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Tablet Audiometers – The Good, the Bad and the Ugly

David Pinchot, President and CEO of Workplace Integra

I have been around occupational Audiology for a long time.  As a software developer, I have seen a lot of interesting innovations over the years, both in audiometers and in software.  I have written software to communicate with just about every audiometer that is out there and some old ones that are no longer being sold.  Lately, I have been getting some questions and recommendations on tablet-based audiometers.  Specifically, audiometers based on the iPad tablet.  There seems to be a lot of interest on the subject, so I wanted to offer my opinion on these new testing devices and methods, utilizing my 25 years of experience in the field.

The Good:

  • The tablets used for testing are off the shelf devices that can be purchased rather inexpensively and replaced quickly if one were to fail.
  • They are light and portable. This makes them ideal for testing when a booth is not an option.
  • They do not need a PC or laptop to function. The software is downloaded onto the tablet, the headphones are plugged in and the subject interacts with the tablet during the test.  With so few moving parts or equipment to setup, one could be setup and testing in minutes.
  • They are modern, and attractive to younger nurses and technicians. Hey, as a developer, I love gadgets.  I have been using tablets since the original iPad, and I think they do a fabulous job for certain tasks.

The Bad:

  • They are generally only used for open room testing. Since the testing apps on these devices are made to interact directly with the subject, the technician needs to be looking over their shoulder to observe when the subject is having issues with the test.  Open room testing, while sometimes necessary, will (in my opinion) yield poorer test results than a test performed in a sound booth.  While special headphones can mitigate some of the problems, other issues such as visual distractions can detract from the quality of the test.
  • Manual testing is awkward. In order to do manual testing, the technician must take over the tablet, and request that the subject raise their hand when they hear the tones.  Just like it was done some 30 years ago.  The technician would then enter the response on the tablet.  Hearing testing technicians still must be CAOHC certified to do manual testing, and it is best practice to have CAOHC training for all hearing testing technicians how do any type of testing.  Automatic or manual.
  • With tablets, daily calibration checks must be done on a person. Modern hearing conservation programs with traditional audiometers have a bio-acoustic simulator that is used every morning to check for issues with the audiometer and cabling.  This simulator responds at preset values and the results are compared with the values from the last annual audiometer calibration.  Tablet audiometers cannot be hooked up to a simulator, so a human subject must be used to do the daily calibration checks.  Just like it was done over 30 years ago before modern audiometers and simulators were made available.  This daily calibration check is in the OSHA 1910.95 standard and is required to be performed every 24 hours.  Testing a human subject for the calibration check is time consuming, and error prone.
  • For the annual audiometer calibration, the tablet and headphone must be sent off to be calibrated, or a replacement headset along with the calibration “numbers” must be sent to the client. Sending the audiometer and headset off for calibration means downtime for the client.  Getting a replacement headset that was calibrated on another tablet, may be fine, or it may not be.  It all depends on how close the audio calibration values are between the client tablet and the one the calibration was performed on.  Any differences can mean STS’s and possible recordable shifts.
  • These tablets are intended for purposes other than occupational hearing testing. The manufacturer can at any time change the specifications, ports or software.  Or, they could discontinue the device all together.  Traditional audiometers are made to be used for years, and most last well over 20 years.  That cannot be said for any tablet that I know of.
  • It is difficult to incorporate a tablet audiometer with existing hearing conservation programs. Our clients use our state of the art hearing conservation program that can communicate with most audiometers and HR software programs.  Because tablet-based audiometers have no way of connecting to an existing company HR or hearing database, one must import and export demographics and hearing data to and from the tablet.

The Ugly:

  • From the studies I have seen, the accuracy is “within 10dB” of a standard audiometer. In my opinion this is unacceptable.  Occupational audiological testing has an accuracy of 5dB. When I read a specification that says “within 10dB”, that means it is less than 10dB but greater than 5dB. A Standard Threshold Shifts occur when there is a 10dB average shift (with or without aging) against the baseline.  This “accuracy” issue has the possibility of generating STS’s when comparing the results of a tablet audiometer test and a baseline done on a traditional audiometer.   You can’t get around the fact that a tablet audiometer is less accurate than a traditional audiometer.
  • Beware of companies advertising their tablet audiometers ability for open room testing. For any audiometer to be used in an open room environment, the noise level must be constantly monitored with a Type II microphone.  To my knowledge, none of the current mass market tablets have a built in Type II microphone.  Specifically, the iPad, the most common tablet used as a tablet-based audiometer, does not have a Type II microphone built in.  This means that to have a valid open room test with the iPad that meets the 1910.95 OSHA standard, you will need either an external type II microphone, or a separate device to monitor the noise levels.
  • Also, beware claims that “this is an OSHA approved device”. OSHA does not approve devices, they are regulatory agency only.

In my opinion, and with the consultation of my Doctors of Audiology, I cannot recommend tablet-based audiometers to our clients at this time.  As a Hearing Conservation consulting company that has been in business for 20 years, our clients rely on us to provide sound and accurate advice on their hearing conservation programs.  In many cases, our Audiologists act as the Professional Supervisor of our clients audiometric monitoring programs.  We would be negligent in our responsibilities if we allowed one of our clients to suffer a negative audit because we did not warn them about the potential issues in tablet-based audiometers.

