1 Chemicals and Hearing Loss California Industrial Hygiene Conference December 4, 2006 LT Anne M....
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Transcript of 1 Chemicals and Hearing Loss California Industrial Hygiene Conference December 4, 2006 LT Anne M....
1
Chemicals and Hearing Loss
California Industrial Hygiene Conference December 4, 2006
LT Anne M. Jarrett, M.A., CCC-A
Occupational Audiologist, MSC, USN
Hearing Conservation Program
Naval Medical Center San Diego
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Hearing in the Work Environment Important for understanding:
Individually and others in the work environment critical orders warning and alerting signals (including listening to equipment
sounds) Productivity
general directions Job related communication between coworkers
Hearing can be difficult in the work environment poor acoustical environments
noise, distance, reverberation, distractions work space, intercoms, meetings, telephones, walkie-talkie
Compounded by any underlying hearing loss
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Workers in the United States 30 million individuals in the labor force who are exposed
to hazardous noise 9.5 million individuals who may be exposed to organic
solvents
1988 – Nat. Institute for Occup. Safety & Heath (NIOSH) began studying the solvents and HL
1998 - National Occupational Research Agenda (NORA) included noise + chemicals topic
2001 - NIOSH made available grants for investigating
2002 - NIOSH Best Practices Workshop (Effects of Chemicals & Noise on Hearing)
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Work Environments with Solvents Painting Printing Boat Building Construction Furniture Making Manufacturing of metal, leather, and petroleum
products
Cause: Spills, explosions/fires, industrial wastes, water contamination, occupational environment, etc.
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OtotoxinsOrganic solvents
** Toluene (printing)** Xylenes (plastics)** Styrenes (plastics)** Trichloroethylene (degrease)* Carbon Disulfide (textile)* Stoddard/white spirits* N-hexane Fuels (JP-8 fuel) Ethyl benzene Perchloroethylene Butyl Nitrite Methylene chloride
Metals* Mercury and derivatives* Lead and derivatives* Arsenic (atoxyl)* Manganese Trimethyltin (organic tin) Cobalt
Asphyxiants** Carbon Monoxide* Cyanide
Army ID: * potential ** high-priority
Drugs Aminoglycosides Loop diuretics Anti-neoplastic agents ASA Quinine compounds
Others Chem. warfare nerve agents Organophosphate (pesticide) Paraquat (pesticide)
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Morata,TC., Dunn,DE., Kretschmer, LW., Lemasters, GK., Keith, RW., Scandinavian Journal of Work, Environment & Health, 19(4): 245-54, 1993 Aug.
Paint and print industries - risk of hearing loss Unexposed (no noise or solvent) Noise exposed only – hearing loss risk 4x Toluene solvent only – hearing loss risk 5x Toluene solvents and noise –hearing loss risk 11x
Controls: previous exposure to noise and/or chemicals, medical and audiological history, age, length of employment, recreational exposure, and military service
Tests: puretones, immittance (tympanograms, reflexes, reflex decay)
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Problems caused by solvents Hearing Loss
Sensorineural Hearing Loss - Inner Ear Tuning (clarity and loudness) Testing: common audiometric procedures (Puretones, Speech, Other)
Central/Retrocochlear Hearing Loss - Brainstem and Cortex Processing (transmission, cognition, varying degrees of tuning and loudness) Testing:
Speech Processing (interrupted speech, speech in noise, temporal integration) Evoked Potentials (brainstem or cortical potentials), DPOAE: Contra-lateral suppression (efferent testing) Reflex and Reflex Decay Modified Puretone: masking level difference, gap detection, duration pattern, pitch
pattern, temporal integration, high frequency audiometry, step size less 5dB Questionnaire on speech discrimination difficulties or other auditory problems that
are inconsistent with thresholds
Disequilibrium, Headaches, Vision Problems, Neurological
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Many other causes of Hearing Loss Accumulative noise exposure
occupational and recreational
Disease Processes outer, middle, inner ear and combinations
Accidents Ototoxic exposure that are medical Aging Genetics: anatomical and sensitivity/susceptibility Medical contributions to poor hearing health
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Hearing Conservation Programs (HCP)
Most HCP have no mandate for chemical exposure
American Conference of Industrial Hygienists (ACGIH) Advise Monitoring
US Army (1998): Initiation enrollment when there is excessive
exposures to ototoxins (1 of 13 solvents) Monitoring (same as noise exposure)
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Questions with integrating into solvent exposure in HCP
Which solvents to include?
Excessive exposure levels?
Best audiometric test battery? Location of damage - Retrocochlear hearing loss Efficient Monitoring Program
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2002 Best Practices Workshop Comb. Effects of Chem. & Noise on Hearing NORA – Nat. Occupational Research Agenda NIOSH – Nat. Institute for Occupational Safety and Health NHCA – Nat. Hearing Conservation Association
Goal: Review current knowledge Determine how to address chemical exposures in hearing loss
prevention efforts
Next Slides:Main Results of the Workshop
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Current knowledge
Yes, enough evidence that solvents alone and solvents combined with noise exposure cause hearing, but more research is needed
Research does not capture all conditions/questions to outline a new national guideline for Hearing Conservation Programs
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Mechanistic Research guide research to determine auditory risk - affect
Understand the mechanisms by which chemicals affect the auditory system. Lead to a prediction of which chemicals to target by preventive efforts
Issues: Species respond differently – clues to the mechanism of
ototoxicity Toxic interactions – manipulate exposure parameters Physical or other factors considerations
Health status, genetics, and age of participants
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Rationale for Inclusion of Chemicalsguide research on specific solvents and establish recommendations for best practices
Magnitude of exposed population Evidence of chemical's ototoxicity, general
toxicity, and neurotoxicity Chemical produces reactive oxygen species
(free radicals) or glutathione depletion -cellular injury Glutathione –antioxidant that limits cell damage
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Exposure Issues Methods for administering chemicals
inhalation, dermal, injection sites Methods for evaluating exposures
Task-based exposures assessments experienced, specifically trained control variables)
Comprehensive noise measurements Biomarkers for type of cell damage in the ear Personal protective use Target workers who have held their jobs
Methods for assessing auditory effects Approach that discerns peripheral vs. central systems No gold standard auditory test battery
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Response Level and Action Concentration level at which protective action
(i.e.. enrolled in HCP) should be initiated What actions for various solvents
Intervals between testing HCP= annually
Alert/Criteria signal HCP = puretones significant threshold shift
Alternatives Evaluation/control exposure HCP = NIOSH 8 hour TWA =>85dB A SPL, hearing
protection, remove from noise
New training needs for exposed population HCP = initial and annual (effects, purpose testing & protection)
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Other Issues Identified Information Dissemination Database (IH, HCP) Other research questions
Development of standardized case history Interactions that modify the effects (smoking) Occurrence of tinnitus Incorporating neurological tests periodical
medical evaluations Antioxidant therapy impact on preventive
strategies
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Key points – Take home message Keep updated on new research findings and
guidelines Review exposures in current work area and workers No standard yet but it is coming Hearing is:
Complex (when damaged causes many problems) Painless (often taken for granted) Effects others (not just the hearing impaired) Permanent (except for many OM and ME problems) Accumulative and Progressive Often preventable