Noise pollution in industrial enterprises is inevitable, and employees who have been engaged in front-line work for a long time can't accept it. The main purpose of on-the-job physical examination and on-the-job physical examination is to prevent the occurrence of occupational diseases in the future, and the unit is overwhelmed.
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With the country's emphasis on occupational health monitoring, the number of people who undergo occupational health examination will increase every year. Standardization of occupational health monitoring has also become the first problem to be solved. The new technical specification of occupational health monitoring is of great significance and practical value. For example, regarding the conclusions in the personal occupational health examination report, there was no uniform report format when the physical examination results were normal, so there were various conclusions such as "nothing unusual", "normal" and "normal physical examination". Now the new Technical Specification for Occupational Health Supervision gives specific operational guidance to the conclusion. I like the language expression in it very much. For example, if the physical examination results are normal, it is necessary to write "No occupational health examination". In terms of the format of the occupational contraindication report, some regulations have been made for the re-examiners, such as "Not suitable for XXX work" before taking up the post and "Not suitable for XXX work, so it is recommended to change jobs" during the on-the-job period. I feel that the new standard is more scientific, reasonable and rigorous, and more operable. However, there is still something worth thinking about: for example, Appendix A5 of the Technical Specification for Occupational Health Surveillance downloaded from the Internet clearly explains the difference between suspected occupational diseases and suspected occupational diseases; The conclusions of the personal occupational health examination report described in this specification (section 4. 10. 1) include five situations, the third of which is a suspected occupational disease, which is also written in the newly issued occupational health monitoring guide. However, in the brief introduction of the Technical Specification for Occupational Health Surveillance, this description belongs to suspected occupational diseases. I think it is more appropriate to use suspected occupational diseases here. It should be just a typo, I hope to correct it in time.
I am an occupational health supervisor, and the most common abnormality in my work is the abnormality of electrical audiometry. I have always been concerned about the problem of occupational noise deafness. I have read the new draft of Diagnostic Criteria for Occupational Noise Deafness, which is more detailed and reasonable than before revision. However, there are still some things I don't understand about noise deafness in the newly promulgated Technical Specification for Occupational Health Surveillance. There is such a regulation in occupational contraindication for those who are susceptible to noise: those who are susceptible to noise (working in a noisy environment for one year, hearing loss of both ears at any frequency of 3000Hz, 4000Hz and 6000Hz ≥65dBHL), but there is no such regulation before taking up their posts. For these pre-job personnel with the same degree of hearing loss, it will lead to the following situations: first, we can't be completely sure that they are not sensitive to noise, and second, if they are employed, what will be the conclusion of physical examination after one year? Whether to wait for one year during the on-the-job period and then treat it as a contraindication to noise occupation. Third, if hearing continues to decline, how should we evaluate the results of physical examination? Is it an occupational disease to reach the level of mild hearing impairment? This also increases the difficulty of occupational disease diagnosis in the future. Therefore, I personally think that people with this kind of hearing loss are also contraindications before employment. I just think it's a little unreasonable in theory If you know the following, you will know that this may be unnecessary worry.
For occupational noise deafness, occupational contraindications are now more clearly defined before employment, which is more scientific and specific than before revision. The actual situation encountered in the work is like this. Although our chief physician strictly implements the category of pre-job occupational contraindications, many units are unwilling to accept these people as long as the results of audiometry in the conclusion of occupational health monitoring report are abnormal, even if they are mild, that is, there is actually an exaggeration of the scope of use of occupational contraindications. Perhaps it is because of the popularity of MP3 or the influence of other sound effects in society. Before taking up their posts, a considerable number of people have abnormal frequency bands, but they are not occupational contraindications. What we are doing now is patiently explaining to both parties that this is not a occupational contraindication. But we found that the effect was not obvious. How to make occupational contraindications play a real role may require cooperation in many aspects. At this time, we may also need to listen to the ideas of the management.
There is no classification of hearing loss in the review of Diagnostic Criteria for Occupational Noise Deafness and Technical Specification for Occupational Health Monitoring. It is true that the classification in GBZ-49-2002 (hearing loss grade I-V) is of little significance to the diagnosis of occupational noise deafness, and it is used in the conclusion of personal occupational health examination report, which makes ordinary people seemingly unable to understand its meaning and can't tell the severity of hearing loss. But I think it is essential to classify hearing loss in the conclusion of personal occupational health examination report. Otherwise, how to express the abnormality in the results of electrical audiometry when drawing a conclusion? That is to say, there may be no classification in the diagnostic standard of occupational noise deafness, but it is better to have a unified classification standard in the technical specification of occupational health monitoring. It may be better understood if hearing impairment can be divided into five grades: mild, moderate, moderate, severe and extreme. Of course, the authoritative department may have a better scoring method.
With regard to hearing test, according to Article 21 of the Code for Hearing Protection of Workers in Industrial Enterprises, pure tone air conduction method should be adopted for hearing test. The hearing evaluation of occupational noise deafness in Diagnostic Criteria for Occupational Hearing Impairment is based on the air conduction results of pure tone audiometry. It often gives some people who are engaged in occupational diseases an illusion that the hearing test in occupational health monitoring only needs to be carried out through air, not through bones. In fact, bone conduction is very helpful to distinguish whether the frequency band of audiometry is abnormal or sensorineural hearing loss, which makes up for the deficiency of judging whether the middle ear is abnormal in some otological physical examinations and can better grasp the occupational contraindications before taking up the post. In the process of occupational disease diagnosis of noise deafness, bone conduction is not the basis of diagnosis, but it is also indispensable. I hope that the new regulations can also attach importance to the role of bone conduction and give more guidance on what circumstances to do bone conduction. Electrical audiometry is essential for the diagnosis and degree judgment of noise deafness, because it can accurately understand the degree of hearing loss of the subjects, accurately analyze the lesion site, and sometimes even analyze the causes of deafness. However, this is a subjective judgment and requires the close cooperation of customers. Acoustic immittance can objectively judge the situation of middle ear cavity and distinguish conductive deafness from induced neurological deafness. Otoacoustic emission can objectively judge the damage of outer hair cells in inner ear, and can distinguish sensory deafness from neurological deafness for those who exclude conductive deafness. These three tests mentioned in the new specification are very targeted for the diagnosis of occupational noise deafness and point out the direction for us in instrument inspection. I hope that the authoritative occupational health examination institutions will give us more guidance in this respect, including designating some designated hospitals, how to do these examinations in a targeted manner, and make a good diagnosis of occupational noise deafness.
Who is the biggest occupational disease in China? Wang Shiqiang from the Noise and Vibration Research Office of Beijing Labor Protection Science firmly believes that hearing loss is the biggest occupational disease in China. He once made a sampling survey among people working in noisy environment, and the incidence of hearing loss was 20-50%. At the time of drawing a conclusion, I also found that the abnormal rate detected by audiometry in occupational health monitoring is the highest, and I deeply realized the authenticity of this data before and during my post. In addition to the diagnosis of severe noise deafness, there is still a great opportunity for the diagnosis of mild occupational deafness, but why are there so few people reporting the diagnosis of occupational noise deafness and so many pneumoconiosis in China? This is a question worth thinking about. Although noise deafness is not as harmful to the body as pneumoconiosis, it involves a wide range, so it is particularly important to diagnose hearing damage early and take timely intervention measures. I hope that one day I can see more detailed work instructions about the diagnosis of occupational noise deafness, including some examples of successful diagnosis, so that we can do a good job of health monitoring of occupational noise deafness with confidence.