The Official Patient's Sourcebook On Noise-induced Hearing Loss: Directory For The Internet Age

THE OFFICIAL PATIENT’S SOURCEBOOK on NOISE-INDUCED HEARING LOSS J AMES N. P ARKER , M.D. AND P HILIP M. P ARK...

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THE OFFICIAL

PATIENT’S SOURCEBOOK

on

NOISE-INDUCED

HEARING LOSS

J AMES N. P ARKER , M.D.

AND P HILIP M. P ARKER , P H .D., E DITORS

ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2004 by ICON Group International, Inc. Copyright Ó2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961 Parker, Philip M., 1960 The Official Patient’s Sourcebook on Noise-Induced Hearing Loss: A Revised and Updated Directory for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm.

Includes bibliographical references, glossary and index.

ISBN: 0-597-84196-9

1. Noise-Induced Hearing Loss-Popular works. I. Title.

Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this sourcebook for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this sourcebook.

Dedication To the healthcare professionals dedicating their time and efforts to the study of noiseinduced hearing loss.

Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to noise-induced hearing loss. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

v

About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.

Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.

vi

About ICON Health Publications

In addition to noise-induced hearing loss, Official Patient’s Sourcebooks are available for the following related topics: ·

The Official Patient's Sourcebook on Acoustic Neurinoma

·

The Official Patient's Sourcebook on Balance Disorders

·

The Official Patient's Sourcebook on Cochlear Implants

·

The Official Patient's Sourcebook on Hearing Loss

·

The Official Patient's Sourcebook on Landau-kleffner Syndrome

·

The Official Patient's Sourcebook on Ménière Disease

·

The Official Patient's Sourcebook on Otitis Media

·

The Official Patient's Sourcebook on Otosclerosis

·

The Official Patient's Sourcebook on Presbycusis

·

The Official Patient's Sourcebook on Sudden Sensorineural Hearing Loss

·

The Official Patient's Sourcebook on Tinnitus

·

The Official Patient's Sourcebook on Usher Syndrome

·

The Official Patient's Sourcebook on Waardenburg Syndrome

To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc.

4370 La Jolla Village Drive, Fourth Floor

San Diego, CA 92122 USA

Fax: 858-546-4341

Web site: www.icongrouponline.com/health

Table of Contents INTRODUCTION ...................................................................................... 1

Overview ...............................................................................................................1

Organization .........................................................................................................3

Scope ......................................................................................................................3

Moving Forward ...................................................................................................4

PART I: THE ESSENTIALS ................................................. 7

CHAPTER 1. THE ESSENTIALS ON NOISE-INDUCED HEARING LOSS:

GUIDELINES ........................................................................................... 9

Overview ...............................................................................................................9

Noise and Hearing Loss.......................................................................................10

What Is Noise-Induced Hearing Loss?................................................................12

What Sounds Can Damage Hearing? .................................................................16

Susceptibility to Noise-Induced Hearing Loss? ..................................................18

Differences within Individuals ............................................................................20

What Can Be Done to Prevent Noise-Induced Hearing Loss? ...........................21

What Are the Directions for Future Research?...................................................24

Conclusions and Recommendations ....................................................................25

More Guideline Sources ......................................................................................25

Vocabulary Builder..............................................................................................36

CHAPTER 2. SEEKING GUIDANCE ....................................................... 39

Overview .............................................................................................................39

Finding Associations ...........................................................................................39

Finding Doctors...................................................................................................41

Finding an Otolaryngologist...............................................................................42

Selecting Your Doctor .........................................................................................43

Working with Your Doctor .................................................................................43

Broader Health-Related Resources ......................................................................45


PART II: ADDITIONAL RESOURCES AND

ADVANCED MATERIAL.................................................. 47

CHAPTER 3. STUDIES ON NOISE-INDUCED HEARING LOSS................ 49

Overview .............................................................................................................49

The Combined Health Information Database ......................................................49

Federally Funded Research on Noise-Induced Hearing Loss..............................52

The National Library of Medicine: PubMed .......................................................60


CHAPTER 4. PATENTS ON NOISE-INDUCED HEARING LOSS .............. 63

Overview .............................................................................................................63

Patent Applications on Noise-Induced Hearing Loss .........................................64

viii Contents

Keeping Current..................................................................................................64

CHAPTER 5. BOOKS ON NOISE-INDUCED HEARING LOSS .................. 67

Overview .............................................................................................................67

Book Summaries: Federal Agencies.....................................................................67

Chapters on Noise-Induced Hearing Loss...........................................................68

General Home References ....................................................................................79


CHAPTER 6. MULTIMEDIA ON NOISE-INDUCED HEARING LOSS ....... 81

Overview .............................................................................................................81

Video Recordings.................................................................................................81

Audio Recordings ................................................................................................82

CHAPTER 7. PERIODICALS AND NEWS ON NOISE-INDUCED HEARING

LOSS ..................................................................................................... 85

Overview .............................................................................................................85

News Services and Press Releases.......................................................................85

Newsletters on Noise-Induced Hearing Loss ......................................................87

Newsletter Articles..............................................................................................88


CHAPTER 8. PHYSICIAN GUIDELINES AND DATABASES ..................... 93

Overview .............................................................................................................93

NIH Guidelines ...................................................................................................93

NIH Databases ....................................................................................................94

Other Commercial Databases ..............................................................................99

PART III. APPENDICES .................................................. 101

APPENDIX A. RESEARCHING ALTERNATIVE MEDICINE ................... 103

Overview ...........................................................................................................103

What Is CAM? ..................................................................................................103

What Are the Domains of Alternative Medicine? ............................................104

Can Alternatives Affect My Treatment? ..........................................................107

Additional Web Resources.................................................................................109

General References.............................................................................................109

APPENDIX B. FINDING MEDICAL LIBRARIES..................................... 113

Overview ...........................................................................................................113

Preparation ........................................................................................................113

Finding a Local Medical Library .......................................................................114

Medical Libraries in the U.S. and Canada ........................................................114

APPENDIX C. YOUR RIGHTS AND INSURANCE ................................. 121

Overview ...........................................................................................................121

Your Rights as a Patient ...................................................................................121

Patient Responsibilities .....................................................................................125

Choosing an Insurance Plan .............................................................................126

Medicare and Medicaid .....................................................................................128

Contents

ix

NORD’s Medication Assistance Programs ......................................................131

Additional Resources.........................................................................................132

APPENDIX D. HOW LOUD IS TOO LOUD? ........................................ 135

ONLINE GLOSSARIES.................................................... 137

Online Dictionary Directories ..........................................................................138

NOISE-INDUCED HEARING LOSS GLOSSARY .... 139

General Dictionaries and Glossaries .................................................................143

INDEX................................................................................... 145

1

INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don't know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3

Quotation from http://www.drkoop.com.

The Agency for Healthcare Research and Quality (AHRQ):

http://www.ahcpr.gov/consumer/diaginfo.htm.

3 From the NIH, National Cancer Institute (NCI):

http://cancertrials.nci.nih.gov/beyond/evaluating.html.

1 2

2

Noise-Induced Hearing Loss

Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor's offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The Official Patient’s Sourcebook on Noise-Induced Hearing Loss has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to noise-induced hearing loss, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on noiseinduced hearing loss. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on noise-induced hearing loss should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on

Introduction

3

appropriate options is always up to the patient in consultation with their physician and healthcare providers.

Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching noise-induced hearing loss (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to noise-induced hearing loss. It also gives you sources of information that can help you find a doctor in your local area specializing in treating noise-induced hearing loss. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with noise-induced hearing loss. Part II moves on to advanced research dedicated to noise-induced hearing loss. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on noise-induced hearing loss. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “free-to-use” options. Part III provides appendices of useful background reading for all patients with noise-induced hearing loss or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with noiseinduced hearing loss. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with noise-induced hearing loss.

Scope While this sourcebook covers noise-induced hearing loss, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that noise-induced hearing loss is often considered a synonym or a condition closely related to the following:

4

Noise-Induced Hearing Loss

·

Hearing Loss due to Noise

·

Noise Induced Hearing Impairment

In addition to synonyms and related conditions, physicians may refer to noise-induced hearing loss using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world's illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for noise-induced hearing loss:4 ·

388.12 noise-induced hearing loss

For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to noise-induced hearing loss. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.

Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses. Some are written by patients or their family members. These generally take a layperson's approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful. As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian.

4 This list is based on the official version of the World Health Organization's 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, "ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government."

Introduction

5

Why “Internet age”? All too often, patients diagnosed with noise-induced hearing loss will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients are left to wonder where the relevant information is, and how to obtain it. Since only the smallest fraction of information dealing with noise-induced hearing loss is even indexed in search engines, a nonsystematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. While we focus on the more scientific aspects of noise-induced hearing loss, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors

7

PART I: THE ESSENTIALS

ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on noise-induced hearing loss. The essentials of a disease typically include the definition or description of the disease, a discussion of who it affects, the signs or symptoms associated with the disease, tests or diagnostic procedures that might be specific to the disease, and treatments for the disease. Your doctor or healthcare provider may have already explained the essentials of noise-induced hearing loss to you or even given you a pamphlet or brochure describing noise-induced hearing loss. Now you are searching for more in-depth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.

9

CHAPTER 1. THE ESSENTIALS ON NOISE-INDUCED HEARING LOSS: GUIDELINES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines on noise-induced hearing loss. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on noise-induced hearing loss can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

The National Institutes of Health (NIH)5 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on noise-induced hearing loss. Originally founded in 1887, the NIH is one of the world's foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world's most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine. 5

Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.

10 Noise-Induced Hearing Loss

There is no guarantee that any one Institute will have a guideline on a specific disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare diseases. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with noise-induced hearing loss and associated conditions: ·

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

·

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html

·

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines available at http://www.nidcd.nih.gov/health/health.htm

Among the above, the National Institute on Deafness and Other Communication Disorders (NIDCD) is particularly noteworthy. The mission of the NIDCD is to conduct and support biomedical and behavioral research and research training in the normal and disordered processes of hearing, balance, smell, taste, voice, speech, and language.6 The Institute also conducts and supports research and research training related to disease prevention and health promotion; addresses special biomedical and behavioral problems associated with people who have communication impairments or disorders; and supports efforts to create devices which substitute for lost and impaired sensory and communication function. The following patient guideline was recently published by the NIDCD on noise-induced hearing loss.

Noise and Hearing Loss7 Hearing loss afflicts approximately 28 million people in the United States. Approximately 10 million of these impairments are at least partially 6 This paragraph has been adapted from the NIDCD:

http://www.nidcd.nih.gov/about/about.htm. “Adapted” signifies that a passage has been

reproduced exactly or slightly edited for this book.

7 Adapted from the National Institute on Deafness and Other Communication Disorders

(NIDCD): http://text.nlm.nih.gov/nih/cdc/www/76txt.html#Head2.

Guidelines 11

attributable to damage from exposure to loud sounds. Sounds that are sufficiently loud to damage sensitive inner ear structures can produce hearing loss that is not reversible by any presently available medical or surgical treatment. Hearing impairment associated with noise exposure can occur at any age, including early infancy, and is often characterized by difficulty in understanding speech and the potentially troublesome symptom, tinnitus (i.e., ringing in the ears). Very loud sounds of short duration, such as an explosion or gunfire, can produce immediate, severe, and permanent loss of hearing. Longer exposure to less intense but still hazardous sounds, commonly encountered in the workplace or in certain leisure time activities, exacts a gradual toll on hearing sensitivity, initially without the victim’s awareness. More than 20 million Americans are exposed on a regular basis to hazardous noise levels that could result in hearing loss. Occupational noise exposure, the most common cause of noise-induced hearing loss (NIHL), threatens the hearing of firefighters, police officers, military personnel, construction and factory workers, musicians, farmers, and truck drivers, to name a few. Live or recorded high-volume music, recreational vehicles, airplanes, lawn-care equipment, woodworking tools, some household appliances, and chain saws are examples of non-occupational sources of potentially hazardous noise. One important feature of NIHL is that it is preventable in all but certain cases of accidental exposure. Legislation and regulations have been enacted that spell out guidelines for protecting workers from hazardous noise levels in the workplace and consumers from hazardous noise during leisure time pursuits. Inconsistent compliance and spotty enforcement of existing governmental regulations have been the underlying cause for their relative ineffectiveness in achieving prevention of NIHL. A particularly unfortunate occurrence was the elimination of the Office of Noise Abatement and Control within the Environmental Protection Agency in 1982. On January 22-24, 1990, the National Institute on Deafness and Other Communication Disorders, together with the Office of Medical Applications of Research of the National Institutes of Health, convened a Consensus Development Conference on Noise and Hearing Loss. Cosponsors of the conference were the National Institute of Child Health and Human Development, the National Institute on Aging, and the National Institute for Occupational Safety and Health of the Centers for Disease Control. The effects of environmental sounds on human listeners may include: ·

Interference with speech communication and other auditory signals.


·

Annoyance and aversion.

·

Noise-induced hearing loss.

·

Changes in various body systems.

·

Interference with sleep.

This conference was entirely centered on NIHL. The panel focused on five questions related to noise and hearing loss: ·

What is noise-induced hearing loss?

·

What sounds can damage hearing?

·

What factors, including age, determine an individual’s susceptibility to noise-induced hearing loss?

·

What can be done to prevent noise-induced hearing loss?

·

What are the directions for future research?

Following a day and a half of presentations by experts in the relevant fields and discussion from the audience, a consensus panel comprising specialists and generalists from the medical and other related scientific disciplines, together with public representatives, considered the evidence and formulated a consensus statement in response to the five previously stated questions.

What Is Noise-Induced Hearing Loss? Sounds of sufficient intensity and duration will damage the ear and result in temporary or permanent hearing loss. The hearing loss may range from mild to profound and may also result in tinnitus. The effect of repeated sound overstimulation is cumulative over a lifetime and is not currently treatable. Hearing impairment has a major impact on one’s communication ability and even mild impairment may adversely affect the quality of life. Unfortunately, although NIHL is preventable, our increasingly noisy environment places more and more people at risk. Studies of NIHL Most studies of the association between sound exposure and hearing loss in humans are retrospective measurements of the hearing sensitivities of numerous individuals correlated with their noise exposures. The variability

Guidelines 13

within these studies is usually large; thus, it is difficult to predict the precise magnitude of hearing loss that will result from a specific sound exposure. Prospective studies of selected workers’ hearing levels over a long time while their sound exposures are carefully monitored are costly and timeconsuming and, due to attrition, require a large number of subjects. When significant hearing loss is found, for ethical reasons, exposures must be reduced, interfering with the relationships under study. Although studies of NIHL in humans are difficult, they provide valuable information not available from animal studies and should be continued. In prospective animal studies, sound exposures can be carefully controlled, and the anatomic and physiologic correlates of NIHL can be precisely defined. Although there may be interspecies differences with respect to the absolute sound exposure that will injure the ear, the basic mechanisms that lead to damage appear to be similar in all mammalian ears.

Anatomic and Physiologic Correlates of NIHL Two types of injury are recognized: acoustic trauma and NIHL. Shortduration sound of sufficient intensity (e.g., a gunshot or explosion) may result in an immediate, severe, and permanent hearing loss, which is termed acoustic trauma. Virtually all of the structures of the ear can be damaged, in particular the organ of Corti, the delicate sensory structure of the auditory portion of the inner ear (cochlea), which may be torn apart. Moderate exposure may initially cause temporary hearing loss, termed temporary threshold shift (TTS). Structural changes associated with TTS have not been fully established but may include subtle intracellular changes in the sensory cells (hair cells) and swelling of the auditory nerve endings. Other potentially reversible effects include vascular changes, metabolic exhaustion, and chemical changes within the hair cells. There is also evidence of a regional decrease in the stiffness of the stereocilia (the hair bundles at the top of the hair cells), which may recover. This decrease in stereocilia stiffness may lead to a decrease in the coupling of sound energy to the hair cells, which thereby alters hearing sensitivity. Repeated exposure to sounds that cause TTS may gradually cause permanent NIHL in experimental animals. In this type of injury, cochlear blood flow may be impaired, and a few scattered hair cells are damaged with each exposure. With continued exposure, the number of damaged hair cells increases. Although most structures in the inner ear can be harmed by excessive sound exposure, the sensory cells are the most vulnerable. Damage


to the stereocilia is often the first change, specifically, alteration of the rootlet structures that normally anchor the stereocilia into the top of the hair cell. Once destroyed, the sensory cells are not replaced. During the recovery period between some sound exposures, damaged regions of the organ of Corti heal by scar formation. This process is very important because it reestablishes the barrier between the two fluids of the inner ear (perilymph and endolymph). If this barrier is not reestablished, degeneration of hair cells may continue. Further, once a sufficient number of hair cells are lost, the nerve fibers to that region also degenerate. With degeneration of the cochlear nerve fibers, there is corresponding degeneration within the central nervous system. The extent to which these neural changes contribute to NIHL is not clear. With moderate periods of exposure to potentially hazardous high-frequency sound, the damage is usually confined to a restricted area in the highfrequency region of the cochlea. With a comparable exposure to lowfrequency noise, hair cell damage is not confined to the low-frequency region but may also affect the high-frequency regions. The predominance of damage in different cochlear regions with different frequency exposures reflects factors such as the resonance of the ear canal, the middle-ear transfer characteristics, and the mechanical characteristics of the organ of Corti and basilar membrane. Assessment of NIHL Hearing loss is measured by determining auditory thresholds (sensitivity) at various frequencies (pure-tone audiometry). Complete assessment should also include measures of speech understanding and middle-ear status (immittance audiometry). Pure-tone audiometry is also used in industrial hearing conservation programs to determine whether adequate protection against hazardous sound levels is provided. The first audiometric sign of NIHL resulting from broadband noise is usually a loss of sensitivity in the higher frequencies from 3,000 through 6,000 Hertz (Hz) (i.e., cycles per second), resulting in a characteristic audiometric “notch.” With additional hearing loss from noise or aging, the threshold at 8,000 Hz may worsen and eliminate this characteristic audiometric pattern. Thus, the presence or absence of NIHL cannot be established on the basis of audiometric shape, per se. The hearing loss is usually bilateral, but some degree of asymmetry is not unusual, especially with lateralized noise sources such as rifles. After moderate sound exposure, TTS may occur, and, during a period of relative quiet, thresholds will return to normal levels. If the

Guidelines 15

exposure continues on a regular basis, permanent threshold shifts (PTS) will result, increasing in magnitude and extending to lower and higher frequencies. If the exposures continue, NIHL increases, more rapidly in the early years. After many years of exposure, NIHL levels off in the high frequencies, but continues to worsen in the low frequencies. Although TTS and PTS are correlated, the relation is not strong enough to use TTS to predict the magnitude of permanent hearing loss. An important consequence of the sensitivity loss associated with NIHL is difficulty in understanding speech. Whereas a large proportion of the energy in speech is contained within the low-frequency range, much of the information required to differentiate one speech sound from another is contained within the higher frequencies. With significant hearing loss in the high frequencies, important speech information is often inaudible or unusable. Other interfering sounds such as background noise, competing voices, or room reverberation may reduce even further the hearing-impaired listener’s receptive communication ability. The presence of tinnitus may be an additional debilitating condition. NIHL may interfere with daily life, especially those social activities that occur in noisy settings. Increased effort is required for understanding speech in these situations, which leads to fatigue, anxiety, and stress. Decreased participation in these activities often results, affecting not only hearingimpaired individuals but also friends and family members. Hearing loss is associated with depression in the elderly and may be related to dementia and cognitive dysfunction. Systematic study of the effects of hearing loss on the quality of life have only lately focused specifically on individuals with NIHL; therefore, continued studies of this kind are desirable. The impairment in hearing ability resulting from NIHL may vary from mild to severe. An individual’s ability to communicate and function in daily life varies with the degree of loss and the individual’s communication needs although these relationships are complex. The magnitude of the effect on communication ability may be estimated by a variety of scales, which are often used in disability determinations. These scales, which vary substantially in the frequencies used, the upper and lower limits of impairment, age correction, and adjustment for asymmetric hearing loss, attempt to predict the degree of communication impairment (understanding of speech) on the basis of pure-tone thresholds. There is no consensus about the validity or utility of the scales, which scale should be used, whether measures of speech understanding should be included, or whether selfassessment ratings should be incorporated into either impairment rating scales or disability determinations.


What Sounds Can Damage Hearing? Some sounds are so weak physically that they are not heard. Some sounds are audible but do not have any temporary or permanent after-effects. Some sounds are strong enough to produce a temporary hearing loss from which there may appear to be complete recovery. Damaging sounds are those that are sufficiently strong, sufficiently long-lasting, and involve appropriate frequencies so that permanent hearing loss will ensue. Most of the sounds in the environment that produce such permanent effects occur over a very long time (for example, about 8 hours per workday over a period of 10 or more years). On the other hand, there are some particularly abrupt or explosive sounds that can cause damage even with a single exposure. The line between these categories of sounds cannot be stated simply because not all persons respond to sound in the same manner. Thus, if a sound of given frequency bandwidth, level, and duration is considered hazardous, one must specify for what proportion of the population it will be hazardous and, within that proportion, by what criterion of damage (whether anatomical, audiometric, speech understanding) it is hazardous. The most widely used measure of a sound’s strength or amplitude is called “sound level,” measured by a sound-level meter in units called “decibels” (dB). For example, the sound level of speech at typical conversational distances is between 65 and 70 dB. There are weaker sounds, still audible, and of course much stronger sounds. Those above 85 dB are potentially hazardous. Sounds must also be specified in terms of frequency or bandwidth, roughly like the span of keys on a piano. The range of audible frequencies extends from about 20 Hz, below the lowest notes on a piano, to at least 16,000 or 20,000 Hz, well above the highest notes on a piccolo. Most environmental noises include a wide band of frequencies and, by convention, are measured through the “A” filter in the sound-level meter and thus are designated in dB(A) units. It is not clear what effect, if any, sound outside the frequency range covered in dB(A) measurements may have on hearing. At this time, it is not known whether ultrasonic vibration will damage hearing. To define what sounds can damage hearing, sound level, whether across all frequency bands or taken band by band, is not enough. The duration of

Guidelines 17

exposure--typical for a day and accumulated over many years--is critical. Sound levels associated with particular sources such as snowmobiles, rock music, and chain saws, are often cited, but predicting the likelihood of NIHL from such sources also requires knowledge of typical durations and the number of exposures. There appears to be reasonable agreement that sound levels below 75 dB(A) will not engender a permanent hearing loss, even at 4000 Hz. At higher levels, the amount of hearing loss is directly related to sound level for comparable durations. According to some existing rules and regulations, a noise level of 85 dB(A) for an 8-hour daily exposure is potentially damaging. If total sound energy were the important predictor, an equivalent exposure could be as high as 88 dB(A) if restricted to 4 hours. (A 3-dB increase is equivalent to doubling the sound intensity.) This relation, enshrined in some standards and regulations, is a theory based on a dose or exposure defined by total energy. In spite of the physical simplicity of a total-energy concept, other principles have been invoked to define equivalent exposures of different sound levels and durations. Early research suggested that NIHL after 10 years could be predicted from temporary threshold shifts (TTS) measured 2 minutes after a comparable single-day exposure. Those results, however, were taken to indicate that a halving of duration could be offset by a 5-dB change in sound level rather than a 3-dB change. This 5-dB rule is implemented in the WalshHealey Act of 1969 and subsequent Occupational Safety and Health Administration regulations for the purpose of requiring preventive efforts for noise-exposed workers. The 3-dB trading rule is agreed to in International Standards Organization (ISO) Standard 1999.2 (1989) for the purpose of predicting the amount of noise-induced hearing loss resulting from different exposures. There is no consensus concerning a single rule to be used for all purposes in the United States. Generally, for sound levels below about 140 dB, different temporal forms of sound, whether impulse (gunshot), impact (drop forge) or steady state (turbine), when specified with respect to their level and duration, produce the same hearing loss. This does not appear to follow at levels above 140 dB, where impulse noise creates more damage than would be predicted. This may imply that impulse noise above a certain critical level results in acoustic trauma from which the ear cannot recover. Although sound exposures that are potentially hazardous to hearing are usually defined in terms of sound level, frequency bandwidths, and


duration, there are several simple approximations that indicate that a sound exposure may be suspected as hazardous. These include the following: If the sound is appreciably louder than conversational level, it is potentially harmful, provided that the sound is present for a sufficient period of time. Hazardous noise may also be suspected if the listener experiences: (a) difficulty in communication while in the sound, (b) ringing in the ear (tinnitus) after exposure to the sound, and/or (c) the experience that sounds seem muffled after leaving the sound-exposure area. In the consideration of sounds that can damage hearing, one point is clear: it is the acoustic energy of the sound reaching the ear, not its source, which is important. That is, it does not matter if the hazardous sound is generated by a machine in the workplace, by an amplifier/loudspeaker at a rock concert, or by a snowmobile ridden by the listener. Significant amounts of acoustic energy reaching the ear will create damage--at work, at school, at home, or during leisure activities. Although there has been a tendency to concentrate on the more significant occupational and transportation noise, the same rules apply to all potential noise hazards.

