An image of an audiologist performing an occupational hearing testing audiological review of an employees hearing test results from the SHOEBOX Data Management portal

Audiological Review as Part of a Hearing Conservation Program

Hearing Conservation, Hearing Conservation eBook

Vanessa Gauthier-Davidson, an In-house Audiologist at SHOEBOX Ltd, acts as a coordinator of the SHOEBOX Audiology Review Network; an international team of licensed Audiologists available to assist SHOEBOX customers meet their OSHA and MSHA compliance requirements. The Audiology Review Network offers businesses compliant access to regionally licensed Audiologist(s) for rapid review of their occupational hearing testing results. Vanessa has extensive experience and a keen understanding of the various roles. Audiologists play in a successful occupational hearing testing program. Here she shares her insights with us.

Can you explain two main professional roles in a Hearing Conservation Program?

The two main roles that are mandated by OSHA/MSHA are 1) Professional Supervisor and 2) Audiology Reviewer. These roles can be fulfilled by the same person or by different individuals. Various organizations and standards use interchangeable terms from ‘Supervising Audiologist or Physician’ to ‘responsible to an Audiologist or Physician’ to ‘Professional Supervisor.’ For our purposes here, we will combine these under the term ‘Professional Supervisor (PS).’

Notably, the Council for Accreditation in Hearing Conservation (CAOHC) provides a unique certification to Audiologists and Physicians to oversee Hearing Conservation Programs (HCPs): ‘Certified Professional Supervisor of the Audiometric Monitoring Program©.’ This certification is renewable every 5 years, and although not mandatory for an Audiologist or Occupational Health Physician to have when overseeing a program or perform reviews, it is considered best practice. CAOHC also offers the most up-to-date knowledge and materials for certification. Visit for more information on becoming a certified Professional Supervisor.

The PS is responsible for overseeing the clinical, training, and testing aspects of an HCP. They need to understand what type and intensity of noise the employees are exposed to, how the workplace noise is measured and monitored, the content of the annual hearing conservation training, as well as the hearing protection provided to workers. A PS can also fulfill the role of Audiology Reviewer for the same organization, or this role can be fulfilled by other qualified professionals.

Take, for example, a large organization with program participants across multiple states. To be in compliance with state-based audiology clinical regulations, Reviewers must be licensed in the states where they are providing review. Therefore, an organization that has HCP participants in 44 different states would require Reviewers licensed in each of those states. Many Audiologists working in hearing conservation hold licenses in several states. In contrast, individuals holding solely PS responsibilities can oversee a program that is active in multiple states without requiring licensure in all of those states. It would be counterintuitive to require multiple supervisors to oversee a single program to meet individual state licensing requirements. In this scenario, the PS provides direction and oversees the work of the state-licensed Audiology Reviewers across the entire HCP.

Audiology Reviewers must be either a licensed Audiologist or a Physician trained in the interpretation of audiograms. They are responsible for assessing audiograms for all employees in an organization’s HCP. As a clinician, the Reviewer is looking for changes in an employee’s hearing from one test to the next and also for ‘problem audiograms,’ which are results that may indicate the need for further testing. Note that this is an OSHA-mandated requirement on top of reviewing audiograms for noise-related hearing shifts. If further evaluation is needed, the Reviewer will recommend a medical or an audiological referral.

The Audiology Reviewer provides both clinical reviews and knowledge of hearing. They act as a hearing health advisor. While it may be relatively easy to read an audiogram, it’s harder to interpret one and provide appropriate follow-up recommendations. It’s not just about looking at the audiogram and its symbols; the individual responses on the annual pre-test questionnaire, as well as the historical audiograms and trends in results, are key in results interpretation. Several data sources are drawn upon for follow-up recommendations.

Reviewers use their clinical expertise to determine whether a change in hearing could be the result of a medical condition that may benefit from further investigation (e.g. a sudden drop in hearing, potential middle-ear involvement). They also evaluate results to ensure their validity, as some types and degrees of hearing loss should be evaluated manually by a hearing professional, in contrast to testing with a technician. Ultimately, HCPs are in place to prevent workplace hearing loss. And it is preventable! The Professional Supervisor and Audiology Reviewers play key roles as they are responsible for probing into and understanding the reasons why a shift in hearing may have occurred and subsequently making impactful recommendations.

What qualifications or certifications does an Audiology Reviewer require?

