1例职业性轻度噪声聋诊断结论改变原因

Reasons for diagnosis change of a case of mild occupational noise deafness

目的分析1例"职业性轻度噪声聋"的职业病诊断与鉴定结论不一致的原因。方法根据患者在噪声环境下工作听力下降,结合患者职业接触史和职业健康检查资料及职业病诊断与鉴定资料,分析其职业病诊断与鉴定结论不一致的原因。结果按照GBZ 49-2014《职业性噪声聋的诊断》标准A10中e)和f)条计算结果为:双耳高频平均听阈(BHFTA)46.5 dB HL、左耳单耳听阈加权值(MTMV-L)35.1 dB HL、右耳单耳听阈加权值(MTMV-R)38.1 dB HL,按标准规定应取MTMV-L 35.1 dB HL。但是,诊断机构与鉴定机构的分歧是诊断结论。该患者职业病诊断结论为"职业性轻度噪声聋",在鉴定过程中鉴定专家组认为:(1)噪声性耳聋的听力学特点主要是以高频下降为主,双耳基本对称,听力损失呈渐进性改变。本例患者双耳听力损失图明显不符合噪声性听力损失特点。(2)诊断过程中的检查结果出现主观与客观测听不相符。(3)对《职业性噪声聋诊断》标准的运用应首先基于正确诊断。按照GBZ 49-2014《职业性噪声聋的诊断》标准最终鉴定结论为"无职业性噪声聋"。结论按照GBZ 49-2014《职业性噪声聋的诊断》标准最终鉴定结论为"无职业性噪声聋"。在职业性噪声性聋的诊断过程中,要正确理解应用《职业性噪声聋诊断》的标准,邀请临床高水平的听力学专家参与做好鉴别诊断,以保证诊断与鉴定结论的正确性。

[Objective]To analyze the reasons for the inconsistent results of occupational disease diagnosis and identification in a case of mild occupational noise deafness.[Methods]According to the patient＇s hearing loss in the noise environment,the reasons for the inconsistency of occupational disease diagnosis and identification were analyzed on the basis of patient＇s history of occupa-tional exposure and occupational health examination data,and the data of occupational disease diagnosis and identification.[Results]The results that were calculated in accordance with the criteria for the standard A10 e） and f） of the Diagnosis of occupational noise induced deafness（GBZ 49-2014） were as follows：binaural frequency hearing threshold in average（BHFTA）was 46.5 dB HL,while monaural weighted value-left（MTMV-L） and monaural weighted value-right（MTMV-R） was 35.1 dB HL and 38.1 dB HL respectively,and the MTMV-L（35.1 dB HL） should be taken as the measured value. However,there was the difference in diagnosis conclusion between the diagnosis institution and the identification institution. The occupational disease diagnosis of the patient was mild occupational noise deafness. The identification expert group considered that：（1）the audiological characteristic of noise deafness is dominated by high frequency drop,with symmetrical hearing loss and gradual change in hearing loss,and the binaural hearing loss chart of this patient did not meet the characteristics of noise induced hearing loss.（2）The dignosis showed inconsistent results in subjective and objective audiometry.（3）The application of the Diagnosis of occupational noise induced deafness should firstly be based on the correct diagnosis. According to the diagnostic criteria of GBZ 49-2014,the final identification result was no occupational noise induced hearing loss.[Conclusion] According to the diagnostic criteria of the Diagnosis of occupational noise induced deafness（GBZ 49-2014）,the final conclusion is no occupational noise induced hearing loss. In the diagnosis of occupational noise induced deafness,it is necessary to correctly understand the diagnostic criteria and invite clinical audiology experts to make the differential diagnosis,to ensure correct diagnosis and appraisal conclusion.