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Interventions to prevent occupational noise-induced hearing loss.

Abstract This is the second update of a Cochrane Review originally published in 2009. Millions of workers worldwide are exposed to noise levels that increase their risk of hearing disorders. There is uncertainty about the effectiveness of hearing loss prevention interventions.
Related Publications

Interventions to prevent occupational noise-induced hearing loss: a Cochrane systematic review.

Interventions to promote the wearing of hearing protection.

Interventions to promote the wearing of hearing protection.

Interventions to prevent occupational noise induced hearing loss.

Interventions to prevent occupational noise-induced hearing loss.


Mayor MeshTerms

Ear Protective Devices

Journal Title the cochrane database of systematic reviews
Publication Year Start

PMID- 28685503
DA  - 20170707
DCOM- 20170912
LR  - 20170912
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
VI  - 7
DP  - 2017 Jul 07
TI  - Interventions to prevent occupational noise-induced hearing loss.
PG  - CD006396
LID - 10.1002/14651858.CD006396.pub4 [doi]
AB  - BACKGROUND: This is the second update of a Cochrane Review originally published
      in 2009. Millions of workers worldwide are exposed to noise levels that increase 
      their risk of hearing disorders. There is uncertainty about the effectiveness of 
      hearing loss prevention interventions. OBJECTIVES: To assess the effectiveness of
      non-pharmaceutical interventions for preventing occupational noise exposure or
      occupational hearing loss compared to no intervention or alternative
      interventions. SEARCH METHODS: We searched the CENTRAL; PubMed; Embase; CINAHL;
      Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; and OSH UPDATE
      to 3 October 2016. SELECTION CRITERIA: We included randomised controlled trials
      (RCT), controlled before-after studies (CBA) and interrupted time-series (ITS) of
      non-clinical interventions under field conditions among workers to prevent or
      reduce noise exposure and hearing loss. We also collected uncontrolled case
      studies of engineering controls about the effect on noise exposure. DATA
      COLLECTION AND ANALYSIS: Two authors independently assessed study eligibility and
      risk of bias and extracted data. We categorised interventions as engineering
      controls, administrative controls, personal hearing protection devices, and
      hearing surveillance. MAIN RESULTS: We included 29 studies. One study evaluated
      legislation to reduce noise exposure in a 12-year time-series analysis but there 
      were no controlled studies on engineering controls for noise exposure. Eleven
      studies with 3725 participants evaluated effects of personal hearing protection
      devices and 17 studies with 84,028 participants evaluated effects of hearing loss
      prevention programmes (HLPPs). Effects on noise exposure Engineering
      interventions following legislationOne ITS study found that new legislation in
      the mining industry reduced the median personal noise exposure dose in
      underground coal mining by 27.7 percentage points (95% confidence interval (CI)
      -36.1 to -19.3 percentage points) immediately after the implementation of
      stricter legislation. This roughly translates to a 4.5 dB(A) decrease in noise
      level. The intervention was associated with a favourable but statistically
      non-significant downward trend in time of the noise dose of -2.1 percentage
      points per year (95% CI -4.9 to 0.7, 4 year follow-up, very low-quality
      evidence). Engineering intervention case studiesWe found 12 studies that
      described 107 uncontrolled case studies of immediate reductions in noise levels
      of machinery ranging from 11.1 to 19.7 dB(A) as a result of purchasing new
      equipment, segregating noise sources or installing panels or curtains around
      sources. However, the studies lacked long-term follow-up and dose measurements of
      workers, and we did not use these studies for our conclusions. Hearing protection
      devicesIn general hearing protection devices reduced noise exposure on average by
      about 20 dB(A) in one RCT and three CBAs (57 participants, low-quality evidence).
      Two RCTs showed that, with instructions for insertion, the attenuation of noise
      by earplugs was 8.59 dB better (95% CI 6.92 dB to 10.25 dB) compared to no
      instruction (2 RCTs, 140 participants, moderate-quality evidence). Administrative
      controls: information and noise exposure feedbackOn-site training sessions did