Susceptibility to Noise-Induced Hearing Loss? One thoroughly established characteristic of NIHL is that, on the average, more intense and longer-duration noise exposures cause more severe hearing loss. A second is that there is a remarkably broad range of individual differences in sensitivity to any given noise exposure. Several factors have been proposed to explain differences in NIHL among individuals; others may be associated with differences over time within the same individual. It is important to distinguish those factors whose roles in determining susceptibility are supported by a consistent body of theory and empirical evidence from other factors whose roles have been proposed but for which theory, data, or both are less conclusive.

Differences among Individuals Both temporary threshold shift (TTS) and permanent threshold shift (PTS) in response to a given intense noise may differ as much as 30 to 50 dB among individuals. Both animal research and retrospective studies of humans exposed to industrial noise have demonstrated this remarkable variation in susceptibility. The biological bases for these differences are unknown. A number of extrinsic factors (e.g., characteristics of the ear canal and middle ear, drugs, and prior exposure to noise) may influence an individual’s

Guidelines 19

susceptibility to NIHL. However, animal studies that have controlled these variables suggest that individual differences in inner ear anatomy and physiology also may be significant. Additional research is necessary to determine whether vascular, neural feedback (efferent system), or other mechanisms can account for and predict such individual variation. One factor that may be associated with decreased susceptibility to NIHL is conductive hearing loss; the cochlear structures may be protected by any form of acoustic attenuation. For similar reasons, middle ear muscles, which normally serve a protective function by contracting in response to intense sound, when inoperative, can result in increased susceptibility. Among the other factors that are theoretically associated with differences in susceptibility are (a) unusually efficient acoustic transfer through the external and middle ear, as a determinant of the amount of energy coupled to the inner ear structures, and (b) preexisting hearing loss, which could imply that less additional loss would occur if the sensitive structures have already been damaged. Support for these hypotheses has been modest, in the case of the transfer function, because little empirical work has been done to test that hypothesis, and, in the case of reduced sensitivity, because several studies disagree. In general, when there is a difference in average loss to a given noise exposure, those ears with previous PTS or TTS have shown somewhat less additional loss than those not previously exposed. Findings have sometimes implicated degree of pigmentation, both of the receptor structures (melanization) and of the eye and skin, as related to susceptibility. However, these results too are equivocal. Gender There is little difference in hearing thresholds between young male and female children. Between ages 10 and 20, males begin to show reduced highfrequency auditory sensitivity relative to females. Women continue to demonstrate better hearing than men into advanced age. These gender differences are probably due to greater exposure of males to noise rather than to their inherent susceptibility to its effects.


Differences within Individuals Ototoxic drugs Among the causes of differences of susceptibility to noise exposure within individuals are ototoxic drugs and other chemicals. In animal research, certain antibiotics (aminoglycosides) appear to exacerbate the damaging effects of noise exposure. Clinical evidence of corresponding effects in human patients has not been established, but precautions should be taken with regard to noise exposures of individual patients treated with these medications. Although high doses of aspirin are widely known to cause TTS and tinnitus, aspirin has not been shown to increase susceptibility to NIHL.

Age In certain animal models there is evidence of heightened susceptibility to noise exposure shortly after birth--a “critical period” (possibly following the time when fluids fill the middle ear but before complete development of the cochlear structures). However, it is not clear that data from such animal models can be generalized to full-term normal human infants. Premature infants in noisy environments (e.g. neonatal intensive care units), however, may be at risk At the other extreme, increasing age has been hypothesized to be associated with decreasing susceptibility. This contention is based on the existence of presbycusis, hearing loss that increases with age and that is not known to be attributable to excessive noise exposure or other known etiology. The typical levels of presbycusis at various ages have recently been incorporated as Annex A in International Standards Organization Standard 1999.2 (1989). That standard may be used to estimate the portion of overall hearing loss that is attributable to exposure to excessive noise. In summary, scientific knowledge is currently inadequate to predict that any individual will be safe in noise that exceeds established damage-risk criteria, nor that specific individuals will show greater-than-average loss following a given exposure. Among the many proposed explanations, the hypothesis that the resonant and transmission properties of the external and middle ear affect individual susceptibility deserves further attention. Empirical support for this hypothesis should not be difficult to obtain, but very few data have been collected on this question, both for TTS (experimentally) and PTS (retrospectively). Differences in susceptibility of the cochlear structures to NIHL may exist, but no practical approach to predicting them is yet

Guidelines 21

available. Identification of susceptible humans will almost certainly be delayed until a successful animal model is available.

What Can Be Done to Prevent Noise-Induced Hearing Loss? Noise-induced hearing loss occurs every day--in both occupational and nonoccupational settings. The crucial questions for prevention are as follows: (1) What can individuals do to protect themselves from NIHL? (2) What role should others, such as educators, employers, or the Government, play in preventing NIHL? (3) What general strategies should be employed to prevent NIHL? Answers to these questions have long been known, but solutions have not been effectively implemented in many cases. As a result, many people have needlessly suffered hearing loss.

Individual Protection Strategies Hearing conservation must begin by providing each individual with basic information. NIHL is insidious, permanent, and irreparable, causing communication interference that can substantially affect the quality of life. Ringing in the ears and muffling of sounds after sound exposure are indicators of potential hazard. Dangerous sound exposures can cause significant damage without pain, and hearing aids do not restore normal hearing. Individuals should become aware of loud noise situations and avoid them if possible or properly use hearing protection. It is important to recognize that both the level of the noise and its duration (i.e., exposure) contribute to the overall risk. Certain noises, such as explosions, may cause immediate permanent damage. Many sources, such as guns, power tools, chain saws, small airplanes, farm vehicles, firecrackers, some types of toys, and some medical and dental instruments may produce dangerous exposures. Music concerts, car and motorcycle races, and other spectator events often produce sound levels that warrant hearing protection. Similarly, some stereo headphones and loudspeakers are capable of producing hazardous exposures. Parents should exercise special care in supervising the use of personal headset listening devices, and adults and children alike should learn to operate them at safe volume settings.


Non-Occupational Strategies Hearing loss from non-occupational noise is common, but public awareness of the hazard is low. Educational programs should be targeted toward children, parents, hobby groups, public role models, and professionals in influential positions such as teachers, physicians, audiologists and other health care professionals, engineers, architects, and legislators. In particular, primary health care physicians and educators who deal with young people should be targeted through their professional organizations. Consumers need guidance and product noise labeling to assist them in purchasing quieter devices and in implementing exposure reduction strategies. The public should be made aware of the availability of affordable, effective hearing protectors (ear plugs, ear muffs, and canal caps). Hearing protection manufacturers should supply comprehensive instructions concerning proper protector use and also be encouraged to increase device availability to the public sector. Newborn nurseries, including neonatal intensive care units, should be made quieter. Medical and dental personnel should be trained to educate their patients about NIHL. Individuals with significant noise exposure need counseling. Basic audiometric evaluations should be widely available. The goal is to detect early noise-induced damage and interrupt its progression before hearing thresholds exceed the normal range.

Occupational Strategies Hearing conservation programs for occupational settings must include the following interactive components: sound surveys to assess the degree of hazardous noise exposure, engineering and administrative noise controls to reduce exposures, education to inform at-risk individuals why and how to prevent hearing loss, hearing protection devices (earplugs, earmuffs, and canal caps) to reduce the sound reaching the ear, and audiometric evaluations to detect hearing changes. Governmental regulations that currently apply to most noisy industries should be revised to encompass all industries and all employees, strengthened in certain requirements, and strictly enforced with more inspections and more severe penalties for violations. Many existing hearing conservation programs remain ineffective due to poor organization and inadequately trained program staff. Senior management must use available noise controls, purchase quieter equipment, and incorporate noise reduction in planning new facilities. Noise exposures must

Guidelines 23

be measured accurately and the degree of hazard communicated to employees. Hearing protection devices must be available that are comfortable, practical for the demands of work tasks, and provide adequate attenuation. Labeled ratings of hearing protector attenuation must be more realistic so that the degree of protection achieved in the workplace can be properly estimated. Each employee must be individually fitted with protectors and trained in their correct use and care. Employees need feedback about their audiometric monitoring results annually. Employers need to monitor program effectiveness by using appropriate techniques for analysis of group audiometric data. By detecting problem areas, managers can prioritize resource allocations and modify company policies to achieve effectiveness. Potential benefits include reduced costs for worker’s compensation, enhanced worker morale, reduced absenteeism, fewer accidents, and greater productivity. Enactment of uniform regulations for awarding worker’s compensation for occupational hearing loss would stimulate employers’ interest in achieving effective hearing conservation programs. Equitable criteria for compensability should be developed based on scientific investigations of the difficulties in communication and other aspects of auditory function encountered in everyday life by persons with differing degrees of NIHL. General Strategies Both nonoccupational and occupational NIHL could be reduced by implementing broader preventive efforts. Labeling of consumer product noise emission levels should be enforced according to existing regulations. Incentives for manufacturers to design quieter industrial equipment and consumer goods are needed along with regulations governing the maximum emission levels of certain consumer products, such as power tools. Reestablishment of a Federal agency coordinating committee with central responsibility for practical solutions to noise issues is essential. Model community ordinances could promote local planning to control environmental noise and, where feasible, noise levels at certain spectator events. High-visibility media campaigns are needed to develop public awareness of the effects of noise on hearing and the means for selfprotection. Prevention of NIHL should be part of the health curricula in elementary through high schools. Self-education materials for adults should be readily available.


What Are the Directions for Future Research? The panel recommends that research be undertaken in two broad categories: (1) Studies that use existing knowledge to prevent NIHL in the immediate future, and (2) research on basic mechanisms to prevent NIHL in the longterm future. · Development of rationale and collection of empirical data to evaluate systems for combining sound level and duration to predict NIHL. · Longitudinal studies to further delineate responses of the ear to noise over time in different groups of people with varying levels of exposure. · Continued investigation of engineering noise measurement and control techniques, such as acoustic intensity measurement, active noisecancellation systems, and cost-benefit analyses of noise reduction. · Development and investigation of hearing protector designs that provide improved wearer comfort, usability, and more natural audition. · Development of repeatable laboratory procedures that incorporate behavioral tests to yield realistic estimates of hearing protector attenuation performance that are accepted for device labeling purposes. · Empirical evaluation of the efficacy of hearing conservation programs and the field performance of hearing protection devices in industry. · Development and validation of evaluation techniques for detection of the following: a) subtle changes in hearing resulting from noise exposure and b) early indicators of NIHL. · Determination of the pathophysiological correlates of TTS and PTS. · Investigation of the anatomic and physiologic bases of presbycusis and interactive effects with NIHL. · Investigation of genetic bases for susceptibility to NIHL, using contemporary techniques, including molecular biology. · Further studies of drugs (e.g., vasodilating agents) and other preexposure conditions (e.g., activation of efferent systems or exposure to “conditioning” noise) that have been suggested in preliminary reports to protect the inner ear from NIHL and elucidation of the underlying mechanisms. · Investigation into the physiologic mechanisms underlying the synergistic effects of certain drugs and noise exposure in animal models.

Guidelines 25

Conclusions and Recommendations ·

Sounds of sufficient intensity and duration will damage the ear and result in temporary or permanent hearing loss at any age.

·

NIHL is characterized by specific anatomic and physiologic changes in the inner ear.

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Sounds with levels less than 75 dB(A), even after long exposures, are unlikely to cause permanent hearing loss.

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Sounds with levels above 85 dB(A) with exposures of 8 hours per day will produce permanent hearing loss after many years.

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There is a broad range of individual differences among people in the amount of hearing loss each suffers as a result of identical exposures.

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Current scientific knowledge is inadequate to predict that any particular individual will be safe when exposed to a hazardous noise.

·

Because sources of potentially hazardous sound are present in both occupational and nonoccupational settings, personal hearing protection should be used when hazardous exposures are unavoidable.

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Vigorous enforcement of existing regulations, particularly for the workplace and consumer product labeling, would significantly reduce the risk of workplace NIHL. Regulations should be broadened to encompass all employees with hazardous noise exposures.

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Application of existing technologies for source noise control, especially in the manufacture of new equipment and construction of new facilities, would significantly reduce sound levels at the ear.

·

In addition to existing hearing conservation programs, a comprehensive program of education regarding the causes and prevention of NIHL should be developed and disseminated, with specific attention directed toward educating school-age children.

More Guideline Sources The guideline above on noise-induced hearing loss is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you find additional guidelines on topics related to noiseinduced hearing loss. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with noise-induced hearing loss. Due to space


limitations these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly.

Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patientoriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following as being relevant to noise-induced hearing loss: ·

Other guides Dizziness and Vertigo http://www.nlm.nih.gov/medlineplus/dizzinessandvertigo.html Ear Infections http://www.nlm.nih.gov/medlineplus/earinfections.html Hearing Disorders and Deafness http://www.nlm.nih.gov/medlineplus/hearingdisordersanddeafnes s.html Hearing Problems in Children http://www.nlm.nih.gov/medlineplus/hearingproblemsinchildren.h tml Meniere's Disease http://www.nlm.nih.gov/medlineplus/menieresdisease.html

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search.

Guidelines 27

The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on noiseinduced hearing loss and related conditions. One of the advantages of CHID over other sources is that it offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·

Safe, In Sound: Protecting Yourself from Hearing Loss Source: Livonia, MI: International Hearing Society (IHS). 1999. [4 p.]. Contact: Available from International Hearing Society (IHS). 16880 Middlebelt Road, Suite 4, Livonia, MI 48154. (734) 522-7200. Fax (734) 522 0200. Website: www.hearingihs.org. PRICE: Available in bulk orders only, $25.00 for 100 plus shipping and handling. Summary: Noise induced hearing loss (NIHL) is a growing concern among people of all ages. NIHL can happen over time or with a single exposure to a loud sound. This brochure reviews the related concepts and offers common sense hearing precautions. Topics include how the hearing loss can occur, how to detect hearing loss, practicing safe hearing strategies (including being aware of noisy environments, using ear protection devices, and decreasing the volume whenever possible), and the identification of hearing loss. The brochure describes the certification process for hearing instrument specialists and the role of the International Hearing Society. The brochure notes that sensitivity to noise differs between individuals, but encourages readers to pay attention to both their own body and their sound environment. One chart demonstrates the loudness of everyday sounds and activities, from a whispered voice, through common household appliances, to jet planes, jackhammers, and firearms. The brochure is produced by the International Hearing Society (IHS) that advocates and supports the highest standard of professional competency, business integrity, and excellence in serving the hearing impaired. The toll free telephone number of the Hearing Aid Helpline is provided (800 521 5247).

·

Dental Drilling and Tinnitus Source: London, England: Royal National Institute for Deaf People. 1999. 3 p.


Contact: Available from RNID Helpline. P.O. Box 16464, London EC1Y 8TT, United Kingdom. 0870 60 50 123. Fax 0171 296 8199. E-mail: [email protected]. Website: www.rnid.org.uk. PRICE: Single copy free. Summary: People with tinnitus (ringing or other noises in the ear) have reason to be concerned about exposing themselves to any loud noise that may aggravate their tinnitus. Similarly, people who do not have tinnitus should take care to avoid too much loud noise, as it can cause hearing loss or tinnitus. This fact sheet from the Royal National Institute for Deaf People (RNID, London, England) reviews the problem of dental drilling and tinnitus. The author notes that research into the noise levels of dental drills and their potential for hearing damage has produced conflicting conclusions. Dentists themselves are at risk for noise induced hearing loss and or tinnitus. And although dental patients are exposed to dental drill noise for short periods of time, the noise is conducted directly to the ears through the bones of the jaw and skull, as well as through the air. The fact sheet reviews strategies that can reduce the risk of dental drill noise exacerbating tinnitus. The fact sheet concludes with information about the RNID tinnitus helpline, including the web site and email address of the organization. 7 references. ·

Practical Guide to: Firearm Use and Hearing Source: Denver, CO: National Hearing Conservation Association. 1998. [2 p.]. Contact: Available from National Hearing Conservation Association. 9101 Kenyon Avenue, Suite 3000, Denver, CO 80237. (303) 224-9022. Fax (303) 770-1812. Website: www.hearingconservation.org. PRICE: $0.25; bulk copies available. Summary: The mission of the National Hearing Conservation Association (NHCA) is to prevent hearing loss due to noise and other environmental factors in all sectors of society. This brochure from the NHCA offers a practical guide to firearm use and hearing. Gunfire is an intensely loud impulse noise that shatters the acoustic environment with incredible concussion, generating a rapid change in pressure and extremely high sound levels. Although impulse type noise only lasts for a few thousandths of a second, the extreme force it generates has the potential to destroy the delicate tissue in the inner ear if the sound level reaches a critical level. The brochure emphasizes that this critical level varies from person to person, with some people more susceptible than others to noise induced hearing loss (NIHL), whatever its source. The brochure describes the typical results of NIHL, guidelines for noise levels, the use of hearing protection devices (HPDs) during target practice, and special

Guidelines 29

HPDs for use during hunting (when one's ears must be involved in listening for approaching game). The brochure includes a section reminding readers of the risks of the cumulative noise load, listing the symptoms of an environment that is too noisy. 1 table. ·

Noise at Work: Are You Being Dealt a Fair Hand? Source: London, United Kingdom: Royal National Institute for Deaf People (RNID). February 1999. 11 p. Contact: Available from RNID Helpline. P.O. Box 16464, London EC1Y 8TT, United Kingdom. Voice 0870 60 50 123. TTY 0870 60 33 007. Fax 020 7296 8199. E-mail: [email protected]. Website: www.rnid.org.uk. PRICE: Single copy free. Summary: There are some industries such as textiles and footwear, metalworking, shipbuilding, quarrying, and forestry, that have been known for a long time to involve a high risk of damage to the ears. There are other work environments where people have experienced hearing problems or tinnitus (ringing or other sounds in the ears), and these jobs may involve risks that have not yet been fully recognized. This brochure, from the Royal National Institute for Deaf People (RNID, based in London, England) reminds readers of the problem of noise exposure and the potential for noise induced hearing loss, particularly in the workplace. Written for the employer, the brochure covers how to determine if the workplace is noisy, noise assessment, the Noise at Work Regulations (the British legal guidelines to protect the hearing of workers), certain high risk occupations and situations, the use of ear protection, how to make sure people comply with the rules, and where to get further information. The brochure concludes with a description of the goals and activities of RNID. 1 figure.

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Listen Up America, We Hear You Source: Columbia, SC: Audiology Awareness Campaign. 1999. 15 p. Contact: Available from Audiology Awareness Campaign. 3008

Millwood Avenue, Columbia, SC 29205. (888) 833-3277. Website:

www.audiologyawareness.com. PRICE: Single copy free.

Summary: This booklet is the centerpiece of the Audiology Awareness Campaign, a mission to educate the public about the value of hearing care. The booklet begins by describing the role of the audiologist, the professional who specializes in hearing health care, then discusses hearing instruments, hearing care for children, hearing loss prevention, other disorders of hearing and balance, and audiologic rehabilitation. Specific topics covered include how to know if a hearing instrument


(hearing aid) is required, the types and styles of hearing instruments, the use of assistive listening devices (ALDs), the role of ear infections and possible hearing loss, central auditory processing problems in children, noise induced hearing loss, tinnitus (ringing or other sounds in the ears), vertigo, advanced diagnostic procedures, and cochlear implants. The booklet features colorful graphics and full color photographs. The booklet concludes with a brief description of the Campaign, lists of the Board of Directors and the Advisory Board, and a list of sponsors. Readers are also encouraged to participate in the Audiology Awareness Campaign, directly or with a financial contribution. 6 figures. ·

NHCA: National Hearing Conservation Association Source: Denver, CO: National Hearing Conservation Association. 199x. [2 p.]. Contact: Available from National Hearing Conservation Association. 9101 Kenyon Avenue, Suite 3000, Denver, CO 80237. (303) 224-9022. Fax (303) 770-1812. Website: www.hearingconservation.org. PRICE: Single copy free. Summary: This brochure describes the National Hearing Conservation Association (NHCA) whose mission is to prevent hearing loss due to noise and other environmental factors in all sectors of society. NHCA's membership comes from all aspects of the hearing conservation industry, ranging from audiologists, physicians, safety specialists, and nurses to industrial hygienists, engineers, equipment manufacturers, and scientists. The Association's vital concern and focus is the prevention of noise induced hearing loss (NIHL) in all situations in which hazardous noise exists and the education of children and the public as to the hazardous effects of noise. The brochure lists the activities of NHCA, including professional development opportunities, an annual conference, ongoing training seminars, publications, networking, and teaching tools. The brochure also explains the membership categories of the organization, including member, associate, commercial, Professional Service Organization (PSO), and student. A form with which readers can request additional information is included.

