Noise Induced Hearing Loss Erwin Dyah N

KEBISINGAN (NOISE) UNWANTED/UNDESIRED SOUND HIGH INTENSITY AND OR FREQUENCY DIJUMPAI DI HAMPIR SEMUA TEMPAT KERJA MENIMBULKAN GANGGUAN KESEHATAN

Pendahuluan Pendengaran indra penting untuk komunikasi penurunan pendengaran / ketulian  dampak psikologis & sosial Occupational Hearing Loss : NIHL, Trauma akustik NIHL berhubungan dengan paparan kebisingan jangka lama. Kerusakan terjadi pelan dan baru disadari setelah beberapa tahun kemudian. Irreversible HL  Tindakan preventif penting Trauma akustik akibat paparan tunggal dengan intensitas tinggi dan mendadak ( ledakan )

WHY IS THERE SO MUCH NOISE? INDUSTRIALISASI MEKANISASI PENGGUNAAN POWER DI INDUSTRI MENINGKAT PENGEMBANGAN MESIN-MESIN BARU LEBIH CEPAT DARI PADA PENGEMBANGAN METODE UNTUK REDUKSI KEBISINGAN (DIANGGAP KURANG MENGUNTUNGKAN)

Noise Induced Hearing Loss - Levels of Environmental Sounds Source—Safe Levels dBA SPL Heavy Traffic 80  Automobile  (at 20 meters) 70 Vacuum Cleaner 65 Conversational Speech (at 1 meter) 60 Quiet Business Office 50 Residential Area at Night 40 Whisper, Rustle of Leaves 20 Rustle of Leaves 10 Threshold of Audibility   0

KEBISINGAN DIANGGAP MEMBAHAYAKAN JIKA DI TEMPAT KERJA KITA HARUS BERTERIAK AGAR SUARA DAPAT DIDENGAR KURANG DAPAT MENDENGAR / TELINGA BERDENGING SEHABIS BEKERJA ORANG LAIN/ KELUARGA YG MENGENALI COCKTAIL PARTY DEAFNESS NAKER BANYAK YANG TULI SAKIT KEPALA SAAT KERJA DI TEMPAT BISING

PENGARUH BISING PADA PEKERJA Masalah Pendengaran Masalah lain: a. Gangguan fisiologi : meningkatnya Tekanan Darah, Denyut Nadi, Metabolisme Basal, Vasokonstriksi Pembuluh Darah, ischemic heart disease, ketegangan otot (rangsangan sistem syaraf otonom) b.Gangguan Psikologi : Stress, lelah, emosioal,gangguan komunikasi dan konsentrasi, gelisah

EFEK KEBISINGAN TERHADAP PENDENGARAN 1. TRAUMA AKUSTIK AKIBAT PAJANAN TUNGGAL (SINGGLE EXPOSURE) DG INTENSITAS SANGAT TINGGI & TIBA-2 (EX: LEDAKAN BOM) EFEK : MT ROBEK DISLOKASI ATAU KERUSAKAN TL PENDENGARAN & SEL SENSORIS ORGANON CORTI AUDIOGRAM : FLAT RESPONSE (KOMBINASI TULI KONDUKTIF DAN PERSEPTIF)

Masalah Pendengaran 2 KATEGORI KETULIAN TULI KONDUKSI TULI PERSEPSI (SENSORINEURAL )

TUL KONDUKTIF GANGGUAN PADA TELINGA BAGIAN LUAR DAN TENGAH SERUMEN OBSTRUKTIF RUPTURA MEMBRANA TYMPANI (EXPLOSION, MEASLES) ROBEK 1/3 BAGIAN PULIH DLM 9 BLN TERSUMBATNYA TUBA EUSTACHI (KOTORAN, BENGKAK) DISLOKASI TL PENDENGARAN (EXPLOSION, CEDERA KEPALA, OTOSCLEROSIS PD STAPES JOINT---FIXED)