      not have an effect on personal noise-exposure levels compared to information only
      in one cluster-RCT after four months' follow-up (mean difference (MD) 0.14 dB;
      95% CI -2.66 to 2.38). Another arm of the same study found that personal noise
      exposure information had no effect on noise levels (MD 0.30 dB(A), 95% CI -2.31
      to 2.91) compared to no such information (176 participants, low-quality
      evidence). Effects on hearing loss Hearing protection devicesIn two studies the
      authors compared the effect of different devices on temporary threshold shifts at
      short-term follow-up but reported insufficient data for analysis. In two CBA
      studies the authors found no difference in hearing loss from noise exposure above
      89 dB(A) between muffs and earplugs at long-term follow-up (OR 0.8, 95% CI 0.63
      to 1.03 ), very low-quality evidence). Authors of another CBA study found that
      wearing hearing protection more often resulted in less hearing loss at very
      long-term follow-up (very low-quality evidence). Combination of interventions:
      hearing loss prevention programmesOne cluster-RCT found no difference in hearing 
      loss at three- or 16-year follow-up between an intensive HLPP for agricultural
      students and audiometry only. One CBA study found no reduction of the rate of
      hearing loss (MD -0.82 dB per year (95% CI -1.86 to 0.22) for a HLPP that
      provided regular personal noise exposure information compared to a programme
      without this information.There was very-low-quality evidence in four very
      long-term studies, that better use of hearing protection devices as part of a
      HLPP decreased the risk of hearing loss compared to less well used hearing
      protection in HLPPs (OR 0.40, 95% CI 0.23 to 0.69). Other aspects of the HLPP
      such as training and education of workers or engineering controls did not show a 
      similar effect.In three long-term CBA studies, workers in a HLPP had a
      statistically non-significant 1.8 dB (95% CI -0.6 to 4.2) greater hearing loss at
      4 kHz than non-exposed workers and the confidence interval includes the 4.2 dB
      which is the level of hearing loss resulting from 5 years of exposure to 85
      dB(A). In addition, of three other CBA studies that could not be included in the 
      meta-analysis, two showed an increased risk of hearing loss in spite of the
      protection of a HLPP compared to non-exposed workers and one CBA did not.
      AUTHORS' CONCLUSIONS: There is very low-quality evidence that implementation of
      stricter legislation can reduce noise levels in workplaces. Controlled studies of
      other engineering control interventions in the field have not been conducted.
      There is moderate-quality evidence that training of proper insertion of earplugs 
      significantly reduces noise exposure at short-term follow-up but long-term
      follow-up is still needed.There is very low-quality evidence that the better use 
      of hearing protection devices as part of HLPPs reduces the risk of hearing loss, 
      whereas for other programme components of HLPPs we did not find such an effect.
      The absence of conclusive evidence should not be interpreted as evidence of lack 
      of effectiveness. Rather, it means that further research is very likely to have
      an important impact.
FAU - Tikka, Christina
AU  - Tikka C
AD  - Cochrane Work Review Group, Finnish Institute of Occupational Health, PO Box 310,
      Kuopio, Finland, 70101.
FAU - Verbeek, Jos H
AU  - Verbeek JH
FAU - Kateman, Erik
AU  - Kateman E
FAU - Morata, Thais C
AU  - Morata TC
FAU - Dreschler, Wouter A
AU  - Dreschler WA
FAU - Ferrite, Silvia
AU  - Ferrite S
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Review
DEP - 20170707
PL  - England
TA  - Cochrane Database Syst Rev
JT  - The Cochrane database of systematic reviews
JID - 100909747
SB  - IM
UOF - Cochrane Database Syst Rev. 2012 Oct 17;10:CD006396. PMID: 23076923
MH  - Audiometry
MH  - Coal Mining/legislation & jurisprudence
MH  - Controlled Before-After Studies
MH  - *Ear Protective Devices
MH  - Engineering/methods
MH  - Health Education/standards
MH  - Hearing Loss, Noise-Induced/diagnosis/*prevention & control
MH  - Humans
MH  - Noise, Occupational/adverse effects/legislation & jurisprudence/*prevention &
MH  - Occupational Diseases/diagnosis/etiology/*prevention & control
MH  - Program Evaluation
MH  - Randomized Controlled Trials as Topic
EDAT- 2017/07/08 06:00
MHDA- 2017/09/13 06:00
CRDT- 2017/07/08 06:00
AID - 10.1002/14651858.CD006396.pub4 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2017 Jul 7;7:CD006396. doi: