Current issues of risk-based prevention of professional hearing disability of employees

Introduction. The multidimensional (medical, social, economic, legal, moral and ethical) problem of professional hearing disability remains one of the most urgent in occupational health.

This is due to the fact that indicators of occupational hearing loss occupy the first place in the structure of occupational morbidity, without a downward trend, as well as an increase in the number of workers with professional hearing disability and a wide prevalence of risk factors for hearing impairment — noise, infra- and ultrasound, vibration, heating microclimate, chemical ototoxic factors, certain types of work, for which the condition of the hearing organ is important.

The study aims to optimize the risk management of the professional unfitness of hearing workers to work under the influence of physical, chemical ototoxic factors and certain types of work.

Materials and methods. The authors have carried out an expert and analytical study. At the first stage, experts conducted a comparative analysis of regulatory legal acts regulating the procedure for conducting mandatory preliminary and periodic medical examinations (PME) for the period 1957–2021.

At the second stage, they analyzed and statistically processed data from the "MEDIALOG" medical information system, including the results of PME performed at the Institute's clinic in 2019–2023 (a total of 104,482 people aged 20 to 80 years, including 5,177 with medical contraindications, 1300 of them for hearing). According to the GOST R ISO 1999-2017 model, the attributive risk of hearing loss for employees of various classes of working conditions, age, and length of service groups is calculated, and a single-digit index of professional unfitness is justified.

Results. The authors proposed measures to optimize the PME of workers in terms of physical, chemical, ototoxic factors and certain types of work (adjusting the scope of research and the list of medical contraindications). In the structure of medical contraindications to work with harmful and(or) dangerous industrial factors and types of work identified in 5,177 employees (hereinafter referred to as medical contraindications), diseases of the eye and its accessory apparatus (ICD-10, class VII) occupy the first place — 26.39%, the second — diseases of the ear and mastoid process (ICD-10, class VIII) — 25.11%, the third — circulatory diseases (ICD-10, class IX) — 12.63%. The frequency of identified medical contraindications per 10,000 examined patients amounted to 495.49 cases, professional unfitness — 190.75 cases. Of the 1,300 workers (mostly men) with medical contraindications to hearing, 44.9% were more often registered in the age groups 50-59 years old and 27.10% in the age groups 60-69 years old, 1,028 people had a sensorineural form of hearing loss (79.08%). 842 people (64.7%) and 455 people (35.0%) were found eligible, with an average age of 53.7±0.3 years and 56.1±0.5 years, respectively (p<0.05). The frequency of identified (per 10,000 examined) hearing contraindications amounted to 124.42 cases, occupational unfitness — 43.55 cases, preliminary diagnoses of occupational diseases — bilateral sensorineural hearing loss — 27.09 cases. The largest share of professionally unsuitable workers (64.6%) is accounted for by workers in professions associated with increased noise levels, 29.4% by those who work at height, and 6.0% by those who work in contact with lead and its inorganic compounds. According to the attributive risk data (a model according to GOST R ISO 1999-2017), an overestimation of the criterion values of the hearing thresholds adopted in the classification of clinical recommendations (2024) was confirmed, and a single-digit indicator of professional hearing disability was justified.

Conclusion. The improvement of regulations governing the conduct of medical examinations will improve the effectiveness of medical examinations and the examination of the professional suitability of employees. In order to implement risk-based prevention or risk management, it is necessary that the PME and the examination of professional aptitude be completed by organizing the rehabilitation of employees and developing individual preventive measures taking into account the attributive risk of hearing impairment.

Limitations. The study is limited by the number of employees who have undergone mandatory pre-employment and periodic medical examinations, types of economic activities and professions.

Ethics. This study did not require the conclusion of an Ethics Committee.

Contributions:
Prokopenko L.V. — research concept and design, data collection and interpretation, text writing;
Lagutina A.V. — data collection, processing and interpretation, text writing;
Kuryerov N.N. — data processing.

Funding. The study had funding.

Conflict of interest. The authors declare no conflict of interest.

Received: 00.00.2025 / Accepted: 31.07.2025 / Published: 05.09.2025

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