TULI PERSEPTIF GANGGUAN PADA TELINGA BAGIAN DALAM KERUSAKAN TELINGA BAGIAN DALAM : RAMBUT GETAR, N. AUDITORIUS (N. VIII), OTAK

PRESBYACUSIS BEGIN AT A EARLY AGE (EARLY TEENS) THE HAIR CELLS AT THE BASE OF THE COCHLEA WHICH RESPOND TO THE HIGHER FREQUENCY ARE AFFECTED FIRST LAKI-LAKI > PEREMPUAN ORANG KOTA > DESA

BERBAGAI PENYEBAB TULI PERSEPTIF KONGENITAL (RUBELLA, INFLUENSA PADA IBU PD TRIMESTER I KEHAMILAN, OBAT-OBATAN) ACCIDENTS AT BIRTH (MEASLES---BILATERAL, MUMPS ----UNILATERAL) OTOTOXICITY FRACTUR BASIS CRANII NERVE DEAFNESS (COMPLETE LOSS OF HEARING) PRESBYACUSIS NOISE INDUCED HEARING LOSS (NIHL)

PRESBYACUSIS DAN NIHL MERUPAKAN PENYEBAB TULI PERSEPTIF YANG TERBANYAK

PRESBYACUSIS

Presbyacusis Accounting for presbycusis is not mandatory but it is often done in the legal setting.  What is actually sought is to account for non-occupational hearing loss.  Seven states allow deductions for presbycusis. Or to answer the question: Is the progression of hearing loss in the worker more than which can be expected from non-occupational hearing loss?

Presbyacusis NIOSH does NOT recommend accounting for presbycusis when looking for Medical Causation of a progressive hearing loss. If a worker has a progressive hearing loss it is assumed to be due to noise trauma and corrective measures should be taken. However, estimation of presbycusis is used for compensation purposes. The test for compensation is whether the hearing loss is medically more likely than not caused by noise exposure.

Presbycusis --Sex Difference Several researchers have studied primitive cultures to determine the influence of aging on hearing acuity in the absence of occupational noise.  These studies found aging effects on hearing, but observed no sex difference in the hearing loss.  Goycoolea MV, 1986; Rosen S, 1962 Animal studies have also found no sex difference. Hunter KP, 1987  It has been proposed that the difference between male and female thresholds as a function of age, is due to environmental factors.  The most important of which is noise exposure. Kryter KD, 1983

Handicap Equations Presbycusis used to Project Hearing Loss It is assumed with all of the calculators that hearing loss due to noise and presbycusis are additive.  ISO 1999 compression factor is applied when projecting audiometric data. Hearing Loss = ARL + NIL - (ARL * NIL)/120 ARL:  Age Related Loss,  NIL:  Noise Induced Loss

NIHL NIHL mengenai kedua telinga Tahap awal hanya dapat diketahui dengan tes pendengaran. Pekerja yang terkena bisa tidak menyadarinya ( walaupun audiogram ada dip di 4000Hz) Keluhan lain bisa menyertai yaitu mendenging (Tinnitus), recruitment, vertigo Tahap berat timbul kesulitan menangkap pembicaraan dan terganggu komunikasinya  berpengaruh pada kehidupan

Pekerja beresiko : Intensitas kebisingan tinggi dengan akitivitas menggunakan peralatan kecepatan tinggi : Grinding Sawing Drilling Biasanya pada tempat produksi : Metal Pengolahan perkayuan Konstruksi

Anatomi Telinga dan Fisiology Pendengaran

ANATOMI TELINGA

ORGANON CORTI

This is your ear. This is your ear on noise.

