Auditory risk behaviours and hearing problems among college students in Serbia.

AIM: To investigate an association of auditory lifestyle and risk behaviours with hearing loss and to identify the leading hearing problems among college students in Serbia exposed to loud music. METHODS: The participants of the study comprised 780 college students of the High Medical School of Professional Studies of Belgrade (653 females and 127 males), the majority of whom were between 19 to 24 years of age. A cross sectional study was conducted in order to investigate the association between exposure to noise in one's leisure time and subsequent hearing problems using a self-reporting questionnaire. RESULTS: A total of 640 (82.1%) of students had a habit of listening to loud music, 421 (65.8%) experienced tinnitus and 79 (10.1%) had a subjective feeling of hearing loss. The most significant association between self-reported hearing loss was living in noisy environments (p=0.000), and the appearance of difficulties (vertigo, anxiety) (p=0.000), as well as usage of personal music devices (p=0.087). CONCLUSION: While students who were exposed to loud sound levels may still not have shown serious hearing problems or hearing loss, a great number did experience tinnitus or some other difficulties after listening to music at loud volumes.

Possible role of CD22, CD79b and CD20 expression in distinguishing small lymphocytic lymphoma from chronic lymphocytic leukemia.

AIM OF THE STUDY: Flow cytometry has an important role in diagnosis and classification of B-cell lymphoproliferative disorders (BCLPDs). However, in distinguishing chronic lymphocytic leukemia (CLL) from small lymphocytic lymphoma (SLL) only clinical criteria are available so far. Aim of the study was to determine differences in the expression of common B cell markers (CD22, CD79b and CD20) on the malignant lymphocytes in the peripheral blood samples of CLL and SLL patients. MATERIAL AND METHODS: Peripheral blood samples of 56 CLL and 11 SLL patients were analyzed by 5-color flow cytometry on the CD45/CD19/CD5 gate for CD22, CD79b and CD20. RESULTS: In the samples collected from the CLL patients, CD22 expression was detected in only 20% of patients in the low pattern, while in SLL patients the expression was medium and present in 90.9% of patients (p < 0.0001). For CD79b expression, statistical significance is reached both in the expression pattern, which was low/medium for CLL and high for SLL, and expression level (p = 0.006). The expression of CD20 was counted as the CD20/CD19 ratio. The average ratio was 0.512 in the CLL patients vs. 0.931 in the SLL patients (p = 0.0001). CONCLUSIONS: The pattern of expression and expression level of CD22, CD79b and CD20 in peripheral blood could be used for distinguishing SLL from CLL patients.

Primary nasal tuberculosis: a case report.

INTRODUCTION: During the past two decades, tuberculosis (TBC) both pulmonary and extrapulmonary, has emerged to be a major health problem. Nasal tuberculosis is a specific inflammatory process which is, in most cases, joined by the inflammation of neck lymph nodes. CASE REPORT: Thirty-year-old man presented with shortness of breath through the nose and periodical headaches. Clinical examination showed signs of chronic rhinitis, with slight granular changes of nasal septal mucosa. Laboratory analyses were within the reference ranges. Nasal and throat swabs for bacteria and fungi were normal. Skin allergy testing to standard inhalatory allergens was positive. Computer rhinomanometry showed increased nasal resistance at medium difficulty level, on the right. Radiography of paranasal sinuses indicated chronic polysinusitis on the right. Anti-allergy therapy was prescribed. The patient came for checkup after a month with subjective deterioration and a neck tumefact on the right. Nasal endoscopy revealed the presence of dark red infiltrates with the 3 mm diameter on nasal septal mucosa, dominantly on the right, with small greyish nodules. This findings indicated a potential specific nasal inflammatory process. In the upper jugulodigastric area, on the left, painless tumefact 3 x 5 cm in size was palpated, it was mobile comparing to supra- and infrastructure, with unaltered skin above. The definite diagnosis was established on the basis of the results of nasal mucosa biopsy. After histopathological diagnosis was obtained, we started with antituberculosis therapy at once. CONCLUSION: Due to actual trends of TBC incidences, otolaryngologist should have in mind nasal TBC, when granulomatose lesions are found in nose.

Antrochoanal polyp of unusual size.

This paper presents antrochoanal polyp of unusually large size (8x5 cm), which we removed in a 34-year old patient by the antral portion by the Caldwell-Luc approach and the portion form the epipharynx through the oral cavity with skew pliers for the pharynx biopsy.