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Facts About Hearing Loss in Children Source: Washington, DC: Alexander Graham Bell Association for the Deaf and Hard of Hearing. 2000. [4 p.]. Contact: Available from Alexander Graham Bell Association for the Deaf and Hard of Hearing. 3417 Volta Place, NW, Washington, DC 20007-2778. Voice (202) 337-5220. TTY (202) 337-5221. Fax (202) 337-8314. Website:

Guidelines 31

www.agbell.org. PRICE: $2.00 for 10 copies; $8.00 for 50 copies, plus shipping and handling. Summary: This brochure provides an overview of basic information about hearing loss in children. The brochure stresses that any degree of hearing loss can have a negative impact on the child's education; even children with mild to moderate hearing loss can miss up to 50 percent of classroom discussions. Unmanaged hearing loss in children can affect their speech and language development as well as their academic capabilities and development. It can also affect their self image and social emotional development. The brochure reviews the types of hearing losses that are found in children, the potential impact of frequent middle ear infections on a child's hearing, the symptoms of hearing loss in children (by age group), how newborns and other young infants can be assessed for a hearing loss, what to do for a suspected hearing loss, treatment options for children with hearing loss (hearing aids, cochlear implants, various educational strategies), the problem of loud noises (noise induced hearing loss), and the types of modifications that can be made in a classroom for children with hearing loss. The brochure emphasizes that the key to success in children with hearing loss is early diagnosis and early intervention. The brochure notes 5 related publications that are available from the AG Bell Association (202-337-5220). ·

Presbycusis: Age-Related Hearing Loss Source: Seattle, WA: Otolaryngology-Head and Neck Surgery Center, University of Washington Medical Center. 1997. 12 p. Contact: Available from Virginia Merrill Bloedel Hearing Research Center. University of Washington, Box 357923, Seattle, WA 98195-7923. (206) 616-4105. E-mail: [email protected]. Website: weber.u.washington.edu/~hearing. PRICE: Single copy free. Summary: This brochure reviews the problem of presbycusis, defined as age related hearing loss. Presbycusis is the most common form of hearing loss; everyone who lives long enough will develop some degree of presbycusis, and those who damage their ears from loud noise exposure will develop it sooner. The brochure notes that hearing loss impairs communication, subtly at first and increasing with the magnitude of the loss; this can have an impact on social activities and interpersonal relationships. The brochure reviews normal ear function and then discusses the causes of presbycusis, including aging, noise exposure, diseases, and toxins. The brochure describes the effects of presbycusis, diagnostic issues, and treatment issues and options, including hearing aids, hearing aid candidacy, assistive listening devices, cochlear implants, and medical therapy. The brochure concludes with a section emphasizing


the role of prevention, particularly that achieved by preventing noise induced hearing loss (NIHL). One illustration familiarizes readers with the anatomy of the inner ear. 5 figures. ·

Noise at Work: Is Hearing Loss on the Cards for You? Source: London, United Kingdom: Royal National Institute for Deaf People (RNID). February 1999. 11 p. Contact: Available from RNID Helpline. P.O. Box 16464, London EC1Y 8TT, United Kingdom. Voice 0870 60 50 123. TTY 0870 60 33 007. Fax 020 7296 8199. E-mail: [email protected]. Website: www.rnid.org.uk. PRICE: Single copy free. Summary: This brochure, from the Royal National Institute for Deaf People (RNID, based in London, England) reminds readers of the problem of noise exposure and the potential for noise induced hearing loss, particularly in the workplace. Topics include determining if the workplace is noisy, the effects of hearing loss, tinnitus, the Noise at Work Regulations (the British legal guidelines to protect the hearing of workers), certain high risk occupations and situations, noise measurement, and the role of noise levels outside work. The brochure concludes with a description of other educational materials available. An insert is included with the brochure for readers who would like to request more information or materials from RNID. 1 table.

·

Hearing Loss and Older Adults Source: Bethesda, MD: National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health (NIH). January 2001. [5 p.]. Contact: Available from NIDCD Information Clearinghouse. 1 Communication Avenue, Bethesda, MD 20892-3456. Voice (800) 241-1044. TTY (800) 241-1055. Fax (301) 907-8830. E-mail: [email protected]. Website: www.nidcd.nih.gov. PRICE: Single copy free. Summary: This fact sheet offers basic information about hearing loss and older adults. The fact sheet begins with a list of common symptoms of hearing loss, noting that if readers can answer three of the questions affirmatively, they may need to have their hearing checked. The fact sheet then describes the different health care providers who may be helpful in diagnosing and treating hearing loss. The fact sheet continues by noting the causes of hearing loss (including presbycusis or age related hearing loss, noise induced hearing loss, and tinnitus) and describing treatments and devices that may be used to improve one's hearing. These can include hearing aids, personal listening systems, TV listening systems,

Guidelines 33

direct audio input hearing aids, telephone amplifying devices, mobile phone amplifying devices, auditorium type assistive listening devices (ALDs), cochlear implants, and speechreading. The fact sheet also reviews strategies that can be used to improve communication with someone who has a hearing loss. The fact sheet concludes with the contact information for a number of organizations including the National Institute on Deafness and Other Communication Disorders (NIDCD, 800241-1044, www.nidcd.nih.gov), the Alexander Graham Bell Association for the Deaf and Hard of Hearing (800-HEAR-KID, www.agbell.org), the American Tinnitus Association (800-634-8978, www.ata.org), the American Academy of Otolaryngology Head and Neck Surgery (www.entnet.org), the American Academy of Audiology (800-AAA-2336, www.audiology.org), Self Help for Hard of Hearing People (www.shhh.org), the American Speech-Language-Hearing Association (800-638-8255, www.asha.org), the League for the Hard of Hearing (www.lhh.org), the National Institute on Aging Information Center (800222-2225, www.nih.gov/nia), and WISE EARS! Health Education Campaign (www.nidcd.nih.gov). ·

Conversation Aids Source: London, England: Royal National Institute for Deaf People. 2000. 10 p. Contact: Available from RNID Helpline. P.O. Box 16464, London EC1Y 8TT, United Kingdom. 0870 60 50 123. Fax 0171 296 8199. E-mail: [email protected]. Website: www.rnid.org.uk. PRICE: Single copy free. Summary: This fact sheet offers information about conversations aids, also called listening aids or communication aids, or assistive devices (the latter more common in the United States). The fact sheet, from the British based Royal National Institute for Deaf People (RNID), gives information about listening devices that are portable and battery operated and do not have to be used with a loop system. The fact sheet describes how the technology works, the parts of the listening aid (microphone, amplifier, sound output transducers), noise induced hearing loss attributable to amplification devices (especially a problem with over the counter types of listening devices), television listening aids, conversation aids, loop systems, infrared systems, and the features of conversation aids (sound pickup, sound output, amplification, automatic gain control, tone controls, batteries, hours of use). The fact sheet concludes with a table that lists a range of conversation aids, with a price guide for each device. In most cases, the price given is the cost of an aid with a neckloop, which is probably the most expensive option. A list of 11 resources to obtain


devices or more information about devices is provided; all are in Great Britain. 1 table. ·

Incidence and Prevalence of Hearing Impairment in the United States Source: Rockville, MD: American Speech-Language-Hearing Association (ASHA). 1999. [3 p.]. Contact: Available from American Speech-Language-Hearing Association (ASHA). Product Sales, 10801 Rockville Pike, Rockville, MD 20852. (888) 498-6699. TTY (301) 897-0157. Website: www.asha.org. PRICE: Single copy free. Summary: This fact sheet offers statistics on the incidence and prevalence of hearing impairment in the U.S. The first section reviews the demographics of hearing impairment, including gender, race, and the implementation of the Individuals with Disabilities Education Act (1997). The second section discusses the incidence and prevalence of auditory disorders, including acoustic neuroma and vestibular schwannomas, hyperacusis, Meniere's disease, neurofibromatosis, noise induced hearing loss, otitis media, otosclerosis, presbycusis, sensorineural hearing loss, tinnitus, Waardenburg syndrome, and deafness. The final section briefly reviews current research efforts in the areas of otitis media (middle ear infection), hearing aids, children and hearing loss, tinnitus, and deafness genetics. 21 references.

·

Noise Exposure and Hearing Loss Source: London, England: Royal National Institute for Deaf People. 1999. 10 p. Contact: Available from RNID Helpline. P.O. Box 16464, London EC1Y 8TT, United Kingdom. 0870 60 50 123. Fax 0171-296 8199. E-mail: [email protected]. Website: www.rnid.org.uk. PRICE: Single copy free. Summary: This fact sheet, from the British Royal National Institute for Deaf People (RNID), gives basic information about noise exposure and hearing loss. The fact sheet first briefly reviews the differences between conductive and sensorineural hearing losses, then discusses hearing loss caused by noise, including temporary threshold shift, permanent threshold shift, noise induced or occupational hearing loss, and acoustic trauma. Other topics covered include the practical effects of noise induced hearing loss (NIHL); conditions related to noise exposure, including tinnitus (ringing or other noises in the ears or head) and recruitment (narrowing of the dynamic range of hearing); the causes of NIHL; permanent damage to the cochlea; age related deafness

Guidelines 35

(presbycusis); treatment options; preventing NIHL at work, including reducing noise at the source, and using ear protectors; regulations and compensation issues (in England), including industrial injuries benefits, and benefits for those in the armed forces; socioacusis (hearing loss caused by sources of noise encountered outside work); and research in the area of NIHL. ·

Educational Resource Guide: Noise-Induced Hearing Loss Source: Bethesda, MD: National Institute on Deafness and Other Communication Disorders Information Clearinghouse (NIDCD). 2000. 14 p. Contact: Available from National Institute on Deafness and Other Communication Disorders Information Clearinghouse (NIDCD). 1 Communication Avenue, Bethesda, MD 20892-3456. (800) 241-1044. TTY (800) 241-1055. E-mail: [email protected]. Website: www.nidcd.nih.gov. PRICE: Single copy free. Summary: This resource guide lists patient education and professional education materials in the area of noise induced hearing loss (NIHL). The materials listed include fact sheets, booklets, brochures, books, book chapters, journal and newsletter articles, posters, and videotapes. Each entry includes the title of the item, its source, and pricing information. The resource guide lists the contact information for sources (organizations and companies) in a separate section; internet websites are provided where available. The guide concludes with a title index. This resource guide is part of the WISE EARS! program, a national coalition to prevent NIHL.

The NIH Search Utility After browsing the references listed at the beginning of this chapter, you may want to explore the NIH search utility. This allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to noise-induced hearing loss. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.


Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

·

Family Village: http://www.familyvillage.wisc.edu/specific.htm

·

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

·

Med Help International: http://www.medhelp.org/HealthTopics/A.html

·

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

·

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

·

WebMDÒHealth: http://my.webmd.com/health_topics

Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter: Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Amplification: The production of additional copies of a chromosomal DNA sequence, found as either intrachromosomal or extrachromosomal DNA. [NIH]

Antibiotic: A substance usually produced by vegetal micro-organisms

capable of inhibiting the growth of or killing bacteria. [NIH]

Attenuation: Reduction of transmitted sound energy or its electrical

equivalent. [NIH]

Audiologist: Study of hearing including treatment of persons with hearing

defects. [NIH]

Audition: The sense of hearing. [NIH]

Broadband: A wide frequency range. Sound whose energy is distributed

Guidelines 37

over a broad range of frequency (generally, more than one octave). [NIH] Competency: The capacity of the bacterium to take up DNA from its

surroundings. [NIH]

Efferent: Nerve fibers which conduct impulses from the central nervous

system to muscles and glands. [NIH] Empirical: A treatment based on an assumed diagnosis, prior to receiving

confirmatory laboratory test results. [NIH]

Endolymph: The fluid contained in the membranous labyrinth of the ear.

[NIH]

Exhaustion: The feeling of weariness of mind and body. [NIH]

Fatigue: The feeling of weariness of mind and body. [NIH]

Genetics: The biological science that deals with the phenomena and

mechanisms of heredity. [NIH]

Impairment: In the context of health experience, an impairment is any loss

or abnormality of psychological, physiological, or anatomical structure or

function. [NIH]

Infancy: The period of complete dependency prior to the acquisition of

competence in walking, talking, and self-feeding. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually

4 mm inside diameter) and used in transferring microorganisms. [NIH]

Modification: A change in an organism, or in a process in an organism, that

is acquired from its own activity or environment. [NIH]

Nerve: A cordlike structure of nervous tissue that connects parts of the

nervous system with other tissues of the body and conveys nervous

impulses to, or away from, these tissues. [NIH]

Perilymph: The fluid contained within the space separating the

membranous from the osseous labyrinth of the ear. [NIH] Physiology: The science that deals with the life processes and functions of

organismus, their cells, tissues, and organs. [NIH]

Specialist: In medicine, one who concentrates on 1 special branch of medical

science. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Trauma:

Any injury, wound, or shock, must frequently physical or


structural shock, producing a disturbance. [NIH]

39

CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with noise-induced hearing loss. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.8 In addition to support groups, your physician can be a valuable source of guidance and support. Therefore, finding a physician that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with noise-induced hearing loss. The chapter ends with a discussion on how to find a doctor that is right for you.

Finding Associations There are a several Internet directories that provide lists of medical associations with information on or resources relating to noise-induced hearing loss. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with noise-induced hearing loss. Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 8


The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about noiseinduced hearing loss. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.

DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “noise-induced hearing loss” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations.

The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “noise induced hearing loss”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making these selections and typing in “noise-induced hearing loss” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing with noise-induced hearing loss. You should check back periodically with this database since it is updated every 3 months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific diseases. You can access this database at the following Web site:

Seeking Guidance 41

http://www.rarediseases.org/search/orgsearch.html. Type “noise-induced hearing loss” (or a synonym) in the search box, and click “Submit Query.”

Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service on its Web site: http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your doctor or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective.

Finding Doctors One of the most important aspects of your treatment will be the relationship between you and your doctor or specialist. All patients with noise-induced hearing loss must go through the process of selecting a physician. While this process will vary from person to person, the Agency for Healthcare Research and Quality makes a number of suggestions, including the following:9 · If you are in a managed care plan, check the plan's list of doctors first. · Ask doctors or other health professionals who work with doctors, such as hospital nurses, for referrals. · Call a hospital’s doctor referral service, but keep in mind that these services usually refer you to doctors on staff at that particular hospital. The services do not have information on the quality of care that these doctors provide. · Some local medical societies offer lists of member doctors. Again, these lists do not have information on the quality of care that these doctors provide. Additional steps you can take to locate doctors include the following: ·

Check with the associations listed earlier in this chapter.

This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. 9


· Information on doctors in some states is available on the Internet at http://www.docboard.org. This Web site is run by “Administrators in Medicine,” a group of state medical board directors. · The American Board of Medical Specialties can tell you if your doctor is board certified. “Certified” means that the doctor has completed a training program in a specialty and has passed an exam, or “board,” to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care doctors may also be certified as specialists. The AMBS Web site is located at 10 http://www.abms.org/newsearch.asp. You can also contact the ABMS by phone at 1-866-ASK-ABMS. · You can call the American Medical Association (AMA) at 800-665-2882 for information on training, specialties, and board certification for many licensed doctors in the United States. This information also can be found in “Physician Select” at the AMA's Web site: http://www.amaassn.org/aps/amahg.htm.

Finding an Otolaryngologist An otolaryngologist is a medical doctor who specializes in the treatment of the ear, nose, throat, and related structures of the head and neck. The American Academy of Otolaryngology—Head and Neck Surgery (AAO HNS) has created a “Find an Otolaryngologist” searchable database which contains information on the AAO-HNS’s 9,300 members. To search the database, go to http://www.entlink.net/aao-hns_otolaryngologist.cfm. You will be given the option to search by the following criteria: doctor’s name, city, state, zip code, country, or sub-specialty. If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with expertise in various rare diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.

While board certification is a good measure of a doctor's knowledge, it is possible to receive quality care from doctors who are not board certified.

10

Seeking Guidance 43

Selecting Your Doctor11 When you have compiled a list of prospective doctors, call each of their

offices. First, ask if the doctor accepts your health insurance plan and if he or

she is taking new patients. If the doctor is not covered by your plan, ask

yourself if you are prepared to pay the extra costs. The next step is to

schedule a visit with your chosen physician. During the first visit you will

have the opportunity to evaluate your doctor and to find out if you feel

comfortable with him or her. Ask yourself, did the doctor:

·

Give me a chance to ask questions about noise-induced hearing loss?

·

Really listen to my questions?

·

Answer in terms I understood?

·

Show respect for me?

·

Ask me questions?

·

Make me feel comfortable?

·

Address the health problem(s) I came with?

·

Ask me my preferences about different kinds of treatments for noise-

induced hearing loss?

·

Spend enough time with me?

Trust your instincts when deciding if the doctor is right for you. But remember, it might take time for the relationship to develop. It takes more than one visit for you and your doctor to get to know each other.

Working with Your Doctor12 Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care and have better results. Here are some tips to help you and your doctor become partners: · You know important things about your symptoms and your health history. Tell your doctor what you think he or she needs to know. · It is important to tell your doctor personal information, even if it makes you feel embarrassed or uncomfortable. 11 This

section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. 12 This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.


·

Bring a “health history” list with you (and keep it up to date).

·

Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.

·

Tell your doctor about any natural or alternative medicines you are taking.

·

Bring other medical information, such as x-ray films, test results, and medical records.

·

Ask questions. If you don't, your doctor will assume that you understood everything that was said.

·

Write down your questions before your visit. List the most important ones first to make sure that they are addressed.

·

Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.

·

Ask your doctor to draw pictures if you think that this would help you understand.

·

Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.

·

Let your doctor know if you need more time. If there is not time that day, perhaps you can speak to a nurse or physician assistant on staff or schedule a telephone appointment.

·

Take information home. Ask for written instructions. Your doctor may also have brochures and audio and videotapes that can help you.

·

After leaving the doctor's office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your doctor, call for your test results. If your doctor recommended that you have certain tests, schedule an appointment to get them done. If your doctor said you should see an additional specialist, make an appointment.

By following these steps, you will enhance the relationship you will have with your physician.

Seeking Guidance 45

Broader Health-Related Resources In addition to the references above, the NIH has set up guidance Web sites that can help patients find healthcare professionals. These include:13 ·

Caregivers: http://www.nlm.nih.gov/medlineplus/caregivers.html

·

Choosing a Doctor or Healthcare Service: http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv ice.html

·

Hospitals and Health Facilities: http://www.nlm.nih.gov/medlineplus/healthfacilities.html

Vocabulary Builder The following vocabulary builder provides definitions of words used in this

chapter that have not been defined in previous chapters:

Consultation: A deliberation between two or more physicians concerning

the diagnosis and the proper method of treatment in a case. [NIH]

You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.

13

47

PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL

ABOUT PART II In Part II, we introduce you to additional resources and advanced research on noise-induced hearing loss. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on noise-induced hearing loss. In Part II, as in Part I, our objective is not to interpret the latest advances on noise-induced hearing loss or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with noiseinduced hearing loss is suggested.

49

CHAPTER 3. STUDIES ON NOISE-INDUCED HEARING LOSS Overview Every year, academic studies are published on noise-induced hearing loss or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on noise-induced hearing loss. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on noiseinduced hearing loss and teach you how to keep current on new studies as they are published or undertaken by the scientific community.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and noise-induced hearing loss, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer,


and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type in “noise induced hearing loss” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is a sample of what you can expect from this type of search: · Clinical Evaluation of the Hearing Disability and Handicap Scale in Men with Noise Induced Hearing Loss Source: Noise and Health. 6: 67-78. January-March 2000. Contact: Available from NRN Publications. Editorial Manager of Noise and Health, Institute of Laryngology and Otology, University College, London, 330 Gray's Inn Road, London WC1X 8EE, United Kingdom. 44 171 915 1575. Fax 44 171 278 8041. E-mail: [email protected]. Summary: During the last 30 years, several hearing disability and handicap questionnaires have been designed and used for clinical purposes. This article reports on a study that includes a review of the most frequently used of these scales. The present study evaluates the reliability and validity of the Hearing Disability and Handicap Scale (HDHS), which is a shortened and modified version of the Hearing Measurement Scale. Correlations between the Hearing Handicap and Support Scale, the Communication Strategy Scale from the Communication Profile of the Hearing Impaired, pure tone audiometry, and speech recognition scores in noise were analyzed. Data from 168 men with noise induced hearing loss of different degrees was obtained; a test retest was also conducted. The disability section of the HDHS seemed accurate but offered no improvement of prediction compared to previous scales. The authors conclude that the reliability of the handicap section was sufficient, however, they discuss its validity and clinical use and offer suggestions about improvements. Since standardized scales are necessary if results are to be compared worldwide, guidelines regarding the clinical use and benefit of hearing disability and handicap scales are required. One appendix reprints the 20 questions from the HDHS. 4 tables. 34 references. · Update: Noise Induced Hearing Loss and the Military Environment Source: Journal of the Royal Army Medical Corps. 144(2): 97-101. June 1998.

Studies 51

Contact: Available from Regimental Headquarters RAMC. Keogh Barricks, Ash Vale Aldershot, Hants GU12 5RQ, United Kingdom. 01252340-240. Summary: In the Army, noise induced hearing loss (NIHL) is chiefly seen as being related to exposure to weapon noise and research tends to be in that context. There are however other sources of exposure in both military and civilian environments that potentially affect hearing loss and confound the study of NIHL. This article explores current issues in NIHL with particular regard for the practice and study of hearing conservation in the military. Topics include the historical perspective, a definition of NIHL, personal factors (notably presbycusis, or hearing loss related to aging), external factors (including ototoxic drugs), noise exposure, impairment and disability, and statutory and occupational compensation. Although exposure levels exist, they do not guarantee protection against either continuous or impulse noise. Race, eye color, smoking, and gender have been associated with NIHL but not causally. The authors conclude that industrial chemicals, vibration and temperature may all play a part in mediating damage but perhaps the most rewarding lines for future research are those which link hearing loss with cochlea blood flow and the auditory system's own protective responses. 3 tables. 41 references. ·

Audiological Management of Noise Induced Hearing Loss Source: Scandinavian Audiology. 24(Suppl 48): 131-145. 1998. Contact: Available from Scandinavian University Press North America. 875 Massachusetts Avenue, Suite 84, Cambridge, MA 02139. (800) 498 2877 or (617) 497-6515. Fax (617) 354-6875. Summary: Noise-induced hearing loss (NIHL) is a pathological condition with no specific or exclusive audiological signs. This disorder is generally identified on the strength of a high probability conclusion being likely as a result of an exclusion process. However, because of frequent legal purposes, audiometrical data measured and analyzed need to be as accurate and reliable as possible. This article outlines the procedure involved in the audiological assessment of NIHL, considering different stages for suspicion and identification, hearing threshold measurement, etiological and differential diagnosis, and apportionment. The evaluation of a suspect NIHL starts necessarily with a reliable and accurate audiometric measurement to quantify the extent of auditory damage, bearing in mind the subjective nature of the audiometric examination, its consequent intrinsic variability, and also the opportunity it offers for simulation. Two additional steps are necessary. The first one is the ascertainment of the existence of a direct cause and effect, i.e., reliable and precise information has to be obtained on the patients working


history, and particularly on the intensity of their exposure to noise. The second point concerns the need for a specialistic evaluation capable of excluding or allowing any other factor or hearing system pathology that might have influenced the audiometric findings (such as age, extraoccupational exposure to noise, middle ear pathologies, inherited hearing loss, head trauma, etc.). 1 figure. 6 tables. 22 references. (AA-M).

