming liver is recommended， using distal points of kidney and liver channels and taking Erlong Zuoci Pills （耳聋左慈丸）. Regarding the flat descending type， tonifying qi and nourishing blood is advised， for which acupoints of Conception Vessel， spleen， stomach and large intestine channels can be needled， and Yiqi Congming Decoction （益气聪明汤） can be administered. For the total deafness type， it is recommended to activate blood and dissipate stasis， often with Xuehai （SP 10） and Geshu （BL 17） needled and Tongqiao Huoxue Decoction （通窍活血汤） administered. All these are conducted to treat the root and branch simultaneously. At the same time， it emphasizes the need to consider complex syndrome presentations and disease progression， dynamically analyze the disease causes and mechanisms， and adjust treatment according to the changing syndromes. In conclusion， this article is expected to inspire clinical diagnosis and treatment of SHL.

Congenital unilateral hearing loss from cochlear nerve canal stenosis

@#A 2-month-old baby girl presented with a failed neonatal otoacoustic emission (OAE) hearing screening in the left ear. Combined Auditory Brainstem Response/Auditory Steady-State Response (ABR/ASSR) testing confirmed the presence of a unilateral left moderate to severe hearing loss. No Joint Committee on Infant Hearing (JCIH) risk factors for early childhood hearing loss1 were identified. She subsequently underwent computed tomography (CT) of the temporal bones to determine the presence of any inner ear malformation. No abnormalities of the internal auditory canal, cochlea, semicircular canals and ossicles were noted by the radiologist, and the study was officially reported as a “normal temporal bone CT scan.” Independent review of the CT imaging revealed the presence of a visually apparent disparity in the width of the cochlear nerve canals. (Figure 1) Measurement of the cochlear nerve canal width in the axial plane parallel to the infraorbitomeatal line2 using the length measurement tool in the DICOM imaging software (RadiAnt DICOM Viewer, Version 2024.1, Medixant) indicated a cochlear nerve canal width of 2.18 mm on the right and 1.02 mm on the left. (Figure 2) Applying the suggested cutoff point of 1.2 mm as described by Lin et al.,2 we identified the presence of left cochlear nerve canal stenosis as the etiology of the congenital unilateral hearing loss. The cochlear nerve canal, which has also been referred to as the bony canal for the cochlear nerve (BCNC), cochlear aperture, and cochlear fosette, is the bony transition point between the internal auditory canal and the cochlear modiolus. A relationship between a hypoplastic cochlear nerve canal and congenital sensorineural hearing loss was first suggested by Fatterpekar et al. in 2000.3 Subsequent studies confirmed the association between cochlear nerve canal stenosis and sensorineural hearing loss that ranges from near-normal to profound, with a statistically significant relationship between the degree of hearing loss and the degree of stenosis.4 Various cutoff points to define stenosis of the cochlear nerve canal have been identified in the medical literature. These cutoff points range from 1.2 mm to 1.7 mm when the canal width is measured in the axial plane.2 This particular case demonstrated clear-cut evidence of cochlear nerve canal stenosis, as it satisfied the smallest cutoff criteria (< 1.2 mm) seen in the medical literature. The identification of cochlear nerve canal stenosis as the cause of congenital sensorineural hearing loss is important not only from a diagnostic point, but also from a prognostic perspective. Cochlear nerve deficiency has been noted to be highly prevalent among pediatric patients with cochlear nerve canal stenosis,5 and this has significant negative implications in relation to rehabilitation with external hearing devices and cochlear implants.

The influence of age on the recovery of sudden sensorineural hearing loss / 中国耳鼻咽喉头颈外科

OBJECTIVE To compare the influence of age on the recovery of sudden sensorineural hearing loss.METHODS Detailed medical data of patients were reviewed.The patients were diagnosed as sudden sensorineural hearing loss from Jan 2010 to June 2018 and accepted treatments with neurotrophic drugs,steroid or hyperbaric oxygen.Age grouping was performed by every 5 years'interval.The treatment efficacy and hearing improvement were compared according to the age.RESULTS There were one hundred and sixty-three patients in this study.The majority of patients had moderate or above hearing loss,and most of the hearing curve was flat and profound type.The overall recovery rate was 56.44%,hearing gain was averaged 21.88 dB.55-60 years group had largest number of patients in the 11 age groups.Even with different treatment,the patients aged 57-66 years had the bad recovery,including the hearing gain data and total effective rate.CONCLUSION Ages has influence on the recovery of sudden sensorineural hearing loss,it maybe correlated with the etiology and patients'condition.

Study on the relationship between HSP70 polymorphism and susceptibility to occupational noise-induced hearing loss / 中国职业医学

ObjectiveTo investigate the correlation between genetic polymorphism of heat shock proteins 70 (HSP70) and susceptibility to occupational noise-induced hearing loss (ONIHL). Methods A total of 229 ONIHL workers were selected as the case group and 229 healthy workers with similar age, years of noise exposure, and noise exposure levels were selected as the control group using the case-control study method. Occupational health examinations were conducted on both groups, and peripheral blood of individuals was collected for DNA extraction. The genotypes of three single nucleotide polymorphisms of the HSP70 were detected using the MassArray system. Results The allele frequency distribution of HSP70 rs2227956, rs1043618, and rs1061581 in the control group was in Hardy-Weinberg equilibrium (all P>0.05). The genotype and allele frequency distribution of rs2227956 was significantly different between the two groups (all P<0.05), while no significant difference was found for rs1043618 and rs1061581 (all P>0.05). After adjusting for age, years of noise exposure, individual noise exposure level, smoking, and drinking, individuals with AG and AG+GG genotypes of rs2227956 had a higher risk of ONIHL than those with AA genotype (all P<0.05). The risk of ONIHL was higher in individuals with G allele of rs2227956 than in those with A allele (P<0.05). No correlation was found between rs1043618 and rs1061581 polymorphisms and the risk of ONIHL (all P>0.05). Conclusion The rs2227956 polymorphism of the HSP70 gene is correlated with susceptibility to ONIHL in noise-exposed workers, and the G allele is a risk factor for ONIHL in this population.

