Audiology in Practice in Industrial set-up: Role of audiologist, set up,

equipments

Presenter: Jobish T J
Roll. No: 15
Contents

 Role of an audiologist
 Audiological set-up in Industry
 Equipments

Occupational hearing loss is a specific disease with established symptoms and objectives
findings. Accurate diagnosis requires careful and complete history, physical examination and
laboratory and Audiological findings. NIHL occurs primarily in adults. The National Institute for
Occupation Safety and health (NIOSH) estimates that in 1992, approximately 30 million
American workers were exposed to hazardous levels of occupational noise. The numbers of
exposed workers have increased by over 30% since 1983 (NIOSH, 1988).

NIOSH published two articles to estimate the national burden of hearing difficulty among
workers in the U.S.: "Exposure to Hazardous Workplace Noise and Use of Hearing Protection
Devices among U.S. Workers—NHANES, 1999–2004"1 and "Hearing Difficulty Attributable to
Employment by Industry and Occupation: An Analysis of the National Health Interview Survey
—United States, 1997 to 2003." The articles extrapolate data from the National Health and
Nutrition Examination Survey (NHANES) of 9,275 employed workers to the entire working
population. The analysis revealed:

 More than 22 million U.S. workers were exposed to hazardous workplace noise.
 Workers in the mining industry had the highest prevalence of workplace noise exposure
with almost 3 out of 4 mining industry workers exposed. The mining industry has the
second highest prevalence of hearing difficulty among all industrial sectors.
  Over one third of all manufacturing workers (5.7 million workers total) reported exposure
to loud noise.
 One in four manufacturing workers exposed to loud noise reported non-use of hearing
protection devices.

So the audiologist has a significant role in in industries to assess the hearing loss,
management etc. Before that an audiologist should know about how to do an audiological
set up in the industry, team members and what all equipments are needed for that.

Team: Professionals who are involved in industrial setup are,

1. Physicians
2. Industrial hygienist
3. Occupational health nurses
4. Safety professional
5. Noise control engineers
6. ENT

Role of an audiologist

1. Selecting suitable test areas for noise survey and audiometric tests
2. Getting audiometric tests done
3. To formulate, administer and update the hearing conservation program (HCP)
4. Guidance and management on purchase of Equipments or machinery related to
industrial setup.
5. Training and supervising the workers in proper use of EPDs
6. Maintaining the effective records pertaining to HCPs
7. Participating in the selection of noise control procedures
Audiologist has an important role in hearing conservation program. The role of
audiologist HCP is discussed below.
Role of Audiologist in Hearing Conservation program (HCP):

The primary goal of the “Hearing Conservation Program” is to reduce, and eventually eliminate
hearing loss due to workplace noise exposures.
A model “hearing conservation program” includes 7 general components:

(1)Noise exposure assessment; (2) Engineering and administrative controls of noise

exposure; (3) Personal hearing protection; (4) Hearing assessment -audiometric testing,
audiogram review, and referral; (5) worker and management education and motivation;
(6) Record keeping; (7) Analysis of program effectiveness

The audiologist participates in each program component to a greater or lesser extent

depending on his or her education and skills and the particular employer's needs and resources.
The audiologist can advise management on all operational aspects of the hearing conservation
program, including management responsibilities and liabilities under federal, state, and local
occupational health and safety regulations and worker compensation statutes. The audiologist
can recommend the most efficient means of completing each component of the program.

1. Noise Exposure Assessment

The purpose noise exposure monitoring is to determine the need for implementation of,
and appropriate strategies for, an effective hearing conservation program. The
audiologist with acoustical engineer performs area noise measurement, personal
dosimeter, and related equipment calibration activities.

2. Engineering and Administrative Controls

Engineering controls of noise are usually the domain of the acoustical engineer or other
consultants with noise control expertise. The audiologist should be involved in
consultation to determine the effectiveness of these types of controls.

3. Personal Hearing Protection

When engineering and/or administrative controls are not feasible, a personal hearing
protection program must be implemented. The audiologist is the key team member in
solving problems related to the use of HPDs. The audiologists fit personal hearing
protection and instruct, counsel & motivate the worker regarding its proper use and
 care. The audiologist can also train and supervise technicians in appropriate procedures
for dispensing hearing protectors to workers

4. Audiometric Testing, Audiogram Review, Referral

Audiometric testing, review, and referral are central to the mission of an occupational
hearing conservation program
The audiologist should take a leadership role in the delivery of the following services:
 Advise management on the relative merits of different approaches to
audiometric testing.
 Advise management on the suitability of various types of audiometers (e.g.,
manual, self-recording, software-driven);
 Select and ensure calibration of audiometric equipment;
 Select suitable audiometric testing areas and document ambient noise levels;
 Provide appropriate audiometric services
 Review and interpret audiometric tests performed
 Develop and implement re-test and referral criteria, Refer to appropriate
medical Services for otologic examination.

Audiometric testing should be done at least 3 Stages:-

 Pre-employment hearing testing

Questionnaire (pre exposure, injury) can be used, Establishes hearing status

before exposed to the noise (Baseline audiogram), the results of baseline audiometry
are correlated with OAE.

 Monitoring audiometry

Done if exposed to high level of noise, evaluated regularly (once in 6 months), if

strike of long time, long sick or after an accident, if claims for compensation - aging
effect, and ototoxicity effects must be taken into consideration.
  Exit Audiogram
Audiometry should be conducted when a worker leaves employment or is
permanently rotated out the occupational noise exposure at or above 85dBA as an
8hur TWA. Like baseline audiogram this should be performed after a minimum of
12 hours (NIOSH, 1996).

5. Worker and Management Training

One of the most important components of an effective hearing conservation program is worker
and management motivation and training. The audiologist may perform the following
activities:-

 Develop or recommend appropriate materials;

 Instruct in-house staff in effective methods of motivating and educating workers
 Maintain up-to-date knowledge of pertinent local, state, and federal regulations in order
to provide
 Management with accurate information concerning these matters

6. Record Keeping

An accurate and complete record-keeping system is a requisite element of an OHCP to verify

compliance with relevant standards and to ensure program effectiveness.

The audiologist should advise the employer of required and recommended records that
should be maintained in-house to document each of the components of the program. In
addition, the audiologist should establish and maintain an adequate recordkeeping system for
all services — whether direct, supportive, or consultative — provided for an employer

7. Analysis of Program Effectiveness

 Analyzing the effectiveness of a hearing conservation program provides
meaningful feedback to all levels of personnel within an organization

Audiologist Role on an Interdisciplinary Team

Audiologist should involve members of other disciplines and coordinate activities to enhance
the proper development and operation of effective hearing conservation programs.

The other professional disciplines may include acoustical engineering, industrial

engineering, otolaryngology, occupational medicine, safety engineering, occupational nursing,
industrial hygiene, human resource management, and information management.

In addition to the basic components of an effective OHCP, audiologists may be involved

in forensic activities, such as serving as expert witness in hearing loss compensation claim cases
and other forms of litigation.

Noise survey

A noise survey takes noise measurement throughout an entire plant to identify noise areas. It
provides very useful information which enables us to identify:-

-Areas where employs are likely to be exposed to harmful level of noise and personal
Dosimetry maybe needed.

 Machine and equipments which generate harmful levels of noise

 Employee who might be exposed to unacceptable noise levels, and
 Noise control options to reduce noise exposure

It gives details about the frequency composition, noise level and duration of noise
exposure. If the noise level can’t be in order to restrict below Damage Risk Criteria (DRC) then
the role of EPDs should be given emphasis for the employers or workers. A noise survey map
can be produced by drawing lines on the sketching between points of equal sound level (points
of measurement). It provides very useful information by clearly identifying area where there
are noise hazards. Employee working this area needs to be taken care specially.

There are 2 methods of noise survey:-

(A). Survey method- It requires least amount of time and equipment. It uses SLM with limited
number of measuring points in A-weighting network or linear response. Checks noise is
constant or intermittent, how long workers are exposed (to be noted) and No detail analysis of
environment.

(B). Engineering method- It does detailed analysis of noise. It uses large number of measuring
points

-Frequency range is selected a/c to objective. Temporal factor is recorded. It helps in

assessing SIL (Speech interference levels) and estimates auditory and non-auditory effects of
noise.

Equipment used in the measurement of noise levels

Sl No. Equipment Specification/Area of usage

1. Sound level meter Type-0 : Laboratory reference standard

Type-1: Lab use and field use in specified controlled

environment

Type-2: General field use (Commonly used)

Type-3: Noise survey

2. Impulse meters For measurement of impulse noise levels e.g. hammer blows,
 punch press strokes etc.

3. Frequency analyzers For detailed design and engineering purpose using a set of
filters.

4. Graphic recorders Attached to sound level meter. Plots the SPL as a function of
time on a moving paper chart.

5. Noise dosimeters Used to find out the noise levels in a working environment
attached to the worker

6. Calibrators For checking the accuracy of sound level meters.

Audiological set-up in Industry

The site of the audiometric testing is important as the test tones can be masked by the ambient
noise. Unless an extremely quiet room is available, an audiometric testing room is required to
conduct an accurate test.

Set-up: -administrative Dept. (place far from Industry is preferred), and work place is less
preferred. Each location must be first checked for quietness with noise level meter (SLM).

Test frequency of the audiometer Octave band

125 40

250 40

500 40

750 40

1000 40

1500 42

2000 47

3000 52
 4000 57

6000 62

8000 67

If any value is exceeded, the site is not good enough for the audiometric testing. Therefore
either audiometric booth should be utilized or another site should be selected.

Audiometric room or booth do not eliminate noise, they only attenuate it. More the
attenuation is required, greater the cost. Audiometric room audiometric room size can vary
from smaller to 6*10ft room. Acoustically treated double room is preferred.

Equipments for Hearing Assessment

1. Audiometer (Diagnostic) - Should have facility of AC and BC, Frequencies (500Hz,

1000Hz, 2000Hz, 3000Hz, 4000Hz, 6000Hz and 8000Hz, high frequency ( 10,000Hz,
12000Hz, and 16000Hz), Speech Audiometer, SISI, ABLB.
2. Immittance-meter should have facility of Immittance, reflex threshold (Ipsi and Contra),
reflex Decay
3. Otoacoustic Emission –DPOAE, TEOAE both are required. High frequency audiometry is
required for early detection of hearing loss.
4. VEMP
5. ABR
Equipments for hearing aid trail
 Different types and categories of hearing aids, programing soft wares
 Different ear protective devices
 Audiometers with free field calibrated loudspeakers
 Assistive listening devises – to communicate between employers in the intrusty

References

 Sataloff J (1957). Industrial deafness. The Blakiston Division. New York.

 Hosford-Dunn H Roeser R. J, & Valente M, (2000). Audiology practice management.
Thieme. New York.
 http://www.cdc.gov/niosh/topics/noise/default.html. National Institute for
Occupational Safety.
 http://www.osha.gov/.Occupational Safety and Health Administration.
 http://www.bgsu.edu/offices/envhs/page18435.html Bowling Green State University.
Personal Protective Equipment.
 Noise and Audiology- Lpscomb.DM
 Industrial deafness-Sataloff .J
 Occupational Hearing loss- Sataloff J and Sataloff R.T
 Jack katz, 2008 ;Handbook of Audiology 5th edition Lippincott William & Wilkins,
Newyork
 Lipscomb, David M. (1988). Hearing conservation in industry, schools & military.
 Behar A., Chasin M., & Cheesman M., (2000). Noise control: A Primer
 World Health Organization. Prevention of noise induced hearing loss. Report of a WHO-
PDH Informal Consultation, Geneva, 28-30 October 1997.