特定频段高频噪声长期职业暴露对内耳听觉功能的影响：基于骨传导测听与物理声学模型分析-《中国医学物理学杂志》

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Title:: Effects of long-term occupational exposure to high-frequency noise in specific frequency bands on auditory function of the inner ear: an analysis based on bone conduction audiometry and acoustic physical model

文章编号:: 1005-202X（2024）11-1404-07

作者:: 陆天豪; 何建乔; 汪安昭; 周义德; 海军军医大学第一附属医院耳鼻喉科，上海 200082

Author(s):: LU Tianhao; HE Jianqiao; WANG Anzhao; ZHOU Yide; Department of Otolaryngology, the First Affiliated Hospital of Navy Medical University, Shanghai 200082, China

关键词:: 职业暴露; 高频噪声; 内耳; 听觉功能; 骨传导测听; 物理声学模型

Keywords:: Keywords: occupational exposure high-frequency noise inner ear auditory function bone conduction audiometry acoustic physical model

分类号:: R318.5；R135

DOI:: DOI:10.3969/j.issn.1005-202X.2024.11.012

文献标志码:: A

摘要:: 目的：探讨长期职业暴露于特定频段的高频噪声对内耳听觉功能的影响，基于骨传导测听与物理声学模型，评估高频噪声暴露对听觉阈值的损伤机制。方法：研究对象包括长期在高噪声环境中工作的工厂工人和机场地勤等职业人员，设立暴露组和对照组。暴露组按暴露年限分为5~9年、10~14年和15年以上3组，使用骨传导测听评估各频段（4、6、8 kHz）听觉阈值的变化，同时采用噪声计记录噪声暴露强度，结合物理声学模型模拟噪声对耳蜗的影响。通过多变量回归分析，控制年龄、性别等混杂因素，进一步分析暴露年限和强度对听觉损伤的独立影响。结果：暴露组在高频段的听觉阈值显著高于对照组，尤其在8 kHz频段（P<0.001）。随暴露年限的增加，暴露组听觉损伤逐渐加重，15年以上组的听觉阈值最为显著。物理声学模型预测与实际测量结果高度一致，长期暴露组的模型拟合度（R2：0.85~0.90）表明该模型对耳蜗损伤的累积效应具有较高的预测精度。结论：长期暴露于特定频段的高频噪声对内耳听觉功能具有显著的累积性损伤，暴露年限和强度是主要的独立影响因素。

Abstract:: Abstract: Objective To investigate the effects of long-term occupational exposure to high-frequency noise in specific frequency bands on auditory function of the inner ear, and to evaluate the mechanisms of auditory threshold damages due to high-frequency noise exposure utilizing bone conduction audiometry and acoustic physical models. Methods The study subjects included factory workers and airport ground staff working in high-noise environments for a long period. Two groups (an exposure group and a control group) were established, and the exposure group was further divided into 3 subgroups according to exposure duration: 5-9 years, 10-14 years, and over 15 years. Bone conduction audiometry was used to assess auditory threshold changes in different frequency bands (4, 6, 8 kHz), while a sound level meter was employed to record noise exposure intensity. The impact of noise on the cochlea was simulated using an acoustic physical model. Multivariable regression analysis, controlling for confounding factors such as age and gender, was used to further analyze the independent effects of exposure duration and intensity on auditory damage. Results The auditory thresholds of exposure group were significantly higher than those of control group in the high-frequency bands, particularly in 8 kHz frequency band (P<0.001). With increasing exposure duration, auditory damage in exposure group progressively worsened, and the most significant auditory threshold changes was found in the group exposed for over 15 years. The predictions made by the acoustic physical model closely matched the actual measurements, and the high model fitting degree (R2: 0.85-0.90) in the long-term exposure group indicated a strong predictive capability for the cumulative effects of cochlear damage. Conclusion Long-term exposure to high-frequency noise in specific frequency bands results in significant cumulative damage to auditory function of the inner ear. Exposure duration and intensity are the primary independent risk factors.

《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]

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