Federally Funded Research on Noise-Induced Hearing Loss The U.S. Government supports a variety of research studies relating to noiseinduced hearing loss and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.14 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Visit CRISP at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You can perform targeted searches by various criteria including geography, date, as well as topics related to noise-induced hearing loss and related conditions. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore noise-induced hearing loss and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for noise-induced hearing loss: · Project Title: ANTIOXIDANT INVOLVEMENT IN NOISE INDUCED HEARING LOSS Principal Investigator & Institution: Henderson, Donald;; State University of New York at Buffalo Suite 211 Ub Commons Amherst, Ny 14228 Timing: Fiscal Year 2002 Summary: This research focuses on the relation between the cochlea's antioxidant system and resistance to noise or carboplatin. The project is a logical extension of previous research in our lab that showed (1) the ear Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

14

Studies 53

could acquire resistance to noise by prior exposure to benign moderate level noise; (2) the antioxidant enzymes catalase, glutathione reductase and gamma-glutamyl cysteine synthtase (GCS) are increased in concentration in both stria and organ of Corti after prophylactic noise exposures; (3) the degree of temporary and permanent hearing loss as well as hair loss from exposures to a traumatic noise could be reduced by prior treatment of R- phenylisopropyladenoisine (R-PIA). Collectively, these results suggest that high level noise exposures produce hearing loss by the mechanism of reactive oxygen intermediates (ROI) cytotoxicity and that prophylactic noise exposures, as well as intervention by R-PIA, can reduce both the effects of noise and cisplatin (Ryback et al., 1995). The proposed set of experiments has four specific aims: (1) What is the relation between glutathione related enzymes (specifically GCS), and susceptibility to noise? (2) Can the susceptibility to noise-induced hearing loss be decreased with drugs that up-regulate GCS or increased with drugs that suppress GCS? (3) What is the normal anatomical distribution of glutathione (GSH) and does it change with exposure to noise? (4) Is the otoxicity of carboplatin influenced by drugs that up-regulate or downregulate the antioxidant system? These experiments will be conducted on chinchillas. Hearing functions will be measured by evoked potentials and otoacoustic emissions. GCS levels will be assessed by our collaborator Dr. Howard Steinman at Albert Einstein College of Medicine. Cochlear analysis will include cell counts from surface preparations and confocal studies of GSH distribution. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen · Project Title: DANGEROUS DECIBELS--PARTNERSHIPS IN PUBLIC HEALTH Principal Investigator & Institution: Jackman, Andrew M.; Vp of Education; Oregon Museum of Sciences and Industry and Industry Portland, or 97214 Timing: Fiscal Year 2002; Project Start 30-SEP-2000; Project End 31-AUG2005 Summary: (Adapted from the applicants abstract): A consortium of innovative basic science researchers, museum educators, civic leaders and volunteers propose a unique partnership to reduce the incidence and prevalence of Noise Induced Hearing Loss (NIHL), a growing problem among children and adults. To address this critical public health concern, a unique public/private partnership, including the Oregon Museum of Science and Industry (OMSI), the Oregon Hearing Research Center at the Oregon Health Sciences University (OHSU), the Portland Veterans Administration Medical Center National Center for Rehabilitative


Auditory Research (NCRAR), the American Tinnitus Association (ATA), and Oregon and Southwest Washington elementary and secondary schools, propose a regional campaign to significantly reduce the prevalence of preventable hearing loss and tinnitus. The project is comprised of three freestanding, but interlocking components that create a strong public health campaign against Noise Induced Hearing Loss.. These components are: (1) exhibitry; (2) curriculum; and (3) research. We propose a three phase, five-year program, directly targeting school-age youth, using established volunteer and volunteer training programs among each of the participating institutions: Phase 1: Prototype exhibit development and full production of one exhibit incorporating education, entertainment and pre-post knowledge evaluation; test-ready curriculum; draft evaluation tools and hearing screening capabilities for data acquisition. Phase 11: Classroom presentations with exhibitry and data acquisition in six Oregon and Southwest Washington for pilot testing. Phase III: Regional model program and implementation strategy for hearing science education and hearing loss prevention. Program evaluation analysis will include research results regarding subject factors and noise induced hearing loss in children. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen · Project Title: ENDOGENOUS TRANSDUCER ADAPTATION

FACTORS

REGULATING

Principal Investigator & Institution: Ricci, Anthony J.; Assistant Professor; Neuroscience Ctr of Excellence; Louisiana State Univ Hsc New Orleans New Orleans, La 70112 Timing: Fiscal Year 2002; Project Start 01-JAN-1999; Project End 31-DEC2002 Summary: Adaptation is a process by which hair cells extend their dynamic range, reducing saturation and preventing damage. A tonographic distribution in the adaptation rate of the mechano-electric transducer (MET) current has demonstrate in hair cells of the turtle auditory papilla leading to the suggestions that the rate of adaptation serves as a high pass filter to mechanical stimulation. The purpose of this proposal is to substantiate the filtering properties of adaptation and to elucidate the underling mechanisms involved in establishing this gradient. The possible mechanisms to be addressed include: (i) a distribution in the effective calcium buffering in the stereocilia of hair bundles along the papilla, (ii) a change in the Ca/2+ load per stereocilium, either by varying the number of MET channels per stereocilium or by a variation in the relative calcium permeability of the MET channel across the papilla, (ii) a change in the Ca2+ load per

Studies 55

stereocilium, either by varying the number of MET channel across the papilla and, (iii) a change in the relative force exerted by the adaptation processes across the papilla. These possible mechanisms will be addressed by recording the MET currents from hair cells in a newly developed Intact turtle auditory papilla preparation using both whole cell and perforated patch techniques (i-iv). Both displacement-clamp and force-clamp stimuli will be employed. Single-channel measurements, calcium imaging experiments and flash photolysis experiments will be incorporated to better resolve the mechanisms involved in the regulation of calcium homeostasis and the adaptation process. Recently cyclic nucleotides have been reported to shift the set point of the displacement sensitivity of the hair bundle by some unknown mechanism. A fourth topic of study for this proposal will be to characterize the cyclic nucleotide effects and to determine the mechanisms of action. Understanding calcium dynamics in the hair bundle as well as the cyclic nucleotide effects on adaptation have broad implications into the physiologic function of auditory and vestibular hair cells and may underlie the large frequency range at which hair cells are capable of responding. Pathophysiologic implications of alterations in calcium homeostasis in the stereociliary bundle may be linked to both temporary and permanent threshold shifts and noise induced hearing loss. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen · Project Title: GENETIC PREDISPOSITION TO NOISE INDUCED HEARING LOSS Principal Investigator & Institution: Taggart, Robert T.; Associate Professor; Communicative Disorders & Scis; State University of New York at Buffalo Suite 211 Ub Commons Amherst, Ny 14228 Timing: Fiscal Year 2002; Project Start 15-SEP-2001; Project End 31-AUG2004 Summary: (provided by applicant): Noise induced hearing loss has substantial impact on the productivity and quality of life for as many as 10 million people in the United States. There is increasing evidence from human and animal studies that mutations within genes expressed within the cochlea can render individuals more susceptible to hearing impairment caused by exposure to acoustic overstimulation, trauma or ototoxic agents. We propose to search for NIHL susceptibility gene mutations by examining subjects who routinely receive high levels of noise exposure. A series of 2000 military personnel who are found to have permanent changes in hearing thresholds (PTS) during yearly audiological examination and 1000 control subjects will be screened for sequence variations that either directly or in combination with other


factors are associated with NIHL susceptibility. PTS and control subjects will be compared for mutations in candidate genes, history of occupational noise exposure and other epidemiological factors (i.e., smoking, ethnic background, family history of hearing impairment). The gene mutations examined will include sequence variants associated with specific inherited forms of hearing impairment and sequence variations identified within candidate genes suspected to have important roles in maintenance of cochlear function. We suspect that an increased frequency of one or more inherited gene mutations will be found in PTS subjects relative to control subjects, perhaps as the result of being carriers for recessively inherited non-syndromic deafness traits (congenital), dominantly inherited hearing impairment genes with a later age of onset or one of several mitochondrial DNA mutations. We will identify PTS subjects with a family history of NIHL to identify families that will be suitable for future linkage and candidate gene localization studies. These studies represent an innovative approach toward identification of cochlear genes that have important roles in the protection and recovery from acoustic trauma caused by chronic acoustic over-stimulation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen · Project Title: HEALTH COMMUNICATION: NIHL AND TINNITUS PREVENTION Principal Investigator & Institution: Martin, William H.; Otolaryngology Head & Neck Surgery; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2004; Project Start 01-DEC-2003; Project End 30-NOV2006 Summary: (provided by applicant): Noise-induced hearing loss (NIHL) and related tinnitus pose significant health risks to millions of Americans. Educational interventions, based upon health communication theory, have yet to be systematically applied to NIHL and tinnitus prevention. The purpose of this project is to design, implement and evaluate intervention strategies applying current health communication and behavior theory, to increase knowledge, change attitude and behavioral intention consistent with hearing loss prevention. The target population will be 4th grade school students in Oregon and SW Washington. Four single educational interventions (some established and some new innovations) will be compared to a non-intervention, control group. Also, health communication theory predicts that certain intervention strategies will be more effective than others. Health communication research demonstrates that paired-interventions, especially in the form of a "booster" separated in time from the initial program, will be more

Studies 57

effective than a single-intervention approach. Once evaluation of the four interventions is complete, a second evaluation will be conducted using paired combinations of the most effective educational interventions. Subjects will receive pre- and post-intervention and follow-up questionnaires. Intervention 1: Classroom Presentation by Older-Peer Educators. High school students will present an NIHL and tinnitus prevention program. Intervention 2: Classroom Presentation by Health Professional Educators. School nurses will present an NIHL and tinnitus prevention program. Intervention 3: On-site Museum Experience. Students will visit a 12-component exhibition of noise-induced hearing loss and tinnitus prevention. The exhibit provides a novel and innovative method of communicating information to visitors, young and old. Intervention 4: Web-based Museum Experience. A web-based version of the above museum exhibit will be the vehicle to communicate information about noise-induced hearing loss and tinnitus prevention to fourth-grade students. Non-Intervention: Control groups matched for age, gender, socioeconomic and geographic (rural/ urban) factors will receive pre- and post-evaluation questionnaires without receiving an educational intervention. Results from the comparison of these interventions will be used to enhance delivery methods and vehicles for public education to increase awareness, change attitudes and behavioral intentions about the dangers of noise-induced hearing loss and tinnitus. The goal is to decrease the number of cases of preventable noise induced hearing loss and tinnitus, and to promote healthy hearing and good aural communication in the population. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen · Project Title: INFLUENCES OF HYPOXIA ON NOISE INDUCED HEARING LOSS Principal Investigator & Institution: Chen, Guang-Di; Pharmaceutical Sciences; University of Oklahoma Hlth Sciences Ctr Health Sciences Center Oklahoma City, Ok 73126 Timing: Fiscal Year 2002; Project Start 15-AUG-2001; Project End 31-JUL2004 Summary: (provided by applicant): Noise-induced hearing loss (NIHL) is the most common occupational disease in the United States, yet it's mechanisms are not fully understood. The goal of this application is to determine whether and how hypoxia can interrupt auditory function transiently. People may suffer from insufficient blood oxygen supply due to pulmonary or cardiovascular disease, altitude, and environmental pollution by chemical asphyxiates. The risk of environmental noise may be tremendously increased when the noise is under hypoxic conditions.


As indirect evidence, carbon monoxide (CO) exposure, which among other effects reduces oxygen supply to tissues, potentiates permanent NIHL at a level that alone does not cause a permanent threshold loss. The investigation of effect of hypoxic inhalation on NIHL will provide a direct test of the susceptibility of the cochlea to reduced oxygen tension. In this application, noise intensity will be varied from lower than the current permissible exposure level (PEL) to 120 dB SPL. Noise intensity higher than 120 dB SPL may cause some mechanical damage to the cochlea. Oxygen level in the exposure chamber will be varied from the normal level (21%) to 6%. Hypoxic inhalation alone with oxygen level lower than 6% may cause a temporary auditory function loss. The designed experiments will measure: (1) noise-induced and noise+hypoxia-induced hearing loss and hair cell loss 4 weeks after the exposure; (2) free radical generation, succinate dehydrogenase (SDH) activity reduction and apoptotic cell death in the cochlea immediately after the exposure; and (3) time course of these biochemical alterations and the protective effect of a free radical scavenger against SDH-activity reduction and apoptosis. We hypothesize that the noise under hypoxic conditions will generate more free radicals than noise alone, which then impair mitochondria, causing a reduction in SDH activity and also release of cytochrome c that may cause apoptosis. We further hypothesize that free radical scavenging will protect against SDH activity reduction and apoptosis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen · Project Title: INTERACTION OF AGE RELATED & NOISE INDUCED HEARING LOSS Principal Investigator & Institution: Boettcher, Flint A.; Assistant Professor; Otolaryngology-Head & Neck Surgery; Medical University of South Carolina 171 Ashley Ave Charleston, Sc 29425 Timing: Fiscal Year 2002; Project Start 01-JUN-1999; Project End 31-MAY2004 Summary: (Adapted from Abstract): Dr. Boettcher will conduct a series of experiments to investigate the additivity of age-related and noiseinduced hearing loss in the gerbil. Animals will be raised in a soundisolating environment, and hearing testing will be performed on each ear before and after exposure of a single ear to noise at a level intended to produce a mild hearing loss. Dr. Boettcher will investigate whether susceptibility to noise-induced hearing loss varies as a function of age, and whether a non- traumatic conditioning sound can reduce the magnitude of age- related hearing loss. Dr. Boettcher will measure auditory threshold using auditory brainstem responses, and will also, in

Studies 59

a subset of animals, obtain measures of histopathology of the stria

vacularis, hair cells and eighth nerve fibers.

Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

· Project Title: OXIDATIVE STRESS PATHWAYS IN NOISE INDUCED HEARING LOSS Principal Investigator & Institution: Schacht, Jochen H.; Professor & Director, Khri; Otolaryngology; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR2006 Summary: Cellular responses to a traumatic insult include the activation of multiple pathways that lead either to survival (homeostatic pathways) or cell death (apoptotic or necrotic pathways). The control of these pathways requires the concerted efforts of second messengers, protein kinases, and transcription factors that will ultimately change the patterns of gene expression in the cell. Depending on the intensity of the stress, different genes will be activated, eventually shifting the balance from homeostatic pathways (at low stress) to cell death pathways (at high stress). This project intends to unravel some of these pathways and their contributions to noise-induced hearing loss. It is the underlying hypothesis - based on solid preliminary evidence - that an initial event in noise trauma is the formation of reactive oxygen species leading to the activation of transcription factors and upregulation of oxidant stress response genes. Specifically, the following aims will be addressed in a mouse model of noise-induced hearing loss: (1) the formation and distribution of reactive oxygen species and the activation of the transcription factors AP-1 and NF-kappaB; (2) the hypothesis that the phosphoinositide pathway (phosphoinositide-3-OH kinase; PI 3-kinase) and NF-kappaB integrate noise-induced signaling by mediating the effects of ROS and neurotrophic factor; (3) the expression of specific antioxidant genes and the localization of their protein products. The project is coordinated with the other projects and core facilities in this application both by the common theme and by shared coordinated design and shared animals. The joint analysis of the data will yield a wide-ranging and integrated model of cochlear stress responses which, in turn, will provide a rational basis for designing pharmacological interventions to prevent noise-induced hearing loss. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen


· Project Title: POTENTIATION--NOISE INDUCED HEARING LOSS-ACRYLONITRILE Principal Investigator & Institution: Fechter, Laurence D.; Professor; Pharmaceutical Sciences; University of Oklahoma Hlth Sciences Ctr Health Sciences Center Oklahoma City, Ok 73126 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 30-JAN2003 Summary: (provided by applicant): Oxidative stress is recognized to play an important role in cochlear injury associated with noise exposure as well as ototoxicant exposure. We hypothesize that exposure to drugs and chemical agents that disrupt intrinsic buffers of reactive oxygen species (ROS) can serve as risk factors for noise induced hearing loss by promoting ROS that are initiated by the noise. We propose that the chemical intermediary, acrylonitrile, will potentiate noise induced hearing loss in this manner. The metabolism of acrylonitrile is known to deplete glutathione, an important intrinsic buffer against reactive oxygen species (ROS). Acrylonitrile metabolism can also produce cyanide, in vivo, which is capable of inhibiting superoxide dismutase. Acrylonitrile is one of the 50 most common chemicals and it is produced in quantities of billions of pounds per year. In order to generate sufficient data to support a successful R01 grant application, we propose a limited series of experiments aimed at establishing an effective dose response relationship between acrylonitrile and auditory impairment at a physiological level. This will entail the use of distortion product otoacoustic emissions (DPOAE) testing along with assessment of auditory threshold via measurement of the compound action potential (CAP) from the round window. We will also establish a dose response relationship between acrylonitrile administration and extent of glutathione depletion in the cochlea as well as cyanide generation. Finally, we will determine whether oxidative stress is elevated among rats receiving combined exposure to noise and acrylonitrile by trapping ROS in cochlear homogenates and measuring the adducts by electron paramagnetic spin resonance (EPR). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign

Studies 61

references. It is also free to the public.15 If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with noise-induced hearing loss, simply go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type “noise-induced hearing loss” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “noise-induced hearing loss” (hyperlinks lead to article summaries): · Vestibular findings associated with chronic noise induced hearing impairment. Author(s): Shupak A, Bar-El E, Podoshin L, Spitzer O, Gordon CR, Ben-

David J.

Source: Acta Oto-Laryngologica. 1994 November; 114(6): 579-85.

http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=

PubMed&list_uids=7879613&dopt=Abstract

Vocabulary Builder Adduct: Complex formed when a carcinogen combines with DNA or a

protein. [NIH]

Clamp: A u-shaped steel rod used with a pin or wire for skeletal traction in

the treatment of certain fractures. [NIH]

Cyanide: An extremely toxic class of compounds that can be lethal on

inhaling of ingesting in minute quantities. [NIH]

Cytotoxicity: Quality of being capable of producing a specific toxic action

upon cells of special organs. [NIH]

Handicap: A handicap occurs as a result of disability, but disability does not

always constitute a handicap. A handicap may be said to exist when a

disability causes a substantial and continuing reduction in a person's

capacity to function socially and vocationally. [NIH]

PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

15


Homogenate: A suspension of animal tissue that is ground in the all-glass "homogenizer" described by Potter and Elvehjem in 1936. [NIH]

Joint: The point of contact between elements of an animal skeleton with the

parts that surround and support it. [NIH]

Linkage: The tendency of two or more genes in the same chromosome to

remain together from one generation to the next more frequently than

expected according to the law of independent assortment. [NIH]

Otology: The branch of medicine which deals with the diagnosis and

treatment of the disorders and diseases of the ear. [NIH]

Papilla: A small nipple-shaped elevation. [NIH]

Patch: A piece of material used to cover or protect a wound, an injured part,

etc.: a patch over the eye. [NIH]

Pathologies: The study of abnormality, especially the study of diseases. [NIH]

Potentiate: A degree of synergism which causes the exposure of the

organism to a harmful substance to worsen a disease already contracted. [NIH]

Potentiation: An overall effect of two drugs taken together which is greater

than the sum of the effects of each drug taken alone. [NIH]

Reductase: Enzyme converting testosterone to dihydrotestosterone. [NIH]

Rehabilitative: Instruction of incapacitated individuals or of those affected

with some mental disorder, so that some or all of their lost ability may be regained. [NIH] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH] Superoxide: Derivative of molecular oxygen that can damage cells. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH]

Patents 63

CHAPTER 4. PATENTS ON NOISE-INDUCED HEARING LOSS Overview You can learn about innovations relating to noise-induced hearing loss by reading recent patents and patent applications. Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.16 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available to patients with noise-induced hearing loss within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available to patients with noise-induced hearing loss. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information.

16Adapted

from The U. S. Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.


Patent Applications on Noise-Induced Hearing Loss As of December 2000, U.S. patent applications are open to public viewing.17 Applications are patent requests which have yet to be granted (the process to achieve a patent can take several years). The following patent applications have been filed since December 2000 relating to noise-induced hearing loss: ·

Use of medicaments Inventor(s): Etheridge, Steven; (Harlow, NC) Correspondence: David J Levy, Corporate Intellectual Property; Glaxosmithkline; Five Moore Dr., PO Box 13398; Research Triangle Park; NC; 27709-3398; US Patent Application Number: 20040023962 Date filed: August 14, 2003 Abstract: The present invention provides the use of frequency dependent voltage activated sodium channel blockers particularly lamotrigine in the prevention of noise induced hearing loss.. Excerpt(s): The present invention relates to a new use of frequency dependent voltage activated sodium channel blockers. In particular, the present invention relates to a new use of 3,5-diamino-6-(2,3dichlorophenyl)-1,2,- 4-triazine and its pharmaceutically acceptable acid addition salts.... Compounds exhibiting frequency dependent voltage activated sodium channel blocker activity include those described in EPA-0021121, WO97/09317, WO98/38174, WO99/32462 and WO00/12488.... Simpson et al., The Assessment of Lamotrigine, an Antieplileptic Drug, in The Treatment of Tinnitus, Am J Otol 1999; 20: p 627-631 suggests that lamotrigine might be useful in the treatment of tinnitus. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with noise-induced hearing loss, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, 17

This has been a common practice outside the United States prior to December 2000.

Patents 65

perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “noise-induced hearing loss” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on noise-induced hearing loss. You can also use this procedure to view pending patent applications concerning noise-induced hearing loss. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

67

CHAPTER 5. BOOKS ON NOISE-INDUCED HEARING LOSS Overview This chapter provides bibliographic book references relating to noiseinduced hearing loss. You have many options to locate books on noiseinduced hearing loss. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on noise-induced hearing loss include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “noise-induced hearing loss” (or synonyms) into the “For these words:” box. You will only receive results on books. You should check back periodically with this database which is updated every 3 months. The following is a typical result when searching for books on noise-induced hearing loss:


·

Cochlear Pharmacology and Noise Trauma: Proceedings of the Joint Symposium Organised by the European Commission Concerted Action Protection Against Noise and the Novartis Foundation Source: London, England: NRN Publications. 1999. 206 p. Contact: Available from NRN Publications. Institute of Laryngology and Otology, 330 Gray's Inn Road, London, WC1X 8EE, United Kingdom. 440 207 915 1590. PRICE: Contact publisher for current price. ISBN: 190174700x. Summary: This book reprints the Proceedings of the Joint Symposium on Cochlear Pharmacology and Noise Trauma, organized by the European Commission Concerted Action Protection Against Noise and the Novartis Foundation, held in London, England in May 1998. Excessive exposure to noise results in either direct mechanical damage to the sensitive cochlear structures or from metabolic overload due to overstimulation. The probability of acquiring a hearing impairment increases if noise exposure is combined with other factors such as chemicals, extreme temperatures, and vibration. The book includes 16 chapters that cover inner ear pharmacology and clinical implications; immunocytochemical clues to the handling of excitatory neurotransmitters in the cochlea; GABA, dopamine, and serotonin in cochlear innervation, specifically models of protection against neurotoxicity; oral magnesium used to reduce noise induced temporary and permanent hearing loss; medical treatment for acoustic trauma; strategies for preventing hearing loss; intervention possibilities for noise induced hearing loss;; strategies for protection of the inner ear from noise induced hearing loss (NIHL); toluene and styrene induced hearing losses; mechanisms of ototoxicity by chemical contaminants; therapeutic strategies for improving cochlear blood flow; peripheral and central effects of noise exposure in rats as determined by electrophysiological methods; noise induced calcium increases and the outer hair cell; protection against cisplatin ototoxicity by melanocortins; and thoughts on the type of patients who could benefit from in situ pharmacology. Each chapter concludes with a reference list and with a brief reprint of the discussion that happened after each presentation. A subject index concludes the volume.

