CODEPEH关于预防儿童期噪声性听力损失的建议

文献信息

中文摘要

噪声性听力损失是可预防的，但在早期阶段可能永久存在、累积且临床隐匿。这份来自西班牙听力损失早期检测委员会（Comisión para la Detección Precoz de la Hipoacusia，CODEPEH）的共识文件结合了循证综述与实用建议，旨在预防从出生至18岁期间的噪声相关听觉损伤。文件回顾了发育易感性、损伤机制、暴露环境、个体易感性、临床表现和听力学评估。在儿童中，外周和中枢听觉系统的持续成熟、年龄依赖的中耳传输、识别和控制危险暴露的能力有限，以及听力困难对语言、学习和心理社会发展的后果，均支持采取特定的预防策略。噪声不仅可能损伤感觉毛细胞和基底膜，还可能损伤血管纹、螺旋韧带、带状突触、螺旋神经节神经元和中枢听觉通路。机械性破坏、氧化和亚硝化应激、线粒体功能障碍、炎症、谷氨酸兴奋性毒性、自噬改变和凋亡均参与损伤过程。CODEPEH建议采用分级控制策略：在源头降低声音；对产品、场所、学校、医疗环境和娱乐活动进行监管；推广适合年龄的听力保护和安全聆听；并在有指征时使用常规及扩展高频测听、耳声发射、噪声中言语测试和其他测试实施基于风险的监测。目前不推荐任何药物用于常规预防。有效的预防需要家庭、教育工作者、医疗专业人员、产业界、活动组织者和公共当局的协调行动。

英文摘要

Noise-induced hearing loss is preventable but may be permanent, cumulative, and clinically silent in its early stages. This consensus document from the Spanish Commission for the Early Detection of Hearing Loss (Comisión para la Detección Precoz de la Hipoacusia, CODEPEH) combines an evidence-based review with practical recommendations for the prevention of noise-related auditory injury from birth to 18 years of age. It reviews developmental vulnerability, mechanisms of injury, exposure settings, individual susceptibility, clinical manifestations, and audiological assessment. In children, ongoing maturation of the peripheral and central auditory systems, age-dependent middle-ear transmission, limited capacity to recognize and control hazardous exposure, and the consequences of hearing difficulty for language, learning, and psychosocial development justify a specific preventive approach. Noise may damage not only sensory hair cells and the basilar membrane but also the stria vascularis, spiral ligament, ribbon synapses, spiral ganglion neurons, and central auditory pathways. Mechanical disruption, oxidative and nitrosative stress, mitochondrial dysfunction, inflammation, glutamate excitotoxicity, altered autophagy, and apoptosis contribute to injury. CODEPEH recommends a hierarchy of controls: reduce sound at source; regulate products, venues, schools, healthcare environments, and recreational activities; promote age-appropriate hearing protection and safe listening; and implement risk-based surveillance using conventional and extended high-frequency audiometry, otoacoustic emissions, speech-in-noise testing, and other tests when indicated. No pharmacological agent is currently recommended for routine prophylaxis. Effective prevention requires coordinated action by families, educators, healthcare professionals, industry, event organizers, and public authorities.