Introduction to four kinds of risk-assessment methods for occupational noise-induced hearing loss / 中国职业医学

Noise is a common occupational hazard in workplaces. Long-term exposure to high-intensity noise mainly causes occupational noise-induced hearing loss (ONIHL). The development of ONIHL is irreversible, and there is currently no cure. At present, risk assessment methods based on noise exposure intensities mainly include risk index assessment method, Engineering Professional Council assessment method in United Kingdom (EDC assessment method in UK), National Institute of Occupational Safety and Health assessment method in United State (NIOSH assessment method in US), and International Standardization Organization assessment method (ISO assessment method). However, the risk index assessment method is subjective and does not consider the effectiveness of workers wearing protective equipment. The EDC assessment method in UK defines ONIHL differently from China. The NIOSH assessment method in US and ISO assessment methods have population data sources that deviate from China, which can lead to bias in risk assessment. In the future, it is necessary to further carry out application research on the risk assessment of ONIHL in Chinese noise-exposed workers, compare the applicabilities of various assessment methods, conduct large-sample population epidemiological studies for verification, and fully utilize the risk-prediction function to prevent and control ONIHL.

Study on the relationship between occupational noise exposure and arteriosclerosis in mechanical manufacturing workers / 中国职业医学

ObjectiveTo explore the relationship between the occupational noise exposure and arteriosclerosis in mechanical manufacturing workers. Methods A total of 453 employees of a machinery manufacturing enterprise were selected as the study subjects using the judgment sampling method. The noise exposure levels in their workplaces were measured, and their cumulative noise exposure (CNE) was assessed based on the type of job-noise exposure matrix and occupational hazard exposure history. Pure-tone audiometry was performed on the research subjects, and their brachial-ankle pulse wave velocity (baPWV) was measured. Results The CNE was (91±11) dB(A) per year and the median baPWV was 1 278.0 cm/s in the research subjects. The results of the generalized linear regression model analysis showed that for every one dB(A) per year increase in CNE, the baPWV of the general population increased by 0.20% ［95% confidence interval (CI) 0.10%-0.30%, P<0.01］, with an increase of 0.17% in males (95%CI 0.06%-0.28%, P<0.01) and 0.28% in females (95%CI 0.07%-0.49%, P<0.01). Using the hearing loss as an outcome indicator for high intensity noise exposure, the results showed that baPWV increased by 7.04% (95%CI 2.42%-11.87%, P<0.01) in individuals with bilateral hearing loss, and by 9.84% and 6.53% (95%CI 3.07%-17.07% and 2.13%-11.11%, all P<0.01) in individuals with elevated high-frequency hearing thresholds in both ears and in either ear, respectively. There was no significant association in elevated speech-frequency hearing thresholds and arteriosclerosis (P>0.05). Conclusion Occupational noise exposure may increase the risk of arteriosclerosis.

Interaction of occupational and non-occupational noise exposure leads to high frequency hearing loss / 中国职业医学

ObjectiveTo explore the impact of the interaction between occupational and non-occupational noise exposure on the risk of high-frequency hearing loss (HFHL) in noise-exposed workers. Methods A total of 602 male workers with normal hearing, engaged in an automobile manufacturing company between 2016 and 2018, were selected as the study subjects using the retrospective cohort study method. Pure-tone audiometry and questionnaire surveys were conducted on the workers. The Kaplan-Meier survival analysis and multivariate Cox proportional hazards regression model were used to analyze the interaction between occupational and non-occupational noise exposure and the risk of HFHL in these workers. Results The prevalence of HFHL of the workers was 34.1% in 2020, without any cases of speech frequency hearing loss. Kaplan-Meier survival analysis result showed that the risk of HFHL increased in workers with excessive national occupational noise exposure intensity, self-reported noisy living environments, and both excessive national occupational noise exposure intensity and self-reported noisy living environments (all P<0.01). The results of the Cox proportional hazards model showed that the combined effect of excessive national occupational noise exposure intensity and self-reported noisy living environments [relative risk (RR)=2.40, P<0.01] was higher than the individual effects of excessive national occupational noise exposure intensity (RR=2.09, P<0.01) and self-reported noisy living environments (RR=2.39, P<0.01). There was an antagonistic effect between excessive national occupational noise exposure intensity and self-reported noisy living environments (interaction index <1.00). Conclusion Both occupational and non-occupational noise exposure can increase the risk of HFHL in noise-exposed workers, and there is an interaction between them.

Genetic counseling for hearing loss today / 临床耳鼻咽喉头颈外科杂志

Genetic counseling for hearing loss today originated from decoding the genetic code of hereditary hearing loss, which serves as an effective strategy for preventing hearing loss and constitutes a crucial component of the diagnostic and therapeutic framework. This paper described the main principles and contents of genetic counseling for hearing loss, the key points of counseling across various genetic models and its application in tertiary prevention strategies targeting hearing impairment. The prospects of an AI-assisted genetic counseling decision system and the envisions of genetic counseling in preventing hereditary hearing loss were introduced. Genetic counseling for hearing loss today embodies the hallmark of a new era, which is inseparable from the advancements in science and technology, and will undoubtedly contribute to precise gene intervention!