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Risk of hearing loss from combined exposure to hand-arm vibrations and noise
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Hearing loss from noise exposure is one of the most common occupational injuries, and exposure to vibrations may increase the risk of noise-induced hearing loss. Earlier cross-sectional and longitudinal studies found an increased risk of noise-induced hearing loss among workers with vibration-induced white fingers (VWF) symptoms compared to workers without such symptoms. It has been suggested that vibrations to the hand stimulate the sympathetic nervous system and cause vasoconstriction in both the exposed hand and the ears and that this contributes to noise-induced hearing loss. The overall aim of this thesis was to examine how hand-arm vibrations (HAV) interact with noise in the development of noise-induced hearing loss.

The experimental study in this thesis examined the effects of HAV and noise, both separately and combined, on the temporary threshold shift (TTS) in hearing in 22 healthy male and female subjects. The two longitudinal studies in this thesis were based on a cohort of 189 male workers at a heavy engineering workshop. The first cohort study examined the risk of noise-induced hearing loss from long-term exposure to HAV and noise. The second cohort study examined if workers with VWF had an increased risk of noise-induced hearing loss compared to workers without such symptoms. Finally, the questionnaire study in this thesis examined the occurrence of Raynaud’s phenomenon among 133 men and women with noise-induced hearing loss in relation to exposure to vibrations.

In the experimental study, no differences in TTS in hearing were observed after combined exposure to HAV and noise compared to exposure to only noise. In the first cohort study, there was an increased risk of noise-induced hearing loss with increased exposure to HAV in a noisy environment. In the second cohort study, it was found that workers with VWF had an increased risk of noise-induced hearing loss compared to workers without VWF. In the questionnaire study, many men and women with noise-induced hearing loss had used hand-held vibrating machines suggesting that vibrations might contribute to noise-induced hearing loss. A high prevalence of Raynaud’s phenomenon was found among men.

This thesis demonstrated that there was a long-term effect on noise-induced hearing loss from combined exposure to noise and HAV, but no short-term effect, and that having Raynaud’s phenomenon may also increase the risk of noise-induced hearing loss.

Abstract [sv]

Många arbetare använder sig av handhållna vibrerande verktyg. Det utsätter dem för höga nivåer av både buller och vibrationer. Människor som utsätts för höga bullernivåer under lång tid kan skada sin hörsel. Risken för hörselnedsättning orsakad av buller kan eventuellt öka om personen samtidigt är utsatt för vibrationer från handhållna vibrerande verktyg. Syftet med avhandlingen var att studera om vibrationer i kombination med buller ökar risken för hörselnedsättning.

Avhandlingen består av fyra studier. Den första studien är en experimentell studie med 22 friska deltagare med god hörsel. Denna studie undersökte hur hörseln tillfälligt påverkas av buller och vibrationer, separat och i kombination. Den andra och tredje studien bygger på en population bestående av 189 verkstadsarbetare i Sundsvall som följts regelbundet sedan 1987. Den andra studien undersökte om det finns en ökad risk för hörselnedsättning för arbetare som utsätts för buller och vibrationer under lång tid. Den tredje studien undersökte om arbetare med vita fingrar har en ökad risk för hörselnedsättning än arbetare utan vita fingrar.

Vita fingrar är en kärlskada orsakad av vibrationer som gör att fingrarna reagerar onormalt snabbt på kyla. Fingrarna blir vita när blodtillförseln till dem stryps. Den fjärde studien är en enkätstudie med 342 kvinnor och män som har en bekräftad hörselnedsättning orsakad av buller. Studien undersökte hur många ur denna grupp som utsätts för vibrationer samt har vita fingrar.

Resultaten från studierna visar att det inte finns någon skillnad i hörselpåverkan från buller och vibrationer i kombination jämfört med enbart buller under kort tid. De som utsätts för vibrationer från handhållna vibrerande verktyg i en bullrig miljö under lång tid har en ökad risk för hörselnedsättning. Arbetare med vita fingrar har en högre risk för hörselnedsättning än de utan. En hög andel av de med hörselnedsättning orsakad av buller använder sig av handhållna vibrerande verktyg. I studien fanns även en hög andel med vita fingrar.

