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Life cycle analysis of noise and hearing handicap in Finland
Esko Toppila1, Ilmari Pyykkö2, Rauno Pääkkönen1
1=Finnish Institute of Occupational Health2=University of Tampere
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Noise and Work
Military branch
Industry
Services
Schools
Environment
Annoyance Communication Hearing loss
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Characteristics of work in 20th century (Ruben 2000)
0
10
20
3040
50
60
70
80
90
1900 1950 2000
Physical Communication
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Hearing handicap
• Symptoms– hearing loss– hyperacusia– difficulties in sound localisation– tinnitus– reduced speach intelligibility especially in ambient noise– diplacusis – --.
• Symptoms start typically in age of 45– First affect in poor acoustical conditions
95,0
85,0
75,0
65,0
55,0
45,0
35,0
25,0
15,0
300
200
100
0
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Classification of hearing handicaps
• Non-noise induced (>10 % of people under 65)– Presbyacusis
• Often genetic background• CNS infection, ear infection• sociocusis
– Middle ear problems (seldom)
• Noise induced (<10 % of workers in noise over 85 dB)– Acute trauma– Chronic trauma (The "real" hearing handicap)
• Evaluation based on audiogram• Tinnitus .. do not affect typically
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Social effects of hearing handicap
• Reduced speech intelligibility– Do no understand especially in ambient noise– Social isolation– Mental problems (. 2x)
• Tendency to believe that others make fun– Increased accident risk
• Misunderstanding instructions• Failure to hear warning signals
– Reduced career opportunities• Training difficult speech• is not understood
– Increased risk of unemplyoment• " dumb people do not work here"
• Reduced capability to localize sounds– Increased accident risk
• if moving machines around– Reduced speech intelligibility
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Social effects of hearing handicap
• Tinnitus– Increased annoyance– may interfere with warning signals– sleep disturbance– avoidance of social noisy events
• concerts, public events,….
– …
• Hyperacusia– stress– avoidance of social noisy events
• concerts, public events,…
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Self evaluated hearing
Q114
3.53.02.52.01.51.0.5
Mea
n le
vel a
t sp
eech
fre
qu
enci
es (
0.5-
2 kH
z)
60
50
40
30
20
10
0
-10
Normal Mild Moderate
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Quality of life and self-evaluated hearing
115161257147N =
Self-evaluated hearing
Deafalmost deaf
Some difficulties
Minor problems
Normal
EQ
-5D
th
erm
om
ete
r
80
70
60
50
40
30
20
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Effect of hearing in different populations
0.5
0.55
0.6
0.65
0.7
0.75
0.8
0.85
0.9
TAYS<66 Laminoijat Puusepät KorkeaKommunikaatio
Normaali
Lievä
Kohtalainen
Vakava
0.5
0.55
0.6
0.65
0.7
0.75
0.8
0.85
0.9
Users ofhearing aids
Physical workers
Technicians High commworkers
Normal
Mild
Moderate
Almost deaf
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Life cycle of noise
NosocusisDiscos and concertsEquipment
Infections
Conscript noise
Life styleWork noise
Ambient noise
Ambient noiseFree time noise
Earlyretirementdementia
(0-5 y) (20-30 y)(45-68 y)
Accumulation of noise effects
- Vaccination- Personal pacifier
-Exercise-Noise limits in discos-Teaching attitudes
-Hearing protection-Healthier life style
-Personal hearing solutions- Office noise
Earlier accessto hearing aids
-Better hearingprotection
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Estimates of the size of the problem
• Number of conscripts with hearing loss >20 dB at any frequency has increased from 13 % to 20 %
– Noise ?– Life style factors (Young age cholesterol RR=7.2, Pyykkö et
al 2007)– Kindergarten infections ?
• Call centers (Toppila et al 2008)– 15 -25% complaints about hearing– Demanding job -> subclinical hearing loss important
• Protection against work noise not efficient– In elderly people in noisy occupations overpresented in
hearing aids fitting– Factor ~2
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Size of problem
• Finland looses 21 B€ every year because of early removal from workforce (Ahonen, Vainio 2010)
• Hearing impairment seems to be involved in 5-15 % of the cases
– Annual cost 2.1 B€ (Extrapolated to US 176 B$)– Mostly from work not done– Direct costs 200-400 M€ (Extrapolated to US 2.5B$)
• These calculations exclude – Lost career opportunities– Effect on pensionnaires
• earlier dementia etc.
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Hearing loss, removal from workforce and statistics (Total workforce 2.2 M)
Toistuvatkorvatulehdukset
Vapaa-ajanMelu
Nuoren iänkolesteroli
Riskitekijät
Risk group
Asevelvollisuusmelu
300-500
300-500
100-400
700
1000
1000
Unempolyment
Hearing loss 50%
130%
3000
2000Ei työmelua: 1600 000
Ototoksinenlääkitys
Chemicals, vibration, medication
30-40?
Statistics
Noise caused accident0%
70
<10
500?
Repeatedinfections
Free time -noise
Young agecholersterol
Risk factorsj
Worknoise
for earlyremoval from workforce250 000
Conscript noise
300-500
300-500
100-400
700
1000
1000
Early retirement
NIHL
50%
130%
3000
2000
Work noise 400 0000
No worknoise: 1600 000
Accident
Dementia
Ototoxicmedication
Combined exposure
30-40?
Stat
A0%
70
<10
500?
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Potential for savings
• Reduction of sociocusis, early age effects 30%• Reduction of Noise Induced Hearing Loss 70 %
– Not 100 % because of overdiagnosis
• Totally in work force ~35%– 750M€/y (US 62 B$)
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Discussion
• Noise is underestimated problem in modern societies– Affects people with hearing handicap in harsh
communication environments
• Cause for underestimation– Affects several factors– Never the most important factor but ranked 3-5 (de
Hollander et al 1999)
• To reduce the adverse effects of noise– work noise protection– reduction of nosocusis– protection of free time noise