CODEPEH关于预防儿童期噪声性听力损失的建议。
完整摘要 · 中文译文
噪声性听力损失是可预防的，但在早期阶段可能是永久性、累积性和临床静默的。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）的共识文件将循证综述与出生至18岁噪声相关听觉损伤预防的实用建议相结合。它回顾了发育脆弱性、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方法。噪声不仅可能损害感觉毛细胞和基底膜，还可能损害血管纹、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建议采取分级控制措施：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；促进适合年龄的听力保护和安全聆听；并使用常规和扩展高频测听、耳声发射实施基于风险的监测 排放、噪声中言语测试，以及有指征时的其他测试。目前不建议将任何药物用于常规预防。有效的预防需要家庭、教育工作者、医疗保健专业人员、行业、活动组织者和公共当局的协调行动。
完整摘要 · 英文原文
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.