Sammanfattningsvis visar resultaten att det finns en långtidseffekt av buller och vibrationer på hörselnedsättning men inte någon korttidseffekt, och att vita fingrar kan påverka risken för hörselnedsättning.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2013. , 48 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1546
Keyword [en]
Hearing loss, noise, hand-arm vibration, combined exposure, vibration induced white fingers, Raynaud's phenomenon
National Category
Environmental Health and Occupational Health
Research subject
Occupational and Environmental Medicine
Identifiers
URN: urn:nbn:se:umu:diva-64191ISBN: 978-91-7459-543-7 (print)OAI: oai:DiVA.org:umu-64191DiVA: diva2:589455
Public defence
2013-02-22, Triple Helix, Samverkanhuset, Universitetstorget 4, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2013-01-23 Created: 2013-01-18 Last updated: 2014-07-08Bibliographically approved
List of papers
1. The effect on the temporary threshold shift in hearing acuity from combined exposure to authentic noise and hand-arm vibration
Open this publication in new window or tab >>The effect on the temporary threshold shift in hearing acuity from combined exposure to authentic noise and hand-arm vibration
2011 (English)In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 84, no 8, 951-957 p.Article in journal (Refereed) Published
Abstract [en]

This study examined and compared the effect on temporary threshold shift in hearing (TTS) in healthy subjects of noise and hand-arm vibration (HAV) combined and separately using controlled and authentic exposure conditions. This study also investigated the effect on TTS in hearing in relation to gender after such exposures.

Twenty-two healthy subjects (11 men/women, mean age 22 years, range 18-31 years) were exposed both separately and in combination with HAV (6.7 m/s(2)), using vibrating handles and to noise (99dB(A)) using headphones, for 20 min. The HAV and noise were reproduced from recordings from angular grinder in operation. Hearing thresholds at 1, 4, and 8 kHz were measured before and up to 30 min after exposure. 

Combined exposure to noise and HAV created significantly greater TTS in hearing than HAV exposure at 4 and 8 kHz alone. After exposure to HAV, there was no significant change in hearing threshold. At 1 kHz, there was a significant difference between noise and HAV exposure in TTS in hearing. There was no significant difference between combined exposure and noise exposure for any test frequency. There was no significant difference in TTS in hearing in relation to gender for 1, 4, and 8 kHz for HAV, noise, or a combined exposure.

The results indicate that there is no difference in the TTS in hearing after combined exposure compared to noise exposure alone. HAV exposure did not change the hearing threshold. The TTS in hearing did not differ significantly in relation to gender after HAV, noise, or combined exposure.

Place, publisher, year, edition, pages
New York: Springer, 2011
Keyword
Hand-arm vibration (HAV), Noise, Temporary threshold shift (TTS), Gender, Combined exposure
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-44083 (URN)10.1007/s00420-011-0635-6 (DOI)21499793 (PubMedID)
Available from: 2011-05-19 Created: 2011-05-19 Last updated: 2017-12-11Bibliographically approved
2. Noise and hand-arm vibration exposure in relation to the risk of hearing loss
Open this publication in new window or tab >>Noise and hand-arm vibration exposure in relation to the risk of hearing loss
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2012 (English)In: Noise & Health, ISSN 1463-1741, E-ISSN 1998-4030, Vol. 14, no 59, 159-165 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to examine the possible association of combined exposure of noise and hand-arm vibration (HAV) and the risk of noise-induced hearing loss. Workers in a heavy engineering industry were part of a dynamic cohort. Of these workers, 189 had HAV exposure, and their age and hearing status were recorded in the same year and were, therefore, included in the analysis. Data on HAV duration and acceleration was gathered through questionnaires, observations, and measurements. All available audiograms were categorized into normal and hearing loss. The first exposure variable included the lifetime HAV exposure. The lifetime HAV exposure was multiplied by the acceleration of HAV for the second and third exposure variable. Logistic regression using the Generalized Estimation Equations method was chosen to analyze the data to account for the repeated measurements. The analysis was performed with both continuous exposure variables and with exposure variables grouped into exposure quartiles with hearing loss as an outcome and age as a covariate. With continuous exposure variables, the odds ratio (OR) with a 95% confidence interval (CI) for hearing loss was equal to or greater than one for all exposure variables. When the exposure variables were grouped into quartiles, the OR with a 95% CI was greater than one at the third and fourth quartile. The results show that working with vibrating machines in an environment with noise exposure increases the risk of hearing loss, supporting an association between exposure to noise and HAV, and the noise-induced hearing loss.

Place, publisher, year, edition, pages
Medknow Publications, 2012
National Category
Environmental Health and Occupational Health
Identifiers
urn:nbn:se:umu:diva-60024 (URN)10.4103/1463-1741.99887 (DOI)22918146 (PubMedID)
Available from: 2012-09-28 Created: 2012-09-28 Last updated: 2017-12-07Bibliographically approved
3. Risk of hearing loss in relation to vibration-induced white fingers among workers using hand-held vibrating tools
Open this publication in new window or tab >>Risk of hearing loss in relation to vibration-induced white fingers among workers using hand-held vibrating tools
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background Vibration-induced white fingers (VWF) may increase the risk of hearing loss among workers using hand-held vibrating machines who are exposed to noise and hand-arm vibrations (HAV). The present study uses a 21-year follow-up cohort of workers who use hand-held vibrating machines. The aim of this study is to examine the risk of hearing loss for workers with and without VWF who use hand-held vibrating tools.

