January - March
2024

GLOBAL EXPOSURE MANAGER
Editor: Maharshi Mehta, CIH, CSP, FAIHA, Maharshi.Mehta@ioha.net
Published with the support from the British Occupational Hygiene Society

OTOTOXICANTS:CHEMICALS THAT IMPACT HEARING
Eduardo Shaw, MS, CIH, CSP, Eduardo.shaw.morais@ericsson.com
Ototoxicants are chemical substances that canenter the body through inhalation, absorption, andingestion. These substances target different
components of the inner ear to adversely affecthearing. The adverse effects of these substances
range from blurring sounds to hearing loss.
Although the ototoxic effects of different
medications are well documented in thepharmaceutical industry, further studies areneeded to understand the health effects of dual
occupational exposures to ototoxicants and noise.
This article aims to provide a summary of the
etiology of ototoxicants, classifications ofototoxicants, and recommended control
measures.
Historical Perspective
The knowledge that chemicals can cause hearing
loss is not new. It was first documented in the XI
century when Avicenna, a Persian philosopher,
described how individuals exposed to mercury
vapor to treat head lice experienced deafness. XIXcentury literature documents temporary hearing
loss from quinine and chloroquine. Research into
the adverse effects on hearing from occupational
exposures to noise and ototoxicants increased
rapidly in the 1970s and 1980s.

At least two countries, Australia and Brazil,
have enacted worker compensation laws that
include hearing loss caused by ototoxicants.
Etiology
Occupational hygienists are typically well versedon the inner workings of hearing loss due to noise
exposures. Hearing loss from noise is a purely
mechanical process where high-pressure waves
structurally damage hair cells in the cochlea.
Ototoxicants, on the other hand, cause hearing
damage from various bio-chemical and metabolicmechanisms. Examples of these mechanisms
include constriction of blood vessels that deliver
oxygen to the inner ear, over-generation of radicals
that destroy hair cells, reduction of antioxidant
levels in the inner ear, and poisoning of theauditory nerve. The auditory nerve transforms thevibrations into electrical impulses to the brain.
These actions can disable the tensor tympani, themuscle that tightens the tympanic membrane toattenuate incoming sound pressures. Additionally,
there is evidence that some of these processes
remain present in the inner ear for days after initial
exposure and continue to cause hearing damage
even after an ototoxicant’s exposure ceases toexist.

Example of OtotoxicantsGlobal occupational health and safety
organizations classify ototoxicants as (a)confirmed/potential, (b)definitive/suspect/questionable, or (c)possible/non-conclusive. Occupational hygienists
must exercise caution as ototoxicant classifications
can vary between organizations responsible forclassification. One option to address theclassification variability is to develop a companyspecific list of ototoxicants and their classifications.
Ototoxicant chemicals include various solvents,
such as carbon disulfide, ethylbenzene, styrene,
toluene, trichloroethylene, and xylene. Metals likelead and mercury and at least one asphyxiant,carbon monoxide, are also identified as
ototoxicants. Carbon monoxide can potentiate
hearing loss from concurrent high noise andcarbon monoxide exposure.
Credible organizations that have published alisting of ototoxicants and their rationale include
the European Agency for Safety and Health at
Work (EU-OSHA), Institut de recherche RobertSauvé en santé et en sécurité du travail (IRSST,
Canada), Nordic Expert Group for Criteria
Documentation of Health Risks from Chemicals,
Safe Work Australia, and the National Institute ofOccupational Safety and Health (NIOSH, USA).
In many workplaces, employees are potentially
exposed to ototoxicants in the presence of highnoise levels. Although research is limited in thisarea, evidence suggests that there are synergistic
effects from dual exposure to noise and chemicals
such as toluene, styrene, and lead. Hearing
damage could also occur from ototoxicant
exposure even when noise exposures are below
regulated exposure limits (e.g., 85 dBA).
Control Measures
The organizations that have researched andpublished chemicals considered to be ototoxicants
have also promulgated measures to control
hearing loss from potential exposures toototoxicants. The hierarchy of controls can beeffectively applied to eliminate or mitigate the riskof exposure to hazards such as ototoxicants. Once
ototoxicants are identified in the workplace andwhen noise exposure is likely, a risk assessment fornoise should also include concomitant potential
exposure to noise and ototoxicants.
Examples of specific control measures forototoxicant exposure include (a) developing andimplementing a hearing conservation program forworkers with ototoxicant exposure above 50
percent of an ototoxicant’s occupational exposure
limit, (b) requiring periodic audiometricexaminations for workers where inhalation anddermal exposure to an ototoxicant is uncontrolled,
and c) including occupational and nonoccupational ototoxicant (e.g., medications)
exposures and potential health effects in acompany’s hazard communication program.
Control measures for potential exposure to noiseand ototoxicants may include (a) reducing theeight-hour noise occupational exposure limit to
below the regulatory limit (e.g., 80 dBA from 85dBA) and/or (b) lowering the occupational
exposure limit for an ototoxicant of concern.
Ototoxicants do not always cause hearing loss but
may create difficulty in understanding speech forthe exposed person. As a result, a Distortion
Product Otoacoustic Emissions Test may be
conducted to determine overall hearing function
compared to the conventionally used pure-tone
air-conduction audiometry.
Globally, occupational and non-occupational noise
exposures are a concern. Ototoxicants potentiallycontribute to adverse effects on hearing. Including
ototoxicants in an occupational noise risk
assessment program and developing a risk control
strategy reduces the potential risk of hearing
damage and impairment resulting from exposure
to ototoxicants and noise.