Immunohistochemistry in diagnosis of extranasopharyngeal angiofibroma originating from nasal cavity: case presentation and review of the literature.

Angiofibromas are rare vascular tumors which originate predominantly in the nasopharynx and occur typically in male adolescents. Extranasopharyngeal sites such as nasal cavity and paranasal sinuses are less frequent. This review article was undertaken to evaluate the incidence, clinical features and management of extranasopharyngeal angiofibromas originating exclusivelly from nasal cavity structures. Our focus of interest was to evaluate the significance of immunohistochemical analysis in diagnosis of such extremely rare neoplasms. In the PubMed and Google Search, we found only 39 cases of nasal angifibroma, 27 males and 12 females from 1980 to 2012. The most prevalent site of origin was nasal septum, followed by inferior and middle turbinate. The commonest symptoms were nasal obstruction and epistaxis. Nasal angiofibromas are clinically distinct from nasopharyneal angiofibromas and can therefore be misdiagnosed. The differential diagnosis includes other vascular lesions, such as lobular capillary hemangioma and sinonasal-type hemangiopericytoma. Although immunohistochemistry is not necessary for differentiation between angiofibroma and capillary hemangioma, that diagnostic procedure may be helpful in distinction from sinonasal hemangiopericytoma. As an ilustration for immunohistochemical analysis, we presented a case of an elderly woman with tumor arising from the middle turbinate, diagnosed as angiofibroma. The staining was positive for CD34, CD31, factor VIII, vimentin and smooth muscle alpha-actin, and negative for desmin.

[Sudden hearing loss: our experiences in treatment with vasoactive and corticosteroid therapy].

INTRODUCTION: Sudden hearing loss is a clinical entity of ambiguously defined aetiology manifested by hearing loss of more than 30 dB on three contiguous frequencies occurring within 72 hours. The lack of standard therapy protocol led to the use of variety of different therapies, thus making difficult objective quantification of their effect. OBJECTIVE: The aim of the study was to present our experience in the treatment of sudden hearing loss with administration of vasoactive and corticosteroid therapy. METHODS: Our research included 59 hospitally treated patients with a sudden hearing loss. During the period 1995-2004, 37 patients were treated using vasoactive agents (xanthinol nicotinate and pentoxifylline), and from 2004-2009, 22 patients were treated using parenteral corticosteroids (dexamethasone). All patients had unilateral sensorineural hearing loss of different level at frequencies from 500-4000 Hz, while other diagnostic procedures (laboratory tests, internist and neurology examinations, X-ray) were within normal limits. Evaluation of therapy effect was done by follow-up of hearing threshold changes and subjective complaints. RESULTS: The results showed that full recovery was achieved in patients with a mild and not fully severe hearing loss, with the majority of those (73%) under corticosteroid treatment. In these patients recovery was also achieved more rapidly. A partial recovery of hearing was detected in patients with hearing loss of more than 80 dB, and mostly in patients treated with corticosteroids. CONCLUSION: Although statistical evaluation does not indicate significant differences between the application of vasoactive drugs or corticosteroids, clinical findings support advantages of corticosteroid therapy. Treatment of hearing loss, although controversial, requires change of some up-to-now used agents. Advantages should go in favour of contricosteroids.

Neonatal screening of hearing function by otoacustic emissions--a single center experience.

BACKGROUND/AIM: Nowadays development of techniques enables detection of hearing impairment in a very short time, immediately after birth by using otoacoustic emissions. They are low-pitched sounds produced in physiologically clear cochlea and can be recorded in cochlear outer meatus. By this method, complete data are found on a whole presynaptic auditory nervous system functioning that has mostly been affected by pathological changes making it a perfect screening test. Reliability and sensibility of this method is up to 98%. The aim of this study was to present the first results of systematic neonatal screening of hearing function by otoacoustic emissions in the Clinical Center Kragujevac (Kragujevac, Serbia). METHODS: This prospective study of neonatal hearing screening function, initiated systematically by the 2008 at the Clinical Center Kragujevac, included full-term newborns and premature born ones, within the first 24 h after birth, using a DPOAEs interacoustics otoread-screener. Retesting was done after a month. RESULTS: From January 1st, 2009 to December 1st, 2010, a total number of examined infants by this method was 1,994 out of which 1,778 were full-term and 216 were premature born. The test passing was higher in the group of full-term babies (92.5%) than in the preterm ones (55.1%). No bilateral answers were recorded in premature born children compared to the full-term ones, of whom a larger number was with missing lateral responses. The results of re-examination test in the group of full-term born and premature newborns were 83.7%, and 61%, respectively. CONCLUSION: Deliberately provoked transient otoacoustic emission is an efficient method in testing hearing function in newborns, since it is non-invasive, rapid and objective. Its correlation with audibly evoked potentials is very high, which confirms its reliability.