Chapters on Noise-Induced Hearing Loss Frequently, noise-induced hearing loss will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with noise-induced hearing loss, an excellent source of abstracts is the Combined Health Information Database. You will need to

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limit your search to book chapters and noise-induced hearing loss using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “noise-induced hearing loss” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books. The following is a typical result when searching for book chapters on noise-induced hearing loss: ·

Occupational Hearing Loss Prevention Programs Source: in Musiek, F.E. and Rintelmann, W.F., eds. Contemporary Perspectives in Hearing Assessment. Needham Heights, MA: Allyn and Bacon. 1999. p. 465-484. Contact: Available from Allyn and Bacon. 160 Gould Street, Needham Heights, MA 02194. (800) 278-3525. Website: www.abacon.com. PRICE: $65.33. ISBN: 0205274579. Summary: Audiologists are uniquely qualified to assume positions of responsibility in occupational hearing loss prevention programs (HLPPs). Audiologists should also acquire knowledge and skills necessary to interact with professionals from other disciplines commonly associated with occupational health nurses, physicians, industrial hygienists, safety professionals, and noise control engineers. This chapter on occupational hearing loss prevention programs is from a textbook designed to serve as a text for graduate level audiology courses concerned with the assessment of the peripheral and central auditory systems. The textbook includes an auditory compact disc (CD) that provides students with an opportunity to have some experience with acoustic stimuli. This chapter provides a brief overview of current legal requirements and 'best practices' for occupational hearing loss prevention programs. Legal requirements will identify minimum steps necessary to achieve compliance with federal regulations. The author notes that professional supervision by audiologists of audiometric testing programs is necessary to assure reliable and valid data for early identification and intervention. Topics include the basic concepts and terminology of noise induced hearing loss (NIHL), damage risk criteria, federal regulations, noise exposure monitoring, audiometric testing programs, hearing protection programs, training and motivation programs, recordkeeping, program evaluation, noise control, worker compensation, and research needs. 4 figures. 4 tables. 156 references.


·

Standards and Regulations Source: in Berger, E.H., et al, eds. Noise Manual. 5th ed. Fairfax, VA: American Industrial Hygiene Association. 2000. p. 639-668. Contact: Available from American Industrial Hygiene Association. Publication Orders, Department 796, Alexandria, VA 22334-0796. (703) 849-8888. Fax (703) 207-3561. Website: www.aiha.org. PRICE: $59.00 for members; $74.00 for nonmembers, plus shipping and handling. ISBN: 0932628029. Summary: In the United States, the advent of federal regulations for noise control was preceded by a series of consensus standards; the Federal government imposed uniformity with a noise regulation. Of course, uniformity is sometimes achieved through a process of simplification at the expense of precision. This chapter on noise standards and regulations is from a textbook that serves as a comprehensive reference tool for hearing conservationists. Topics include the need for standards and regulations, the need to be informed, terminology, consensus standards, damage-risk criteria, Federal government regulations, international standards and regulations for occupational exposure to noise, enforcement and compliance, employment criteria, and the Americans with Disabilities Act (ADA). These standards and regulations provide a foundation on which hearing care professionals can base their programs to prevent noise induced hearing loss (NIHL). The author concludes that professionals should also keep in mind that the various standards and regulations are subject to change, that in some cases they provide only minimal protection, and that they can, therefore, be improved upon to the benefit of employers and employees alike. 4 tables. 46 references.

·

Nongenetic Sensorineural Hearing Loss in Children Source: in Canalis, R.F. and Lambert, P.R., eds. Ear: Comprehensive Otology. Philadelphia, PA: Lippincott Williams and Wilkins. 2000. p. 489 510. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030. Fax (301) 223-2300. Website: www.lww.com. PRICE: $179.00 plus shipping and handling. ISBN: 078171558X. Summary: Persistent, bilateral congenital or early onset hearing loss in the moderate to profound range (41 to 100 dB) distorts the speech perception of a developing child. This chapter on nongenetic sensorineural hearing loss in children is from a textbook that offers complete coverage of the field of clinical otology (study of the ear). The book is oriented to serve both the otolaryngology resident as a practical

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learning tool and the practicing otolaryngologist as an updated reference source of clinical and basic information. Topics include the evaluation of a young child with a hearing loss, including history and physical examination, laboratory testing, and audiometric testing; and specific causes of nongenetic sensorineural hearing loss, including congenital and early onset infections, late onset infections, ototoxic drugs and chemicals, hyperbilirubinemia, prematurity and term low birth weight, ear and head trauma, and noise induced hearing loss.. The authors stress that comprehensive evaluation of a child with educationally significant hearing impairment is best accomplished by a team of specialists. Rehabilitative advances such as cochlear implants and improved hearing aid technology have improved the prospects for children with marked sensorineural hearing loss (SNHL). 2 figures. 3 tables. 68 references. ·

Acoustic Trauma and Noise-Induced Hearing Loss Source: in Canalis, R.F. and Lambert, P.R., eds. Ear: Comprehensive Otology. Philadelphia, PA: Lippincott Williams and Wilkins. 2000. p. 773 783. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030. Fax (301) 223-2300. Website: www.lww.com. PRICE: $179.00 plus shipping and handling. ISBN: 078171558X. Summary: The extraordinary auditory (hearing) capability and sensitivity is vulnerable to the effects of acute acoustic trauma and chronic environmental noise. From an otologic perspective, it is the acoustic energy reaching the ear that is important, not the nature or quality of the sound; beautiful music may inflict as much damage on the ear as a jackhammer if delivered with equal intensity. This chapter on acoustic trauma and noise induced hearing loss (NIHL) is from a textbook that offers complete coverage of the field of clinical otology (study of the ear). The book is oriented to serve both the otolaryngology resident as a practical learning tool and the practicing otolaryngologist as an updated reference source of clinical and basic information. Topics include noise classification; the clinical aspects of noise, including acute acoustic trauma and chronic NIHL; the pathophysiology of both conditions; temporal bone histopathology; industrial noise and workers' compensation; nonoccupational noise; and the constitutional nonauditory effects of noise. The authors conclude that NIHL is a growing health hazard. Noise is the most common preventable cause of irreversible sensorineural hearing loss in the United States. 6 figures. 4 tables. 48 references.


·

Evaluating Hearing Conservation Program Effectiveness Source: in Berger, E.H., et al, eds. Noise Manual. 5th ed. Fairfax, VA: American Industrial Hygiene Association. 2000. p. 517-548. Contact: Available from American Industrial Hygiene Association. Publication Orders, Department 796, Alexandria, VA 22334-0796. (703) 849-8888. Fax (703) 207-3561. Website: www.aiha.org. PRICE: $59.00 for members; $74.00 for nonmembers, plus shipping and handling. ISBN: 0932628029. Summary: The goal of occupational hearing conservation programs (HCPs) is to prevent significant on the job, noise-induced hearing loss; therefore, the ultimate outcome measure of HCP performance can be found in the audiometric database of annual audiograms for noise exposed personnel. This chapter on evaluating hearing conservation program effectiveness is from a textbook that serves as a comprehensive reference tool for hearing conservationists. The authors cover several methods of using audiometric database analysis (ADBA) to evaluate HCP success and gives examples of their application and interpretation. Topics include tabulation assessment approaches, reasons for using ADBA, ADBA options, population comparisons, criteria comparisons, the selection of groups for analysis, determination of HCP effectiveness, HCP effectiveness for later years of testing, evaluation of hearing protector adequacy, the adequacy of protection from noise, and audiometric testing reliability. ADBA is a performance based approach to HCP evaluation, which yields information not obtainable through compliance oriented audits. The HCP is judged as acceptable if the noise exposed population does not exhibit significant development or progression of occupational noise induced hearing loss (NIHL), and if audiometric variability is low. 20 figures. 3 tables. 34 references.

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Workers' Compensation Source: in Berger, E.H., et al, eds. Noise Manual. 5th ed. Fairfax, VA: American Industrial Hygiene Association. 2000. p. 689-710. Contact: Available from American Industrial Hygiene Association. Publication Orders, Department 796, Alexandria, VA 22334-0796. (703) 849-8888. Fax (703) 207-3561. Website: www.aiha.org. PRICE: $59.00 for members; $74.00 for nonmembers, plus shipping and handling. ISBN: 0932628029. Summary: There are many reasons for preventing hearing loss. One reason that is sometimes underestimated is the cost of paying workers for their noise induced hearing loss (NIHL), an occupational disease now scheduled (or otherwise covered) in workers' compensation (WC) laws of

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most states. Outside of WC laws, hearing loss, monetary loss, or injury resulting from negligent failure to control noise may result in civil liability to the employer or to the noise source manufacturer. Persons having responsibilities in hearing conservation programs should become acquainted with at least the basic legal aspects of the industrial noise problem. This chapter on workers' compensation is from a textbook that serves as a comprehensive reference tool for hearing conservationists. Topics include a history of WC; workers' compensation for hearing loss, including impairment, handicap, disability, calculation of binaural impairment, adjustments for age, waiting period, the use of hearing protection devices, the statute of limitations, hearing aids, tinnitus, and duration and level of exposure. Other topics include considerations for handling claims, including the validation of a claim, testimony and records, the expert witness, and handling claims; implications for hearing conservation professionals, including noise surveys and analysis, audiometric monitoring, and personal protection. 2 tables. 21 references. · How Vocal Abilities Can Be Limited by Diseases and Disorders of the Auditory System Source: in Thurman, L. and Welch, G., eds. Bodymind and Voice: Foundations of Voice Education, Volumes 1-3. 2nd ed. Collegeville, MN: VoiceCare Network. 2000. p. 564-572. Contact: Available from National Center for Voice and Speech (NCVS). Book Sales, 334 Speech and Hearing Center, University of Iowa, Iowa City, IA 52242. Website: www.ncvs.org. PRICE: $75.00 plus shipping and handling. ISBN: 0874141230. Summary: This chapter on diseases and disorders of the auditory system is from a multi-volume text that brings a biopsychosocial approach to the study of the voice. The authors use the phrase 'bodyminds' to describe the interrelationship of perception, memory, learning, behavior, and health, as they combine to affect all environmental interactions, adaptations, and learning. The books are written for teachers, voice professionals, people who use their voices on an avocational basis, and interested members of the general public. This chapter emphasizes that auditory (hearing) experiences, and the development of finer auditory discriminations, are the blocks on which language, paralanguage, and singing abilities are built. If any part of the auditory system (from ear through brain and voice) functions abnormally, these blocks will be incompletely formed and spoken language, reading, and singing abilities will be impaired. Topics include types of hearing loss, conductive hearing loss, otitis media with effusion (OME, middle ear infection), conductive hearing loss in children, sensorineural hearing loss in adults and


children, noise induced hearing loss, and problems with music induced hearing loss (MIHL). The chapter concludes with a brief section on hearing protection devices. 56 references. ·

Disorders of the Auditory System Source: in Roeser, R.J.; Valente. M.; Hosford-Dunn, H., eds. Audiology: Diagnosis. New York, NY: Thieme. 2000. p. 85-108. Contact: Available from Thieme. 333 Seventh Avenue, New York, NY 10001. (800) 782-3488. Fax (212) 947-0108. E-mail: [email protected]. PRICE: $59.00 plus shipping and handling. ISBN: 0865778574. Summary: This chapter on disorders of the auditory system is from a textbook that provides a comprehensive overview of the diagnostic options available to identify and diagnose the clinical symptoms seen in an audiology practice. The authors provide a brief overview of most of the common disorders seen by the otologist and audiologist, including diagnostic information and treatment options. Topics include the otologic examination, including the patient history, tinnitus, hearing loss, otalgia (pain in the ear), otorrhea (drainage from the ear), vertigo (a sensation of spinning or dizziness), and physical examination of the ear; diseases of the ear canal, including dermatitis, external bacterial otitis, malignant otitis externa (necrotizing external otitis), fungal external otitis, congenital aural atresias, osteomas and exostoses, and keratosis obturans; disorders of the tympanic membrane (eardrum), middle ear, and mastoid process, including tympanic membrane perforations and retractions, otitis media (middle ear infection), tympanosclerosis and myringosclerosis, cholesteatoma, otosclerosis, ossicular chain discontinuity, and neoplasms; and disorders of the inner ear and internal auditory canal, including sensorineural hearing loss, progressive sensorineural hearing loss, noise induced hearing loss, aging and hearing loss, ototoxicity, vestibular neuronitis, benign paroxsymal positional vertigo, perilymph fistula, Meniere's disease, autoimmune inner ear disease, tumors of the internal auditory canal and cerebellopontine angle, and vascular compression syndrome. The chapter includes an outline of the topic covered, a list of references, a summary outline of the related preferred practice guidelines, and various 'pearls and pitfalls' offering practical advice to the reader. 20 figures. 2 tables. 17 references.

·

Sensorineural Hearing Loss Associated With Trauma Source: in Pappas, D.G. Diagnosis and Treatment of Hearing Impairment in Children. 2nd ed. San Diego, CA: Singular Publishing Group, Inc. 1998. p. 169-194.

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Contact: Available from Singular Publishing Group, Inc. 401 West 'A' Street, Suite 325, San Diego, CA 92101-7904. (800) 521-8545. Fax (800) 774 8398. E-mail: [email protected]. Website: www.singpub.com. PRICE: $55.00 plus shipping and handling. ISBN: 1565938658. Summary: This chapter on sensorineural hearing loss associated with trauma is from a text that discusses the prevention, diagnosis, and treatment of hearing impairment in children. The authors cover birth related trauma, including low birth weight (LBW), hyperbilirubinemia (jaundice), and perinatal asphyxia; audiometrics; pathophysiology; head injuries and acquired sensorineural hearing loss (SNHL), including temporal bone fracture, and labyrinthine concussion; otitic barotrauma; noise induced hearing loss (NIHL), including infant incubator noise characteristics, noise levels and recreational activities, and noise levels in school; the pathophysiology of sound trauma; hearing in the presence of noise; SNHL associated with toxins, including aminoglycosides, antiprotozoal agents, salicylates, diuretics, alcohol (fetal alcohol syndrome), ototoxicity from organic solvents and metals, and tobacco; and hearing loss and persistent fetal circulation. 4 figures. 1 table. 95 references. ·

Ears Source: in Kelly, R.B., ed. Family Health and Medical Guide. Dallas, TX: Word Publishing. 1996. p. 76-85. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. PRICE: $30.00 for members; $35.00 for non members; plus shipping and handling. ISBN: 0849908396. Summary: This chapter on the anatomy and physiology of the ears is from a family health and medical guide. The chapter first describes the anatomy of the outer, middle and inner ear, and the eustachian tubes. The chapter then covers problems of the ears, including benign positional vertigo; different types of hearing loss, including eustachian tube problems, noise induced hearing loss, otosclerosis (hardening of one of the bones of the middle ear), presbycusis (hearing loss related to aging), and ruptured eardrum; infection of the ear canal; infection of the middle ear; fluid in the middle ear; foreign objects in the ear; labyrinthitis; Meniere's disease; ringing in the ears (tinnitus); tumors of the inner ear (acoustic neuroma); tumors of the outer ear; and wax (cerumen) buildup in the ear. For each topic, the authors discuss symptoms, diagnostic tests, treatment options, and prevention. Sidebars cover decibel levels of common sounds, the causes of deafness, preventing hearing loss, preventing middle ear infections, and otitis symptoms. 4 figures.


·

Audiometric Monitoring Phase of the HCP Source: in Berger, E.H., et al, eds. Noise Manual. 5th ed. Fairfax, VA: American Industrial Hygiene Association. 2000. p. 455-516. Contact: Available from American Industrial Hygiene Association. Publication Orders, Department 796, Alexandria, VA 22334-0796. (703) 849-8888. Fax (703) 207-3561. Website: www.aiha.org. PRICE: $59.00 for members; $74.00 for nonmembers, plus shipping and handling. ISBN: 0932628029. Summary: This chapter on the audiometric monitoring phase of the hearing conservation program (HCP) is from a textbook that serves as a comprehensive reference tool for hearing conservationists. The author takes a proactive view of the audiometric monitoring phase, noting that this phase offers the employer's best chance to make the entire HCP meaningful and effective for the individual, thereby preventing noise induced hearing loss (NIHL). This goal can be attained only if the face to face contact at the time of the audiogram (hearing evaluation), as well as subsequent written feedback and follow up actions, are used for the purposes of educating and motivating the employee. Topics covered include the quality of the audiometric phase, options for implementing the audiometric monitoring phase, technical factors for valid and reliable audiograms, process factors in obtaining valid and reliable audiograms, audiogram review and written feedback, follow up steps after audiograms, recordkeeping for the audiometric phase, evaluating an audiometric testing program, audiometric data as an indicator of HCP effectiveness, and capturing the full potential of audiometric monitoring. The chapter deals primarily with audiometric evaluations conducted with the context of an HCP for employees with noise exposures at OSHA's action level or higher. 16 figures. 8 tables. 66 references.

·

Auditory System and Related Disorders Source: in Gelfand, S.A. Essentials of Audiology. 2nd ed. New York, NY: Thieme Medical Publishers, Inc. 2001. p. 173-218. Contact: Available from Thieme Medical Publishers, Inc. 333 Seventh Avenue, New York, NY 10001. (800) 782-3488. Fax (212) 947-0108. E-mail: [email protected]. PRICE: $49.00 plus shipping and handling. ISBN: 1588900177. Summary: This chapter on the auditory (hearing) system and related disorders is from an undergraduate textbook that deals with audiology and related topics in speech language pathology. The author addresses the nature of various pathologies (problems or diseases), where and when they occur, their major signs and symptoms, how hearing is

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affected, and the ways they are treated. The author first explains the importance of the case history in diagnosis and patient care. The chapter then covers conductive, sensorineural, and mixed hearing impairments; tinnitus (ringing or buzzing sounds in the ears); congenital and hereditary disorders; maternal infections, including syphilis, toxoplasmosis, rubella, cytomegalovirus (CMV); other influences in the maternal environment; congenital anomalies of the ear, including dysplasia (abnormal development in the anatomical structure); syndromes involving the ear and hearing; acquired disorders, including head trauma; outer ear disorders, including impacted cerumen (earwax), foreign bodies, growths and tumors, and infections; middle ear disorders, including bullus myringitis, tympanosclerosis, perforations of the tympanic membrane (eardrum), otitis media (middle ear infection), and otosclerosis (bone disease); surgery to improve or restore hearing, including otosclerosis surgery, tympanoplasy (repair and reconstruction of the eardrum), and surgery for growths and tumors; cochlear disorders, including noise induced hearing loss (NIHL), Meniere's disease, ototoxicity (chemical damage to the ear), infections, perilymphatic fistulas; retrocochlear disorders; auditory neuropathy; central disorders; sudden hearing loss; presbycusis (hearing loss related to aging); Paget's disease (osteitis deformans, a progressive bone disease); obscure auditory dysfunction; and nonorganic hearing loss. 19 figures. 2 tables. 138 references. ·

Effects of Noise and Industrial Audiology Source: in Gelfand, S.A. Essentials of Audiology. 2nd ed. New York, NY: Thieme Medical Publishers, Inc. 2001. p. 501-541. Contact: Available from Thieme Medical Publishers, Inc. 333 Seventh Avenue, New York, NY 10001. (800) 782-3488. Fax (212) 947-0108. E-mail: [email protected]. PRICE: $49.00 plus shipping and handling. ISBN: 1588900177. Summary: This chapter on the effects of noise and industrial audiology is from an undergraduate textbook that deals with audiology and related topics in speech language pathology. The author reviews the branch of audiology that deals with the effects and ramifications of excessive sound exposure. Topics include the effects of noise on hearing ability and speech communication, its nonauditory effects, occupational noise exposure and industrial hearing conservation, and the related issue of workers' compensation for noise induced hearing loss (NIHL). The author begins by reviewing ways that noises are described and measured, which is often part of audiological practice and is also prerequisite to understanding the effects of noise exposure. The author


also covers noise exposure criteria, as established by the National Institute for Occupational Safety and Health (NIOSH). Noise can be unwanted not only because it causes hearing impairment, but because it may interfere with one's work, leisure activities, rest, or sleep; interfere with speech communication; be distracting or startling; or convey a disturbing meaning. Exposure to noise can have wide reaching negative effects on many aspects of physical and mental health and performance. The author outlines the use of hearing protection devices and the importance of workplace conservation programs. 20 figures. 9 tables. 117 references. ·

Types, Degrees, and Causes of Hearing Loss Source: in Flexer, C. Facilitating Hearing and Listening in Young Children. 2nd ed. San Diego, CA: Singular Publishing Group, Inc. 1999. p. 35-72. Contact: Available from Singular Publishing Group, Inc. 401 West 'A' Street, Suite 325, San Diego, CA 92101-7904. (800) 521-8545 or (619) 238 6777. Fax (800) 774-8398 or (619) 238-6789. E-mail: [email protected]. Website: www.singpub.com. PRICE: $45.00 plus shipping and handling. ISBN: 1565939891. Summary: This chapter on the types, degrees, and causes of hearing loss is from a textbook that emphasizes the need to create an auditory world for children, in which their auditory brain centers continue to develop the neurological and experiential foundations for literacy and learning. This chapter presents an overview of the general classifications of hearing impairment and then details specific pathologies that can cause hearing impairment in children. Topics include congenital and acquired hearing impairments, distinguishing audiometric and functional definitions for hard of hearing and deaf persons, classification of hearing loss, genetic syndromes and the incidence of hearing loss associated with some syndromes (Treacher Collins, Crouzon, Waardenburg, Alport, Usher, Pendred, Jervell, Lange Nielsen), auditory pathologies, conductive hearing impairments (otitis media, collapsed ear canals, abnormalities of the middle ear ossicles, atresia, stenosis, cerumen impaction, otitis externa, perforated tympanic membrane, objects in the ear canal, cholesteatoma, and mastoiditis), sensorineural hearing impairments (tinnitus, noise induced hearing loss, viral and bacterial infections, anoxia, ototoxicity, large vestibular aqueduct, perilymph fistula, acoustic neuroma, Rh incompatibility), dysplasias (malformations or incomplete development of the inner ear), auditory neuropathy, mixed hearing impairments, progressive hearing impairments, and central and functional hearing impairments. A list of factors that place an infant or

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child at risk for hearing impairment is included at the end of the chapter. 2 figures. 3 tables.

General Home References In addition to references for noise-induced hearing loss, you may want a general home medical guide that spans all aspects of home healthcare. The following list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): ·

The Encyclopedia of Deafness and Hearing Disorders (Facts on File Library of Health and Living) by Carol Turkington, Allen E. Sussman; (Library Binding - December 2000), Facts on File, Inc.; ISBN: 081604046X; http://www.amazon.com/exec/obidos/ASIN/081604046X/icongroupinter na

·

An Introduction to Ear Disease by Bruce Black, M.D.; Paperback - 90 pages, 1st edition (October 1, 1998), Singular Publishing Group; ISBN: 076930012X; http://www.amazon.com/exec/obidos/ASIN/076930012X/icongroupinter na

·

Living With Hearing Loss: The Sourcebook for Deafness and Hearing Disorders (The Facts for Life Series) by Carol Turkington, Allen E. Sussman; (Paperback - December 2000), Checkmark Books; ISBN: 0816041407; http://www.amazon.com/exec/obidos/ASIN/0816041407/icongroupinter na

·

When the Brain Can't Hear: Unraveling the Mystery of Auditory Processing Disorder by Teri James Bellis; Hardcover - 288 pages (February 2002), Pocket Books; ISBN: 0743428633; http://www.amazon.com/exec/obidos/ASIN/0743428633/icongroupinter na

Vocabulary Builder Berger: A binocular loupe with the lenses mounted at the anterior end of a

light-excluding chamber fitting over the eyes and held in place by an elastic

headband. [NIH]

Binaural: Used of the two ears functioning together. [NIH]

Branch: Most commonly used for branches of nerves, but applied also to


other structures. [NIH]

CMV: A virus that belongs to the herpes virus group. [NIH]

Dermatitis: Inflammation of the skin. [NIH]

Discrimination: The act of qualitative and/or quantitative differentiation

between two or more stimuli. [NIH]

Eardrum: A thin, tense membrane forming the greater part of the outer wall

of the tympanic cavity and separating it from the external auditory meatus; it

constitutes the boundary between the external and middle ear. [NIH]

Excitatory: When cortical neurons are excited, their output increases and

each new input they receive while they are still excited raises their output markedly. [NIH]

Fistulas: An abnormal passage from one hollow structure of the body to

another, or from a hollow structure to the surface, formed by an abscess,

disease process, incomplete closure of a wound, or by a congenital anomaly.

[NIH]

Gould: Turning of the head downward in walking to bring the image of the ground on the functioning position of the retina, in destructive disease of the peripheral retina. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH]

Hereditary: Of, relating to, or denoting factors that can be transmitted

genetically from one generation to another. [NIH]

Incubator: Consists of a transparent plastic cubicle, electrical heating

equipment, safety and warning devices, and oxygen and air filtering and

regulating apparatus; an enclosed transparent boxlike apparatus for housing

prematurely born babies under optimum conditions. [NIH]

Labyrinthine: A vestibular nystagmus resulting from stimulation, injury, or disease of the labyrinth. [NIH]

Ossicles: The hammer, anvil and stirrup, the small bones of the middle ear,

which transmit the vibrations from the tympanic membrane to the oval

window. [NIH]

Retrocochlear: Hearing loss in which the air conduction threshold and the

bone conduction threshold have risen almost equally with no gap between

them. In such cases the defect is usually either in the cochlea of the inner ear

or in the central pathways. [NIH]

Salicylate: Non-steroidal anti-inflammatory drugs. [NIH]

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CHAPTER 6. MULTIMEDIA ON NOISE-INDUCED HEARING LOSS Overview Information on noise-induced hearing loss can come in a variety of formats. Among multimedia sources, video productions, slides, audiotapes, and computer databases are often available. In this chapter, we show you how to keep current on multimedia sources of information on noise-induced hearing loss. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine. If you see an interesting item, visit your local medical library to check on the availability of the title.

Video Recordings Most diseases do not have a video dedicated to them. If they do, they are often rather technical in nature. An excellent source of multimedia information on noise-induced hearing loss is the Combined Health Information Database. You will need to limit your search to “video recording” and “noise-induced hearing loss” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” By making these selections and typing “noise-induced hearing loss” (or synonyms) into the “For these words:” box, you will only receive results on video productions. The following is a typical result when searching for video recordings on noiseinduced hearing loss:


·

Eardrum-Hum: Exploring the Health of Hearing Source: Wheeling, IL: Film Ideas, Inc. 1999. (videocassette). Contact: Available from Film Ideas, Inc. 308 North Wolf Road, Wheeling, IL 60090. (800) 475-3456 or (847) 419-0255. Fax (847) 419-8933. E-mail: [email protected]. Website: www.filmideas.com. PRICE: $175.00 plus shipping and handling. Summary: This educational videotape program teaches children about noise induced hearing loss.. The program emphasizes that loud sounds, no matter what causes them, are potentially dangerous. Children are encouraged to protect their hearing by not playing music or television too loudly, not pointing noise making toys directly at the ears, not popping balloons near the ears, and not shouting in people's ear; these activities are all demonstrated at a child's birthday party. Other topics discussed and depicted include the problems that can arise from using a Walkman personal stereo with earphones; how loud noise damages ears, including graphics of the inner ear, cochlea, and hair cells; symptoms of noiseinduced hearing loss, including humming in the ears and the sense of muffled sounds; how ear infections can damage hearing; and the importance of preventing eardrum perforation. The program features young adolescents in various every day settings, to emphasize the need to remain aware of the potential for noise-induced hearing loss.

Audio Recordings The Combined Health Information Database contains abstracts on audio productions. To search CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find audio productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Sound Recordings.” By making these selections and typing “noise-induced hearing loss” (or synonyms) into the “For these words:” box, you will only receive results on sound recordings (again, most diseases do not have results, so do not expect to find many). The following is a typical result when searching for sound recordings on noise-induced hearing loss: ·

Lend Me Your Ears: Experiencing Noise Induced Hearing Loss Source: Portland, OR: Audiology Research Laboratory, Portland State University. 1999. (audiocassette, instructor's manual).

Multimedia 83

Contact: Available from Audiology Research Laboratory, Portland State University. P.O. Box 751 Portland, OR 97215-0751. (503) 725-3577. E-mail: [email protected]. PRICE: $20.00 plus shipping and handling. Summary: This program features a series of three audio programs aimed at alerting people to the deleterious effects of noise induced hearing loss (NIHL) on communication and safety. The three programs demonstrate how a hearing loss affects the comprehension of speech, warning sounds, and environmental sounds. In addition, the series contains simple listening exercises in which the listener evaluates his or her ability to understand speech that is filtered to simulate NIHL. The self scored exercises demonstrate how simple commands and questions can be misunderstood, and how warning signals and environmental sounds can go unheard when a person has a hearing loss. Having a listener 'experience' a hearing loss before it actually occurs is intended to motivate him or her to use hearing protection. The accompanying instructor's manual explains how to administer the listening tests, contains a sample answer sheet, and provides additional educational materials for promoting hearing conservation.

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CHAPTER 7. PERIODICALS AND NEWS ON NOISE-INDUCED HEARING LOSS Overview Keeping up on the news relating to noise-induced hearing loss can be challenging. Subscribing to targeted periodicals can be an effective way to stay abreast of recent developments on noise-induced hearing loss. Periodicals include newsletters, magazines, and academic journals. In this chapter, we suggest a number of news sources and present various periodicals that cover noise-induced hearing loss beyond and including those which are published by patient associations mentioned earlier. We will first focus on news services, and then on periodicals. News services, press releases, and newsletters generally use more accessible language, so if you do chose to subscribe to one of the more technical periodicals, make sure that it uses language you can easily follow.

News Services and Press Releases Well before articles show up in newsletters or the popular press, they may appear in the form of a press release or a public relations announcement. One of the simplest ways of tracking press releases on noise-induced hearing loss is to search the news wires. News wires are used by professional journalists, and have existed since the invention of the telegraph. Today, there are several major “wires” that are used by companies, universities, and other organizations to announce new medical breakthroughs. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.


PR Newswire Perhaps the broadest of the wires is PR Newswire Association, Inc. To access this archive, simply go to http://www.prnewswire.com. Below the search box, select the option “The last 30 days.” In the search box, type “noise induced hearing loss” or synonyms. The search results are shown by order of relevance. When reading these press releases, do not forget that the sponsor of the release may be a company or organization that is trying to sell a particular product or therapy. Their views, therefore, may be biased.

Reuters Health The Reuters' Medical News and Health eLine databases can be very useful in exploring news archives relating to noise-induced hearing loss. While some of the listed articles are free to view, others can be purchased for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “noise-induced hearing loss” (or synonyms).

The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within their search engine.

Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com. You can scan the news by industry category or company name.

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Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, log on to Market Wire’s Medical/Health channel at the following hyperlink http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Market Wire’s home page is http://www.marketwire.com/mw/home. From here, type “noise-induced hearing loss” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests.

Search Engines Free-to-view news can also be found in the news section of your favorite search engines (see the health news page at Yahoo: http://dir.yahoo.com/Health/News_and_Media/, or use this Web site’s general news search page http://news.yahoo.com/. Type in “noise-induced hearing loss” (or synonyms). If you know the name of a company that is relevant to noise-induced hearing loss, you can go to any stock trading Web site (such as www.etrade.com) and search for the company name there. News items across various news sources are reported on indicated hyperlinks.

BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “noise-induced hearing loss” (or synonyms).

Newsletters on Noise-Induced Hearing Loss Given their focus on current and relevant developments, newsletters are often more useful to patients than academic articles. You can find newsletters using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Your investigation must limit the search to “Newsletter” and “noise-induced


hearing loss.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” By making these selections and typing in “noise-induced hearing loss” or synonyms into the “For these words:” box, you will only receive results on newsletters. The following list was generated using the options described above: ·

Listen Up! Learn How to Protect Your Hearing Source: Today's Supervisor. 64(2): 1-19. February 2000. Contact: Available from National Safety Council. 1121 Spring Lake Drive, Itasca, IL 60143-3201. (800) 621-7619 or (630) 775-2056. Website: www.nsc.org. Summary: Work related hearing loss continues to be a critical workplace safety and health issue. Noise induced hearing loss (NIHL) is one of the most common occupational diseases and the second most self reported occupational illness or injury. This special issue of a newsletter written for workplace supervisors is dedicated to hearing loss prevention. The newsletter includes articles on hearing loss prevention programs, cost considerations, frequently asked questions about hearing loss, the types of noise protection devices, how to choose appropriate noise protection devices, the results of a conference on recommended practices for hearing loss prevention, and the noise reduction ratio (NRR) labels. The authors stress that NIHL is fully preventable, but once acquired, it is permanent and irreversible. Employers and workers must take preventive measures to preserve and protect workers' hearing. The newsletter is illustrated with black and white line drawings. This issue of the newsletter is a collaboration between the National Safety Council and National Institute for Occupational Safety and Health (NIOSH). 6 figures.

Newsletter Articles If you choose not to subscribe to a newsletter, you can nevertheless find references to newsletter articles. We recommend that you use the Combined Health Information Database, while limiting your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option at http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” By making these selections, and typing in “noise-induced hearing loss” (or synonyms) into the “For these words:” box, you will only receive results on


newsletter articles. You should check back periodically with this database as it is updated every 3 months. The following is a typical result when searching for newsletter articles on noise-induced hearing loss: · Workplace Noise Can Cause Hearing Loss Source: 3M JobHealth Highlights. Special Edition: 1-4. 1997. Contact: Available from 3M Occupational Health and Environmental Safety Division. 3M Center, Building 275-6W-01, St. Paul, MN 55144-1000. Summary: Noise is probably the most common occupational health problem, especially in the manufacturing industries. Hearing protection can be a satisfactory solution, as long as protectors are properly fitted, worn, and maintained. This article on workplace noise is from a special issue of JobHealth Highlights (a newsletter from the 3M company) that includes six articles on noise, hearing conservation, and hearing protection. The articles are written by Alice Suter, PhD, a consultant in industrial audiology and community noise; Dr. Suter is known as the principal author of OSHA's hearing conservation amendment to the standard for occupational noise exposure. The article discusses the decibel level at which hearing may be at risk, the impact of exposure duration, the progression of noise induced hearing loss (NIHL), communication interference, and the use of noise masking. Voice levels and levels of background noise, the effects of noise on job performance, and the effects of noise on health are also discussed. 1 figure. 2 tables. 3 references. · Mine Safety and Health Administration Announces New Health Standard Source: CAOHC Update. 11(1): 2-3. Spring 2000. Contact: Available from Council for Accreditation in Occupational Hearing Conservation. 611 East Wells Street, Milwaukee, WI 53202-3816. (414) 276-5338. Fax (414) 276-3349. E-mail: [email protected]. Summary: The mining workplace has extensive challenges and hazards inherent to the work being done. Among the most difficult health hazard is exposure to excessive noise. Recently, the Mine Safety and Health Administration (MSHA) published a new health standard for occupational noise exposure (September 1999). This newsletter article summarizes the main points of this regulation, comparing it to the Occupational Safety and Health Administration (OSHA) current noise and hearing conservation regulation. Topics include the decibels exchange rates and weighted average, noise measurement programs and methods, the use of noise controls and administrative actions as the first


line of defense, the indications for a hearing conservation program, the components of the audiometric evaluation program, the requirements for the qualified technician who performs the audiometric tests, hearing protection devices, training requirements for miners, and recordkeeping. This new standard is intended to better control the occurrence of noise induced hearing loss in the mining industry. The regulation is available online (www.msha.gov). 1 table. ·

Tullio Phenomenon (Noise-Induced Imbalance and Dizziness) Source: On the Level. 17(3): 3. Summer 2000. Contact: Available from Vestibular Disorders Association. P.O. Box 4467, Portland, OR 97208-4467. (800) 837-8428. E-mail: [email protected]. Website: www.vestibular.org. Summary: This brief article from a newsletter for people with vestibular disorders, reports on the Tullio phenomenon (noise induced imbalance and dizziness). The article features a letter from a reader who has experienced noise induced hearing loss, tinnitus (ringing in the ears), and noise induced imbalance. The reader's concerns are addressed by Dr. Moller who notes that the Tullio phenomenon is a rare disorder in which exposure to very loud sounds can trigger imbalance, dizziness, and nystagmus (involuntary rhythmic eye movements). Various disorders have been reported to cause such sound sensitivity, including Meniere's disease, changes in the middle ear (dislocated stirrup footplate), and fistulas of the bony canals of the inner ears. In cases involving the Tullio phenomenon, MRI or CT scans are usually normal, and surgical exploration of the middle ear seldom reveals any abnormalities. The treatment for the Tullio phenomenon is to block loud low frequency sounds. The most effective way to do this is to use earmuffs. The next best solution is to use custom made earmolds.

·

Age, Hearing Loss, and Hearing Aids Source: Harvard Health Letter. 26(1): 4-5. November 2000. Contact: Available from Harvard Health Letter. P.O. Box 380, Boston, MA 02117. (800) 829-9045 or (617) 432-1485. Summary: This health newsletter article reminds readers of the relationship between age and hearing loss, focusing on the use of hearing aids. The author reviews presbycusis (hearing loss associated with aging), noting that about 33 percent of all Americans aged 65 to 75 years have some hearing loss, and the percentage climbs to 50 percent among people aged 75 and over. The article discusses the signs and symptoms of hearing loss, including threshold and discrimination, the physiology of


hearing loss (including noise induced hearing loss, which often becomes more apparent over time), the indications for hearing aids, cost considerations, and the hearing aid dispensing industry. The article focuses on educating consumers to make wise choices about hearing aids. One illustration explains the parts of the outer, middle, and inner ear. 1 figure. ·

Hearing Loss Prevention Programs Are a Good Value Source: Today's Supervisor. 64(2): 4-5. February 2000. Contact: Available from National Safety Council. 1121 Spring Lake Drive, Itasca, IL 60143-3201. (800) 621-7619 or (630) 775-2056. Website: www.nsc.org. Summary: Work related hearing loss continues to be a critical workplace safety and health issue. Noise induced hearing loss (NIHL) is one of the most common occupational diseases and the second most self reported occupational illness or injury. This article is from a special issue of a newsletter written for workplace supervisors that is dedicated to hearing loss prevention. This article explains how an effective hearing loss prevention program will save employers money, even if implementing such a program requires an initial investment. For example, a hearing loss prevention program will help employers minimize compensation claims for hearing loss. In addition, retaining good employees and retraining them as needed is more cost-effective that hiring new employees. Ensuring that employees retain their sense of hearing will increase the likelihood that they remain versatile in their capabilities. Studies have also shown that quieter workplaces are more productive and efficient, especially when the work is complex or requires concentration. Workplaces that are quieter also have lower injury rates. The article concludes that companies that have implemented hearing loss prevention programs often find less absenteeism, greater job satisfaction, and improved morale among their employees. The newsletter is illustrated with black and white line drawings. This issue of the newsletter is a collaboration between the National Safety Council and National Institute for Occupational Safety and Health (NIOSH). 1 figure.

Vocabulary Builder Involuntary: Reaction occurring without intention or volition. [NIH] Nystagmus: Rhythmical oscillation of the eyeballs, either pendular or jerky. [NIH]

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CHAPTER 8. PHYSICIAN GUIDELINES AND DATABASES Overview Doctors and medical researchers rely on a number of information sources to help patients with their conditions. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internet-based guidelines created or written for this professional audience.

NIH Guidelines For the more common diseases, The National Institutes of Health publish guidelines that are frequently consulted by physicians. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: · Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm · National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/ · National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html · National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/


NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.18 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:19 · Bioethics: Access to published literature on the ethical, legal and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html · HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html · NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html · Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/ · Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html · Cancer Information: Access to caner-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 19 See http://www.nlm.nih.gov/databases/databases.html. 18

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· Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/ · Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html · Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html · Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html · MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html ·

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

· Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html While all of the above references may be of interest to physicians who study and treat noise-induced hearing loss, the following are particularly noteworthy.

The Combined Health Information Database A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to “Brochure/Pamphlet,” “Fact Sheet,” or “Information Package” and noise-induced hearing loss using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years,” select your preferred language, and the format option “Fact Sheet.” By making these selections and typing “noise-induced hearing loss” (or synonyms) into the “For these


words:” box above, you will only receive results on fact sheets dealing with noise-induced hearing loss. The following is a sample result: ·

Hearing Loss: A Guide to Prevention and Treatment Source: Boston, MA: Harvard Health Publications. 2000. 41 p. Contact: Available from Harvard Health Publications. P.O. Box 421073, Palm Coast, FL 32142-1073. Website: www.health.harvard.edu. PRICE: $16.00 plus shipping and handling. Summary: This report from the Harvard Medical School offers an overview of the prevention and treatment of hearing loss. The report begins with a review of the anatomy and physiology of hearing, then describes the diagnostic tests that may be used to evaluate hearing. The next section discusses the use of hearing aids, including the new technology, hearing aid dispensing, choosing hearing aid circuitry, deciding between one hearing aid (monaural) or two (binaural), fitting a hearing aid, and adjusting to a hearing aid. Surgical options for hearing loss, including cochlear implants and other surgeries, are also considered. Additional sections cover current research and technology directions, coping with hearing loss, and preventing hearing loss. The booklet concludes with a list of resources (organizations and publications) and a glossary of related terms. Various sidebars include a do it yourself five minute hearing test, a definition of the roles of hearing professionals, a description of tinnitus (ringing in the ears), assistive listening devices (besides hearing aids), hearing loss and the law, and noise induced hearing loss.. The report is illustrated with black and white photographs. 6 figures. Hearing.

·

Issues: Occupational and Environmental Hearing Conservation Source: ASHA. American Speech-Language-Hearing Association. 39(Supplement 17): 30-34. Spring 1997. Contact: Available from American Speech-Language-Hearing Association (ASHA). Product Sales, 10801 Rockville Pike, Rockville, MD 20852. (888) 498-6699. TTY (301) 897-0157. Website: www.asha.org. Summary: This report summarizes the major issues affecting occupational and environmental hearing conservation service delivery by audiologists. The major issues identified relate to coalition activity, continuing education, professional education and training, public awareness, and legislation and regulation. Each issue is summarized, a strategy is suggested, and specific Association actions are recommended. Recent actions taken by the American Speech Language Hearing Association (ASHA) are noted as well, to provide concrete examples of


each issue. Collaborative agreements, partnering, and coalition activities allow limited resources for hearing conservation to go further. Professional graduate education and continuing education for audiologists must include the training and experience required for providing hearing conservation services. The general public needs to be educated regarding how to prevent noise induced hearing loss (NIHL). Worker's compensation data should be routinely updated and disseminated, and workers who are exposed to hazardous noise but are not covered by regulatory protections should be identified and educated.

The NLM Gateway20 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing “one-stop searching” for many of NLM's information resources or databases.21 One target audience for the Gateway is the Internet user who is new to NLM's online resources and does not know what information is available or how best to search for it. This audience may include physicians and other healthcare providers, researchers, librarians, students, and, increasingly, patients, their families, and the public.22 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “noise-induced hearing loss” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category.

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x. The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 22 Other users may find the Gateway useful for an overall search of NLM's information resources. Some searchers may locate what they need immediately, while others will utilize the Gateway as an adjunct tool to other NLM search services such as PubMed® and MEDLINEplus®. The Gateway connects users with multiple NLM retrieval systems while also providing a search interface for its own collections. These collections include various types of information that do not logically belong in PubMed, LOCATORplus, or other established NLM retrieval systems (e.g., meeting announcements and pre-1966 journal citations). The Gateway will provide access to the information found in an increasing number of NLM retrieval systems in several phases. 20 21


Results Summary Category Items Found Journal Articles 4307 Books / Periodicals / Audio Visual See Details Consumer Health 962 Meeting Abstracts 1 Other Collections 1 Total 5271

HSTAT23 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.24 HSTAT's audience includes healthcare providers, health service researchers, policy makers, insurance companies, consumers, and the information professionals who serve these groups. HSTAT provides access to a wide variety of publications, including clinical practice guidelines, quick-reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ's Put Prevention Into Practice.25 Simply search by “noise-induced hearing loss” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

Coffee Break: Tutorials for Biologists26 Some patients may wish to have access to a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. To this end, we recommend “Coffee Break,” a collection of short reports on recent biological Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. The HSTAT URL is http://hstat.nlm.nih.gov/. 25 Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 26 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 23 24


discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.27 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.28 This site has new articles every few weeks, so it can be considered an online magazine of sorts, and intended for general background information. You can access Coffee Break at http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: ·

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

·

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 28 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process. 27

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PART III. APPENDICES

ABOUT PART III

Part III is a collection of appendices on general medical topics which may be of interest to patients with noise-induced hearing loss and related conditions.

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APPENDIX A. RESEARCHING ALTERNATIVE MEDICINE Overview Complementary and alternative medicine (CAM) is one of the most contentious aspects of modern medical practice. You may have heard of these treatments on the radio or on television. Maybe you have seen articles written about these treatments in magazines, newspapers, or books. Perhaps your friends or doctor have mentioned alternatives. In this chapter, we will begin by giving you a broad perspective on complementary and alternative therapies. Next, we will introduce you to official information sources on CAM relating to noise-induced hearing loss. Finally, at the conclusion of this chapter, we will provide a list of readings on noise-induced hearing loss from various authors. We will begin, however, with the National Center for Complementary and Alternative Medicine's (NCCAM) overview of complementary and alternative medicine.

What Is CAM?29 Complementary and alternative medicine (CAM) covers a broad range of healing philosophies, approaches, and therapies. Generally, it is defined as those treatments and healthcare practices which are not taught in medical schools, used in hospitals, or reimbursed by medical insurance companies. Many CAM therapies are termed “holistic,” which generally means that the healthcare practitioner considers the whole person, including physical, mental, emotional, and spiritual health. Some of these therapies are also known as “preventive,” which means that the practitioner educates and 29

Adapted from the NCCAM: http://nccam.nih.gov/health/whatiscam/#4.


treats the person to prevent health problems from arising, rather than treating symptoms after problems have occurred. People use CAM treatments and therapies in a variety of ways. Therapies are used alone (often referred to as alternative), in combination with other alternative therapies, or in addition to conventional treatment (sometimes referred to as complementary). Complementary and alternative medicine, or “integrative medicine,” includes a broad range of healing philosophies, approaches, and therapies. Some approaches are consistent with physiological principles of Western medicine, while others constitute healing systems with non-Western origins. While some therapies are far outside the realm of accepted Western medical theory and practice, others are becoming established in mainstream medicine. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. Some commonly used methods of complementary or alternative therapy include mind/body control interventions such as visualization and relaxation, manual healing including acupressure and massage, homeopathy, vitamins or herbal products, and acupuncture.

What Are the Domains of Alternative Medicine?30 The list of CAM practices changes continually. The reason being is that these new practices and therapies are often proved to be safe and effective, and therefore become generally accepted as “mainstream” healthcare practices. Today, CAM practices may be grouped within five major domains: (1) alternative medical systems, (2) mind-body interventions, (3) biologicallybased treatments, (4) manipulative and body-based methods, and (5) energy therapies. The individual systems and treatments comprising these categories are too numerous to list in this sourcebook. Thus, only limited examples are provided within each. Alternative Medical Systems Alternative medical systems involve complete systems of theory and practice that have evolved independent of, and often prior to, conventional biomedical approaches. Many are traditional systems of medicine that are

30

Adapted from the NCCAM: http://nccam.nih.gov/health/whatiscam/#4.

Researching Nutrition 105

practiced by individual cultures throughout the world, including a number of venerable Asian approaches. Traditional oriental medicine emphasizes the balance or disturbances of qi (pronounced chi) or vital energy in health and disease, respectively. Traditional oriental medicine consists of a group of techniques and methods including acupuncture, herbal medicine, oriental massage, and qi gong (a form of energy therapy). Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes, usually by puncturing the skin with a thin needle. Ayurveda is India's traditional system of medicine. Ayurvedic medicine (meaning “science of life”) is a comprehensive system of medicine that places equal emphasis on body, mind, and spirit. Ayurveda strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing. Other traditional healing systems have been developed by the world’s indigenous populations. These populations include Native American, Aboriginal, African, Middle Eastern, Tibetan, and Central and South American cultures. Homeopathy and naturopathy are also examples of complete alternative medicine systems. Homeopathic medicine is an unconventional Western system that is based on the principle that “like cures like,” i.e., that the same substance that in large doses produces the symptoms of an illness, in very minute doses cures it. Homeopathic health practitioners believe that the more dilute the remedy, the greater its potency. Therefore, they use small doses of specially prepared plant extracts and minerals to stimulate the body's defense mechanisms and healing processes in order to treat illness. Naturopathic medicine is based on the theory that disease is a manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than disease treatment. Naturopathic physicians employ an array of healing practices, including the following: diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy (the use of water in a range of temperatures and methods of applications), spinal and soft-tissue manipulation, physical therapies (such as those involving electrical currents, ultrasound, and light), therapeutic counseling, and pharmacology.


Mind-Body Interventions Mind-body interventions employ a variety of techniques designed to facilitate the mind's capacity to affect bodily function and symptoms. Only a select group of mind-body interventions having well-documented theoretical foundations are considered CAM. For example, patient education and cognitive-behavioral approaches are now considered “mainstream.” On the other hand, complementary and alternative medicine includes meditation, certain uses of hypnosis, dance, music, and art therapy, as well as prayer and mental healing.

Biological-Based Therapies This category of CAM includes natural and biological-based practices, interventions, and products, many of which overlap with conventional medicine's use of dietary supplements. This category includes herbal, special dietary, orthomolecular, and individual biological therapies. Herbal therapy employs an individual herb or a mixture of herbs for healing purposes. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Special diet therapies, such as those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to prevent and/or control illness as well as promote health. Orthomolecular therapies aim to treat disease with varying concentrations of chemicals such as magnesium, melatonin, and mega-doses of vitamins. Biological therapies include, for example, the use of laetrile and shark cartilage to treat cancer and the use of bee pollen to treat autoimmune and inflammatory diseases.

Manipulative and Body-Based Methods This category includes methods that are based on manipulation and/or movement of the body. For example, chiropractors focus on the relationship between structure and function, primarily pertaining to the spine, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool. In contrast, osteopaths place particular emphasis on the musculoskeletal system and practice osteopathic manipulation. Osteopaths believe that all of the body's systems work together and that disturbances in one system may have an impact upon function elsewhere in the body. Massage therapists manipulate the soft tissues of the body to normalize those tissues.


Energy Therapies Energy therapies focus on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields). Biofield therapies are intended to affect energy fields (the existence of which is not yet experimentally proven) that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in or through these fields. Examples include Qi gong, Reiki and Therapeutic Touch. Qi gong is a component of traditional oriental medicine that combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi) in the body, improve blood circulation, and enhance immune function. Reiki, the Japanese word representing Universal Life Energy, is based on the belief that, by channeling spiritual energy through the practitioner, the spirit is healed and, in turn, heals the physical body. Therapeutic Touch is derived from the ancient technique of “laying-on of hands.” It is based on the premises that the therapist’s healing force affects the patient's recovery and that healing is promoted when the body's energies are in balance. By passing their hands over the patient, these healers identify energy imbalances. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields to treat illnesses or manage pain. These therapies are often used to treat asthma, cancer, and migraine headaches. Types of electromagnetic fields which are manipulated in these therapies include pulsed fields, magnetic fields, and alternating current or direct current fields.

Can Alternatives Affect My Treatment? A critical issue in pursuing complementary alternatives mentioned thus far is the risk that these might have undesirable interactions with your medical treatment. It becomes all the more important to speak with your doctor who can offer advice on the use of alternatives. Official sources confirm this view. Though written for women, we find that the National Women’s Health Information Center’s advice on pursuing alternative medicine is appropriate for patients of both genders and all ages.31

31

Adapted from http://www.4woman.gov/faq/alternative.htm.


Is It Okay to Want Both Traditional and Alternative or Complementary Medicine? Should you wish to explore non-traditional types of treatment, be sure to discuss all issues concerning treatments and therapies with your healthcare provider, whether a physician or practitioner of complementary and alternative medicine. Competent healthcare management requires knowledge of both conventional and alternative therapies you are taking for the practitioner to have a complete picture of your treatment plan. The decision to use complementary and alternative treatments is an important one. Consider before selecting an alternative therapy, the safety and effectiveness of the therapy or treatment, the expertise and qualifications of the healthcare practitioner, and the quality of delivery. These topics should be considered when selecting any practitioner or therapy.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov) has created a link to the National Library of Medicine's databases to allow patients to search for articles that specifically relate to noise-induced hearing loss and complementary medicine. To search the database, go to www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “noise-induced hearing loss” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine (CAM) that are related to noiseinduced hearing loss: · Evaluating noise induced hearing loss with distortion product otoacoustic emissions. Author(s): Attias J, Bresloff I, Reshef I, Horowitz G, Furman V. Source: British Journal of Audiology. 1998 February; 32(1): 39-46. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9643306&dopt=Abstract · Increased noise severity limits potentiation of noise induced hearing loss by carbon monoxide. Author(s): Rao DB, Fechter LD. Source: Hearing Research. 2000 December; 150(1-2): 206-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11077204&dopt=Abstract


· Noise induced hearing loss in fetal sheep. Author(s): Griffiths SK, Pierson LL, Gerhardt KJ, Abrams RM, Peters AJ. Source: Hearing Research. 1994 April; 74(1-2): 221-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8040092&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering

CAM and related topics. The following is a representative sample:

·

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

·

AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

·

Chinese Medicine: http://www.newcenturynutrition.com/

·

Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

·

Google: http://directory.google.com/Top/Health/Alternative/

·

Open Directory Project: http://dmoz.org/Health/Alternative/

·

TPN.com: http://www.tnp.com/

·

Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

·

WebMDÒHealth: http://my.webmd.com/drugs_and_herbs

·

WholeHealthMD.com:

http://www.wholehealthmd.com/reflib/0,1529,,00.html

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at: www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources. The following additional references describe, in broad terms, alternative and complementary medicine (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · No More Amoxicillin: Preventing and Treating Ear and Respiratory Infections Without Antibiotics by Mary Ann Block; Paperback: 144


pages; (August 1998), Kensington Publishing Corp.; ISBN: 1575663163; http://www.amazon.com/exec/obidos/ASIN/1575663163/icongroupinter na ·

Alternative Medicine for Dummies by James Dillard (Author); Audio Cassette, Abridged edition (1998), Harper Audio; ISBN: 0694520659; http://www.amazon.com/exec/obidos/ASIN/0694520659/icongroupinter na

·

Complementary and Alternative Medicine Secrets by W. Kohatsu (Editor); Hardcover (2001), Hanley & Belfus; ISBN: 1560534400; http://www.amazon.com/exec/obidos/ASIN/1560534400/icongroupinter na

·

Dictionary of Alternative Medicine by J. C. Segen; Paperback-2nd edition (2001), Appleton & Lange; ISBN: 0838516211; http://www.amazon.com/exec/obidos/ASIN/0838516211/icongroupinter na

·

Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating by Walter C. Willett, MD, et al; Hardcover - 352 pages (2001), Simon & Schuster; ISBN: 0684863375; http://www.amazon.com/exec/obidos/ASIN/0684863375/icongroupinter na

·

Encyclopedia of Natural Medicine, Revised 2nd Edition by Michael T. Murray, Joseph E. Pizzorno; Paperback - 960 pages, 2nd Rev edition (1997), Prima Publishing; ISBN: 0761511571; http://www.amazon.com/exec/obidos/ASIN/0761511571/icongroupinter na

·

Integrative Medicine: An Introduction to the Art & Science of Healing by Andrew Weil (Author); Audio Cassette, Unabridged edition (2001), Sounds True; ISBN: 1564558541; http://www.amazon.com/exec/obidos/ASIN/1564558541/icongroupinter na

·

New Encyclopedia of Herbs & Their Uses by Deni Bown; Hardcover 448 pages, Revised edition (2001), DK Publishing; ISBN: 078948031X; http://www.amazon.com/exec/obidos/ASIN/078948031X/icongroupinter na

·

Textbook of Complementary and Alternative Medicine by Wayne B. Jonas; Hardcover (2003), Lippincott, Williams & Wilkins; ISBN: 0683044370; http://www.amazon.com/exec/obidos/ASIN/0683044370/icongroupinter na


For additional information on complementary and alternative medicine, ask your doctor or write to: National Center for Complementary and Alternative Medicine Clearinghouse National Institutes of Health P. O. Box 8218 Silver Spring, MD 20907-8218

113

APPENDIX B. FINDING MEDICAL LIBRARIES Overview At a medical library you can find medical texts and reference books, consumer health publications, specialty newspapers and magazines, as well as medical journals. In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Before going to the library, highlight the references mentioned in this sourcebook that you find interesting. Focus on those items that are not available via the Internet, and ask the reference librarian for help with your search. He or she may know of additional resources that could be helpful to you. Most importantly, your local public library and medical libraries have Interlibrary Loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. NLM's interlibrary loan services are only available to libraries. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.32

32

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.


Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)33: · Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/ · Alabama: Richard M. Scrushy Library (American Sports Medicine Institute) · Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm · California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html · California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html · California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html ·

California: Gateway Health Library (Sutter Gould Medical Foundation)

·

California: Health Library (Stanford University Medical Center), http://www-med.stanford.edu/healthlibrary/

33

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

Finding Medical Libraries 115

· California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp · California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html · California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/ · California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/ · California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/ · California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html · California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/ · Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/ · Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/ · Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/ · Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml · Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health _info.cfm · Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html · Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm · Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp


· Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/ · Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm · Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html · Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/ · Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm · Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/ · Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/ · Louisiana: Louisiana State University Health Sciences Center Medical Library-Shreveport, http://lib-sh.lsuhsc.edu/ · Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm · Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html · Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm · Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/ · Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/ · Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10 · Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/ · Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html


· Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp · Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp · Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/ · Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://medlibwww.bu.edu/library/lib.html · Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm · Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp · Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/ · Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html · Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/ · Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm · Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/ · Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html · Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm · Michigan: Sladen Library & Center for Health Information Resources Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330


· Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula) · National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html · National: National Network of Libraries of Medicine (National Library of Medicine) - provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/ · National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/ · Nevada: Health Science Library, West Charleston Library (Las VegasClark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm · New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld · New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm · New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm · New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/ · New York: Choices in Health Information (New York Public Library) NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html · New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/ · New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html · New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/ · Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm


· Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfhtulsa.com/services/healthinfo.asp · Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/ · Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/ · Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml · Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html · Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html · Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml · Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp · Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm · Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/ · South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp · Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/ · Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/ · Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

121

APPENDIX C. YOUR RIGHTS AND INSURANCE Overview Any patient with noise-induced hearing loss faces a series of issues related more to the healthcare industry than to the medical condition itself. This appendix covers two important topics in this regard: your rights and responsibilities as a patient, and how to get the most out of your medical insurance plan.

Your Rights as a Patient The President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has created the following summary of your rights as a patient.34

Information Disclosure Consumers have the right to receive accurate, easily understood information. Some consumers require assistance in making informed decisions about health plans, health professionals, and healthcare facilities. Such information includes: ·

Health plans. Covered benefits, cost-sharing, and procedures for resolving complaints, licensure, certification, and accreditation status, comparable measures of quality and consumer satisfaction, provider

34Adapted

from Consumer Bill of Rights and Responsibilities: http://www.hcqualitycommission.gov/press/cbor.html#head1.


network composition, the procedures that govern access to specialists and emergency services, and care management information. · Health professionals. Education, board certification, and recertification, years of practice, experience performing certain procedures, and comparable measures of quality and consumer satisfaction. · Healthcare facilities. Experience in performing certain procedures and services, accreditation status, comparable measures of quality, worker, and consumer satisfaction, and procedures for resolving complaints. · Consumer assistance programs. Programs must be carefully structured to promote consumer confidence and to work cooperatively with health plans, providers, payers, and regulators. Desirable characteristics of such programs are sponsorship that ensures accountability to the interests of consumers and stable, adequate funding. Choice of Providers and Plans Consumers have the right to a choice of healthcare providers that is sufficient to ensure access to appropriate high-quality healthcare. To ensure such choice, the Commission recommends the following: · Provider network adequacy. All health plan networks should provide access to sufficient numbers and types of providers to assure that all covered services will be accessible without unreasonable delay - including access to emergency services 24 hours a day and 7 days a week. If a health plan has an insufficient number or type of providers to provide a covered benefit with the appropriate degree of specialization, the plan should ensure that the consumer obtains the benefit outside the network at no greater cost than if the benefit were obtained from participating providers. · Women's health services. Women should be able to choose a qualified provider offered by a plan -- such as gynecologists, certified nurse midwives, and other qualified healthcare providers -- for the provision of covered care necessary to provide routine and preventative women's healthcare services. · Access to specialists. Consumers with complex or serious medical conditions who require frequent specialty care should have direct access to a qualified specialist of their choice within a plan's network of providers. Authorizations, when required, should be for an adequate number of direct access visits under an approved treatment plan.

Your Rights and Insurance 123

· Transitional care. Consumers who are undergoing a course of treatment for a chronic or disabling condition (or who are in the second or third trimester of a pregnancy) at the time they involuntarily change health plans or at a time when a provider is terminated by a plan for other than cause should be able to continue seeing their current specialty providers for up to 90 days (or through completion of postpartum care) to allow for transition of care. · Choice of health plans. Public and private group purchasers should, wherever feasible, offer consumers a choice of high-quality health insurance plans.

Access to Emergency Services Consumers have the right to access emergency healthcare services when and where the need arises. Health plans should provide payment when a consumer presents to an emergency department with acute symptoms of sufficient severity--including severe pain--such that a “prudent layperson” could reasonably expect the absence of medical attention to result in placing that consumer's health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part. Participation in Treatment Decisions Consumers have the right and responsibility to fully participate in all decisions related to their healthcare. Consumers who are unable to fully participate in treatment decisions have the right to be represented by parents, guardians, family members, or other conservators. Physicians and other health professionals should: ·

Provide patients with sufficient information and opportunity to decide among treatment options consistent with the informed consent process.

·

Discuss all treatment options with a patient in a culturally competent manner, including the option of no treatment at all.

·

Ensure that persons with disabilities have effective communications with members of the health system in making such decisions.

·

Discuss all current treatments a consumer may be undergoing.

·

Discuss all risks, nontreatment.

benefits,

and

consequences

to

treatment

or


·

Give patients the opportunity to refuse treatment and to express preferences about future treatment decisions.

·

Discuss the use of advance directives -- both living wills and durable powers of attorney for healthcare -- with patients and their designated family members.

·

Abide by the decisions made by their patients and/or their designated representatives consistent with the informed consent process.

Health plans, health providers, and healthcare facilities should: ·

Disclose to consumers factors -- such as methods of compensation, ownership of or interest in healthcare facilities, or matters of conscience - that could influence advice or treatment decisions.

·

Assure that provider contracts do not contain any so-called “gag clauses” or other contractual mechanisms that restrict healthcare providers' ability to communicate with and advise patients about medically necessary treatment options.

·

Be prohibited from penalizing or seeking retribution against healthcare professionals or other health workers for advocating on behalf of their patients.

Respect and Nondiscrimination Consumers have the right to considerate, respectful care from all members of the healthcare industry at all times and under all circumstances. An environment of mutual respect is essential to maintain a quality healthcare system. To assure that right, the Commission recommends the following: ·

Consumers must not be discriminated against in the delivery of healthcare services consistent with the benefits covered in their policy, or as required by law, based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.

·

Consumers eligible for coverage under the terms and conditions of a health plan or program, or as required by law, must not be discriminated against in marketing and enrollment practices based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.


Confidentiality of Health Information Consumers have the right to communicate with healthcare providers in confidence and to have the confidentiality of their individually identifiable healthcare information protected. Consumers also have the right to review and copy their own medical records and request amendments to their records.

Complaints and Appeals Consumers have the right to a fair and efficient process for resolving differences with their health plans, healthcare providers, and the institutions that serve them, including a rigorous system of internal review and an independent system of external review. A free copy of the Patient's Bill of Rights is available from the American Hospital Association.35

Patient Responsibilities Treatment is a two-way street between you and your healthcare providers. To underscore the importance of finance in modern healthcare as well as your responsibility for the financial aspects of your care, the President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has proposed that patients understand the following “Consumer Responsibilities.”36 In a healthcare system that protects consumers' rights, it is reasonable to expect and encourage consumers to assume certain responsibilities. Greater individual involvement by the consumer in his or her care increases the likelihood of achieving the best outcome and helps support a quality-oriented, cost-conscious environment. Such responsibilities include: ·

Take responsibility for maximizing healthy habits such as exercising, not smoking, and eating a healthy diet.

·

Work collaboratively with healthcare providers in developing and carrying out agreed-upon treatment plans.

·

Disclose relevant information and clearly communicate wants and needs.

35 To order your free copy of the Patient's Bill of Rights, telephone 312-422-3000 or visit the American Hospital Association’s Web site: http://www.aha.org. Click on “Resource Center,” go to “Search” at bottom of page, and then type in “Patient's Bill of Rights.” The Patient’s Bill of Rights is also available from Fax on Demand, at 312-422-2020, document number 471124. 36 Adapted from http://www.hcqualitycommission.gov/press/cbor.html#head1.


·

Use your health insurance plan's internal complaint and appeal processes to address your concerns.

·

Avoid knowingly spreading disease.

·

Recognize the reality of risks, the limits of the medical science, and the human fallibility of the healthcare professional.

·

Be aware of a healthcare provider's obligation to be reasonably efficient and equitable in providing care to other patients and the community.

·

Become knowledgeable about your health plan’s coverage and options (when available) including all covered benefits, limitations, and exclusions, rules regarding use of network providers, coverage and referral rules, appropriate processes to secure additional information, and the process to appeal coverage decisions.

·

Show respect for other patients and health workers.

·

Make a good-faith effort to meet financial obligations.

·

Abide by administrative and operational procedures of health plans, healthcare providers, and Government health benefit programs.

Choosing an Insurance Plan There are a number of official government agencies that help consumers understand their healthcare insurance choices.37 The U.S. Department of Labor, in particular, recommends ten ways to make your health benefits choices work best for you.38 1. Your options are important. There are many different types of health benefit plans. Find out which one your employer offers, then check out the plan, or plans, offered. Your employer's human resource office, the health plan administrator, or your union can provide information to help you match your needs and preferences with the available plans. The more information you have, the better your healthcare decisions will be. 2. Reviewing the benefits available. Do the plans offered cover preventive care, well-baby care, vision or dental care? Are there deductibles? Answers to these questions can help determine the out-of-pocket expenses you may face. Matching your needs and those of your family members will result in More information about quality across programs is provided at the following AHRQ Web

site: http://www.ahrq.gov/consumer/qntascii/qnthplan.htm.

38 Adapted from the Department of Labor:

http://www.dol.gov/dol/pwba/public/pubs/health/top10-text.html.

37


the best possible benefits. Cheapest may not always be best. Your goal is high quality health benefits. 3. Look for quality. The quality of healthcare services varies, but quality can be measured. You should consider the quality of healthcare in deciding among the healthcare plans or options available to you. Not all health plans, doctors, hospitals and other providers give the highest quality care. Fortunately, there is quality information you can use right now to help you compare your healthcare choices. Find out how you can measure quality. Consult the U.S. Department of Health and Human Services publication “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer. 4. Your plan's summary plan description (SPD) provides a wealth of information. Your health plan administrator can provide you with a copy of your plan’s SPD. It outlines your benefits and your legal rights under the Employee Retirement Income Security Act (ERISA), the federal law that protects your health benefits. It should contain information about the coverage of dependents, what services will require a co-pay, and the circumstances under which your employer can change or terminate a health benefits plan. Save the SPD and all other health plan brochures and documents, along with memos or correspondence from your employer relating to health benefits. 5. Assess your benefit coverage as your family status changes. Marriage, divorce, childbirth or adoption, and the death of a spouse are all life events that may signal a need to change your health benefits. You, your spouse and dependent children may be eligible for a special enrollment period under provisions of the Health Insurance Portability and Accountability Act (HIPAA). Even without life-changing events, the information provided by your employer should tell you how you can change benefits or switch plans, if more than one plan is offered. If your spouse's employer also offers a health benefits package, consider coordinating both plans for maximum coverage. 6. Changing jobs and other life events can affect your health benefits. Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), you, your covered spouse, and your dependent children may be eligible to purchase extended health coverage under your employer's plan if you lose your job, change employers, get divorced, or upon occurrence of certain other events. Coverage can range from 18 to 36 months depending on your situation. COBRA applies to most employers with 20 or more workers and requires your plan to notify you of your rights. Most plans require eligible


individuals to make their COBRA election within 60 days of the plan's notice. Be sure to follow up with your plan sponsor if you don't receive notice, and make sure you respond within the allotted time. 7. HIPAA can also help if you are changing jobs, particularly if you have a medical condition. HIPAA generally limits pre-existing condition exclusions to a maximum of 12 months (18 months for late enrollees). HIPAA also requires this maximum period to be reduced by the length of time you had prior “creditable coverage.” You should receive a certificate documenting your prior creditable coverage from your old plan when coverage ends. 8. Plan for retirement. Before you retire, find out what health benefits, if any, extend to you and your spouse during your retirement years. Consult with your employer's human resources office, your union, the plan administrator, and check your SPD. Make sure there is no conflicting information among these sources about the benefits you will receive or the circumstances under which they can change or be eliminated. With this information in hand, you can make other important choices, like finding out if you are eligible for Medicare and Medigap insurance coverage. 9. Know how to file an appeal if your health benefits claim is denied. Understand how your plan handles grievances and where to make appeals of the plan's decisions. Keep records and copies of correspondence. Check your health benefits package and your SPD to determine who is responsible for handling problems with benefit claims. Contact PWBA for customer service assistance if you are unable to obtain a response to your complaint. 10. You can take steps to improve the quality of the healthcare and the health benefits you receive. Look for and use things like Quality Reports and Accreditation Reports whenever you can. Quality reports may contain consumer ratings -- how satisfied consumers are with the doctors in their plan, for instance-- and clinical performance measures -- how well a healthcare organization prevents and treats illness. Accreditation reports provide information on how accredited organizations meet national standards, and often include clinical performance measures. Look for these quality measures whenever possible. Consult “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer.

Medicare and Medicaid Illness strikes both rich and poor families. For low-income families, Medicaid is available to defer the costs of treatment. The Health Care Financing


Administration (HCFA) administers Medicare, the nation's largest health insurance program, which covers 39 million Americans. In the following pages, you will learn the basics about Medicare insurance as well as useful contact information on how to find more in-depth information about Medicaid.39

Who Is Eligible for Medicare? Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States. You might also qualify for coverage if you are under age 65 but have a disability or End-Stage Renal disease (permanent kidney failure requiring dialysis or transplant). Here are some simple guidelines: You can get Part A at age 65 without having to pay premiums if: ·

You are already receiving retirement benefits from Social Security or the Railroad Retirement Board.

·

You are eligible to receive Social Security or Railroad benefits but have not yet filed for them.

·

You or your spouse had Medicare-covered government employment.

If you are under 65, you can get Part A without having to pay premiums if: ·

You have received Social Security or Railroad Retirement Board disability benefit for 24 months.

·

You are a kidney dialysis or kidney transplant patient.

Medicare has two parts:

·

Part A (Hospital Insurance). Most people do not have to pay for Part A.

·

Part B (Medical Insurance). Most people pay monthly for Part B.

This section has been adapted from the Official U.S. Site for Medicare Information: http://www.medicare.gov/Basics/Overview.asp.

39


Part A (Hospital Insurance) Helps Pay For: Inpatient hospital care, care in critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas) and skilled nursing facilities, hospice care, and some home healthcare. Cost: Most people get Part A automatically when they turn age 65. You do not have to pay a monthly payment called a premium for Part A because you or a spouse paid Medicare taxes while you were working. If you (or your spouse) did not pay Medicare taxes while you were working and you are age 65 or older, you still may be able to buy Part A. If you are not sure you have Part A, look on your red, white, and blue Medicare card. It will show “Hospital Part A” on the lower left corner of the card. You can also call the Social Security Administration toll free at 1-800-772-1213 or call your local Social Security office for more information about buying Part A. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Fiscal Intermediary about Part A bills and services. The phone number for the Fiscal Intermediary office in your area can be obtained from the following Web site: http://www.medicare.gov/Contacts/home.asp. Part B (Medical Insurance) Helps Pay For: Doctors, services, outpatient hospital care, and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home healthcare. Part B helps pay for covered services and supplies when they are medically necessary. Cost: As of 2001, you pay the Medicare Part B premium of $50.00 per month. In some cases this amount may be higher if you did not choose Part B when you first became eligible at age 65. The cost of Part B may go up 10% for each 12-month period that you were eligible for Part B but declined coverage, except in special cases. You will have to pay the extra 10% cost for the rest of your life. Enrolling in Part B is your choice. You can sign up for Part B anytime during a 7-month period that begins 3 months before you turn 65. Visit your local Social Security office, or call the Social Security Administration at 1-800-7721213 to sign up. If you choose to enroll in Part B, the premium is usually taken out of your monthly Social Security, Railroad Retirement, or Civil Service Retirement payment. If you do not receive any of the above


payments, Medicare sends you a bill for your part B premium every 3 months. You should receive your Medicare premium bill in the mail by the 10th of the month. If you do not, call the Social Security Administration at 1800-772-1213, or your local Social Security office. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Medicare carrier about bills and services. The phone number for the Medicare carrier in your area can be found at the following Web site: http://www.medicare.gov/Contacts/home.asp. You may have choices in how you get your healthcare including the Original Medicare Plan, Medicare Managed Care Plans (like HMOs), and Medicare Private Feefor-Service Plans. Medicaid Medicaid is a joint federal and state program that helps pay medical costs for some people with low incomes and limited resources. Medicaid programs vary from state to state. People on Medicaid may also get coverage for nursing home care and outpatient prescription drugs which are not covered by Medicare. You can find more information about Medicaid on the HCFA.gov Web site at http://www.hcfa.gov/medicaid/medicaid.htm. States also have programs that pay some or all of Medicare's premiums and may also pay Medicare deductibles and coinsurance for certain people who have Medicare and a low income. To qualify, you must have: ·

Part A (Hospital Insurance),

·

Assets, such as bank accounts, stocks, and bonds that are not more than $4,000 for a single person, or $6,000 for a couple, and

·

A monthly income that is below certain limits.

For more information, look at the Medicare Savings Programs brochure, http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Langua ge=English&Type=Pub&PubID=10126. There are also Prescription Drug Assistance Programs available. Find information on these programs which offer discounts or free medications to individuals in need at http://www.medicare.gov/Prescription/Home.asp.

NORD’s Medication Assistance Programs Finally, the National Organization for Rare Disorders, Inc. (NORD) administers medication programs sponsored by humanitarian-minded


pharmaceutical and biotechnology companies to help uninsured or underinsured individuals secure life-saving or life-sustaining drugs.40 NORD programs ensure that certain vital drugs are available “to those individuals whose income is too high to qualify for Medicaid but too low to pay for their prescribed medications.” The program has standards for fairness, equity, and unbiased eligibility. It currently covers some 14 programs for nine pharmaceutical companies. NORD also offers early access programs for investigational new drugs (IND) under the approved “Treatment INDs” programs of the Food and Drug Administration (FDA). In these programs, a limited number of individuals can receive investigational drugs that have yet to be approved by the FDA. These programs are generally designed for rare diseases or disorders. For more information, visit www.rarediseases.org.

Additional Resources In addition to the references already listed in this chapter, you may need more information on health insurance, hospitals, or the healthcare system in general. The NIH has set up an excellent guidance Web site that addresses these and other issues. Topics include:41 ·

Health Insurance: http://www.nlm.nih.gov/medlineplus/healthinsurance.html

·

Health Statistics: http://www.nlm.nih.gov/medlineplus/healthstatistics.html

·

HMO and Managed Care: http://www.nlm.nih.gov/medlineplus/managedcare.html

·

Hospice Care: http://www.nlm.nih.gov/medlineplus/hospicecare.html

·

Medicaid: http://www.nlm.nih.gov/medlineplus/medicaid.html

·

Medicare: http://www.nlm.nih.gov/medlineplus/medicare.html

·

Nursing Homes and Long-Term Care: http://www.nlm.nih.gov/medlineplus/nursinghomes.html

·

Patient's Rights, Confidentiality, Informed Consent, Ombudsman Programs, Privacy and Patient Issues: http://www.nlm.nih.gov/medlineplus/patientissues.html

·

Veteran's Health, Persian Gulf War, Gulf War Syndrome, Agent Orange: http://www.nlm.nih.gov/medlineplus/veteranshealth.html

Adapted from NORD: http://www.rarediseases.org/programs/medication. You can access this information at http://www.nlm.nih.gov/medlineplus/healthsystem.html.

40 41


135

APPENDIX D. HOW LOUD IS TOO LOUD? Loud noise can cause damage at the following levels and durations42: · 110 Decibels: Regular exposure of more than 1 minute risks permanent hearing loss. · 100 Decibels: No more than 15 minutes unprotected exposure recommended. · 90 Decibels: Prolonged exposure to any noise above 90 decibels can cause gradual hearing loss. Know which noises can cause damage and wear ear plugs when you are involved in a loud activity.

Adapted from the National Institute on Deafness and Other Communication Disorders (NIDCD): http://www.nidcd.nih.gov/health/pubs_hb/ruler.htm.

42


137

ONLINE GLOSSARIES

The Internet provides access to a number of free-to-use medical dictionaries and glossaries. The National Library of Medicine has compiled the following list of online dictionaries: ·

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

·

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

·

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

·

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

·

On-line Medical Dictionary (CancerWEB): http://www.graylab.ac.uk/omd/

·

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

·

Terms and Definitions (Office of Rare Diseases): http://rarediseases.info.nih.gov/ord/glossary_a-e.html

Beyond these, MEDLINEplus contains a very user-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed via the following Web site address: http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a) and drkoop.com (http://www.drkoop.com/). Topics of interest can be researched by using keywords before continuing elsewhere, as these basic definitions and concepts will be useful in more advanced areas of research. You may choose to print various pages specifically relating to noise-induced hearing loss and keep them on file.


Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries and glossaries: ·

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

·

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

·

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

·

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

139

NOISE-INDUCED HEARING LOSS GLOSSARY

The following is a complete glossary of terms used in this sourcebook. The

definitions are derived from official public sources including the National

Institutes of Health [NIH] and the European Union [EU]. After this glossary, we

list a number of additional hardbound and electronic glossaries and

dictionaries that you may wish to consult.

Adduct: Complex formed when a carcinogen combines with DNA or a

protein. [NIH]

Adjustment: The dynamic process wherein the thoughts, feelings, behavior,

and biophysiological mechanisms of the individual continually change to

adjust to the environment. [NIH]

Amplification: The production of additional copies of a chromosomal DNA

sequence, found as either intrachromosomal or extrachromosomal DNA.

[NIH]

Antibiotic: A substance usually produced by vegetal micro-organisms

capable of inhibiting the growth of or killing bacteria. [NIH]

Attenuation: Reduction of transmitted sound energy or its electrical

equivalent. [NIH]

Audiologist: Study of hearing including treatment of persons with hearing

defects. [NIH]

Audition: The sense of hearing. [NIH]

Berger: A binocular loupe with the lenses mounted at the anterior end of a

light-excluding chamber fitting over the eyes and held in place by an elastic

headband. [NIH]

Binaural: Used of the two ears functioning together. [NIH] Branch: Most commonly used for branches of nerves, but applied also to

other structures. [NIH]

Broadband: A wide frequency range. Sound whose energy is distributed

over a broad range of frequency (generally, more than one octave). [NIH] Clamp: A u-shaped steel rod used with a pin or wire for skeletal traction in

the treatment of certain fractures. [NIH]

CMV: A virus that belongs to the herpes virus group. [NIH]

Competency: The capacity of the bacterium to take up DNA from its

surroundings. [NIH]

Consultation: A deliberation between two or more physicians concerning

the diagnosis and the proper method of treatment in a case. [NIH]


Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Cyanide: An extremely toxic class of compounds that can be lethal on inhaling of ingesting in minute quantities. [NIH]

Cytotoxicity: Quality of being capable of producing a specific toxic action

upon cells of special organs. [NIH]

Dermatitis: Inflammation of the skin. [NIH] Discrimination: The act of qualitative and/or quantitative differentiation

between two or more stimuli. [NIH]

Eardrum: A thin, tense membrane forming the greater part of the outer wall

of the tympanic cavity and separating it from the external auditory meatus; it constitutes the boundary between the external and middle ear. [NIH]

Efferent: Nerve fibers which conduct impulses from the central nervous

system to muscles and glands. [NIH]

Empirical: A treatment based on an assumed diagnosis, prior to receiving

confirmatory laboratory test results. [NIH]

Endolymph: The fluid contained in the membranous labyrinth of the ear.

[NIH]

Excitatory: When cortical neurons are excited, their output increases and

each new input they receive while they are still excited raises their output

markedly. [NIH]

Exhaustion: The feeling of weariness of mind and body. [NIH]

Fatigue: The feeling of weariness of mind and body. [NIH]

Fistulas: An abnormal passage from one hollow structure of the body to

another, or from a hollow structure to the surface, formed by an abscess,

disease process, incomplete closure of a wound, or by a congenital anomaly.

[NIH]

Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Gould: Turning of the head downward in walking to bring the image of the ground on the functioning position of the retina, in destructive disease of the peripheral retina. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Handicap: A handicap occurs as a result of disability, but disability does not always constitute a handicap. A handicap may be said to exist when a disability causes a substantial and continuing reduction in a person's capacity to function socially and vocationally. [NIH]

Glossary 141

Harmony: Attribute of a product which gives rise to an overall pleasant sensation. This sensation is produced by the perception of the product components as olfactory, gustatory, tactile and kinaesthetic stimuli because they are present in suitable concentration ratios. [NIH] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH]

Homogenate: A suspension of animal tissue that is ground in the all-glass

"homogenizer" described by Potter and Elvehjem in 1936. [NIH]

Hospice: Institution dedicated to caring for the terminally ill. [NIH]

Impairment: In the context of health experience, an impairment is any loss

or abnormality of psychological, physiological, or anatomical structure or

function. [NIH]

Incubator: Consists of a transparent plastic cubicle, electrical heating

equipment, safety and warning devices, and oxygen and air filtering and

regulating apparatus; an enclosed transparent boxlike apparatus for housing

prematurely born babies under optimum conditions. [NIH]

Infancy: The period of complete dependency prior to the acquisition of

competence in walking, talking, and self-feeding. [NIH]

Involuntary: Reaction occurring without intention or volition. [NIH]

Jefferson: A fracture produced by a compressive downward force that is

transmitted evenly through occipital condyles to superior articular surfaces

of the lateral masses of C1. [NIH]

Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH]

Labyrinthine: A vestibular nystagmus resulting from stimulation, injury, or

disease of the labyrinth. [NIH]

Linkage: The tendency of two or more genes in the same chromosome to

remain together from one generation to the next more frequently than

expected according to the law of independent assortment. [NIH]

Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Networks: Pertaining to a nerve or to the nerves, a meshlike structure of


interlocking fibers or strands. [NIH]

Nystagmus: Rhythmical oscillation of the eyeballs, either pendular or jerky.

[NIH]

Ossicles: The hammer, anvil and stirrup, the small bones of the middle ear, which transmit the vibrations from the tympanic membrane to the oval window. [NIH] Otology: The branch of medicine which deals with the diagnosis and treatment of the disorders and diseases of the ear. [NIH]

Outpatient: A patient who is not an inmate of a hospital but receives

diagnosis or treatment in a clinic or dispensary connected with the hospital.

[NIH]

Papilla: A small nipple-shaped elevation. [NIH] Patch: A piece of material used to cover or protect a wound, an injured part,

etc.: a patch over the eye. [NIH]

Pathologies: The study of abnormality, especially the study of diseases. [NIH]

Perilymph: The fluid contained within the space separating the

membranous from the osseous labyrinth of the ear. [NIH] Physiology: The science that deals with the life processes and functions of

organismus, their cells, tissues, and organs. [NIH]

Potentiate: A degree of synergism which causes the exposure of the

organism to a harmful substance to worsen a disease already contracted. [NIH] Potentiation: An overall effect of two drugs taken together which is greater

than the sum of the effects of each drug taken alone. [NIH]

Reductase: Enzyme converting testosterone to dihydrotestosterone. [NIH]

Rehabilitative: Instruction of incapacitated individuals or of those affected

with some mental disorder, so that some or all of their lost ability may be regained. [NIH] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH] Resolving: The ability of the eye or of a lens to make small objects that are close together, separately visible; thus revealing the structure of an object. [NIH]

Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Retrocochlear: Hearing loss in which the air conduction threshold and the bone conduction threshold have risen almost equally with no gap between them. In such cases the defect is usually either in the cochlea of the inner ear or in the central pathways. [NIH]

Glossary 143

Salicylate: Non-steroidal anti-inflammatory drugs. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical

science. [NIH]

Superoxide: Derivative of molecular oxygen that can damage cells. [NIH]

Temporal: One of the two irregular bones forming part of the lateral

surfaces and base of the skull, and containing the organs of hearing. [NIH] Therapeutics: The branch of medicine which is concerned with the

treatment of diseases, palliative or curative. [NIH]

Threshold: For a specified sensory modality (e. g. light, sound, vibration),

the lowest level (absolute threshold) or smallest difference (difference

threshold, difference limen) or intensity of the stimulus discernible in

prescribed conditions of stimulation. [NIH]

Trauma: Any injury, wound, or shock, must frequently physical or

structural shock, producing a disturbance. [NIH]

Vivo: Outside of or removed from the body of a living organism. [NIH]

General Dictionaries and Glossaries While the above glossary is essentially complete, the dictionaries listed here cover virtually all aspects of medicine, from basic words and phrases to more advanced terms (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·

Dictionary of Medical Acronymns & Abbreviations by Stanley Jablonski (Editor), Paperback, 4th edition (2001), Lippincott Williams & Wilkins Publishers, ISBN: 1560534605, http://www.amazon.com/exec/obidos/ASIN/1560534605/icongroupinter na

·

Dictionary of Medical Terms : For the Nonmedical Person (Dictionary of Medical Terms for the Nonmedical Person, Ed 4) by Mikel A. Rothenberg, M.D, et al, Paperback - 544 pages, 4th edition (2000), Barrons Educational Series, ISBN: 0764112015, http://www.amazon.com/exec/obidos/ASIN/0764112015/icongroupinter na

·

A Dictionary of the History of Medicine by A. Sebastian, CD-Rom edition (2001), CRC Press-Parthenon Publishers, ISBN: 185070368X, http://www.amazon.com/exec/obidos/ASIN/185070368X/icongroupinter na

·

Dorland's Illustrated Medical Dictionary (Standard Version) by Dorland, et al, Hardcover - 2088 pages, 29th edition (2000), W B Saunders


Co, ISBN: 0721662544, http://www.amazon.com/exec/obidos/ASIN/0721662544/icongroupinter na ·

Dorland's Electronic Medical Dictionary by Dorland, et al, Software, 29th Book & CD-Rom edition (2000), Harcourt Health Sciences, ISBN: 0721694934, http://www.amazon.com/exec/obidos/ASIN/0721694934/icongroupinter na

·

Dorland's Pocket Medical Dictionary (Dorland's Pocket Medical Dictionary, 26th Ed) Hardcover - 912 pages, 26th edition (2001), W B Saunders Co, ISBN: 0721682812, http://www.amazon.com/exec/obidos/ASIN/0721682812/icongroupinter na/103-4193558-7304618

·

Melloni's Illustrated Medical Dictionary (Melloni's Illustrated Medical Dictionary, 4th Ed) by Melloni, Hardcover, 4th edition (2001), CRC PressParthenon Publishers, ISBN: 85070094X, http://www.amazon.com/exec/obidos/ASIN/85070094X/icongroupintern a

·

Stedman's Electronic Medical Dictionary Version 5.0 (CD-ROM for Windows and Macintosh, Individual) by Stedmans, CD-ROM edition (2000), Lippincott Williams & Wilkins Publishers, ISBN: 0781726328, http://www.amazon.com/exec/obidos/ASIN/0781726328/icongroupinter na

·

Stedman's Medical Dictionary by Thomas Lathrop Stedman, Hardcover - 2098 pages, 27th edition (2000), Lippincott, Williams & Wilkins, ISBN: 068340007X, http://www.amazon.com/exec/obidos/ASIN/068340007X/icongroupinter na

·

Tabers Cyclopedic Medical Dictionary (Thumb Index) by Donald Venes (Editor), et al, Hardcover - 2439 pages, 19th edition (2001), F A Davis Co, ISBN: 0803606540, http://www.amazon.com/exec/obidos/ASIN/0803606540/icongroupinter na

145

INDEX

A Adjustment.................................................15

Amplification .............................................33

Attenuation ....................................19, 23, 24

Audiologist...........................................29, 74

Audition .....................................................24

B Binaural ................................................73, 96

Branch ..................... 37, 62, 77, 118, 142, 143

Broadband ..................................................14

C Clamp..........................................................55

Competency ...............................................27

Consultation................................. ii, iii, 3, 47

Contraindications ....................................... ii

Cyanide.......................................................60

Cytotoxicity ................................................53

D Dermatitis...................................................74

Discrimination ...........................................90

E Eardrum....................................74, 75, 77, 82

Efferent .................................................19, 24

Empirical ........................................18, 19, 24

Endolymph.................................................14

Excitatory....................................................68

Exhaustion..................................................13

F Fatigue ........................................................15

Fistulas..................................................77, 90

G Genetics ......................................................34

Growth................................................36, 139

H Handicap ................................50, 61, 73, 140

Harmony ..................................................105

Hereditary ..................................................77

Hospice .....................................................130

I Impairment 11, 12, 15, 34, 37, 51, 55, 60, 61, 68, 71, 73, 75, 78, 123, 141 Incubator ....................................................75

Involuntary ................................................ 90

J Joint..................................................... 59, 131

L Labyrinthine .............................................. 75

Linkage....................................................... 56

Loop.............................................. 33, 37, 141

N Need ...2, 5, 22, 23, 32, 39, 40, 44, 49, 51, 67, 68, 70, 78, 81, 82, 87, 88, 95, 97, 123, 127, 131, 132 Nerve ...................................... 13, 14, 59, 141 Networks.............................................. 3, 122 Nystagmus................................... 80, 90, 141 O Ossicles....................................................... 78 Otology................................................. 70, 71 Outpatient........................................ 130, 131 P Papilla......................................................... 54 Patch ............................................. 55, 62, 142 Pathologies..................................... 52, 76, 78 Perilymph ...................................... 14, 74, 78 Physiology ............................... 19, 75, 90, 96 Potentiate ................................................... 60 Potentiation.............................................. 108 R Reductase ................................................... 53 Reliability ............................................. 50, 72 Resolving ................................. 121, 122, 125 Restoration....................................... 105, 106 Retrocochlear............................................. 77 S Specialist ................................ 40, 41, 44, 122 Superoxide ................................................. 60 T Temporal ........................................ 17, 71, 75 Threshold ...13, 14, 17, 18, 34, 37, 51, 55, 58, 60, 80, 90, 142, 143 Trauma ..13, 17, 34, 52, 55, 59, 68, 71, 75, 77 V Vivo............................................................. 60


The Official Patient's Sourcebook On Noise-induced Hearing Loss: Directory For The Internet Age

The Official Patient's Sourcebook On Gastrointestinal Carcinoid Tumors: Directory For The Internet Age

The Official Parent's Sourcebook on Chiari Malformation: Updated Directory for the Internet Age

The Official Patient's Sourcebook on Botulism: A Revised and Updated Directory for the Internet Age

The 2002 Official Patient's Sourcebook on Psoriasis: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Genital Candidiasis: A Revised and Updated Directory for the Internet Age

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