References
1. European Agency for Safety and Health at
Work: Combined Exposures to Noise and Ototoxic
Substances (2009).
2. Proceedings of the International Workshop“Synergistic exposure to noise, vibrations andototoxic substances” (PDF, September 2010)[Morata, Thais and Johnson, Ann-Christin:
Chemical interactions in the auditory system:
implications for occupational healthAIDII’S PILLS OF INDUSTRIAL AND ENVIRONMENTALHYGIENE AS A COMMUNICATION TOOL
Andrea Martinelli,

Italian Association of Industrial Hygienists (AIDII); Department of Cardiac Thoracic Vascular Sciences andPublic Health, University of Padua, 35132 Padova, Italy. andrea.martinelli@unipd.it

Andrea Spinazzé

Italian Association of Industrial Hygienists (AIDII); Department of Science and High Technology, University ofInsubria, 22100 Como, Italy. andrea.spinazze@uninsubria.it

The "Pills of Industrial and Environmental Hygiene" (in Italian: “Pillole di Igiene Industriale e Ambientale”)
represent a continuing series of short communications edited by the Italian Association of Industrial
Hygienists (AIDII) beginning in 2022, and now numbering 28 issues.
Because of their accessibility
and ability to provide clear
The pills are distributed free and open access through the website andand concise information, theLinkedIn page of AIDII. With this series of publications, AIDII aims to"Pills" are a valuable tool forcover topics, peculiar to Occupational and Environmental Hygiene,
in a way that is, hopefully, more enjoyable for readers, whether they are disseminating information on
environmental andexperts in the subject or not in order to promote and spread theoccupational hygiene.
occupational hygiene in the community.
Indeed, the style adopted is one-page document, which presents an essential and schematic summaryof each topic. Pills published to date include those on basic concepts and the history and future
prospects of occupational hygiene, as well as those related to more specific topics such as aerosols andnanoparticle monitoring, biological monitoring, respiratory protective equipment, or legislative updates.
The pills are published (in Italian only) monthly, but they can be more frequently according to needs orin case it is interesting to publish a pill on topical issues.
AIDII website: https://www.aidii.it/pillole-di-igiene-industriale-e-ambientale-2/

IOHA

UPDATESIOHA 2024 Collaboration Award

IOHA congratulates the Occupational Hygiene
Training Association (www.ohtatraining.org) forreceiving the IOHA 2024 Collaboration Award. This
recognition is bestowed upon groups and projects
that exemplify exceptional collaboration within theoccupational hygiene community.
From the size of the population directly impacted
to the level of inspiration it offers to occupational
hygienists worldwide, OHTA’s work excelled in every
aspect. Moreover, the long-term collaboration
efforts and dedication to sustainable improvement
genuinely align with IOHA's mission to provide asafe and healthy working environment for all.
Congratulations to OHTA members and volunteers
on this telling achievement!

IOHA 2024 Lifetime Achievement Award
IOHA congratulates Deon Jansen van Vuuren forbeing selected as the Lifetime Achievement Award
recipient this year. IOHA Lifetime Achievement
Award honors individuals who have madesignificant contributions to the promotion anddevelopment of occupational hygiene practice that
improve the health and welfare of working men
and women. Deon’s rousing nomination from theSouthern African Institute for Occupational Hygiene
can perhaps best described by a direct quote fromtheir letter of recommendation as follows here;“It is truly difficult to overemphasize
Deon's worthiness for a "lifetime"achievement award in Occupational
Hygiene. His consistent and enduringcontributions have left an indelible
mark on the field, impacting the lives
and well-being of countless individuals.
Deon's legacy is one of selflessness,expertise, and a profound passion for the
improvement of occupational hygiene standards.”
Congratulations to Deon for his latest award and“Thank You” for your lifelong leadership andcommitment to worker safety and our profession!
Join us at IOHA2024 to celebrate the winners on
Wednesday, June 12.