Patogenesis NIHL Adaptasi : fisiologis, sebagai pertahanan tubuh, reversibel  kembali cepat Fenomena Fisiologis Terjadi bila terpajan bising 70 db Nama lain : per-Stimulatory Fatigue, pemulihan biasanya terjadi dalam setengah detik Ambang Pendengaran berkurang sementara TTS : patologis, terjadi perubahan metabolik reversibel  kembali lambat (bbrp menit—jam) TERJADI PADA PAJANAN > 85 dBA Berkurang secara menetap PTS : patologis, terjadi kerusakan sel irreversibel  menetap

2. TEMPORARY THRESHOLD SHIFT (TTS) GANGGUAN BERSIFAT SEMENTARA TIMBUL KARENA KELELAHAN SYARAF WAKTU PULIH BEBERAPA MENIT SAMPAI BEBERAPA JAM (MAKSIMUM 10 JAM JIKA DALAM 10-14 JAM BELUM PULIH ----PERSISTEN THRESHOLD SHIFT JIKA DALAM 40 JAM BELUM PULIH ----PERMANENT THRESHOLD SHIFT

3.PERMANEN THRESHOLD SHIFT = NIHL (NOISE INDUCED HEARING LOSS) AKIBAT PAPARAN BISING BERULANG , SEBELUM PEMULIHAN SECARA LENGKAP---AKUMULASI SISA TTS SETELAH ≥10 TAHUN TERJADI PERLAHAN-LAHAN –NAKER TAK MENYADARI

Histopatologi Degenerasi sel rambut (luar) organ corti Fase awal : 3  6 kHz (terutama 4 kHz ) Fase lanjut mengenai frekwensi yang lebih luas Kebisingan intensitas sedang menyebabkan gangguan metabolisme  degenerasi Intensitas tinggi akan menimbulkan kerusakan mekanis

Kerusakan organ : Organ Corti , membrane, stereocilia, haircell, Subceluler organ , stria vascularis

Source –dangerous level dBA SPL Produces pain 140 – 150 Jet aircraft during takeoff (20 meters) 130 Discomfort level, tractor without cab 120 Rock concert 110 Hammer,chain saw, pneumatic drill 100 – 105 Semi-trailers (20 meters) 90

Source dBA SPL Heavy traffic 80 Automobile (20 meters) 70 Vacuum cleaner 65 Conversational speech (1 meter) 60 Quiet business office 50 Residential area at night 40 Whisper, 20 Rustle of leaves 10

CIRI KHAS NIHL TINNITUS SULIT MENDENGAR DERING TELEPHONE SULIT MENDENGAR PERCAKAPAN ORANG LAIN DENGAN JELAS TERUTAMA DI TEMPAT YANG RAMAI DAN BISING TANPA RASA NYERI (TIDAK DISADARI) After 10 years of exposure, the damage caused by noise remains constant, but presbycusis progresses as predicted.

Noise Induced Hearing Loss - Characteristics Sensory hearing loss with loss of discrimination commensurate with the loss in hearing. Maximum in the high frequencies sometimes with a 4000 Hz Notch. 23% will have tinnitus (Phoon WH, 1983) Vertigo is not present

NIHL ORANG B ARU SADAR AKAN ADANYA NIHL JIKA : KEHILANGAN PENDENGARAN MENCAPAI FREK PEMBICARAAN (500-1000-2000 Hz) GEJALA AWAL :TINNITUS , TELINGA TERASA TERSUMBAT KURANG DENGAR FREKUENSI TINGGI (“T” , “D” PADA AHIR KATA), SUARA ANAK-ANAK PADA JARAK JAUH , PEMBICARAAN PADA TEMPAT RAMAI, WALAU JARAK LAWAN BICARA DEKAT) ORANG LAIN YANG PERTAMA KALI MENGENALI

Diagnosa NIHL Anamnesis : - Usia- atherosclerosis; hipertensi;proses penuaan - Lama bekerja - Riwayat penyakit (peny.telinga sebelumnya) - Riwayat trauma - Onset Penurunan pendengaran  mendadak, berangsur-angsur - Riwayat Pekerjaan :Bising di tempat kerja > 85 dBA, lama pajanan per hari, penggunaan APT - Riwayat Keluarga PENEGAKAN DIAGNOSIS pemeriksaan pendengaran berkala

