In the article there are presented results of studies on the hygienic assessment of working conditions and health status of 1200 workers of mining and processing enterprises (MPE) developing deposits of iron ores of the Kursk Magnetic Anomaly: Lebedinskiy MPE, Mikhaylovskiy MPE, Stoylenskiy MPE. There were revealed the differences in the character and intensity of adverse occupational factors, there was made the quantitation of the occupational risk level to the health workers of MPE both factories and quarries. The structure of occupational diseases in MPE factories is formed by dust lung diseases and the occupational pathology of the organ of hearing. In the structure of professional pathology in quarries workers vibration disease (61.5%) prevails. The obtained results indicate to the need of the development of the system of measures for the reduction in general and occupational morbidity rate of workers, the creation of safe working conditions, improving the early diagnosis of occupational and common diseases at the stage of preliminary and periodic medical examinations.

Общеизвестно, что шум как акустически адекватный раздражитель вызывает специфические изменения пери-ферического отдела слухового анализатора и приводит к развитию профессиональной нейросенсорной тугоухости (ПНСТ). Вместе с тем шум относится к факторам, облада-ющим высокой биологической активностью и вызываю-щим целый ряд неспецифических, так называемых экс-траауральных нарушений со стороны различных органов и систем [1][2][3].Исследования последних лет показали, что длитель-ное воздействие шума и вибрации приводит к истощению адаптационных резервов организма, развитию кардио-и цереброваскулярных осложнений, нанося существенный социально-экономический ущерб вследствие утраты здо-ровья [4][5][6]. В структуре общей заболеваемости у работ-ников шумо-и виброопасных производств болезни орга-нов кровообращения занимают одно из первых мест, а высокие риски развития данной патологии позволяют от-нести их к профессионально-обусловленным заболевани-ям [7][8][9]. В то же время сердечно-сосудистые заболевания могут способствовать развитию нейросенсорной тугоухо-сти, в патогенезе которой значительная роль принадлежит гемодинамическим расстройствам. Поэтому вопросы па-тогенетической взаимосвязи данных нарушений, первич-ности и вторичности их развития по отношению к тугоу-хости имеют большое прогностическое и медико-соци-альное значение, определяют направленность лечебно- Цель работы -анализ структуры сопутствующей соматической патологии у работников с профессиональной потерей слуха. Отмечено нарастание частоты сопутствующих хронических заболеваний и преобладание полинозологии по мере усиления степени выраженности тугоухости. Доказано, что заболевания сердечнососудистой системы потенцируют действие шума на орган слуха и повышают риск потери слуха у работников «шумовых» профессий. Установлены при чинноследственные связи и определена этиологическая доля сосудистого фактора в формировании профессиональной патологии органа слуха. Выявлены клиникоаудиологические особенности коморбидного течения профессиональной тугоухости на фоне сосудистой патологии, характеризующиеся сокращением сроков развития и прогрессирования за болевания, постепенным исчезновением специфичных для шумового поражения аудиологических признаков.

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An urgent task in modern conditions is to improve the existing models of occupational risk assessment to ensure the safety and health of employees, obtain and analyze objective information sufficient to develop scientifically sound management decisions on the prevention of occupational and general morbidity, reduce labour loss and preserve labour longevity. The review provides information on domestic and foreign models of occupational risk assessment, their improvement to ensure the safety and health of employees. Various models of occupational risk assessment are analyzed, both quantitative, semi-quantitative, and qualitative methods of assessing occupational risk that causes the risk for employee health disorders associated with exposure to chemicals, dust factor, noise, and vibration. Methodological principles of various models of occupational risk assessment differ in approaches to assessment of hazard and impact. The advantages and disadvantages of domestic and foreign models of occupational risk assessment are established. This requires the development of a single unified methodology (procedure) for assessing and managing occupational risks, criteria for assessing occupational health risks of an individual and cohort (group, collective) nature. The ideas and evidence discussed in this review indicate that scientific research and professional practice on occupational risk assessment in occupational should develop towards a more holistic, health-oriented model of occupational risk assessment and management. When preparing the review, the databases Scopus, Web of Science, Medline, The Cochrane Library, EMBASE, Global Health, CyberLeninka, RSCI were used.

The article reflects the main sections of Clinical guidelines «Hearing loss, noise-induced» (second revision) included in the Rubric of Clinical guidelines of the Ministry of health of the Russian Federation in 2018, CG609 and aimed at streamlining and unification of actions in clinical diagnostic and expert work. The purpose of the of research is to help the practitioner in making the right decision on the assessment of health, treatment of hearing loss caused by industrial noise, on the basis of evidence-based step-by-step protocols. Material and methods. The subject of the development of the CG609 were high rates of occupational hearing loss in employees of “noise-hazardous” industries, classified as “Professional sensorineural hearing loss”. Results. The structure of the CG609 is presented, the importance of unified approaches to the diagnosis, treatment, rehabilitation, prevention, examination of the relationship of the disease of the hearing with the profession and aptitude is shown. The criteria of evidence and credibility of specific recommendations are given. Discussion. CG609 are created on the generally accepted, repeatedly approved methodology of development of SIGN (2014) guaranteeing reliability of recommendations, generalization of the best world experience and modern knowledge, applicability in practice and convenience in use. The use of high-quality clinical guidelines makes it possible to introduce into medical practice the most effective medical technologies, to refuse unreasonable and unsafe interventions and to improve the quality of medical care. Conclusion. CG609 are required for the integrated interaction of specialists otolaryngologists, audiologists-otorhinolaryngologists, pathologists, physicians, occupational health, occupational medicine and all medical professionals involved in diagnostic and expert work of the assessment of hearing in workers «noise hazardous» professions.