An illustration depicting the concept of a workflow, or the processes through which a piece of work flows

Occupational Hearing Testing Workflows: Steps to Follow When Using SHOEBOX Audiometry

Hearing Conservation, Hearing Conservation eBook

Kate Mosley is the SHOEBOX Product Manager for Occupational Hearing Testing. Through deep product knowledge and market research, Kate is laying out a vision for occupational hearing testing that offers more flexibility, is easier to conduct, and is cost-effective to perform.

Kate has vast experience and a keen understanding of the steps – or workflow – involved in running a successful occupational hearing testing program. Here, she shares her insights.

Can you tell us what you mean by “workflow.”

In an occupational hearing testing program, there are a series of steps to follow as you work through the process of testing. We call these steps a workflow. This includes preparing your audiometer for a day of testing, preparing your employees, administering the testing itself, offering training, administering questionnaires, reviewing results with the employees, retesting as needed, and following through on required follow-up actions. All of these activities feed into the workflow of your program.

Who is responsible for conducting hearing testing?

This can vary from one organization to the next. Typically, it is managed by the health and safety managers or any other member of the health and safety team. These could include department administrators, industrial hygienists, occupational health nurses, or occupational hearing conservationists. However, the test administrator cannot be the direct manager of the employees being tested for reasons of health information privacy.

How do you determine who needs to be a part of your program?

Any employee who works in an environment where they are exposed to 85 dB(A) of noise time-weighted over eight hours of work needs to be included in the company’s hearing conservation program. Examples of 85 dB(A) of sound could be produced by lawnmowers, leaf blowers, heavy traffic, noisy restaurants, food blenders, or garbage disposals. Employees working in these conditions need to be trained, are required to wear hearing protection, and should have their hearing tested annually to ensure no change in hearing ability from one year to the next.

What steps would the test administrator typically follow on a testing day, and do these change from state to state or region to region?

The steps are consistent and in line with Federal OSHA regulations.

Step 1. Daily Verification Tasks

First, test administrators need to prepare the audiometer and headphones prior to testing. This ensures the audiometric system is working as expected. The two tasks that should be completed before proceeding with testing employees are the Daily Functional Check and Daily Biological Verification. These tests are also covered in detail in this e-book’s Chapter 5: Daily Maintenance and Calibration Requirements for Audiometers Used in Occupational Hearing Testing.

Essentially, each testing day should begin with a left and right Functional Check. SHOEBOX includes a feature that enables you to perform and record a check of the transducers easily. For this test, the system produces a 70 dB(HL) tone at 1000 Hertz. By putting the transducers on your own head and listening one ear at a time, you can check for intermittences and ensure no crackling sound is observed.

Next, perform a Biological Verification of the device. This ensures that there has not been a significant sound output drift from the annual calibration file. You can do this by testing yourself or someone with known hearing levels at all test frequencies and doing a comparison. By testing this same person prior to each testing day, you can ensure that there have been no significant changes to the sound output. If there is more than a 10 dB change in that person’s results, then you should perform further system checks and potentially replace the transducers.

Step 2. Assess your Room

Ensure that your testing room is adequately quiet and does not exceed the OSHA-defined Maximum Permissible Ambient Noise Levels (MPANLs). SHOEBOX offers a room scan feature that uses a Class 2 external microphone, which plugs into the lightning port of the iPad and is used to monitor sound levels. This scan can be performed throughout the testing day, as often as needed, to confirm that the ambient noise levels have not changed.

Step 3. Completing Questionnaires

Many hearing tests start with a questionnaire. This is a personal hearing health history and self-assessment that helps the test administrator, as well as the Audiology Reviewers, better understand factors that could influence the test, as well as how the employee perceives their own hearing health. SHOEBOX offers a number of questionnaires integrated into the device itself, with one specifically designed for hearing conservation programs.

Step 4. Testing

Once the questionnaire is complete, it is time to start testing. SHOEBOX offers automated, assisted, and manual modes of testing. For occupational health, seven frequencies (500, 1000, 2000, 3000, 4000, 6000 and 8000 Hz) on both the left and the right ear will be selected for testing regardless of which testing mode is chosen.

Step 5. Shift Analysis

Once that test is complete, some audiometric testing equipment will notify you right away if a shift has occurred. With SHOEBOX, reports are generated directly on the iPad that are used to determine whether or not the employee had a Standard Threshold Shift (STS). If there has been a shift, the employee may need to be retested and require additional training (Step 7), but first the results must be reviewed by an audiologist.

What steps do employees need to follow?

There is little for the employee to do other than to offer verification. If the test is performed as a baseline, we need to know if they have been exposed to loud noise where they weren’t wearing hearing protection in the previous 14 hours. For example, if they attended a loud concert, had been hunting, or riding a motorcycle. If they have, they’ll need to postpone their test for another day.

The other would be to assess if they have any congestion or wax build-up in the ear; this can affect results and could potentially show a standard threshold shift where one doesn’t exist. They may need to see their doctor to have wax removed, which is perfectly normal, or wait until the congestion has passed. Otherwise, the employee only needs to show up for their test on time.

What are the next steps for both the employer and the employee after testing is complete?

Step 6. Audiological Review and Reporting

If the results on the audiogram meet any of the predetermined filtering criteria, including changes in hearing and/or medical or audiological flags, it will need to be reviewed by an Audiology Reviewer who will then make recommendations based on their review and expertise. We cover Audiology Reviews in more detail in chapter 8.

Step 7: Retesting

After an initial review of the results, the Audiology Reviewer may request that the employee be retested. This can be due to a variety of reasons: to confirm the validity of a test result, to fully complete a test, or to confirm whether an STS is temporary or persistent. Retests may require sending your employee to a local clinic. When testing with SHOEBOX, retests can easily be done on-site.

Step 8. Retraining

If there has been a Standard Threshold Shift, there are additional steps that need to be taken, starting with retraining on hearing protection options and insertion. Asking the employee to demonstrate how they insert their hearing protection is an easy method to assess their knowledge and technique. A reassessment of the employee’s workspace can help determine if there are remediation steps that should be taken to protect them from sources of elevated noise. Occasionally equipment malfunctions, causing it to operate at a higher or noisier level than normal. Those assessments can all be performed by the employer. If there’s a significant change in hearing or something unusual about the audiogram, additional follow-up recommendations may be made.

Step 9. Follow-up

It may be recommended that the employee see either their primary care physician or an audiologist for a full consultation. If there is a Standard Threshold Shift that is deemed recordable and is work-related, there are additional steps required for the employer to ensure that the recordable shift has been logged on the OSHA 300 Log. This is another topic that warrants a more extended conversation. We cover it in more detail in Chapter 9: What to do when an employee has an STS? What is Required for Maintaining OSHA 300 Logs in Occupational Hearing Testing Programs?

This sums up the hearing testing workflow. There are many other elements of the entire Hearing Conservation Program, but when it comes to testing, it starts with daily preparation – your equipment and the room – executing the questionnaires, running the test, reviewing results, retraining if necessary, and planning the next steps or follow-up.

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 12 weeks! However, if you would like to download the complete guide now, complete the form below.

Feel free to share this with colleagues, peers, or others who would benefit from learning more about how to optimize your Hearing Conservation Program with innovative employee-focused testing and follow-up.