FAKTOR YANG BERPENGARUH Riwayat penyakit Masalah telinga dan gejalanya Riwayat trauma kepala atau telinga Pemakaian obat-obatan Pekerjaan sebelumnya, militer Paparan bahan beracun / toxic(CO,CS2,Trichlorethylene) Aktivitas diluar pekerjaan Riwayat gagguan pendengaran pada keluarga

FAKTOR YANG BERPENGARUH Riwayat paparan kebisingan Intensitas bising Tipe bising ( spektrum frekwensi ) Sifat bising Jarak dengan sumber bunyi Posisi telinga Lama bekerja ( paparan kumulatif ) Kerentanan individu

Pemeriksaan Fisik : a. Keadaan Umum. b. Pemeriksaan telinga. c. Otoskopi. d. pem. audiometri

TES AUDIOMETRI NADA MURNI AIR CONDUCTION PEMERIKSAAN AMBANG PENDENGARAN MINIMAL PADA FREKUENSI 500,1000,2000,30000,4000 DAN 6000 HZ JIKA DITEMUKAN PERGESERAN NAD YG BERMAKNA (>10dB) PADA 2000,3000,4000 HZ DIBANDING AUDIOGRAM AWAL –PERIKSA ULANG 1 BULAN KEMUDIAN

d. Tes Audiometri.

PERSYARATAN UNTUK TES AUDIOMETRI TEMPAT PEMERIKSAAN HARUS SUNYI (MAKS. 40 dB) KALIBRASI CERTIFIED OPERATOR/ YANG TELAH BERPENGALAMAN

Indikasi NIHL-audiogram 1.KETULIAN PADA FREK 3000-6000 Hz 2. ACCOUSTICAL DIP PADA4000 Hz 3. PADA TRAUMA AKUSTIK , KETULIAN BIASANYA BILATERAL 4. JIKA UNILATERAL SERING KARENA OMP 5. NIHL JUGA SERING UNILATERAL PADA TELINGA YANG LEBIH DEKAT DENGAN SUMBER BISING

AUDIOMETRI BANDINGKAN HASIL AUDIOGRAM DENGAN PEMERIKSAAN SEBELUMNYA JIKA ADA PENINGKATAN YANG SIGNIFIKAN , ULANG 1 BULAN KEMUDIAN JIKA PERSISTEN: PINDAHKAN KE TEMPAT YANG TIDAK BISING; UKUR KEBISINGAN, KENDALIKAN

AUDIOMETRI PALING SEDIKIT DILAKUKAN 14 JAM (TANPA PAJANAN) , PERLU DIGUNAKAN ALAT PELINDUNG TELINGA FREKUENSI 250-8000 HZ RUANGAN SUNYI NADA MURNI NAIKKAN INTENSITAS tiap 10 dB SETELAH PASIEN MERESPON, TURUNKAN 5 dB-5 dB dst, sampai tak dapat didengar Ulangi 3 kali

Penanganan NIHL Fase akut dengan terapi vasodilatator Ketulian berakibat gangguan komunikasi - diperlukan konseling - rehabilitatif :  latihan mendengar  latihan membaca gerak bibir  Alat Bantu Dengar HLPP

Noise Induced Hearing Loss - Noise Levels Individuals have different susceptibilities to noise. (Kyong-Myong Chon, 1996) Noise levels are measured in dB SPL on the A Scale. Impulse Noise is more damaging than a constant noise.

Noise Levels INA ACGIH NIOSH OSHA Duration of Exposure (hrs/day) Sound Level dB(A) INA ACGIH NIOSH OSHA 16 - 82 82 85 8 85 85 85 90 4 88 88 88 95 2 91 91 91 100 1 94 94 94 105 ½ 97 97 97 110 ¼ 100 100 100 115* 1/8 103 103 103 -- dst *** **

Plaintiff Evaluation -History is very important Other ear diseases can cause a hearing loss. Other associated systemic diseases which can cause a hearing loss. Other exposure to noise trauma. This is very important because noise exposure’s effects on the inner ear are finite and will cause no further damage after approximately 10 years. Thus, it could be argued that the plaintiff's occupational exposure to noise caused no harm because of his home/recreational exposure.

