台灣男性工作者的年度噪音暴露劑量和聽閾及耳石－前庭功能之相關

Study on hearing thresholds shift and otolith-vestibular function associated with annual noise exposure doses in male workers in Taiwan

10.6288/TJPH.202308_42(4).112043

郭姿吟(TZU-YIN KUO)；張宸瑋(CHEN-WEI CHANG)

年度噪音暴露劑量 ； 男性工作者 ； 耳石－前庭功能 ； 聽閾變化 ； annual noise exposure doses ； male worker ； otolith-vestibular function ； hearing thresholds shift

台灣公共衛生雜誌

42卷4期（2023 / 08 / 30）

374 - 388

繁體中文;英文

目標：本研究旨在探究男性工作者年度噪音暴露劑量（ANE）和聽力及前庭功能之相關。方法：我們給予噪音暴露組（NE）51人和對照組（CR）29人，施測純音聽力檢查、頸部和眼部前庭誘發肌電位測驗（VEMPs），並以台灣華語版職業暨休閒娛樂噪音暴露問卷，分別計取得聽力閾值、耳石－前庭功能以及ANE。結果：NE組的平均ANE（85.8 dBA,SD=5.05）顯著高於CR組（67.9 dBA, SD=2.93）（p<.001）。聽力方面，ANE和3,000及4,000Hz純音聽閾有顯著低至中度正相關（r=0.283-0.385,p<.05），ANE數值越高，此兩個頻率聽閾值則越差。此外，噪音暴露和年齡增長都會加重高頻3,000，4,000，6,000 Hz的聽閾值。兩種前庭肌電位檢查均顯示兩耳間振幅差異比在NE組（cVEMPs:28.9%;oVEMPs:26.7%）的異常比例高於CR組（cVEMPs:17.4%;oVEMPs:0%），且NE組整體VEMPs異常的風險比是CR組的4.54倍（95%CI[1.33,15.49]）。結論：年度噪音暴露劑量（ANE）過高的工作者，不僅是噪音型聽力損失高風險族群，其耳石－前庭神經路徑功能檢測異常的比例也較高。建議職場高噪音暴露人員，除監控其聽閾變化，也應關注內耳前庭系統的潛在傷害。

Objectives: This study explores the relationships between personal annual noise exposure doses (ANE), and hearing thresholds, and otolith-vestibular function. Methods: We recruited 51 male workers who had exposed to noise in the past year for the noise-exposed group (NE) and 29 men without noise exposure for the control group (CR). We used pure tone audiometry, cervical and ocular vestibular-evoked myogenic potentials (VEMPs) tests, and "the annual noise exposure questionnaire-Taiwan Mandarin version" to evaluate hearing thresholds, otolith-vestibular neural pathway and the ANE doses, respectively. Results: The mean ANE was higher in the NE group (85.8 dBA, SD = 5.05) than in the CR group (67.9 dBA, SD = 2.93) (p < .001). There were significant low-to-moderate positive correlations between ANE and hearing thresholds at 3,000 and 4,000 Hz, with higher ANE associated with poorer hearing thresholds. We also found that both noise exposure and aging aggravated the high-frequency hearing thresholds (3,000, 4,000, 6,000 Hz). The findings of the interaural amplitude difference ratio showed that percentages of abnormalities for two VEMPs tests were higher in the NE group (cVEMPs: 28.9%; oVEMPs: 26.7%) than in the CR group (cVEMPs: 17.4%; oVEMPs: 0%). Furthermore, the odds ratio of abnormal VEMPs for the NE group was 4.54 (95% CI = 1.33, 15.49) compared to the CR group. Conclusions: The excessively elevated ANE is a strong risk factor for noise-induced hearing loss and abnormal otolith-vestibular function. This research recommends that individuals with high occupational noise exposure should be monitored for their hearing threshold shifts and be aware of the potential damage to the vestibular system.

