噪声作业工人耳鸣患病情况及其影响因素

Prevalence of tinnitus in noise-exposed workers and its influencing factors

[背景]耳鸣为噪声作业工人常见症状,尚无特效治疗方法。关注耳鸣患病影响因素对预防耳鸣至关重要。[目的]调查噪声作业工人的耳鸣患病情况,并探讨噪声暴露相关因素与耳鸣患病的关系。[方法]采用横断面研究方法,以杭州市1011例接触噪声的男性工人为研究对象。通过问卷调查耳鸣情况、年龄、文化程度、个人防护、吸烟史、饮酒史、家族史等,对所有研究对象进行双耳纯音听阈测试,并对工作场所进行环境噪声检测。采用多因素logistic回归分析噪声作业工人耳鸣患病与噪声暴露强度、噪声接触时间、噪声接触类别、累积噪声暴露量、佩戴听力防护用品的关系。[结果]噪声作业工人的耳鸣患病率为36.1%。耳鸣组左右耳的500、3000、4000、6000 Hz的平均听阈高于非耳鸣组(P<0.05);耳鸣组右耳2000 Hz听阈高于非耳鸣组(P<0.05)。单耳语频听损患病率与单耳高频听损患病率两组间差异无统计学意义(P>0.05)。现场噪声强度分为<85、85~<95和≥95 dB(A)三组,耳鸣患病率分别为19.6%、40.5%和66.7%。作业工人接噪工龄分为<1、1~<5和≥5年三组,耳鸣患病率分别为17.9%、34.0%和45.4%。作业工人累积噪声暴露量分为<80、80~<85、85~<90、90~<95、95~<100和≥100 dB(A)·年六组,耳鸣患病率分别为6.8%、25.0%、31.0%、39.6%、43.1%和46.7%。非稳态噪声组耳鸣患病率(42.5%)高于稳态噪声组(26.8%)(χ^(2)=26.18,P<0.01)。不佩戴和佩戴听力防护用品组耳鸣患病率分别为39.7%、35.5%。多因素logistic回归分析结果显示,暴露在更大强度现场噪声、更长接噪工龄、更高累积噪声暴露量、非稳态噪声类别下(对比稳态噪声)的工人耳鸣患病风险更高(P趋势<0.01或P<0.01),佩戴听力防护用品(对比不佩戴听力防护用品)的工人耳鸣患病风险更低(P<0.05)。[结论]作业工人接触现场噪声强度越大、接噪工龄越长、累积噪声暴露量越高,耳鸣患病风险越高。佩戴防护耳塞能够降低耳鸣患病风险。噪声作业工人耳鸣现象可早于听力损失异常的检出。

[Background]Tinnitus is a common symptom in workers exposed to noise,and no specific treatment is available yet.Paying attention to the influencing factors of tinnitus is very important to prevent tinnitus.[Objective]To investigate the situation of tinnitus among noise-exposed workers and its influencing factors.[Methods]Using a cross-sectional study design,1011 noise-exposed male workers in Hangzhou were studied.Tinnitus status,age,education,personal protection,smoking history,drinking history,and family history of the participants were surveyed by questionnaires.Binaural pure tone hearing threshold test was performed on all study subjects.The environmental noise in the workplace was measured.The relationships of tinnitus with noise exposure intensity,noise exposure time,noise exposure category,cumulative noise exposure,and wearing hearing protectors among the noise-exposed workers were analyzed by logistic regression.[Results]The prevalence of tinnitus among the noise-exposed workers was 36.1%.The mean hearing thresholds at 500,3000,4000,and 6000 Hz in the right and left ears were higher in the tinnitus group than in the non-tinnitus group(P<0.05);the hearing threshold at 2000 Hz in the right ear was higher in the tinnitus group than in the non-tinnitus group(P<0.05).There was no statistically significant difference between the two groups in the prevalence of monaural speech-frequency hearing loss or monaural high-frequency hearing loss(P>0.05).The on-site noise intensity was divided into three groups:<85,85-<95,and≥95 dB(A);the prevalence of tinnitus in the three groups was 19.6%,40.5%,and 66.7%respectively.The years of noise exposure was divided into three groups:<1,1-<5,and≥5 years;the prevalence of tinnitus in the three groups was 17.9%,34.0%,and 45.4%respectively.The cumulative noise exposure was divided into six groups:<80,80-<85,85-<90,90-<95,95-<100,and≥100 dB(A)·year;the prevalence of tinnitus in the six groups was 6.8%,25.0%,31.0%,39.6%,43.1%,and 46.7%respectively.The prevalence of tinnitus was higher in the non-stationary noise group(42.5%)than in the stationary noise group(26.8%)(χ^(2)=26.18,P<0.01),and the prevalence in the group without or with hearing protection was 39.7%and 35.5%respectively.The results of logistic regression showed that workers exposed to higher intensity,longer noise exposure,higher cumulative noise exposure,and non-stationary noise(reference:stationary noise)resulted in a higher risk of tinnitus(Ptrend<0.01 or P<0.01);workers wearing of hearing protection device versus those not showed a lower risk of tinnitus(P<0.05).[Conclusion]Higher intensity,longer exposure to noise,and more cumulative noise exposure associate with a higher risk of tinnitus.Wearing hearing protective device can reduce the risk of tinnitus.Tinnitus in noise-exposed workers can precede the presentation of abnormal hearing loss.