Methods All 184 participants used hand-held vibrating machines and were part of a Swedish cohort. At each follow-up each participant answered a questionnaire on basic individual data, use of hand-held vibrating tools, and VWF symptoms. The VWF symptoms were categorized as with or without VWF. HAV acceleration was measured at each follow-up. Hearing threshold levels from audiometric measurements were categorized as normal hearing and hearing loss. Two exposure estimates were used and divided into two exposure groups: lifetime exposure to HAV (Time) and lifetime exposure to HAV multiplied by acceleration (TimeAcc). To be included in the analysis, each participant had to have hearing status, categorized VWF symptoms, exposure estimates and stated smoking habits measured in the same year for either 1987, 1992, 1997, 2002, or 2008. The relationship between binary outcome of hearing status and the interaction of the explanatory variables, i.e. categorized VWF symptoms, exposure estimates, smoking habits and age, were calculated using binary logistic regression. Because of the repeated measurement of these variables, the Generalized Estimating Equations procedure with a first-order autoregressive correlation structure was used. Three analyses were made for left hand and left ear, right hand and right ear, and hand with worst categorized VWF symptoms and ear with worst categorized hearing status.

Results In our study, there was an interaction between exposure estimates (Time and TimeAcc) with the variable categorized VWF symptoms in the left hand on the risk of hearing loss in the left ear. Workers with VWF in the left hand had an increased risk of hearing loss in the left ear if they were in the low exposure group (OR 4.7-7.1) but not in the high exposure groups. There was an increased risk of hearing loss in the left ear for workers in the high exposure group without VWF in the left hand (OR 3.3-3.6) but not for workers with VWF. Workers with VWF in their right hand had an increased risk of hearing loss (OR 2.2-2.3) in the right ear compared to workers without VWF. Workers with VWF on the hand with worst categorization according to the Stockholm Workshop Scale (SWS) for the vascular component did not have any increased risk of hearing loss in the ear with worse hearing status.

Conclusions We found that workers with VWF who are using hand-held vibrating machines had an increased risk of hearing loss compared to workers without VWF. This result supports an association between VWF and an increased risk of hearing loss among workers using hand-held vibrating tools in a noisy environment.

Keyword
Hand-arm vibration, noise, vibration, combined exposure
National Category
Environmental Health and Occupational Health
Research subject
Occupational and Environmental Medicine
Identifiers
urn:nbn:se:umu:diva-64150 (URN)
Available from: 2013-01-17 Created: 2013-01-17 Last updated: 2013-01-23Bibliographically approved
4. Raynaud's phenomenon among men and women with noise-induced hearing loss in relation to vibration exposure
Open this publication in new window or tab >>Raynaud's phenomenon among men and women with noise-induced hearing loss in relation to vibration exposure
2014 (English)In: Noise & Health, ISSN 1463-1741, E-ISSN 1998-4030, Vol. 16, no 69, 89-94 p.Article in journal (Refereed) Published
Abstract [en]

Raynaud's phenomenon is characterized by constriction in blood supply to the fingers causing finger blanching, of white fingers (WF) and is triggered by cold. Earlier studies found that workers using vibrating hand-held tools and who had vibration-induced white fingers (VWF) had an increased risk for hearing loss compared with workers without VWF. This study examined the occurrence of Raynaud's phenomenon among men and women with noise-induced hearing loss in relation to vibration exposure. All 342 participants had a confirmed noise-induced hearing loss medico legally accepted as work-related by AFA Insurance. Each subject answered a questionnaire concerning their health status and the kinds of exposures they had at the time when their hearing loss was first discovered. The questionnaire covered types of exposures, discomforts in the hands or fingers, diseases and medications affecting the blood circulation, the use of alcohol and tobacco and for women, the use of hormones and whether they had been pregnant. The participation rate was 41% (n = 133) with 38% (n = 94) for men and 50% (n = 39) for women. 84 men and 36 women specified if they had Raynaud's phenomenon and also if they had used hand-held vibrating machines. Nearly 41% of them had used hand-held vibrating machines and 18% had used vibrating machines at least 2 h each workday. There were 23 men/6 women with Raynaud's phenomenon. 37% reported WF among those participants who were exposed to hand-arm vibration (HAV) and 15% among those not exposed to HAV. Among the participants with hearing loss with daily use of vibrating hand-held tools more than twice as many reports WF compared with participants that did not use vibrating hand-held tools. This could be interpreted as Raynaud's phenomenon could be associated with an increased risk for noise-induced hearing loss. However, the low participation rate limits the generalization of the results from this study.

Keyword
Hand-arm vibration, hearing loss, noise, Raynaud's phenomenon, white fingers
National Category
Environmental Health and Occupational Health
Identifiers
urn:nbn:se:umu:diva-90870 (URN)10.4103/1463-1741.132087 (DOI)000336524500004 ()
Note

Originally included in thesis in manuscript form.

Available from: 2014-07-08 Created: 2014-07-01 Last updated: 2017-12-05Bibliographically approved

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