The Effect of a High-Frequency-Hearing-Threshold Weighted Value on the Diagnosis of Occupational-Noise-Induced Deafness

Objective: In order to provide a theoretical basis for the revision of the current diagnostic criteria for occupational noise-induced deafness (ONID), we evaluated the degree of ONID by analyzing different high-frequency-hearing- threshold-weighted values (HFTWVs). Methods: A retrospective study was conducted to evaluate the diagnosis of patients with ONID from January 2016 to January 2017 in Guangdong province, China. Based on 3 hearing tests (each interval between the tests was greater than 3 days), the minimum threshold value of each frequency was obtained using the 2007 edition’s diagnostic criteria for ONID. The speech frequency and the HFTWVs were analyzed based on age, noise exposure, and diagnostic classi-fication using SPSS21.0. Results: 168 patients in total were involved in this study, 154 males and 14 females, and the average age was 41.18 ± 6.07. The diagnosis rate was increased by the weighted value of the high frequencies and was more than the mean value of the pure speech frequency (MVPSF). The diagnosis rate for the weighted 4 kHz frequency level increased by 13.69% (χ2 = 9.880, P = 0.002), the weighted 6 kHz level increased by 15.47% (χ2 = 9.985, P = 0.002), and the weighted 4 kHz + 6 kHz level increased by 15.47% (χ2 = 9.985, P = 0.002). The differences were all statistically significant. The diagnostic rate of the different thresholds showed no obvious difference between the genders. The age groups were divided into less than or equal to 40 years old (group A) and 40 - 50 years old (group B). There were several groups with a high frequency: high frequency weighted 4 kHz ( group A χ2 = 3.380, P = 0.050;group B χ2 = 4.054, P = 0.032), high frequency weighted 6 kHz (group A χ2 = 6.362, P = 0.012;group B χ2 = 4.054, P = 0.032), weighted 4 kHz + 6 kHz (group A χ2 = 6.362 P = 0.012;B χ2 = 4.054, P = 0.032) than those of MVPSF in the same group on ONID diagnosis rate. The differences between the groups were statistically significant. There was no significant difference between the age groups (χ2 = 2.265, P = 0.944). The better ear’s (the smaller hearing threshold weighted value) MVPSF and the weighted values for the different high frequencies were examined in light of the number of working years;the group that was exposed to noise for more than 10 years had significantly higher values than those of the average thresholds of each frequency band in the groups with 3 - 5 years of exposure (F = 2.271, P = 0.001) and 6 - 10 years of exposure (F = 1.563, P = 0.046). The differences were statistically significant. The different HFTWVs were higher than those of the MVPSF values, and the high frequency weighted 4 kHz + 6 kHz level showed the greatest difference, with an average increase of 2.83 dB. The diagnostic rate that included the weighted high frequency values was higher for the mild, moderate, and severe cases than those patients who were only screened with the pure frequency tests. The results of the comparisons of the diagnosis rates for mild ONID were as follows: the weighted 3 kHz high frequency level (χ2 = 3.117, P = 0.077) had no significant difference, but the weighted 4 kHz level (χ2 = 10.835, P = 0.001), 6 kHz level (χ2 = 9.985, P = 0.002), 3 kHz + 4 kHz level (χ2 = 6.315, P = 0.012), 3 kHz + 6 kHz level (χ2 = 6.315, P = 0.012), 4 kHz + 6 kHz level (χ2 = 9.985, P = 0.002), and 3 kHz + 4 kHz + 6 kHz level (χ2 = 7.667, P = 0.002) were significantly higher than the diagnosis rate of the mean value of the PSF. There was no significant difference between the 2 groups for the moderate and severe grades (P > 0.05). Conclusion: Different HFTWVs increase the diagnostic rate of ONID. The weighted 4 kHz, 6 kHz, and 4 kHz + 6 kHz high frequency values greatly affected the diagnostic results, and the weighted 4 kHz + 6 kHz high frequency hearing threshold value has the maximum the effect on the ONID diagnosis results.