1. 林道龍, TL,莊弘毅, HY,何啟功, CK,陳秋蓉, CJ,吳聰能, TN(2006)。職業鉛與噪音暴露對於聽覺能力影響－橫斷式研究。勞工安全衛生研究季刊，14，1-7。
   連結：
2. 楊雅惠, YH,林洺秀, MH,楊啟賢, CH,謝曼麗, ML(2016)。鑄造業勞工健康危害狀況分析。勞動及職業安全衛生研究季刊，24，389-401。
   連結：
3. Akin, FW,Murnane, OD(2001).Vestibular evoked myogenic potentials: preliminary report.J Am Acad Audiol,12,445-452.
4. Akin, FW,Murnane, OD,Panus, PC,Caruthers, SK,Wilkinson, AE,Proffitt, TM(2004).The influence of voluntary tonic EMG level on the vestibular-evoked myogenic potential.J Rehabil Res Dev,41,473-487.
5. Akin, FW,Murnane, OD,Tampas, JW,Clinard, C,Byrd, S,Kelly, JK(2012).The effect of noise exposure on the cervical vestibular evoked myogenic potential.Ear Hear,33,458-465.
6. Chihara, Y,Iwasaki, S,Ushio, M,Murofushi, T(2007).Vestibular-evoked extraocular potentials by air-conducted sound: Another clinical test for vestibular function.Clin Neurophysiol,118,2745-2751.
7. Clark, WW,Bohne, BA(1999).Effects of noise on hearing.JAMA,281,1658-1659.
8. Elmoazen, D,Kozou, H,Mekky, J,Ghanem, D(2020).Assessment of cervical and ocular vestibular evoked myogenic potentials in migraine patients.Egypt J Otolaryngol,36,19.
9. Enrietto, JA,Jacobson, KM,Baloh, RW(1999).Aging effects on auditory and vestibular responses: a longitudinal study.Am J Otolaryngol,20,371-378.
10. Giorgianni, C,Spatari, G,Tanzariello, MG,Gangemi, S,Brecciaroli, R,Tanzariello, A(2015).Cervical Vestibular Evoked Myogenic Potential (c-VEMPs) assessment in workers with occupational acoustic trauma.Health,7,456-458.
11. Golz, A,Westerman, ST,Westerman, LM(2001).The effects of noise on the vestibular system.Am J Otolaryngol,22,190-196.
12. Harada, S,Nishiwaki, Y,Michikawa, T(2008).Gender difference in the relationships between vision and hearing impairments and negative well-being.Prev Med,47,433-437.
13. Henderson, D,Hamernik, RP,Dosanjh, DS,Mills, JH(1976).Effects of Noise on Hearing.New York, NY:Raven Press.
14. Hinchcliffe, R,Coles, RR,King, PF(1992).Occupational Noise Induced Vestibular Malfunction?.Br J Ind Med,49,63-65.
15. Hoffman, HJ,Dobie, RA,Losonczy, KG,Themann, CL,Flamme, GA(2017).Declining prevalence of hearing loss in US adults aged 20 to 69 years.JAMA Otolaryngol Head Neck Surg,143,274-285.
16. Humes, LE,Kewley-Port, D,Fogerty, D,Kinney, D(2010).Measures of hearing threshold and temporal processing across the adult lifespan.Hear Res,264,30-40.
17. Johnson, TA,Cooper, S,Stamper, GC,Chertoff, M(2017).Noise exposure questionnaire: a tool for quantifying annual noise exposure.J Am Acad Audiol,28,14-35.
18. Kumar, K,Vivarthini, CJ,Bhat, JS(2010).Vestibular evoked myogenic potential in noise-induced hearing loss.Noise Health,12,191-194.
19. Lacour, M,Helmchen, C,Vidal, PP(2016).Vestibular compensation: the neuro-otologist’s best friend.J Neurol,263(Suppl 1),S54-S64.
20. Lynch, ED,Kil, J(2005).Compounds for the prevention and treatment of noise-induced hearing loss.Drug Discov Today,10,1291-1298.
21. Mirza, R,Kirchner, DB,Dobie, RA,Crawford, J(2017).ACOEM Task Force on Occupational Hearing Loss. Occupational noise-induced hearing loss.J Occup Environ Med,60,e498-e501.
22. Moore, BCJ,Lowe, DA,Cox, G(2022).Guidelines for diagnosing and quantifying noise-induced hearing loss.Trends Hear,26,1-21.
23. Moore, DR,Edmondson-Jones, M,Dawes, P(2014).Relation between speech-in-noise threshold, hearing loss and cognition from 40-69 years of age.PLoS One,9,e107720.