Plaintiff Evaluation - Other ear diseases can cause a hearing loss Vertigo - Endolymphatic Hydrops - Perilymph Fistula Dizziness Eustachian Tube Dysfunction Tympanic Membrane Perforation Ossicular Fixation or Discontinuity

Plaintiff Evaluation - Other systemic diseases which are associated with hearing loss (nosocusis) Vascular Disease Diabetes Heart Disease Smoking Hyperlipidemia Rosenhall U, Penderson KE Presbycusis and Occupational Hearing Loss Occup Med 10(3):593-607,1995 Ototoxic Drug Use Otologic Ear Infections Meningitis Head Trauma Alcohol Usage

Plaintiff Evaluation - Other exposure to noise trauma (Sociocusis) Hunting. Kryter KD, 1991 found that 69% of 9800 railroad workers used guns. Most have an asymmetrical hearing loss. (Job A, Grateau P, Picard J, 1998) Home machinery – Lawn mowers, weed trimmers, etc. Chain saws Loud Music, Rock Concerts (Yassi A et al Canadian Family Physician, 1993)

FAKTOR YANG BERINTERAKSI DENGAN BISING USIA : ATHEROSCLEROSIS; HIPERTENSI;PROSES PENUAAN GETARAN PENGGUNAAN ZAT OTOTOXIC MEROKOK (BELUM DAPAT DIBUKTIKAN) RIWAYAT PAJANAN BISING SEBELUMNYA

Army ID: * potential ** high-priority Ototoxins Organic solvents ** Toluene (printing) ** Xylenes (plastics) ** Styrenes (plastics) ** Trichloroethylene (degrease) * Carbon Disulfide (textile) * Stoddard/white spirits * N-hexane Fuels (JP-8 fuel) Ethyl benzene Perchloroethylene Butyl Nitrite Methylene chloride Metals * Mercury and derivatives * Lead and derivatives * Arsenic (atoxyl) * Manganese Trimethyltin (organic tin) Cobalt Asphyxiants ** Carbon Monoxide * Cyanide Drugs Aminoglycosides Loop diuretics Anti-neoplastic agents ASA (acetyl salyilic acid) Quinine compounds Others Chem. warfare nerve agents (ex: sarin) Organophosphate (pesticide) Paraquat (pesticide) Army ID: * potential ** high-priority

Paint and print industries - risk of hearing loss Morata,TC., Dunn,DE., Kretschmer, LW., Lemasters, GK., Keith, RW., Scandinavian Journal of Work, Environment & Health, 19(4): 245-54, 1993 Aug. Paint and print industries - risk of hearing loss Unexposed (no noise or solvent) Noise exposed only – hearing loss risk 4x Toluene solvent only – hearing loss risk 5x Toluene solvents and noise –hearing loss risk 11x Controls: previous exposure to noise and/or chemicals, medical and audiological history, age, length of employment, recreational exposure, and military service Tests: puretones, immittance (tympanograms, reflexes, reflex decay)

Problems caused by solvents Hearing Loss Sensorineural Hearing Loss - Inner Ear Tuning (clarity and loudness) Testing: common audiometric procedures (Puretones, Speech, Other) Central/Retrocochlear Hearing Loss - Brainstem and Cortex Processing (transmission, cognition, varying degrees of tuning and loudness) Testing: Speech Processing (interrupted speech, speech in noise, temporal integration) Evoked Potentials (brainstem or cortical potentials), DPOAE: Contra-lateral suppression (efferent testing) Reflex and Reflex Decay Modified Puretone: masking level difference, gap detection, duration pattern, pitch pattern, temporal integration, high frequency audiometry, step size less 5dB Questionnaire on speech discrimination difficulties or other auditory problems that are inconsistent with thresholds Disequilibrium, Headaches, Vision Problems, Neurological

Lead (pb) Example Audiogram taken from literature. .5K 1K 2K 3K 4K 6K 8K 30 35 40 45 40 60 70 Biasanya disertai Vertigo

Arsenic (As) Example Audiogram taken from literature. .5K 1K 2K 3K 4K 6K 8K 45 30 10 05 10 15 15 Hearing losses are greater in the lower frequencies at 125, 250, and 500 Hz. Balance problems are also noted.