Risk factors for the appearance of minimal pathologic lesions on vocal folds in vocal professionals.

BACKGROUND/AIM: An excessive use or misuse of voice by vocal professionals may result in symptoms such are husky voice, hoarse voice, total loss of voice, or even organic changes taking place on vocal folds--minimal pathological lesions--MAPLs. The purpose of this study was to identify the type of MAPLs which affects vocal professionals, as well as to identify the risk factors that bring about these changes. METHODS: There were 94 vocal professionals who were examined altogether, out of whom 46 were affected by MAPLs, whereas 48 of them were diagnosed with no MAPLs, so that they served as the control group. All these patients were clinically examined (anamnesis, clinical examination, bacteoriological examination of nose and pharynx, radiography of paranasal cavities, allergological processing, phoniatric examination, endo-video-stroboscopic examination, as well as gastroenterologic examination, and finally endocrinological and pulmological analyses). RESULTS: The changes that occurred most often were identified as nodules (50%; n = 23/46) and polyps (24%; n = 11/46). Risk factors causing MAPLs in vocal professionals were as follows: age, which reduced the risk by 23.9% [OR 0.861 (0.786-0.942)] whereas the years of career increase the risk [OR 1.114 (1.000-1.241)], as well as the presence of a chronic respiratory disease [OR 7.310 (1.712-31.218)], and the presence of gastro-oesophageal reflux disease [OR 4.542 (1.263-16.334)]. The following factors did not contribute to development of MAPLs in vocal professionals: sex, a place of residence, irritation, smoking, endocrinologic disease and the presence of poly-sinusitis. CONCLUSION: It is necessary to introduce comprehensive procedures for prevention of MAPLs, particularly in high-risk groups. Identification of the risk factors for MAPLs and prevention of their influence on vocal professionals (given that their income depends on their vocal ability) is of the highest importance.

Factors influencing the choice of prescribed hearing aid.

In our paper we would like to emphasize the complexity of hearing aid prescription process. It is connected to a series of factors which impact the choice of hearing aid; type of hearing loss, degree of hearing loss according to the average hearing threshold expressed within the range from 500 Hz to 4000 Hz on a tonal audiogram, audiometric curve configuration, speech discrimination ability, patients' age at which the hearing impairment occurred, time elapsed between the occurrence of hearing impairment and prescription of a hearing aid, patients' age, physical and mental health and their cognitive function, anatomical characteristics of the auricle and external auditory canal, patient and parent motivation, cosmetic factors, financial abilities, cooperation with hearing aids manufacturers. This paper is important for everyday practice and can be used as a kind of guideline to the hearing aid prescription process.

Ear injuries caused by parts of hearing aid.

This paper presents two cases of ear injuries caused by parts of hearing aids -a five-year old girl whose tympanic membrane was ruptured by a metal part of the earmold, and a patient with injury and inflammation of outer auditory channel caused by parts of a channel hearing aid. Aid amplifier could serve its purpose only if it is applied and handled with direct coordination with an ORL specialist.

[Subjective difficulties in young people related to extensive loud music listening].

