INDUCED

HEARING
LOSS
dr Made Wiranadha SpTHT-KL

Noise induced hearing loss

(NIHL)
Typically occurs gradually over time due to

prolonged exposure to excessive noise levels

greater than 85 decibels (dB).
Also occur from short periods of very intense

sound, such as explosive blasts or gun fire.

High frequency sensorineural hearing loss
No medical or surgical treatment

Patophysiology
Intense sound damages the hair cells.
Outer hair cells are more susceptible than

inner hair cells to damage from sound.

The degree and type of damage to hair cells

are related to the amount of noise exposure.

Patophysiology
The first sign is shortening of the cilial rootlet.

This acute finding, produced by the least

damaging noise, is associated with floppy cilia
and is partly reversible. The resistance of cilia
to deformation after noise stress is reduced.
The first signs of an irreversible change are
damage to the intercilial connections and
actual fracture of the rootlet at the level of the
cuticular plate. The cilia fall over and
ultimately are absorbed.

Symptoms of NIHL
Difficulty understanding high-pitched voices (eg, women's,

children's) even in quiet conversational situations.

NIHL is almost always bilateral.
High-frequency losses rarely exceed 75 dB, and low-frequency

losses rarely exceed 40 dB.

Hearing loss does not progress after noise exposure is

discontinue
Tinnitus
Socioacusis

EFFECT OF SOUND ON
THE EAR
Adaptation: occurs whenever the ear is

stimulated by sound, is a physiologic

phenomenon,and for sounds of 70 dB sound
pressure level (SPL) or less,recovery occurs
within half a second.
Temporary threshold shift : a short-term

effect usually measured in minutes and hours

rather than seconds or days, in which the
hearing threshold elevates temporarily after
exposure to noise.

EFFECT OF SOUND ON
THE EAR
Permanent threshold shift : a permanent

elevation of the hearing threshold; the term is

usually confined to postnoise exposure
elevation of hearing threshold.

NONAUDITORY EFFECTS OF
NOISE
There is great controversy about noise as a cause

of hypertension.
Sound may precipitate acute cardiovascular

changes, but these are almost certainly normal

physiologic responses to warning signals.
If there is a real effect, it is extremely small. The

effect of noise on sleep deprivation is also a

matter of concern.

DIAGNOSIS
A history of occupational or nonoccupational

noise exposure of hazardous intensity and

duration should be sought. Noise exposure
measurements from the workplace.
Physical examination excludes external ear

and middle ear disorders and occasionally

may detect cranial nerve or balance
abnormalities that suggest an acoustic tumor

DIAGNOSIS
Hearing test : Tuning fork (Rinne, Weber,

Schwabach)
Notching of the audiogram at 4000 Hz, with

recovery at 8000 Hz.

HEARING CONSERVATION
PROGRAMS
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)

noise hazard identification

engineering controls,
personal hearing protection
Monitoring
record keeping
health education
enforcement
program evaluation.