Current Issues in Hearing Loss Prevention

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Oswin Morgan
6 years ago
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1 3M OH & ES Division Current Issues in Hearing Loss Prevention Lee Hager, Hearing Conservationist

22,100 163,100 hearing losses since 2004 19,500 18,800 220,700

2 3M OH & ES Division Where do we stand today? Hearing Loss Recordability Trend 28,400 26,900 24,400 23,000 22, ,100 hearing losses since ,500 18, , , , , , , ,

3 3M OH & ES Division What s the Story? Exposure Assessment and Limits? Resource Allotment? Training? Hearing Protectors? Probably all of the above and more 3

4 Exposure Assessment Percentage of employers implementing elements of hearing conservation requirements. Company Size Audiometry Monitoring Hearing Protection Small 0.0% 0.0% 16.5% Medium 5.2% 4.5% 37.9% Large 18.7% 29.5% 83.5% and yes, sadly enough, 26 year old data is the best we have NOES 1986, NIOSH 4

5 Exposure Limit = Acceptable Risk How much noise is OK? Exposure Level db(a) Organization ISO % 10% 0% EPA % 12% 5% NIOSH % 15% 3% Percent risk of material hearing loss (hearing threshold levels >= 25 db) above that anticipated in non-noise exposed population, based on 40-year working lifetime. OSHA accepted 21% to 29% excess risk in 1981 (PEL) Revised position to 10% to 15% in 1983 (Action Level) 5

6 Deeper Look at Damage Risk Avg Exp Level, dba ISO 1971 From NIOSH White Paper (5/2012) Selection of Audiometric Frequencies included in analysis khz khz khz NIOSH 1972 EPA 1973 ISO 1990 NIOSH 1997 NIOSH 1972 ISO 1990 NIOSH 1997 ISO 1990 NIOSH More recent work identifies higher frequencies as key for verbal communication Analysis-dependant inclusion of higher frequencies increases population

7 Risk does not Damage RIsk Criteria % excess risk * * Exposure ISO EPA NIOSH 7

8 Resource Allotment HCP Cost Implications 1976 Cost Impact Analysis $32 per worker - $ in 2007$ $12 (37% of total) for monitoring $20 for audiometric testing 1983 HCA Cost Impact Analysis $41 per worker - $84.31 in 2007$ $12-$18 (44% of total) for monitoring $10 for hearing protection devices 1992 OSHA Philadelphia Region Compliance Guide $86.60 per worker - $ in 2007$ Recent analysis for major manufacturer Automotive - $250 per noise-exposed employee per year General Industry - $350 per noise-exposed employee per year 8

9 Real Cost Implications Worker Compensation $9k to $150k for total loss Partial loss $0 to $? Dobie & Megerson, AIHA Noise Manual, Chapter 18 Long term health care Hearing aids for life 9

10 Instrumentation New Stuff Either: Real smart, or Real smart but hiding it Dan Johnsons Dream Etymotic Research Remote monitoring 10

11 Task-Based Exposure Assessment Modeling 11

12 Training or not so much Promote behavioral change Health Belief Model Behavior depends on perception of: Severity of a potential illness Susceptibility to that illness Benefits of taking preventive action Self-efficacy My actions will make a difference Barriers to taking that action 12

13 Our mission? Define the decibel Beat people up for offthe-job behaviors Provide nap time during workday Check the box Persuade people that hearing loss is a severe impediment to lifestyle Communicate susceptibility Communicate benefits Remove barriers Real Perceived 13

14 What does it sound like? Use hearing loss simulators Caution: May not be effective with workers with pre-existing hearing loss Google NIOSH HLSim to get your copy 14

15 How about Hearing Protectors? Intended to be last line of defense against NIHL Instead, often the ONLY protection against noise So how s that working? 15

16 Do HPD provide what we expect? Laboratory Field Berger, EARLog 20,

Lab based Unreliability leads to derating

2000 3150 4000 6300 8000 NRR Mean 37.4 40.

17 Is it the labeling process? NRR EPA testing and labeling requirements Lab based Unreliability leads to derating OSHA: (NRR-7)/2 NIOSH: Variable by type Pressure on mfr. Label value is inaccurate Variability in even lab data Typical SD 3-5 db per frequency Test Frequency NRR Mean SD

18 Special HPD for special noises and needs Impulse Weapons fire Arc flash Low attenuation Flat attenuation 18

19 Communication in Noise Ambient Listening Radio Communication UHF DECT 19

20 Fit testing Hearing Protectors If we want to know how well HPD work on individuals, test them on individuals Technologies REAT Loudness Balance MIRE PAR Note: All of the approaches described today are point measures 20

21 REAT Approaches Hearing test with and without HPD Each frequency/each ear separately Existing equipment Audiometer phones Caveats Loudspeakers in test booth Gold Standard 21

Time consuming Background noise May be issues with

22 FitCheck Special headphones High output High volume Pulsed 1/3 octave bands Subjective As variable as a hearing test Time consuming Background noise May be issues with HOH/tinnitus 22

23 REAT-like Systems Subjective Threshold response Integrafit Single frequency NIOSH HPDWellFit Under development; limited frequencies QuickFit Pass/fail Web-based 23

earplug Subjective New skill Different test tones

24 Loudness Balance Balance tones binaurally No HPD One HPD Both HPD Each frequency separately Any earplug Subjective New skill Different test tones Time consuming May be issues with HOH workers/tinnitus 24

Loudness Balance Sperian VeriPro www.howardleight.

25 Loudness Balance Sperian VeriPro * Single frequency quick check option 25

HPD Software provides stimulus, calculation and

26 MIRE Simultaneous measurement inside and outside HPD yields noise reduction (NR) Specially prepared/probed HPD Software provides stimulus, calculation and compensation MIRE (objective NR) to REAT (subjective insertion loss) 26

Safety Meter by Phonak Similar to EARfit Custom HPD product

29 What do we find when we can look? % of tests 14% 12% 10% 8% 6% 4% 2% Classic Reg Classic Regular N = 1665 NRR1979 = 29 db Mean = 30 db SD = 6.8 db 80 th = 37 db 20 th = 24 db 0% PAR (db) Note: scale on all charts 1 to 50 PAR on X; % of tests 0% to 15% on Y UltraFit N = 480 NRR1979 = 25 Mean = 26 db SD = 5.5 db 80 th = 31 db 20 th = 22 db % of tests 14% 12% 10% 8% 6% 4% 2% 0% UltraFit M All Rights Reserved. PAR (db)

33 Individual Fit Testing Applications Train and motivate employees Train the trainer Assign/select HPDs Provide standard-threshold-shift (STS) follow up Determine HPD adequacy/sufficiency Audit departments Demonstrate adequacy of training Provide documentation Berger

34 How about compliance? Today s OSHA: Compliance No comment Standards No comment Alliance 34

Comparability With identical octave band attenuation, different systems yield different PAR values Calculation protocols Uncertainty Freq 125

35 Comparability With identical octave band attenuation, different systems yield different PAR values Calculation protocols Uncertainty Freq Att Data and chart courtesy of Murphy, NIOSH, from NHCA M All Rights Reserved.

36 Making Progress Hearing loss prevention is possible New technologies New approaches New attitudes as research continues Courtesy Audibel 36

Hearing Protector Fit Testing: Practical Implications

Hearing Protector Fit Testing: Practical Implications Panel Discussion Format Non-commercial CEU disclaimers Commercial information is available in the exhibit hall Each presenter will have 10 minutes