纳入不同高频听阈加权值对职业性噪声聋诊断结果的影响

目的:对职业性噪声聋使用纳入不同高频听阈加权值对其诊断结果产生的影响展开分析与研究。方法:选取2018年9月-2020年9月国家卫生健康委职业安全卫生研究中心收治的84例疑似职业性噪声聋患者作为研究对象,分别按照GBZ49-2007职业性噪声聋的诊断标准、GBZ49-2014职业性噪声聋的诊断标准展开诊断与分析,对不同诊断结果进行对比。结果:与GBZ49-2007职业性噪声聋诊断结果比较,GBZ49-2014职业性噪声聋诊断观察对象占比更低,其轻度噪声聋占比、无噪声聋占比更高,差异有统计学意义(P<0.05);GBZ49-2014职业性噪声聋诊断的诊断率高于GBZ49-2007职业噪声聋诊断的诊断率,差异有统计学意义(P<0.05)。结论:纳入不同高频听阈加权值诊断职业性噪声聋的结果存在一定差异,且GBZ49-2014职业性噪声聋的诊断标准显著更优,临床价值突出,适合普及使用。

职业性噪声聋2014与2007版诊断标准对比研究

目的分析GBZ 49—2014《职业性噪声聋的诊断》(以下简称"GBZ 49—2014")和GBZ 49—2007《职业性噪声聋诊断标准》(以下简称"GBZ 49—2007")对职业性噪声聋(ONID)诊断结果的影响。方法采用判断抽样方法,以采用GBZ 49—2007诊断为观察对象的84例噪声作业工人为研究对象,分别采用GBZ 49—2014和GBZ 49—2007进行诊断,分析GBZ 49—2014采用的不同诊断听力图、不同年龄与性别修正方法以及纳入权重为0.1的高频4.0 k Hz听阈作为诊断听阈对ONID诊断的影响。结果 84例研究对象采用GBZ 49—2014计算的双耳高频平均听阈(BHFTA)低于采用GBZ 49—2007计算的BHFTA[(52.1±10.3)vs(52.8±10.1)d B,P<0.05],而采用GBZ 49—2014计算的较好耳听阈加权值(MTWV)高于采用GBZ 49—2007计算的较好耳语频平均听阈[(23.2±4.1)vs(19.3±4.8)d B,P<0.01]。84例研究对象采用GBZ 49—2007进行诊断时,BHFTA均≥40 d B,较好耳语频平均听阈均<26 d B,均不能诊断为ONID;采用GBZ 49—2014进行诊断时,33.3%人员BHFTA≥40 d B且较好耳MTWV≥26 d B,可诊断为轻度ONID。在采用不同诊断听力图和不同年龄与性别修正方法的条件下,纳入4.0 k Hz听阈作为诊断听阈时对ONID的检出率较不纳入增加21.4%~34.5%(P<0.01)。结论 GBZ 49—2014中纳入权重为0.1的高频4.0 k Hz听阈作为诊断听阈,降低了ONID的诊断条件。

纳入不同高频听阈值对职业性噪声聋诊断结果的影响

目的探讨纳入不同高频听阈加权值对职业性噪声聋诊断结果的影响及程度，为职业性噪声聋诊断标准的修订提供理论依据。方法回顾性调查2016年1月至2017年1月在广东省职业病防治院进行职业性噪声聋诊断的病案，以在住院期间相隔3天以上的连续3次听力测试结果各频率听阈值最好点为依据，以2007版职业性噪声聋诊断标准为基础，采用SPSS21.0计数资料用卡方检验，计量资料用t检验及方差分析等方法，检验语频均值与纳入不同高频听阈加权值年龄分组、接触噪声工龄分组、诊断分级等不同维度进行比较并判断其差异性。结果符合研究病案168份，男154例，女14例，平均年龄（41.18±6.07）岁。纳入不同高频听阈加权值诊断率比单纯语频均值诊断率均有增高，其中加权4 kHz高频增加了13.69%（χ^2=9.880，P〈0.01）、加权6 kHz高频增加了15.47%（χ^2=9.985，P〈0.01）与加权4 kHz＋6 kHz高频增加了15.47%（χ^2=9.985，P〈0.01）增高最明显，且差异有统计学意义。男女性别比较在不同听阈间诊断率均无明显差异。年龄分组中，≤40岁组及41~50岁组中加权4 kHz高频、加权6 kHz高频、加权4 kHz＋6 kHz高频职业性噪声聋诊断率，均高于同组语频均值差异有统计学意义（均P〈0.01或P〈0.05）。年龄分组间比较，总体两组间诊断率无明显差异（χ^2=2.265，P〉0.05）。较好耳语频均值与纳入不同高频听阈加权值各工龄段均数比较中，工龄大于10年组各频段听阈均值明显高于3~5年组，差异有统计学意义（P〈0.05）。不同高频加权值均高于单纯语频均值，其中加权4 kHz＋6 kHz高频差异最大，平均增加了2.83 dB。纳入不同高频在轻度、中度、重度分级中诊断率均高于单纯语频诊断率。在诊断为轻度的比较中，除3 kHz高频（χ^2=3.117，P〉0.05）无明显差异外，其余4 kHz高频、6 kHz高频、3 kHz＋4 kHz高频、3 kHz＋6 kHz高频、4 kHz＋6 kHz高频、3 kHz＋4 kHz＋6 kHz高频均明显高于单纯语频诊断率（均P〈0.01或P〈0.05）。纳入不同高频在中度、重度分级比较中差异无统计学意义（P〉0.05）。结论纳入不同高频听阈加权值增加了职业性噪声聋的诊断率，其中加权4 kHz高频、6 kHz高频、4 kHz＋ 6kHz高频听阈值对结果的影响较大，4 kHz＋6 kHz高频听阈值影响最大。

职业性噪声聋诊断实践体会与建议

目的探讨职业性噪声聋诊断存在问题。方法回顾性分析2015年在深圳市职业病防治院申请职业性噪声聋诊断的164例病例资料。结果确诊为职业性噪声聋的有60例,确诊率为36.6%。104例未确诊职业性噪声聋的主要原因是:较好耳听阈加权值<26 d B(37/104),噪声作业工龄<3年(29/104),主客观听力检查结果不相符(27/104),双耳高频平均听阈<40 d B(7/104),噪声作业强度<85 d B(A)(4/104)。164例病例中,有149例(90.9%)分别经市、区、街道三级职业健康体检机构报告为"疑似职业性噪声聋",最终经医学观察有55例确诊为职业性噪声聋,职业性噪声聋诊断符合率为36.9%,不同级别职业健康体检机构职业性噪声聋诊断符合率比较,差异无统计学意义(P>0.05)。结论客观听力检查是鉴别夸大聋和伪聋的有效手段;应重视劳动者噪声聋诊断相关知识宣传教育,减少职业健康检查和职业病诊断夸大聋病例出现。

不同高频听阈对疑似职业性噪声聋诊断结果的影响

目的探讨在疑似职业性噪声聋诊断中应用不同高频听阈加权值的影响。方法针对清远市职业病防治院体检中心在2016年1月至2018年1月期间接诊的进行噪声作业的工人进行回顾性调查,根据《职业性噪声聋诊断标准》(GBZ 49-2007),对不同高频听阈加权值进行研究,首先进行诊断分级。根据年龄、性别、接害工龄等维度,予以对比分析,并研究其差异性。结果相比单纯语频,应用不同高频听阈加权值时,能得到更高的诊断率,加权3 k Hz提高了大约16.35%(χ^(2)=31.13,P<0.01)、4 k Hz增加了30.15%(χ^(2)=128.00,P<0.01)、6 k Hz增加了20.17%(χ^(2)=49.52,P<0.01)、(3+4)k Hz增加了22.29%(χ^(2)=62.16,P<0.01)、(3+6)k Hz增加了17.20%(χ^(2)=34.77,P<0.01)、(4+6)k Hz增加了25.26%(χ^(2)=83.20,P<0.01)、(3+4+6)k Hz增加了22.29%(χ^(2)=62.16,P<0.01),上述差异均有统计学意义;不同纳入标准的疑似职业性噪声聋诊断率在轻度(χ^(2)=205.77,P<0.01)、中度(χ^(2)=90.31,P<0.01)、重度(χ^(2)=29.82,P<0.01)比较中,差异均有统计学意义。结论在诊断疑似职业性噪声聋时,应用不同高频听阈能够有效提高诊断率,高频影响最高的是加权4 k Hz,诊断率提升较明显的还有加权(4+6)k Hz高频以及(3+4+6)k Hz高频。