IOHA Code of Ethics
Nancy Wilk, IOHA President-Elect nancy.wilk@wsp.com
The IOHA is dedicated to improving, promoting,and developing occupational hygiene worldwide
through its member organizations and to
improving and maintaining a safe and healthy
working environment for all.
As part of IOHA’s commitment to continual
improvement, IOHA has established a 2024 IOHA
Code of Ethics that provides guiding principles for
its members, member associations, and IOHA
Board Members.
The IOHA Code of Ethics is intended to guidebehavior and decision-making, enhanceaccountability, and promote ethical behavior.
Thank you to the IOHA Executive Committee and
Board members for their review and feedback inthis crucial continual improvement process.
Please refer to the link for a copy of the 2024
IOHA Code of Ethics.

Community of Practice on Sensor Technologies
Samantha Connell, IOHA President, president@ioha.net
Emanuele Cauda, COP Chair, cuu5@cdc.gov
The IOHA Community of Practice for particulatematter sensors met for the first time in two
virtual meetings (due to time zone constraints)
on March 6, 2024. Less than one year ago, the
COP was an idea brought to the IOHA Executive
by Emanuele Cauda of the NIOSH Center for
Direct Reading and Sensor Technologies. With
the support of Past President Maharshi Mehta
and current President Samantha Connell, the
COP was presented to the board in October 2023
and taken onboard.
Several efforts are being made in each country,
and the IOHA COP intends to document themand increase their visibility and dissemination.
The first meetings included COP members withvarious backgrounds and perspectives from 11
countries where IOHA member organizations arepresent: Switzerland, Mongolia, United States,
Australia, Vietnam, New Zealand, Peru, South
Africa, Taiwan, Italy, and Sweden.
Stay tuned for more to come!

The COP's goal is ultimately to support
practitioners around the globe in their efforts toconsider the selection, adoption, andoperationalization of PM sensors in theiroccupational hygiene practice.

IOHA Webinars
IOHA continued to offer most engaging webinars
on unique aspects of occupational hygiene.
Emerging Leaders Institute Update
Samantha Connell, IOHA President, president@ioha.net
Applications for the inaugural Emerging Leaders
Institute (ELI) came in from 21 countries around theworld! The Selection Committee was amazed at how
many applications were received and the highstandard seen across the range of backgrounds,
experiences, and roles.
The Committee was impressed with the candidates'
involvement in the industrial/occupational hygiene
field and their diverse volunteerism with professionalsocieties and the community. From 77 complete
applications, 41 participants were chosen toparticipate in the inaugural ELI Program (pending
confirmation on attendance due to visa approvals).
The 2024 ELI will be held the weekend before in
conjunction with the IOHA 2024 conference. ELI isscheduled for midday Friday, June 7th, to afternoon
Sunday, June 9th, 2024, at the Clayton Ballsbridge
Hotel in Dublin, Ireland.

The committee would like to extend a thank you to
ELI Supporters thus far: IOHA, British Occupational
Hygiene Society, Dutch Occupational Hygiene
Society (NvvA), Indorama Ventures PCL, Institute ofOccupational Medicine, Casella, Shaw City, and theStephen Davis Memorial Fund.

Peter Wilson from the UK based Industrial Noiseand Vibration Center offered a webinar on practicalnoise control solutions. The most significant
number of IOHA webinar participants (91) attended
the webinar and gave rave reviews on the webinar:"Fascinating Presentation!" and "Great webinar!"
IOHA will offer a webinar on Ototoxicants from
Eduardo Shaw on April 24, 2024, from 8:00 to 9:30
am New York time. The webinar is free for all
members of IOHA associations. The registration fee
for industry-sponsored non-IOHA members is 85
GBP. Please encourage industry-sponsoredparticipants to register for the webinar.
Registration link for Ototoxicant Webinar

MEMBER UPDATESAIHN 2024 Council and Webinar
Ifeyinwa Anya, AIHN President, ifyndalaku@gmail.com
The Association of Industrial Hygienists Nigeria (AIHN) conducted its official Changing of the Guard
ceremony on February 10, 2024. The event was significant as we recognized and celebrated theoutgoing 2023/24 Exco for their unwavering commitment to achieving significant milestones for
the AIHN during their tenure. As we embrace a new era for our esteemed Association, we remain
optimistic about achieving even more exceptional accomplishments and reasons to celebrate in
the coming year.
To kickstart our activities for the 2024 calendar year, we organized a webinar titled "New Directionsin Air Sampling: For Particulates, Mixed Phase Contaminants, and Nanoparticles." Debbie
Dietrich, a seasoned Certified Industrial Hygienist with a wealth of knowledge in the field, facilitatedthe session. The session was engaging and insightful, and we had a peak attendance of thirty-six(36) people.

Images from 2nd AIHN ConferenceUPCOMING EVENTSSOFHYT (France) Annual Conference
Nathalie Argentin, President, SOFHYT, presidence@sofhyt.fr
SOFHYT will organize its annual conference on May
13 and 14, 2024. The conference theme is "Health at
Work: Prevention in a Changing World". This oneand-a-half-day conference will focus on chemicalrisk evolution, nanoparticles, endocrine disruptors,
sedentary lifestyle, exoskeletons, and connected
PPEs. Attending this conference is a great
opportunity for EHS managers and industrial
hygienists to share their practices and opinions on
those new challenges.
Registration link for the conference: FORUM 2024 –SOFHYTFirst Occupational Health, Safety andEnvironment Conference Viet Nam
Vietnamese Industrial Hygiene Association(VIHA)
Tuan Nguyen, MBA, CIH, CSP, ARM, FAIHA, Vice President,
VIHA tuancihcsp@gmail.com
The first Occupational Health, Safety, andEnvironment conference will be held in
Hanoi,Vietnam, from October 14- to October 26,
2024. The conference is hosted by the Faculty ofEnvironmental Sciences, University of Science,
Vietnam National University, Hanoi (FES-HUSVNU), and the Central Institute for Natural
Resources and Environmental Studies (CRESVNU)). The organizers invite you to attend theconference and participate as session
moderators, presenters, or abstract reviewers.
This pivotal event will bring together experts,
practitioners, and stakeholders from around theglobe.

Proud to support education and training for healthand safety professionals across the globe

AIDII (Italy) 40th National Congress of Industrial
and Environmental Hygiene – 2024
Mariella Carrieri, President, AIDII, mariella.carrieri@unipd.it
The 40th National Congress of Industrial andEnvironmental Hygiene will be held at the Palazzodella Salute in Padua from June 26 to 27, 2024.
Please refer to AIDII website for additional
information https://www.aidii.it/events/
MIHA-ICE '24 & 7ᵗʰ ANOH Conference 2024
Philip Hibbs, President, ANOH philip.hibbs@hibbs.com.au
The Malaysian Industrial Hygiene Association(MIHA) & the Asian Network of Occupational
Hygiene (ANOH) will jointly host the MIHAInternational Conference & Exhibition 2024 (MIHAICE '24) & the 7th ANOH Conference 2024. The
conference will be held on October 17 to October23, 2024 at Kuala Lumpur Convention Centre,
Malaysia.
The conference theme is “Connect for Innovative
Change—The Asian Way,” with the aim of fosteringcollaboration, exchanging best practices, sharing
lessons learned, and promoting innovative
solutions to enhance Industrial Hygiene (IH) /Occupational Hygiene (OH) standards in theregion.
You are invited to submit an abstract for atechnical paper totechnical.mihaanoh@gmail.com.
MIHA/ANOH are looking forward to receiving
abstracts for papers covering various technicalissues in occupational hygiene.The submission
deadline for the Call for Papers is May 17, 2024.
Please refer to the website for more information.
https://mihaice.anoh2024.org/

UPCOMING EVENTSISRP conference
21st International Conference on “Respiratory
Protection Use and Users” from the European
Section of the International Society for Respiratory
Protection (ISRP) will be held at Oxford, UK from
September 22 to September 24, 2024.
The conference is a great opportunity to hear
about and to share the very latest in respiratory
protection research, innovations, applications, andmany other topics, with the international
community. The conference will include atechnical presentation program, a poster session,an exhibition and many networking opportunities.
Registration and Information Link for the
ConferenceWill we see you at

The conference aims to promote occupational
hygiene and worker health protection by theminimisation of worker exposure to hazardous
agents globally through plenary sessions, keynote
lectures, parallel talks, workshops, and poster
presentations, as well as networking opportunities
and social functions.

Free professional development courses
Alongside the conference programme, we will also
host a number of Professional Development Courses
on Sunday 9th June 2024.
Each PDC will provide 3 hours of free training to
IOHA2024 delegates.
Bookings will open for registered conferencedelegates in April and will be on a first-come, firstserved basis.
The PDC titles can be found below, to find out more
about each course visit www.ioha2024.org.
Pharmaceutical Industries
Ventilation Systems
Leadership Skills
EthicsPresentation Skills

Conference Programme
We're excited to announce the preliminary
programme for IOHA 2024 is now live!
This conference aims to bring together
professionals, researchers, andpractitioners from around the world todiscuss the latest advancements and bestpractices in the field of occupational
hygiene.
The conference theme is: Protecting
workers from health hazards: Advancing
in this changing world.
Click here to view the preliminary
programme

Early Bird Booking Fee
Did you know you can save over £200 bybooking your place at the conference
today?
Early-bird booking rate will only beavailable until April 12th 2024 so act fast to
avoid disappointment!
Click here to secure your place today.

Basic Characterisation
Emergency Response
Elongate Mineral Particles/Asbestos
Nanoparticles
Biological Monitoring
Sustainable Development Goals
Performance-Based Approach

Protecting Workers From Health Hazards:
Advancing in This Changing World

IOHA - In EspañolOTOTÓXICOS:SUSTANCIAS QUÍMICAS QUE AFECTAN A LA AUDICIÓN
Eduardo Shaw, MS, CIH, CSP, eduardo.shaw.morais@ericsson.com
Los ototóxicos son sustancias químicas que
pueden entrar en el organismo por inhalación,
absorción e ingestión. Estas sustancias se dirigen adiferentes componentes del oído interno paraafectar negativamente a la audición. Los efectos
adversos de estas sustancias van desde laborrosidad de los sonidos hasta la pérdida deaudición.
Aunque los efectos ototóxicos de diferentes
medicamentos están bien documentados en las
industrias farmacéuticas, se necesitan másestudios para comprender los efectos sobre lasalud de la doble exposición profesional aototóxicos y ruido.
Este artículo pretende ofrecer un resumen de la
etiología de los ototóxicos, las clasificaciones de losototóxicos y las medidas de control
recomendadas.
Perspectiva histórica
El conocimiento de que las sustancias químicas
pueden causar pérdida de audición no es nuevo.
Se documentó por primera vez en el siglo XI,
cuando Avicena, un filósofo persa, describió cómo
las personas expuestas al vapor de mercurio para
tratar los piojos experimentaban sordera. La
literatura del siglo XIX documenta la pérdida
temporal de audición causada por la quinina y lacloroquina. La investigación sobre los efectos
adversos para la audición de la exposición laboral
al ruido y los ototóxicos aumentó rápidamente enlas décadas de 1970 y 1980.

Al menos dos países, Australia y Brasil, hanpromulgado leyes de compensación a lostrabajadores que incluyen la pérdida deaudición causada por ototóxicos.
Etiología
Los higienistas ocupacionales suelen conocer bienel funcionamiento interno de la pérdida deaudición debida a exposiciones al ruido. La pérdida
de audición por ruido es un proceso puramente
mecánico en el que las ondas de alta presión
dañan estructuralmente las células ciliadas de lacóclea. Por otro lado, los ototóxicos causan daños
auditivos por diversos mecanismos bioquímicos ymetabólicos. Algunos ejemplos de estos
mecanismos son la constricción de los vasos
sanguíneos que suministran oxígeno al oídointerno, la generación excesiva de radicales que
destruyen las células ciliadas, la reducción de losniveles de antioxidantes en el oído interno y elenvenenamiento del nervio auditivo. El nervio
auditivo transforma las vibraciones en impulsos

