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Abstract：
This paper makes recommendations for the diagnosis and quantification of noise-induced hearing loss (NIHL) in a medico-legal context. A distinction is made between NIHL produced by: steady broadband noise, as occurs in some factories; more impulsive factory sounds, such as hammering; noise exposure during military service, which can involve very high peak sound levels; and exposure to very intense tones. It is argued that existing diagnostic methods, which were primarily developed to deal with NIHL produced by steady broadband noise, are not adequate for the diagnosis of NIHL produced by different types of exposures. Furthermore, some existing diagnostic methods are based on now-obsolete standards, and make unrealistic assumptions. Diagnostic methods are proposed for each of the types of noise exposure considered. It is recommended that quantification of NIHL for all types of exposures is based on comparison of the measured hearing threshold levels with the age-associated hearing levels (AAHLs) for a non-noise exposed population, as specified in ISO 7029 (2017), usually using the 50th percentile, but using another percentile if there are good reasons for doing so. When audiograms are available both soon after the end of military service and some time afterwards, the most recent audiogram should be used for diagnosis and quantification, since this reflects any effect of the noise exposure on the subsequent progression of hearing loss. It is recommended that the overall NIHL for each ear be quantified as the average NIHL across the frequencies 1, 2, and 4 kHz.
摘要：
本文为在医学法律背景下对噪声引起的听力损失（NIHL）的诊断和量化提出了建议。NIHL产生的区别在于：稳定的宽带噪声，就像一些工厂发生的那样；更冲动的工厂声音，如锤击；服兵役期间的噪音暴露，这可能涉及非常高的峰值声级；以及暴露于非常强烈的音调。有人认为，现有的诊断方法，主要是为了处理由稳定的宽带噪声产生的NIHL而开发的，不足以诊断由不同类型的暴露产生的NIHL。此外，一些现有的诊断方法是基于现在过时的标准，做出不切实际的假设。针对所考虑的每种类型的噪声暴露提出了诊断方法。建议对所有类型暴露的NIHL进行量化是基于测量的听力阈值水平与非噪声暴露人群的年龄相关听力水平（AAHL）的比较。根据ISO7029(2017)的规定，通常使用第50百分位数，但使用另一个百分位数，如果有很好的理由这样做。当军事服务结束后不久和之后的一段时间都可以使用听力图时，应使用最新的听力图进行诊断和量化，因为这反映了噪声暴露对随后的听力损失进展的任何影响。建议将每只耳朵的总体NIHL量化为频率1、2和4kHz的平均NIHL。