If your Reviewer is an Audiologist, they will have a Doctoral or Masters degree in Audiology as well as active state-based licensure. RulMasters’ses and regulations vary by state/region; therefore, knowledge of those as they pertain to occupational hearing testing would be key. If your Reviewer is a Physician, he or she will be an M.D. or D.O. with experience in occupational medicine.

Although your Audiology Reviewer doesn’t require CAOHC certification, the knowledge provided by this additional training can be of significant benefit to the audiogram assessments and follow-up recommendations. The In-House Audiology Team at SHOEBOX is CAOHC certified as Professional Supervisors.

How is the relationship between Employer and Reviewer established and maintained?

OSHA 29 CFR 1910.95(g)(3) states that “A technician who performs audiometric tests must be responsible to an audiologist, otolaryngologist, or physician.”

For companies that outsource their testing to a service provider, that provider usually establishes the connection to the Audiologist or Physician for review and referral. For companies that manage their own testing, they should establish a relationship with a regional Audiologist to provide reviewer and supervision services.

SHOEBOX Audiometry customers have access to an international network of licensed Audiologists. These companies use automated testing equipment to run the hearing testing and contract Audiology Review services. Many SHOEBOX occupational health customers also contract review services from the SHOEBOX network of Reviewers. Quality audiogram reviews are provided in a timely and clear fashion via the SHOEBOX individualized web portal. The final step of the clinical workflow for an HCP is that appropriate paths of referrals for both medical and audiological follow-up should be established for each company location.

What process does a Reviewer typically follow to provide their services?

Historically, an employer would send paper audiograms to an Audiology Reviewer with whom they had an established business relationship. The Reviewer then assessed each employee record and provided written recommendations back to their client. This was a lengthy and arduous process that can now be streamlined significantly thanks to technology and innovative new products.

With SHOEBOX Audiometry, Reviewers leverage our web portal to perform their reviews and provide feedback. The Reviewers access the hearing health records of the clients in the states they are assigned. The web portal triaging review system intelligently compares the most recent test against an employee’s baseline to know if a shift has occurred and/or if additional review is indicated.

The portal is also the mechanism used for communicating recommendations to the employer, including follow-up actions. When a Reviewer recommends that an employer look at a specific employee file in the portal, we simply change a flag status to “follow-up.” The employer is responsible to log into the web portal and action the Reviewer’s recommendations.

As this is all accomplished digitally, communication is streamlined and easy to access. Tracking of actions is also chronicled, which is especially helpful retrospectively. The steps that remain to be completed are clearly indicated, as well as what has already been actioned. All of this makes complying with OSHA reporting requirements easier and more efficient.

The concept of the SHOEBOX Audiology Reviewer Network is different from how most reviews are done. What are the advantages of using this network?

With the Reviewer Network, we can offer reviews across the United States and Canada. It can be challenging to find a local Reviewer in every state/region where an organization may have facilities. The Review Network removes that burden from the employer and enables a company to offer full hearing conservation services in-house.

With SHOEBOX mobile audiometry, a company can save time and money by conducting tests and retests in-house, and the Reviewer – who is remote but available digitally – can access and analyze the audiograms in real-time. Easy access to the web portal helps the Network to provide swift results turnaround time, with live updates. Furthermore, this real-time progression makes it hassle-free for the reviewer and company to communicate recommended follow-up actions easily.

What happens if a hearing shift is likely not related to noise exposure in the workplace?

When a shift in hearing has been identified by an employee’s annual hearing test, many employers want to know if that hearing loss is potentially due to noise in the workplace or from something else. The employer will want to know if there are factors in the employee’s activities outside of work that may be the main cause of the shift in hearing. During the review process, the Audiology Reviewer will take all factors into consideration and should a cause other than exposure to high levels of noise in the workplace likely be the sole cause of the shift, a recommendation will be made by the Reviewer not to include that shift on the OSHA reporting Log. Often, in this case, a medical or audiological referral is recommended to investigate the cause of the hearing loss further.

In summary, the roles Audiologists and Physicians play in hearing testing results and recommendations, as well as in overall Hearing Conservation Program supervision, are vital to OSHA compliance and the success of the program. SHOEBOX Audiometry and the SHOEBOX Audiology Review Network are uniquely positioned to help with these important elements of your program.

This guide is intended to be a useful tool on your journey to in-house mobile hearing testing or adding iPad-based testing to your services business. We’ll be releasing a new chapter each week for the next 5 weeks! However, if you would like to download the complete guide now, complete the form below.

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