INTRODUCTION: For human ear, noise represents every undesirable and valueless sound. In disco clubs, as in some other places with loud music mostly attended by young people, the level of noise sometimes attains over 100 dB. As reported by numerous studies, a high noise level could induce subjective difficulties (ear buzzing, audition loss, vertigo and palpitations, anxiety, high blood pressure, decreased concentration, lowered memory storing). OBJECTIVE: Assessment of subjective difficulties occurring in young people when staying in places with a high noise level (cafes, disco clubs, rock concerts), which can produce health problems, due to loud music, in association with demographic data, addictions and personal life style data. One of the goals is to find factors leading to subjective difficulties, which would be objectively studied in the second stage of the research and marked as early predictors of possible health problems. METHODS: The study was conducted among 780 students of the Higher Healthcare School of Professional Studied in Belgrade. We used a questionnaire with 20 questions, divided into four categories: demographic data, case-history data, subjective problems and addictions of the subjects. In the statistical data processing we used the methods of descriptive and exploratory analysis, chi-square tests, correlation tests and Mantel-Haenszel odds ratio. RESULTS: After listening loud music, 54.0% of examined subjects felt ear buzzing, and 4.6% had hearing damage. The habit of visiting places with loud music, mostly once a week in duration of 2-3 hours per visit had 80.4% of subjects. The presence of subjective complaints after listening of loud music was in association with loud music listening and disco clubs visits.The major reasons of the present subjective difficulties could be predicated by listening of loud music and club visits (r = 0.918 and r = 0.857). A relative risk for subjective difficulties presentation was 1.599. CONCLUSION: According to the results of our study, over half of children develop loud music-induced subjective problems involving ear buzzing and occasionally hearing loss.

Total fixation of cricoarytenoid joint of a patient with rheumatoid arthritis and Hashimoto thyroiditis.

INTRODUCTION: The incidence of cricoarytenoid joint fixation in case of rheumatoid arthritis is 17 to 33%. In later stages of rheumatoid arthritis, a gradual fixation of cricoarytenoid joint develops and both halves of the larynx become less movable which calls for endotracheal intubation; while total fixation of this joint demands surgical tracheotomy. Hashimoto thyroiditis can display symptoms which are difficult to distinguish from the ones present in total fixation of cricoarytenoid joint caused by rheumatoid arthritis. CASE OUTLINE: A 60-year-old woman in terminal stage of rheumatoid arthritis and Hashimoto thyroiditis, diagnosed after clinical and other examinations. She was treated for strident breathing with surgical tracheotomy. The microscopic examination of the larynx with the use of laryngoscopic pincers suggested the immovability of the right and very limited movability of the left arytenoid cartilage. A computerized endovideostroboscopy showed only passive vertical vibrating movements of the right vocal cord and irregular vibrations of the left vocal cord. CONCLUSION: Total fixation of the cricoarytenoid joint can be caused by many pathological processes, but so far references have shown no case of rheumatoid arthritis and Hashimoto thyroiditis. In differential diagnostics, one of many examinations is the microscopic examination of the larynx, but it is very important to determine the movability of the arytenoid cartilage with the use of appropriate instruments in total endotracheal anaesthesia while the patient is fully relaxed. Movements in cricoarytenoid joints in patients with Hashimoto thyroiditis and the same conditions are preserved.

[Comparative analysis of audiometric and impedancemetric findings in workers exposed to the effects of various duration industrial noise].

BACKGROUND/AIM: Industrial noise is produced in workshops due to factory machinery and tools used in technological processes. It has detrimental effect to primarily the organ of the sense of hearing, thus damaging hearing in oversensitive subjects. The aim of the study was to perform a detailed analysis of audiometric and, especially, impedancemetric parameters in workers exposed to the effects of industrial noise of various duration, as well as to determine similarities and differences in workers with differences in sensitivity to damaging effects of noise. METHODS: The study included a homogenous group of 173 industrial workers involved in the same department of a huge workshop named "Kovacica" exposed to noise level above a threshold intensity, and divided into three groups: the group I of 116 workers (232 ears) exposed to noise for 8 h in the workshop "Kovacica", the group II of 41 workers (82 ears) exposed to noise only half of the working time, and the group III of 16 workers (32 ears) exposed to the same conditions and having the normal hearing sense. The group III served as a control group. Prior to the study any workers went through a thorough anamnesis and complete ORL examination, and then they were submitted to audiometric testing. The study included only the workers with no hearing damage due to diseases, injuries nor other detrimental factors in order to be sure that the hearing findings had been caused by industrial noise. RESULTS: The results obtained by audiometric testing showed that 90.75% of the workers had hearing damage of various degrees, while 9.25% of the workers had regular hearing although had been exposed to the same conditions. More severe hearing damage was revealed in the workers of the group I. Tympanometricly, in most ears of the group I workers (65.52%) a compliance value was found to be more than 0.9 cm3, while in the majority of those of the group II (59.75%) a compliance value was in the range from 0.5 to 0.9 cm3. In the workers of the group III with no hearing damage, a compliance value for any ears was in the range from 0.1 to 0.9 cm3. Mean value of threshold reflex (98.56 dB) at 500 Hz and 1 000 Hz in the group I was increased as compared with the group II (95.6 dB) and the group III (84.38 dB). At higher frequences, 2 000 and 4 000 Hz, threshold reflex was increased in the group I (99.05 dB), and in the group II (97.6 dB) as compared with the group III (86.4 dB). The amplitude of stapedic reflex was lowest in the group I, while mean values of amplitude at 500, 1 000, 2 000 and at 4 000 Hz were 2.31, 1.38, 1 and 0.3, respectively. In the group II mean values of amplitude at 500, 1 000, 2 000 and 4 000 Hz were 2.52, 1.80, 1.30 and 0.5, respectively. In the group III mean values of amplitude at 500, 1 000, 2 000 and at 4 000 Hz were 2.36, 2.45, 2.5 and 2.08, respectively. By measuring input (rising) and output angles it was revealed that most ears of the workers in the groups I and II had rising angle ranging from 41 to 50 degrees, and in the workers with no hearing loss from 31 to 50 degrees. In the majority of the ears of the groups I and II outlet angle was in the range from 16 to 35 degrees, and in the workers with no hearing damage from 26 to 35 degrees. CONCLUSION: By audiometric and impedancemetric examinations it was determined that for the sense of hearing it is significant not only a threshold hearing expressed in the audiometric curve at various frequences, but also a threshold of unpleasantness and pain under higher intensities shown by the occurrence of stapedic reflex. The less hearing field between threshold hearing and threshold acustic reflex is, the less capabilities of hearing perception due to the occurrence of recrutment.