Mercury (Hg) Example Audiogram taken from literature. .5K 1K 2K 3K 4K 6K 8K 25 30 35 40 45 50 55 Hearing loss is in the entire range with greater losses in the high frequencies. However, loss does not always occur even with severe neurological symptoms. Hearing loss reportedly occurs 80% of the time.

Organic Solvents In the early stages oto-neurologic disturbances may include vertigo and nausea. Histopathologic studies have shown damage in the sensory cells of the inner ear.

Organic Solvent- CS2 Used in solvents and insecticide Noise 86-89 dBA + CS2  hearing loss within 2 years of exposure : 47% Within 3 years  incidence 71% Audiometric losses in high freq Example Audiogram taken from literature. .5K 1K 2K 3K 4K 6K 8K 30 35 45 55 70 75 NR

Organic Solvents-Tri Chlor Ethylene This solvent is used as a degreaser, dry cleaning agent, spot remover and rug cleaner. It is used in the production of paints, waxes, pesticides, adhesives and lubricants. Destruction of sensory cells of the inner ear is suspected.

Organic Solvents-Tri Chlor Ethylene It results in a bilateral symmetrical high frequency dip beginning at 2K or 3K Hz and is associated with balance problems Example Audiogram taken from literature. .5K 1K 2K 3K 4K 6K 8K 20 20 40 60 65 65 50

Styrene Styrene is used in the production of plastics, synthetic rubber, resins and insulating materials Lower concentrations of styrene show losses above 8 KHz and do not indicate loss other than noise (gambaran mirip dengan NIHL) Example Audiogram taken from literature. .5K 1K 2K 3K 4K 6K 8K 10 10 10 30 50 45 30

Styrene Higher concentrations (1200 ppm) have losses at all frequencies. Example Audiogram taken from literature. .5K 1K 2K 3K 4K 6K 8K 25 30 40 60 65 70 65

Xylene the most prevalent, exposing more people the most toxic of all the organic solvents found in paints, varnishes, and thinners. It produces damage in the sensory cells of the inner ear. No configurations were found discussed in the literature

Toluene the most studied organic solvent. Uses: manufacturing of chemicals, paints, lacquers (pernis), adhesives, rubber, printing, leather tanning, spray painting, glue, etc. It produces cochlear damage.

Toluene Noise + toluene increased risk 27.5 times. Balance problems and abnormal acoustic reflexes are significant symptoms. The audiogram configuration can be flat, bilateral or unilateral; however the most common configuration is a dip at 3K to 6K Hz (as noise) even in the absence of noise.

Toluene Example Audiogram taken from literature. .5K 1K 2K 3K 4K 6K 8K 20 20 30 40 45 60 40

PENATALAKSANAAN GUNAKAN APT PEMERIKSAAN PENDENGARAN : AUDIOMETRI NADA MURNI : 16-36 JAM BEBAS PAJANAN BISING, LAKUKAN SECARA BERKALA SESUAI DENGAN PENYEBAB KETULIAN---PINDAH TEMPAT KERJA (KE TEMPAT YG TDK BISING) BILA DIPERLUKAN : Alat bantu dengar

Macam Alat Bantu Dengar Behind The ear In the Ear In the Canal Completely in the canal

Penanganan NIHL Fase akut dengan terapi vasodilatator Ketulian berakibat gangguan komunikasi - diperlukan konseling - rehabilitatif :  latihan mendengar  latihan membaca gerak bibir  Alat Bantu Dengar HLPP/HCP

PROGNOSIS IRREVERSIBLE PENCEGAHAN MERUPAKAN HAL YANG TERPENTING

PROGRAM PEMELIHARAAN PENDENGARAN PERLU KERJA SAMA ANTARA: LABOR MANAGEMENT HEALTH PROV.

