1. / Life cycle analysis of noise and hearing handicap in Finland Esko Toppila 1, Ilmari Pyykkö 2, Rauno Pääkkönen 1 1=Finnish Institute of Occupational Health 2=University of Tampere

2. / Noise and Work Military branch Industry Services Schools Environment Annoyance Communication Hearing loss

3. / Characteristics of work in 20th century (Ruben 2000) 0 10 20 30 40 50 60 70 80 90 190019502000 PhysicalCommunication

4. / Hearing handicap Symptoms –hearing loss –hyperacusia –difficulties in sound localisation –tinnitus –reduced speach intelligibility especially in ambient noise –diplacusis –--. Symptoms start typically in age of 45 –First affect in poor acoustical conditions

5. / Classification of hearing handicaps Non-noise induced (>10 % of people under 65) –Presbyacusis Often genetic background CNS infection, ear infection sociocusis –Middle ear problems (seldom) Noise induced (<10 % of workers in noise over 85 dB) –Acute trauma –Chronic trauma (The "real" hearing handicap) Evaluation based on audiogram Tinnitus.. do not affect typically

6. / Social effects of hearing handicap Reduced speech intelligibility –Do no understand especially in ambient noise –Social isolation –Mental problems (. 2x) Tendency to believe that others make fun –Increased accident risk Misunderstanding instructions Failure to hear warning signals –Reduced career opportunities Training difficult speech is not understood –Increased risk of unemplyoment " dumb people do not work here" Reduced capability to localize sounds –Increased accident risk if moving machines around –Reduced speech intelligibility

7. / Social effects of hearing handicap Tinnitus –Increased annoyance –may interfere with warning signals –sleep disturbance –avoidance of social noisy events concerts, public events,…. –… Hyperacusia –stress –avoidance of social noisy events concerts, public events,…

8. / Self evaluated hearing Normal Mild Moderate

9. / Quality of life and self-evaluated hearing 115161257147N = Self-evaluated hearing Deaf almost deaf Some difficulties Minor problems Normal EQ-5D thermometer 80 70 60 50 40 30 20

10. / Effect of hearing in different populations 0.5 0.55 0.6 0.65 0.7 0.75 0.8 0.85 0.9 TAYS<66Laminoijat Puusep ä t Korkea Kommunikaatio Normaali Liev ä Kohtalainen Vakava 0.5 0.55 0.6 0.65 0.7 0.75 0.8 0.85 0.9 Users of hearing aids Physical workers Technicians High comm workers Normal Mild Moderate Almost deaf

11. / Life cycle of noise Nosocusis Discos and concerts Equipment Infections Conscript noise Life style Work noise Ambient noise Free time noise Early retirement dementia (0-5 y) (20-30 y) (45-68 y) Accumulation of noise effects - Vaccination - Personal pacifier -Exercise -Noise limits in discos -Teaching attitudes -Hearing protection -Healthier life style -Personal hearing solutions - Office noise Earlier access to hearing aids -Better hearing protection

12. / Estimates of the size of the problem Number of conscripts with hearing loss >20 dB at any frequency has increased from 13 % to 20 % –Noise ? –Life style factors (Young age cholesterol RR=7.2, Pyykkö et al 2007) –Kindergarten infections ? Call centers (Toppila et al 2008) –15 -25% complaints about hearing –Demanding job -> subclinical hearing loss important Protection against work noise not efficient –In elderly people in noisy occupations overpresented in hearing aids fitting –Factor ~2

13. / Size of problem Finland looses 21 B€ every year because of early removal from workforce (Ahonen, Vainio 2010) Hearing impairment seems to be involved in 5-15 % of the cases –Annual cost 2.1 B€ (Extrapolated to US 176 B$) –Mostly from work not done –Direct costs 200-400 M€ (Extrapolated to US 2.5B$) These calculations exclude –Lost career opportunities –Effect on pensionnaires earlier dementia etc.

14. / Hearing loss, removal from workforce and statistics (Total workforce 2.2 M) Toistuvat korvatulehdukset Vapaa-ajan Melu Nuoren iän kolesteroli Riskitekijät Risk group Asevelvollisuus melu 300-500 300-500 100-400 700 1000 Unempolyment Hearing loss 50% 130% 3000 2000 Ei työmelua: 1600 000 Ototoksinen lääkitys Chemicals, vibration, medication 30-40? Statistics Noise caused accident 0% 70 <10 500? Repeated infections Free time - noise Young age cholersterol Risk factorsj Worknoise for early removal from workforce 250 000 Conscript noise 300-500 300-500 100-400 700 1000 Early retirement NIHL 50% 130% 3000 2000 Work noise 400 0000 No worknoise: 1600 000 Accident Dementia Ototoxic medication Combined exposure 30-40? Stat A 0% 70 <10 500?

15. / Potential for savings Reduction of sociocusis, early age effects 30% Reduction of Noise Induced Hearing Loss70 % –Not 100 % because of overdiagnosis Totally in work force~35% –750M€/y (US 62 B$)

16. / Discussion Noise is underestimated problem in modern societies –Affects people with hearing handicap in harsh communication environments Cause for underestimation –Affects several factors –Never the most important factor but ranked 3-5 (de Hollander et al 1999) To reduce the adverse effects of noise –work noise protection –reduction of nosocusis –protection of free time noise