[Condition of hearing sense and tinnitus before and after the treatment of otosclerosis].

INTRODUCTION: Otosclerosis is an osteodystrophy disease of the bony labyrinth of the ear which leads to stapes fixation and to bradyecoia of a conductive type. The microsurgical treatment by the use of a stapes prosthesis provides hearing improvement and a reduction or disappearing of tinnitus. The aim of our study was to determine the hearing condition and tinnitus before and after the treatment of otosclerosis. MATERIAL AND METHODS: A hundred patients with otosclerosis, aged 20 to 70, were surgically treated at the Otorhinolaryngology Clinic and the Functional Diagnostics, Military Medical Academy, Belgrade. After the treatment, the audiometric examinations were performed in order to assess the hearing condition and tinnitus was assessed by a questionnaire. The subjective assessment of tinnitus was ranged as present, reduced or absent. RESULTS: Before the treatment, hearing impairment was present in all the patients, while tinnitus was found in 91% of them. One year following the surgical treatment hearing improvement was found in 96% of the patients, and tinnitus cessation in 89% of them. CONCLUSION: The surgical treatment can result in hearing improvement and cessation or reduction of tinnitus.

[The comparative analysis of clinical symptomatology before and after the operation of otosclerosis].

INTRODUCTION: Otosclerosis is a progressive osteodystrophic disease of the osseous capsule of the labyrinth which leads to the fixation of the stapes and partial deafness. The progressive hearing loss followed by ear tingling--tinitus and vertigo is of great importance for this disease. The aim of the work was to determine the changes of clinical symptomatology before and after the operative treatment of otoscleoris. MATERIAL AND METHODS: The study included 32 subjects between 25 and 60 years of age affected by otosclerosis who had undergone surgical treatment at the VMA (Military Medical Academy) Clinic, Department of Otolaryngology in Belgrade. Besides the clinical examination and detailed case history, audiometry and tympanometry examinations were performed. During the postoperative period the clinical symptomatology was evaluated and audiometry examinations were performed in order to determine the effect of the surgical intervention. RESULTS: Of the total number of 32 subjects, partial deafness was present in all of them before the operation, whereas tinitus, vertiginous disturbances and otalgia were found in a certain number of the subjects. During the postoperative period a partial recovery was found in a larger number of the subjects in relation to the total hearing recovery. During the postoperative period tinitus of lower intensity was found in a greater number of the subjects, whereas the number of those without tinitus was smaller. The problem of vertiginous disturbances as well as otalgia were not found during the postoperative period. CONCLUSION: By following the changes of the clinical symptomatology we came to the conclusion that surgical treatment of otosclerosis results in the reduction and disappearance of subjective disturbances, tinitus, vertigo and otalgia and leads to the partial or complete hearing recovery.