OBJECTIVES OF HCP EDUCATES EMPLOYERS AND EMPLOYEES ABOUT THE NATURE OF HEARING LOSS (IRREVERSIBLE, SUBTLE IN ONSET, PSYCHOLOGICALLY DISTRESSING IF SEVERE) DIAGNOSIS HEARING LOSS AT EARLY STAGES PROVIDES AND DEMONSTRATES THE PROPER USE OF PPE (WHEN ENGINERING REMEDIES ARE NOT SUFFICIENT)

WHAT IS THE MINIMUM OF HCP? A BASELINE AUDIOGRAMS FOR ALL EMPLOYEES (AT RISK) ANNUAL AUDOGRAM FOR EACH EMPLOYEE EXPOSED TO 85 dB/greater SUCH SERIAL AUDIOGRAMS CAN DETECT NIHL EARLY AND PREVENT FURTHER PROGRESSION OF IT BEFORE THE NOTCH WIDENS TO IMPAIR THE SPEACH FREQUENCIES (500-1000-2000 HZ)

Pengendalian secara teknis Substitusi, eliminasi, upgrade : penggantian alat dgn kebisingan tinggi Isolasi : sound box, sound enclosure Sound Barrier : sound proof materials to block the transmission of noise Acoustic Design : sound absorbent materials

Kontrol Administratif Rotasi Jadwal produksi  mengurangi kontinuitas kebisingan Menggunakan kontrol dan monitoring kebisingan Edukasi dan training tentang : Kesehatan telinga, bagaimana menggunakan alat pelindung / proteksi Tes pendengaran

Personal Protective Equipment Earplugs Earmuffs Helmet

Macam Ear plugs : - Ear plug Bilsom 556 (ANSI S3.19- 1974) NRR : 27 dB - Ear plug 3M 1270 (C.A. 9584) NRR : 25 dB - Ear Muff Bilsom 815 NST (EN 352-1 : 1993) NRR 20 dB

Keberhasilan HLPP Parameter : Menerapkan secara benar program prevensi ( HLPP ) Mengendalikan intensitas kebisingan di tempat kerja Penemuan kasus, insiden and prevalensi NIHL

Hambatan HLPP Kesulitan diagnosis NIHL sebagai penyakit akibat kerja : Paparan kebisingan diluar pekerjaan Penyakit lain yang berpengaruh terhadap pendengaran Tidak adanya data dasar audiogram Kurang disiplin memakai Alat proteksi Mesin dan peralatan yang digunakan sudah tua

Penelitian di Surabaya Pengaruh kebisingan terhadap pendengaran Rus Suheryanto ( 1993) 64 Karyawan pabrik textil Kebisingan 95-99 dBA 30 orang NIHL Masa kerja 5-9 th : 4 orang (44,44%) 10-14 th : 8 orang ( 66,67%) 15-19 th : 18 orang ( 85,91%)

Penelitian di Surabaya NOISE INDUCED HEARING LOOS IN STEEL FACTORY WORKERS Heri Kabullah, Sri Harmadji ( 2004) 50 Karyawan pabrik baja Kebisingan di pabrik : 102 dB, 21 orang NIHL ( 84 % ). Administrasi : 60.4 dB, 1 orang NIHL (4%) Masa kerja 6-10 th : 2 orang (40%) 11-15 th : 7 orang (87,5%) 16-20 th : 3 orang (100%) >20 th : 9 orang (100%)

Penelitian lain Hendarmin 1971 : NIHL pada 50% karyawan Manufactur Plant Pertamina Hendarmin,Hadjar : kebisingan jalan 95 dbA Sundari 1994 : NIHL 31,55% pada karyawan Industri besi di Jakarta , noise intensity : 85-105 db Lusianawaty 1998 : NIHL 31,8% pada pekerja industri kayu di Jawa Barat , noise intensity : 84,9-108,2 db Bashiruddin 2002 NIHL 44,5% pada sopir bajaj, noise intensity : 91 db