24. Morrell, CH,Gordon-Salant, S,Pearson, JD,Brant, LJ,Fozard, JL(1996).Age- and gender-specific reference ranges for hearing level and longitudinal changes in hearing level.J Acoust Soc Am,100,1949-1967.
25. Neitzel, R,Seixas, N,Goldman, B,Daniell, W(2004).Contributions of non-occupational activities to total noise exposure of construction workers.Ann Occup Hyg,48,463-473.
26. Niskar, AS,Kieszak, SM,Holmes, AE,Esteban, E,Rubin, C,Brody, DJ(2001).Estimated prevalence of noise-induced hearing threshold shifts among children 6 to 19 years of age: the Third National Health and Nutrition Examination Survey, 1988-1994, United States.Pediatrics,108,40-43.
27. Passchier-Vermeer, W,Passchie, WF(2000).Noise exposure and public health.Environ Health Perspect,108,123-131.
28. Perez, R,Freeman, S,Cohen, D,Sohmer, H(2002).Functional impairment of the vestibular end organ resulting from impulse noise exposure.Laryngoscope,12,1110-1114.
29. Phillips, SL,Henrich, VC,Mace, ST(2010).Prevalence of noise-induced hearing loss in student musicians.Int J Audiol,49,309-316.
30. Rabinowitz, PM(2000).Noise-induced hearing loss.Am Fam Physician,61,2749-2756+2759-2760.
31. Rosengren, SM,Welgampola, MS,Colebatch, JG(2010).Vestibular evoked myogenic potentials: past, present and future.Clin Neurophysiol,121,636-651.
32. Sohmer, H,Elidan, J,Plotnik, M(1999).Effect of noise on the vestibular system-vestibular evoked potential studies in rats.Noise Health,2,41-52.
33. Sommers, MS,Hale, S,Myerson, J,Rose, N,Tye-Murray, N,Spehar, B(2011).Listening comprehension across the adult lifespan.Ear Hear,32,775-781.
34. Stewart, C,Yu, Y,Huang, J(2016).Effects of high intensity noise on the vestibular system in rats.Hear Res,335,118-127.
35. Stewart, CE,Holt, AG,Altschuler, RA(2020).Effects of noise exposure on the vestibular system: a systematic review.Front Neurol,11,593919.
36. Sułkowski, WJ,National Science Foundation (U.S.)(1980).Industrial Noise Pollution and Hearing Impairment: Problems of Prevention, Diagnosis, and Certification Criteria.Springfield, VA:Foreign Scientific Publications Department, National Center for Scientific, Technical and Economic Information.
37. Wang, CT,Young, YH(2006).Comparison of the head elevation versus rotation methods in eliciting vestibular evoked myogenic potentials.Ear Hear,27,376-381.
38. Wang, SJ,Weng, WJ,Jaw, FS,Young, YH(2010).Ocular and cervical vestibular-evoked myogenic potentials: a study to determine whether air- or bone-conducted stimuli are optimal.Ear Hear,31,283-288.
39. Welgampola, MS,Colebatch, JG(2005).Characteristics and clinical applications of vestibular-evoked myogenic potential.Neurology,64,1682-1688.
40. 尹立銘, LM,楊啟賢, CH,周于婷, YT(2016)。裝潢木工業噪音暴露危害評估。中華職業醫學雜誌，23，1-9。
41. 林純吉, CC,蔡佳珊, CS,王漢珂, HK,劉鴻文, HW(2021)。花蓮縣室內裝潢木工噪音作業及粉塵作業危害評估。中華職業醫學雜誌，28，205-218。
42. 姜泰安, TA,曾智宏, CH,吳佩芬, PF(2015)。消防人員之噪音暴露及聽力損失情形分析與探討－以屏東縣為例。華醫學報，42，25-34。
43. 張淑如, SJ,楊子萱, ZS,王振宇, CY(2010)。汽車車燈製造業勞工聽力損失相關因子之研究。中華職業醫學雜誌，17，27-37。
44. 陳秀卿, SC(1982)。工廠噪音的調查與研究。工業安全衛生月刊，43，57-71。
45. 勞動部職業安全衛生署：109年職業傷病防治年報：97-108年常見職業病診斷通報人次。https://tmsc.osha.gov.tw/info_04.asp。引用2021/11/01。Occupational Safety and Health Administration, Ministry of Labor, R.O.C. (Taiwan). 2020 annual report on occupational injury prevention and control: the number of notifications of common occupational disease diagnoses from 2008 to 2019. Available at: https://tmsc.osha.gov.tw/info_04.asp. Accessed November 1, 2021. [In Chinese]。
46. 黃乾全, CC,董貞吟, CY,吳聰能, TN,姜曉芳, HF(1993)。噪音劑量與暫時性聽力損失之關係探討。勞工安全衛生研究季刊，1，99-111。