耳毒性物質與噪音共同暴露的健康危害及管理策略初探

Preliminary Study on the Health Hazards and Management Strategies of Co-exposure to Ototoxic Substances and Noise

職業性聽力損失在職業傷病種類中相當常見。噪音雖是造成聽力損失的最重要因素，但職場可能還有其他危害成因，其中，耳毒性物質即是來源之一。勞工在職場上暴露於耳毒性物質的機率高且種類多，包含：溶劑、窒息劑、金屬等。耳毒性物質對聽力損失的相關研究早在幾十年前就有探討，近十年更是大幅上升，各國也陸續制定預防職場聽力損失之相關政策及指引，並進行改善。本文蒐集各國之耳毒性物質相關政策及指引，進行歸納統整，並提出我國未來擬定相關規範之參考建議。
結果顯示，美國、加拿大、西班牙等國家已公告職業耳毒性物質風險評估及預防的相關指引，而歐盟、澳洲等國家也建議在同時暴露於噪音及溶劑的職場應將噪音職業暴露限值降低為80 dB。另外，法國、西班牙等國家也透過與研究單位合作，研發辨識高風險作業場所的方法，或是辨認及分類不同耳毒性物質危害的證據權重方法等。

Occupational hearing loss is one of the most common occupational injuries among workers. Although noise is the most important factor causing hearing loss, there is often more than one source of workplace risk, and ototoxic substances are one of the sources. Workers are highly likely to be exposed to various types of ototoxic substances in the workplace, such as solvents, asphyxiants, metals, etc. Studies on hearing loss caused by ototoxic substances started decades ago and have increased significantly in the past de¬cade. Many countries have also gradually improved their relevant policies and guidelines to prevent hearing loss in the workplace. This study will help to collect existing ototoxic substances-related policies and guidelines in various countries and summarize and pres¬ent them as reference suggestions suitable for future criteria in Taiwan.
The integrated results show that the United States, Canada, Spain, and other coun¬tries have announced relevant guidelines for the risk assessment and prevention of ototox¬ic substances in the workplace, while the European Union, Australia, and other countries also recommend setting limits on noise exposure reduced to 80 dB in workplaces that are simultaneously exposed to noise and solvents. In addition, France, Spain, and other coun-tries have also synchronously worked with their research institutes to develop methods for finding high-risk workplaces or identifying and classifying the weight of evidence for different ototoxic substances.