[Sudden hearing loss--our experience in treatment with vasoactive therapy].

INTRODUCTION: A specific title "sudden hearing loss" refers to illness which is characterized by a sudden, rapid sensoneural hearing loss mostly in one ear without obvious causes, accompanied with dizziness, and without vestibular symptomatology. It is defined as a hearing loss for more than 30 dB on 3 or more successive frequencies which appear in 72 hours. OBJECTIVE: The main goal of our paper was to estimate success of implementation of vasoactive method in patients with sudden hearing loss of senso-neural type in different ranges in hospital conditions. METHOD: Our research covered 37 patients hospitalized because of a sudden hearing loss of sensoneural type in different ranges. Diagnosis, in all patients, was established by clinical ORL examination, audiology and vestibular examination. R including CT and MR, neurological, internist and laboratory examinations were used in order to exclude other aetiology. In monitored patients, we started treatment with vasoactive therapy, ampules of xanthinol nicotinate (one ampule of 2 ml, 300 mg) or ampules of pentoxiphylline (one ampule of 5 ml, 100 mg) in form of infusions with addition of vitamins with an everyday gradual increase of dosage up to 12 ampules of xanthinol nicotinate and up to 5 ampules of pentoxiphylline. Then we started with an everyday decrease of dosage down to the first one. RESULTS: After the complete curing protocol, we found out that in patients with light and medium senso-neural damages of hearing sense (23 or 62%), hearing recovery was complete. In patients with heavy damage of hearing (9 or 24%), partial success was evidenced. The most difficult cases, with complete hearing loss, heavy buzzing and vertiginous problem (5 or 14%) responded to therapy, so buzzing and vertiginous problems disappeared but hearing was not improved. CONCLUSION: Usage of vasoactive medicaments in hospital conditions in treatment of sudden hearing loss gives good results and it is the closest to aetiological therapy.

[Effect of noise on changes in the acoustic reflex]. / Promene parmetara akustickog refleksa pod dejstvom buke.

Acoustic, stapedial reflex represents a response of the m. stapedius to a sonic excitation of supra speech intensity. It is the constitutive part of impendancmetric investigations, it is performed on the same apparatus after tympanometry, and it is the inseparable part in representation of impendancmetric findings. Until now, the most frequently monitored parameters of acoustic reflex of clinical importance are: threshold, amplitude, output and input angle of the reflex curve. The aim of this work was to performed detailed analysis of mentioned parameters in workers exposed to extensive action of industrial noise of known physical characteristics (of different durations) and to establish which changes occurred in these workers, to what extent and under which conditions. Investigations included 173 industrial workers (346 ears), which work in working unit "Forge", where during the working process noise is produced which is above permissible limits and of the unfavorable frequency content. Workers were divided into two groups. The first group consisted of workers who were spending the whole working time in the workroom with noise above permissible limits, the second group consisted of workers who were spending 3 hours of the working time in that workroom, while the control group consisted of workers who were spending the whole working time in that workroom but they did not have any hearing impairment. Workers of the first and the second group had the hearing impairment, which occurred exclusively as a consequence of chronical acoustic trauma. For all the workers the anamnesis was taken, as well as ORL status and audiometric and impendancmetric investigations were performed, namely the tympanometry and acoustic reflex. Results have shown that the acoustic reflex threshold at 500 Hz and at 1000 Hz for the first group (95.10 dB) was increased with respect to the reflex threshold of the second and the control group (84 dB). At higher frequencies of 2000 Hz and 4000 Hz an increase of the reflex threshold was found for the first and the second group (96 dB) with respect to the control group (87 dB). The amplitude of acoustic reflex was increased, at frequencies 500 Hz and 1000 Hz (3.38), with respect to the second group (2.78) and the control group (2.36), and at higher frequencies, this increase is more prominent. The input angle of the reflex curve was, for the first and the second group, within limits 41 degrees to 50 degrees, and for the control group was from 31 degrees to 50 degrees. The output angle was, at majority of ears of the first and the second group, from 26 degrees to 35 degrees, and for the control group it was from 16 degrees to 35 degrees. Acoustic reflex, as the noninvasive method, short term one, objective and simple for application, does not require collaboration of workers, what provides for objectivity of obtained results and what caused that wrongful estimations, impressions and subjective reactions of workers were avoided.