Title Audiometric Testing Owner CG Nurse Lead. 1.2 To confirm the efficiency of the hearing conservation programme.

Transcription

1 OPTIMA HEALTH CLINICAL PROCEDURE Procedure Ref. P-CG-016 Issue No. 4 Issue Date 24/10/12 Reviewed Feb 2015 Title Audiometric Testing Owner CG Nurse Lead 1. PURPOSE 1.1 To assess hearing performance. 1.2 To confirm the efficiency of the hearing conservation programme. 2. EQUIPMENT 2.1 AUDIOMETRY BOOTH 2.2 AUROSCOPE 2.3 DOCUMENTATION F-CG-031 F-CG-073 F-CG-043 R-CG-018 F-CG-034 Audiometry Questionnaire Audiometric Screening Referral Letter Consent Form Deaf Not Me Leaflet Fitness Report (If appropriate) Audio Test Card (as appropriate) 3. PREPARATION 3.1 Obtain previous results if applicable 3.2 See manufacturers flow chart for step by step guide to audio set up (See Appendix 1 for Amplivox CA850 series) 3.3 Carry out an audiometric inspection check prior to use using F-CG-138 to document this has been carried out. This includes checking of headset / earphones are working, cabling, response switch and actual instrument. Refer to run test section of Appendix 1 in this document. Page 1 of 7

2 PROCEDURE Cont d The Bekesy and computer tests are both valid methods of testing hearing levels. The Bekesy testing is considered a more accurate test since it will average to within 1 db and the patient needs to achieve a consistent series of responses at each test frequency to achieve a threshold. However, it does require increased concentration and takes longer to perform. The computer test is a valid and acceptable method to use, however clinical staff must ensure that a consistent approach is applied to each person. Comparing categories where different test methods have been used is likely to result in inaccurate categorisation. (The following is based on the Amplivox CA850 series) Hearing test (Computer test/hughson WestlakeAutoThreshold) Before placing client in the booth explain the process carefully. When the test is in progress they will hear a signal first in the left ear. On hearing the beeping tone he/she must press and release the contact button. He/she will carry out the same procedure every time the beep is heard. Warn the client that the beep will increase in pitch and that the test will apply to both ears. Ask the client to remove earrings, sweets or gum and ensure the client is not claustrophobic prior to entering the booth. Sit the client comfortably in the booth and reassure. Make sure the head set is fitted comfortably (blue to left, red to right) and that the instructions are understood Beksey Hearing Test When the test is in progress the worker will hear a continual pulse signal first in the left ear. On hearing the pulse signal he/she must press and hold the contact button. When he/she no longer hears the pulse signal they should release the contact button. This procedure is continued in the left, then the right ear through the different test frequencies. 4.2 Begin the test. Patient details are entered after the test has been carried out Select test type: Computer Test (Hughson-Westlake) or Beksey. Please note that the computer will automatically be preset to computer test (Hughson-Westlake) Press the screen key identified on the display as Run Test Press both Ears or one ear You will be asked if you want to familiarise before test. Select Yes After successful completion of the familiarisation test routine the test will automatically start The test will now be performed according to the type of test selected Once the test has been successfully completed release the client from the booth. 4.3 Patient Details To enter the details of a new patient the new person key must be selected to ensure all details of the previous patient are erased Client details are added or modified using the and keys to select the required line and then using the keyboard to enter the details. The back-arrow key will delete the characters. 4.4 Saving and printing results Select the screen key adjacent to save test to save the test record within the internal database Select the screen key adjacent to print to print the audiogram on the attached printer Please note that there is at least a 20 second delay before the printer will start. The computer will say printer busy. DO NOT KEEP PRESSING PRINT. Page 2 of 7

3 5. RESULTS The CA850 Audiometer automatically categorises audiograms in accordance with the HSE categorisation scheme stated in the BHSE Control of Noise at Work regulations Negative numbers should be included within a hearing categorisation calculation. Negative numbers should be included as negative numbers ie adding threshold values of say -5dB, and 5dB would give a result of 0 db. This format is used throughout Amplivox products which incorporate an automatic HSE categorisation function. Page 3 of 7

4 6. CATEGORISATION and REPORTING of RESULTS There are five category identifiers (1, 2, 3, 4, & U) and each of these corresponds to test criteria which is applied to various parts of the audiometric test data. TABLE 1 Category Calculation Action 1. ACCEPTABLE HEARING ABILITY Hearing within normal limits 2. MILD HEARNG IMPAIRMENT Hearing within 20 th percentile i.e. hearing normally experienced by 1 person in 5. May indicate developing NIHL 3. POOR HEARING Hearing within 5 th percentile i.e. hearing level normally experienced by 1 person in 20. Suggests significant NIHL 4. RAPID HEARING LOSS Reduction in hearing level of 30dB or more, within 3 years or less. Such a change could be caused by noise exposure or disease. U. UNILATERAL HEARING LOSS Difference between the ears is greater that 40dB Sum of hearing levels at 1,2,3,4 & 6 khz Sum of hearing levels at 1,2,3,4 & 6 khz. Compare Value with figure given for appropriate age band and gender in table 2. Sum of hearing levels at 1,2,3,4 & 6 khz. Compare Value with figure given for appropriate age band and gender in table 2. Sum of hearing levels at 3,4& 6 Sum of 1, 2, 3 & 4 khz from each ear. None Warning Referral Referral Referral TABLE 2 AGE IN YEARS MALE WARNING LEVEL (CATEGORY 2) MALE REFERRAL LEVEL FEMALE WARNING LEVEL FEMALE REFERRAL LEVEL Page 4 of 7

5 7. REVIEW & REFERRAL CRITERIA If Category 1 If the sum of both ears is below the warning threshold level then that individual will fall within Category 1 acceptable hearing ability. If Category 2 If the sum from either ear exceeds or is equal to the warning threshold level for their respective age and gender then the individual will fall into Category 2 mild hearing impairment. If Category 3 If the sum exceeds or is equal to the referral level for either ear then the individual would fall into Category 3 poor hearing. See referral guidance. If Category 4 If the previous test was performed within the past 3 years and an increase in hearing threshold of 30dB or more is found then this individual would fall within Category 4 rapid hearing loss. See referral guidance. Unilateral hearing loss A further sum is undertaken to determine whether an individual has any unilateral hearing loss suggesting a problem due to disease or infection. A sum of hearing levels at 1, 2, 3, & 4 khz is made from both ears. If the difference between the ears is greater than 40dB the individual falls into Category U Unilateral hearing loss. See referral guidance. Categories out with 1 or 2 should in the first instance be given an Audiometric Screening Referral Letter (F- CG-073) to take to their General Practitioner. Please ensure that the GP is only informed when there is a change in the clients hearing category. NOTE: ALL individuals must be given a Deaf Not Me leaflet (R-CG-018) and advised on the use of hearing protection 8. Referral Guidance 8.1 Referral to GP should be undertaken for all abnormal audio categories. Everyone falling within these categories for the first time should have a repeat audio within 12 months. DO NOT refer to physician at this stage. 8.2 Referral to OHP should occur when the level of loss in BOTH ears exceeds 150db when 1,2 & 3KHZ are added together (an overall loss of 150db across both ears) and when clinical history does not include another reason for this severe deafness (such as congenital deafness, post meningitis, blast injuries etc.) 8.3 If you are unsure whether to make a referral to the OHP please discuss with the OHP prior to referral. Page 5 of 7

6 REFERRAL ACTION BASELINE CONFIRM BASELINE WITHIN 1 YEAR REPEAT AUDIO WITHIN 1 YEAR Referral Action: Flow Chart 1 4. CATEGORY 1 CATEGORY 2 CATEGORY 3 NO FURTHER ACTION REVIEW 3 YEARS. (This time frame may need to be reviewed depending on noise exposure) FORMAL NOTIFICATION GIVEN TO EMPLOYEE RE: PRESENCE OF HEARING DAMAGE. ADVICE GIVEN RE PREVENTING FURTHER DAMAGE AND HEARING PROTECTION. REVIEW 3 YEARS (depending on noise exposure) SEE FLOW CHART 2 Referral Action: Flow Chart 2 CATEGORY 3/4 Unilateral 1 ST RESULT WITHIN THIS CATEGORY NO DETERIORATION SINCE PREVIOUS TEST REDUCTION IN CATEGORY SINCE LAST TEST REFER TO GP + REPEAT AUDIO WITHIN 12 MONTHS REFER TO OHP( IF MEETS CRITERIA SET OUT IN 8.2) REVIEW 2 YEARS (This time frame may need to be reviewed depending on noise exposure) ENSURE GP HAS BEEN INFORMED REFER BACK TO OHP FOR ADVICE AND REVIEW DATE Page 6 of 7

7 Appendix 1 P-CG-016 Page 7 of 7