“Driving from Brisbane to Normanton was very adventurous and interesting. We drove for 3 days through the coastline enjoying the varying landscape”, said Renita. Normanton was a very different experience – a tiny town in the Gulf of Carpentaria where people were very laid back, enjoying fishing and hunting. Audiometric Testing Queensland provided audiometric services to the Carpentaria Shire Council employees, most of whom work in remote camps. Ninety people were tested for hearing abilities there. “We share the test results with individual employees and re-iterate the significance of wearing hearing protection appropriately”.

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What is an audiometric test? It is a test to determine a workers’ hearing levels with the help of an audiometer.  Simply put, it is a test to determine how well you can hear, or not hear?  The test will validate if a workers’ hearing is being compromised or not.

Audiometric testing identifies…

–  Progressive noise-induced hearing losses before they become an impairment

–  Temporary losses before they become permanent, providing time for remedial steps

The audiogram is a graphical display of the hearing test. The audiogram (a graph or table of an audiometric test results) will be available to the worker and by the employer.

The two main components that are graphed are frequency and intensity. These results are displayed for each ear. When you had your hearing tested, the audiologist was determining the softest sound you could hear at each specific frequency.  Without regular audiometric testing you may not know your hearing is being compromised until it is too late!

Below are the 4 steps needed to ensure that noise, as an occupational hazard, is monitored and operational controls are in place to minimize or eliminate such noise.

1. Measure your workplace sound levels to determine who needs to be tested.
2. Review engineering, administrative and personal protective measures to limit worker noise exposure.
3. Schedule mobile testing, and provide training for employees affected by noise.
4. Understand local jurisdictional and other regulatory bodies requirements for noise hazards and maintain compliance.

PRE TEST EXAMINATION

The examiner will ask you questions as part of the evaluation…

–  Ear, nose, & throat problems such as colds, infections, and congestion?

–  Noisy hobbies or activities?

–  Time since exposure to loud noise?

The examiner may also visually check your outer ear canal with an otoscope for…

–   Ear infections

–   Excessive earwax

–   Obstructions in the ear canal

AUDIOMETRIC TEST

• You will sit in a quiet booth and be equipped with a headset and a signal switch
• You will hear tones of varying level and frequency
• You will be instructed to depress the signal switch to indicate a tone was heard
• Be honest; don’t try to anticipate or intentionally miss a tone, or the test will be invalid

AUDIOMETRIC TEST RESULTS

Your audiogram will be used to indicate hearing change.

–    A Temporary Threshold Shift (TTS)

• A temporary reduction in hearing due to fatigue of the ear caused by noise exposure
• Temporary hearing loss – indicates the potential for permanent loss

–    A Standard Threshold Shift (STS)

• A change in hearing sensitivity for the worse relative to the baseline audiogram
• An average change of 10 dB or more at 2, 3, and 4 kHz in either ear

The benefits of participating in an audiometric test include preventing adverse effects such as tinnitus – ringing in the ears; temporary hearing loss or permanent hearing loss.   Noise is an occupational hazard that can be identified, controlled and measured.  Audiometric testing is a validation of how effective an employer’s hearing conservation program is, or is not.

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There are multiple types of audiometric testing to validate if a workers’ hearing health has been jeopardized due to working around noise.  Some of these tests are briefly described in this article.

1. Pure Tone Audiometry

Pure tone audiometry (PTA) tests are the most common type of test used for evaluation of occupational noise.  During PTA, a machine called an audiometer is used to produce sounds at various volumes and frequencies (pitches). You listen to the sounds through headphones and respond when you hear them by pressing a button.

2. Speech Perception

The speech perception test, also sometimes known as a speech discrimination test or speech audiometry, involves testing your ability to hear words without using any visual information. The words may be played through headphones or a speaker, or spoken by the tester.  Sometimes, you are asked to listen to words while there is a controlled level of background noise.

3. Tympanometry

During tympanometry, a small plastic bung seals your ear and the machine gently changes the pressure in your ear canal. The purpose of a Tympanometry test is that it measures the movement of the eardrum and the pressure behind the eardrum to determine if any fluid is behind the eardrum.  It will also indicate if the Eustachian tube is working properly or not normally.

4. Whispered voice test

The whispered voice test is a very simple hearing test. It involves the tester blocking one of your ears and testing your hearing by whispering words at varying volumes. You will be asked to repeat the words out loud as you hear them.

5. Tuning fork test

A tuning fork test produces sound waves at a fixed pitch when it is gently tapped and can be used to test different aspects of your hearing.  The tester will tap the tuning fork on their elbow or knee to make it vibrate before holding it at various different locations around your head.

The purpose of the tuning fork test is to help determine if you have conductive hearing loss, or sensori-neural hearing loss.

6. Bone conduction test

A bone conduction test is often carried out as part of a routine pure tone audiometry (PTA) test in adults.  A bone conduction test involves placing a vibrating probe against the mastoid bone behind the ear. It tests how well sounds transmitted through the bone are heard.  The bone conduction test is a far more sophisticated version of the tuning fork test, and when used together with PTA, it can help determine whether hearing loss comes from the outer and middle ear, the inner ear, or both.

7. Hearing Test Results – The Audiogram

The results of some hearing tests are plotted on a graph called an audiogram.  An audiogram is used to record the measurements of different volumes and frequencies (pitches) of sounds you are able to hear.  As well as showing a comparison between your ears, an audiogram can also help to determine what type of hearing loss you have, if any.  The type of hearing loss you have is important because it determines what help or treatment is most suitable for you.

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The audiogram is a chart of hearing sensitivity with frequency charted on the X- axis and intensity on the Y-axis. Intensity is the level of sound power measured in decibels; loudness is the perceptual correlate of intensity.  Below is an example of an audiogram:

Most common way to measure hearing sensitivity is to measure pure-tone (sinusoid) thresholds.

Below is an example of an audiogram.  The red line is the right ear of this particular worker.  This audiogram represents Pure Tone Average (PTA).  The average thresholds at 500, 1000, 2000 Hz are the frequencies most important for speech understanding .  In this particular scenario, the PTA of the left ear was 93 dB compared to 50 dB of the right ear.

The magnitude of hearing loss is defined as follows:

• Normal hearing loss:  0 -15 dB.  Some interpretations have normal hearing loss ranging up to 25 dB
• Slight hearing loss:  16-25 dB
• Mild hearing loss:  26-40 dB
• Moderate hearing loss:  41-55 dB
• Moderately-Severe hearing loss:  56-70 dB
• Severe hearing loss:  71-90 dB
• Profound hearing loss:  91+dB

There are 3 types of Hearing Loss to understand when reviewing your audiogram:

1. Conductive is abnormality of the outer or middle ear.  Usually temporary and medically treatable.The Impaired Ear (Conductive Loss) occurs when there is a disruption of the transmission of sound (Ex: fluid in the middle ear).  Typically, this loss occurs in the outer or middle ear and many times is a temporary loss that can be treated medically.
2. Sensorineural is damage to the inner ear or nerves of hearing.  Usually permanent. The Impaired Ear (Sensorineural Loss) occurs for many reasons.  Starting from age 20, the hair cells slowly begin to deteriorate.  Hair cells can also be damaged from loud noises, medicine, head trauma or other causes.  This type of hearing loss are mostly due to natural loss of hair cells.
3. Mixed include both Conductive and Sensorineural.

Besides just understanding the audiogram, it is important to remember that audiometry is a subjective test requiring a verbal or physical response and therefore can be subjective.  Audiometry tests all parts of the ear, the entire auditory system.  The most common type of audiometry, that you and I are familiar with is the Pure Tone audiometry test.  This type of test includes headphone, insert earphone or speaker.  A machine called an audiometer is used to produce sounds at various volumes and frequencies (pitches).You listen to the sounds through headphones and respond when you hear them by pressing a button.This test evaluates the sensitivity of the entire hearing organ.  The audiologist presents single frequency (“pure”) tones produced by a calibrated audiometer. The softest sounds heard by the subject at each pitch are recorded as the thresholds and are compared to normative values.  This recorded comparison is found on the audiogram, a graph that you now understand what it means and how it benefits you by knowing what type, if any hearing loss you may have.  The type of hearing loss you have is important because it determines what help or treatment is most suitable for you.

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This audiometric testing may be required annually or every two years, once again depending on your local occupational safety jurisdictional requirements. This article discusses the benefits of audiometric testing and defines exactly what audiometric testing involves.

WHAT IS AUDIOMETRIC TESTING?

Audiometric testing determines workers’ hearing levels with the help of a tool called an audiometer. It is a very simple procedure that involves an employee receiving a series of different tones; for each tone, the participant can respond indicating that they heard the tone.

The tones are presented at different sound levels and checked multiple times to identify the lowest level at which a person can hear. This is called the “threshold limit,” and is compared to a “baseline test.” Audiometric testing is conducted for different frequencies, and both the left and right ears. As a result, it provides a way to monitor the sharpness and acuity of an employee’s hearing over time.

In particular, audiometric testing identifies:

(1) Progressive noise-induced hearing loss before it becomes an impairment.

(2) Temporary loss before it becomes permanent, providing time to implement remedial steps.

ABOUT THE AUDIOMETRIC TEST ENVIRONMENT

To effectively conduct an audiometric test, the test environment must be controlled. In particular, the optimal test environment must be quiet and free of distractions. There should be no distracting activity outside the test room that the listener can see or hear. The listener needs to focus their attention on the test and not any activity surrounding them. For example, while audible speech would not mask the test tones, it would distract the listener.

While there is no such thing as a “soundproof” test room – i.e., a room which no outside sound can penetrate – it is important that rooms are designed to reduce outside noise to the point where it won’t mask the test signals, and it is just as important to not have unnecessary noise-generating activities in the area of the test room.

BENEFITS OF AUDIOMETRIC TESTING

Regularly scheduled audiometric testing identifies people who are at risk of significant hearing loss by identifying changes in their hearing threshold over time. Employers can then implement appropriate treatment plans, like providing a higher class of hearing protection, ensuring that the employee uses hearing protection correctly, and reducing the noise in particular locations.

Audiometric testing is best conducted at least a few hours into an employee’s shift to identify any Temporary Threshold Shift (TTS). Temporary Threshold Shifts can show that the Personal Hearing Protection and noise reduction strategies are not working effectively and that immediate corrective action is required.

Typical hearing loss as a result of Noise Induced Hearing Loss (NIHL) often occurs at the 3K, 4K & 6K frequencies where a V shape notch is observed when viewed on the audiometric graph, known as an audiogram.

Audiometric testing may also assist in identifying the need for diagnosis of potential medical problems, distinct from workplace hearing loss, that affect a person’s ability to hear.

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When You Should Consider Having A Hearing Test

It will be a good idea for you to have an appointment with an audiologist if you are dealing with any of the problems mentioned below:

• You have trouble falling the presentation of a speaker because you can’t understand what is being said.
• You have a history of hearing loss within the family.
• You are constantly asking people to repeat themselves.
• You have trouble understanding people next to you in a crowded room or a restaurant.
• Your family is complaining that you have the audio equipment in the home too loud.
• You are having a difficulty understanding what people are saying.
• You frequently hear ringing or buzzing in your ears.

You do not have the fear if you have scheduled an appointment with an audiologist because the examination will be simple and painless and be conducted to understand how well you are able to hear sounds and words at different levels of volume. The audiologist will only be looking forward to determining how your ears are functioning during the examination. It is quite possible that your regular doctor may consider checking your ears for wax and other physical issues if you have scheduled an appointment with him or her.

Your audiologist will also want to know about your medical history, especially if you have a history of hearing loss within your family. Information about your listening habits, working in a loud environment or whether you have been exposed to excessive noise will also be sought after. Your doctors may consider looking inside your ears to identify any physical issues, which could be affecting you. You will be advised to undergo further audio tests after you have gone through the physical examination.

There are a number of tests that can determine or assess how well you are hearing. You will be required to go through an entire list of different test before a final determination is made whether you need remedial action immediately or can wait for some time. The determination will be made after looking at the severity of your condition.

A hearing test is a simple procedure, which will help you prepare for the future in case you are afflicted by hearing loss. It is as simple as audiometric testing, which is commonly used in many workplaces. It is quite possible for you to feel that you do not need to go through this process because you would be able to manage the situation easily. However, you must understand it is somewhat distressing to deal with hearing loss because if you are required to use aids of some kind, it will be a matter which would make you feel you would have done better by consulting an audiologist earlier. Therefore, if you need the tests, you should not be looking forward to ignoring them but should rather prefer finishing the tests at the earliest.

Learn how to prevent hearing loss at work with the help of audiometric testing and how it works.

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Hearing loss is entirely preventable and companies are just required to implement the regulations as provided by the law. They can have audiometric testing conducted at their workplaces regularly. These are the same as a hearing test and will give the testing technician information about whether the employee has suffered from noise-induced hearing loss at the workplace. Advances in the techniques of testing have even made it possible for companies to invite testing labs over to their workplaces for the testing to be conducted. They are no longer required to send their employees out and lose valuable man-hours. They can get the results of the testing immediately with the assurance that they are reliable, and in line with the laws mentioned by the governing authorities.

Companies are required to conduct audiometric testing annually if they involved in a business which is highly noisy. They are also required to maintain records of the results and make them available for inspection if they are ever required. These steps have been taken after a number of employees reported loss of hearing because of working in their workplace. Apart from hearing loss, the medical fraternity also found other issues such as high blood pressure, cardiovascular problems, sleep disorders and loss of attention among employees who reported these findings. It was thereafter decided that the employees need to be given protective equipment in order to safeguard their hearing and overall well-being.

Companies that decide to safeguard their employees will stand to benefit from their actions simply because they are making it possible for their employees to become more productive and deliver better results on the job. They are taking preventive actions, which are necessary for the overall health of the employee. The company is giving out a feeling that they care for the benefit of their workers and are not only concerned about their own profitability.

On the other hand, there are companies that are ignoring these matters and are facing trouble not just with the law but also with the employee who is not performing as required and even claiming damages from them for the hearing impairment they suffered.

Looking at how companies can benefit simply by having audiometric tests conducted it can be concluded that it would be better for them to conduct the testing than to deal with the problems that are associated with an issue which is entirely preventable.

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Quiet time before an audiometric test

As an audiometric test aims to find your “threshold” of hearing across a number of frequencies (tones), to get a true indication of your hearing ability you need to be ‘at your best’ for the test. It is commonly understood that exposure to loud noise over long periods of time can permanently decrease your hearing capacity but less known is that exposure to loud noise can also have a short term effect, temporarily decreasing your hearing for up to 16 hours. In fact, usually, it is these repetitive short term hearing losses caused by noise that leads to permanent noise induced hearing loss (NIHL). Therefore it is recommended that you avoid loud noise for 16 hours prior to audiometric testing.

Image from www.bbc.com

Ear wax and audiometric testing

Also commonly known is that ears produce a waxy substance but less commonly known is that for some people this wax can build up and block the ear canal reducing sound reaching the eardrum and therefore decreasing your hearing capacity. For most people wax is directed from the
ears naturally or can be washed from the ears in the shower. More stubborn wax can be broken down by simple-to-use “drops” purchased from your chemist. But, sometimes the wax is so compacted that a doctor is required to “syringe” the wax from the ears. Importantly, making sure sure your ears are clear will make sure you are at your best for your audiometric test.

Cold and flu at time of an audiometric test

As your hearing mechanism includes a series of bones and a tympanic membrane (ear drum) that vibrate when exposed to noise, the ear canal and the middle ear need to be clear. Illness that causes mucus build-up in the middle ear, such as is experienced with a “head-cold”, can reduce the normal vibration of the ear drum and bones temporarily reducing hearing capacity.  Therefore, if you have a cold or flu-like illness at the time of audiometric testing you may need to call to reschedule.

Best preparation for an audiometric test

So in preparation for audiometric testing, also known as a hearing testing, remember to:

1. Have your ears cleared of wax at last 2 days before your hearing test
2. For 16 hours before your hearing test avoid exposure to loud noise (eg. anything louder than a domestic vacuum cleaner) of more than a few minutes.
3. Be free of illness that includes mucus build-up in the middle ear (eg. A head cold or flu). If you are not well request another day for the testing.

If you need or are having audiometric testing and you have a question please feel free to contact us.

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1. The person to be tested will be asked to go into the soundproof audio both and asked to put on a set of head phones.
2. The audiometric officer will then show you how  to respond when you hear a series of tones in your ears.
3. Testing starts on one frequency at a volume you can hear.
4. The volume (measured in decibels) is then decreased until you can no longer hear it, identifying your threshold.
5. This brief process is repeated for both ears on a number of frequencies (typically 8 frequencies), usually taking about 5 minutes.
6. The thresholds are plotted for both of your ears as two separate lines on your audiogram.

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Noise in the workplace is more of a risk than ever to Australian businesses. One would think that as technology advances noise levels in the workplace would decrease. But with KPI’s pushed higher and higher and machine output ever increasing are you pushing the boundary on acceptable noise levels in the workplace?

As part of the OHS/WHS Regulations employers have a duty of care to ensure that;

• Employees are not exposed to noise which can cause risk to their health and safety.
• If noise over the Noise Exposure Standard is present that at a bare minimum; hearing protection and signage advising of such is provided.
• Audiometric testing of employees is provided if hearing protection is required.

What are acceptable noise levels in the workplace /noise limits in the workplace?

The Noise Exposure Standard defines the noise limits in the workplace. The acceptable noise levels in the workplace are the same in all states, the noise limits in the workplace are;

• Noise in the workplace at or above Leaq 8hr 85dB (A) or;
• Noise in the workplace at or above Lc Peak 140db (C).

For a detailed breakdown on the OHS/WHS Regulations see our article Workplace Noise Regulations

Understanding the Noise Exposure Standard and acceptable noise levels in the workplace.

The first step is to understand what the acceptable noise levels in the workplace are;

The first is ‘Leaq 8hr 85dB (A)’ which is a sound pressure level equivalent to 85dB in an (A) filtered frequency range (noise in the frequencies audible to humans) over an 8hr time period. To calculate this is no easy task and requires the use of a noise exposure calculator where spot measurements and the time spent exposed to such noise are entered in and a personal exposure profile calculated.

Example: ‘Employee A’ Spends 3 hours out of the day using an angle grinder (90dB (A)), 1 hour cutting stock with a saw (75dB (A)) and 4hours in the warehouse (65dB (A));

As per the above; on a normal day ‘Employee A’ is exposed to sound pressure of Leaq 8hr 83.5dB (A) which is under the Noise Exposure limit of 85dB (A).

The second part of the noise exposure standard is noise below Lc Peak 140db (C). This is a sound pressure level which occurs for any length of time when measured with a (C) frequency filter. The (C) filter is noise audible to human hearing + lower frequency noise.

Example: a large unshielded Hydraulic press; although it presses ultrafast and noise generated is audible for less than 1 second if the noise is over 140db (C) it is still in excess of the exposure standard.

In order to accurately measure your noise in the workplace a Workplace Noise Assessment is needed.

Safe Noise Levels in the workplace.

In order to maintain a safe working environment your noise should be assessed ensuring that acceptable noise levels in the workplace are present. Noise which exceeds the safe noise levels in the workplace must be controlled and actioned to ensure employees are not exposed. Exposure to such noise can cause permanent hearing damage and may cost the business severely in Workers Compensation, productivity loss and staff turnover.

Noise in the workplace should be systematically identified by means of a risk assessment and then properly assessed to calculate the actual noise levels in the workplace.

For further information on safe noise levels in the workplace see our other noise articles.

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