eléctricos que llegan al cerebro. Estas acciones
llegan incluso a inutilizar el tensor del tímpano, el
músculo que tensa la membrana timpánica para
atenuar las presiones sonoras entrantes. Además,
existen pruebas de que algunos de estos procesos
permanecen presentes en el oído interno durantedías tras la exposición inicial y siguen causando
daños auditivos incluso después de que cese la
exposición a un ototóxico.
Ejemplo de ototóxicos
Las organizaciones mundiales de salud yseguridad en el trabajo clasifican los ototóxicos
como (a) confirmados/potenciales, (b)definitivos/sospechosos/cuestionables, o (c)posibles/no concluyentes. Los higienistas laborales
deben actuar con cautela, ya que lasclasificaciones de los ototóxicos varían de una
organización a otra. Una opción para abordar lavariabilidad de las clasificaciones es elaborar una
lista de ototóxicos y sus clasificaciones específicas
para cada empresa.
Entre los productos químicos ototóxicos se
incluyen diversos disolventes, como el disulfuro decarbono, el etilbenceno, el estireno, el tolueno, el
tricloroetileno y el xileno. Metales como el plomo yel mercurio y al menos un asfixiante, el monóxido
de carbono, también se identifican como
ototóxicos. El monóxido de carbono puede
potenciar la pérdida de audición provocada por
una exposición elevada al ruido y al monóxido decarbono.
Entre las organizaciones creíbles que hanpublicado un listado de ototóxicos y su
justificación se encuentran la Agencia Europea
para la Seguridad y la Salud en el Trabajo (EUOSHA), el Instituto de Investigación Robert-Sauvé
en Salud y Seguridad Laboral (IRSST, Canadá), el
Grupo Nórdico de Expertos para la Documentaciónde Criterios de Riesgos para la Salud derivados deProductos Químicos, Safe Work Australia y elInstituto Nacional de Seguridad y Salud en el
Trabajo (NIOSH, EE.UU.).
En muchos lugares de trabajo, los empleados
están potencialmente expuestos a ototóxicos enpresencia de altos niveles de ruido. Aunque lainvestigación es limitada en este ámbito, laspruebas sugieren que existen efectos sinérgicos
derivados de la doble exposición al ruido y asustancias químicas como el tolueno, el estireno y
el plomo. También pueden producirse daños
auditivos por la exposición a ototóxicos incluso
cuando la exposición al ruido está por debajo delos límites de exposición regulados (por ejemplo,
85 dBA).

Medidas de control
Las organizaciones que han investigado ypublicado sustancias químicas que se consideran
ototóxicas también han promulgado medidas para
controlar la pérdida de audición por exposiciones
potenciales a ototóxicos. El principio de higiene
industrial de la jerarquía de controles también seaplica a los ototóxicos. Una vez identificados losototóxicos en el lugar de trabajo y cuando la
exposición al ruido es probable, una evaluación deriesgos para el ruido también debe incluir la
exposición potencial concomitante al ruido y a losototóxicos.
Entre los ejemplos de medidas de control
específicas para la exposición a ototóxicos se
incluyen: a) desarrollar e implantar un programade conservación de la audición para lostrabajadores con una exposición a ototóxicos
superior al 50 por ciento del límite de exposición
ocupacional de un ototóxico, b) exigir exámenes
audiométricos periódicos para los trabajadores en
los que la exposición por inhalación y dérmica a un
ototóxico no esté controlada, y c) incluir las
exposiciones ocupacionales y no ocupacionales aototóxicos (medicamentos ototóxicos) y los efectos
potenciales sobre la salud en el programa decomunicación de peligros de la empresa.
Las medidas de control para la exposición
potencial al ruido y a los ototóxicos pueden incluir(a) la reducción del límite de exposición
ocupacional al ruido de ocho horas unos decibelios
por debajo del límite reglamentario (por ejemplo,
80 dBA desde 85 dBA) y/o (b) la reducción dellímite de exposición ocupacional para un ototóxico
de interés.
Los ototóxicos no siempre provocan pérdida deaudición, sino que pueden crear únicamente
dificultades para comprender el habla. En
consecuencia, puede realizarse una prueba deotoemisiones acústicas de productos de distorsión
para determinar la función auditiva global encomparación con la audiometría de conducción
aérea de tonos puros utilizada convencionalmente.
En todo el mundo, la exposición ocupacional y no
ocupacional al ruido es motivo de preocupación.
Los ototóxicos contribuyen potencialmente a losefectos auditivos adversos. La inclusión de losototóxicos en el programa de evaluación deriesgos del ruido ocupacional y el desarrollo de una
estrategia de control de riesgos reducen el riesgo
potencial de daños auditivos por ototóxicos yruido.

Referencias:
Agencia Europea para la Seguridad y la Salud en el
Trabajo: Exposiciones combinadas a ruido ysustancias ototóxicas (2009).
Proceedings of the International Workshop"Synergistic exposure to noise, vibrations andototoxic substances" (PDF, septiembre de 2010)[Morata, Thais y Johnson, Ann-Christin:
Interacciones químicas en el sistema auditivo:
implicaciones para la salud laboral