Before you make the decision to purchase a tablet-based audiometer, ask the company these four questions:

  1. Is the microphone on the tablet a Type II microphone? If not, an external Type II microphone is required by OSHA fore open room hearing testing.
  2. Will the tablet audiometer work with my existing hearing conservation software?
  3. Can I use a bio-acoustic simulator (bio-Betty) for my daily calibration checks?
  4. How accurate is the tablet in comparison to a standard audiometer?





Can Improved Cardiovascular Health Enhance Auditory Function?

Hull, Raymond H. PhD; Kerschen, Stacey R. AuD

The Hearing Journal: February 2018 – Volume 71 – Issue 2 – p 22,23
doi: 10.1097/01.HJ.0000530647.09559.0e
Hearing and Cardiovascular Health

The cardiovascular system has been found to directly influence the viability of the cochlea and the central auditory system, and if the blood supply is restricted, can frequently compound other damaging influences including noise, injury, and disease. The relationship between cardiovascular health, the resulting reduction of blood and nutrient supply to the cochlea and the health of that system has been confirmed by a great deal of research dating back over the past 80 years. Among those who conducted that research are Bunch and Raiford (Arch Otolaryngol. 1931;13[3]:423, and Crowe, Guild, and Polvogt (Bull. Johns Hopkins Hosp. 1934;54:315). Other notable research on the topic includes work by Jorgensen (Arch Otolaryngol. 1961;74[2]:164; Proctor (Arch Otolaryngol. 1961;73:444); Kirikae, et al. (Laryngoscope. 1964;74:205; Schuknecht (Arch Otolaryngol. 1964;80[4]:369; Johnsson and Hawkins (Ann Oto. 1972;81[2]:179; Makishima (Otolaryngology. 1978;86[2]:ORL322; Susmono and Rosenbush (Am J Otol. 1988;9[5]:403; Gates, et al. (Arch Otolaryngol Head Neck Surg. 1993;119[2]:156; Schuknecht and Gacek (Ann Otol Rhinol Laryngol. 1993;102[1 Pt 2]:1; Cocchiarella, et al. (Occup Med (Lond). 1995;45[4]:179; Brant, et al. (J Am Acad Audiol. 1996;7[3]:152; Rubenstein, et al. (Gerontology. 1977;23[1]:4; Torre, et al. (J Speech Lang Hear Res. 2005;48[2]:473; Helzner, et al. (J Am Geriatr Soc. 2011;59(6):972; Lin, et al. (JAMA Intern Med. 2013;173[4]:293, among many others.

One research project that is of interest to this author is by Rubinstein, et. al, on the possible relationship between chronic cardiovascular disturbance and hearing status in adults (Gerontology. 1977 They found that adults with cardiovascular disease and signs of peripheral circulation disorders had significantly poorer thresholds in the 500 to 8,000 Hz frequency range compared with other subjects without cardiovascular disease. The researchers felt that this was related to a disturbance of the cochlea’s microcirculation. There are many possible causes of peripheral hearing loss, but whatever those might be, cardiovascular disease appears to exaggerate the degree of potential impact of those causes, and thus the degree of hearing loss.

Even among younger adults, there seems to be a relationship between early onset arteriosclerosis and changes within the cochlea. Nomiya, et al., compared temporal bones of young adult subjects who had arteriosclerosis with temporal bones from seven patients without arteriosclerosis (Otol Neurotol. 2008;29[8]:1193 They found that the temporal bones with generalized arteriosclerosis had significantly fewer ganglion cells at the basal turn of the cochlea, along with an atrophic spiral ganglion, which is associated with high-frequency sensorineural hearing loss.

See full article here.

World Hearing Day 2018

March 3rd Is a Day to Spotlight Your Professional Services

World Hearing Day (WHD)—an international day of outreach on hearing care organized by the World Health Organization—is March 3rd. To mark this important observance, ASHA is providing a Digital Toolkit that members can use to share information on hearing loss, treatment, and the importance of audiology services.

The toolkit offers a series of eye-catching, consumer-friendly resources that can be shared on your personal and professional social media accounts with one click. These graphics showcase statistics on hearing loss, factors contributing to the rise in hearing loss, and specific information and treatment considerations for people with hearing loss across the lifespan (newborn, child, adolescent, and adult).

This year, WHD’s theme for this day is “Hear the Future,” focused on the expected rise in the prevalence of hearing loss. Emphasis will be on preventative efforts to help stem this rise and the need to ensure that people with hearing loss have access to required rehabilitation services and communication tools, and products that they require.

This is an ideal opportunity to spread the word about hearing loss and the importance of treatment—that is, your services! So, mark your calendar—and use these shareables to help raise our collective voice.

Questions? E-mail us at
Help Promote World Hearing Day!

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Going for Gold: Inspiration from Athletes with Hearing Loss

Glantz, Gordon

The Hearing Journal: February 2018 – Volume 71 – Issue 2 – p 26,27,28,33
doi: 10.1097/01.HJ.0000530641.56193.4d
Cover Story

When Heidi Zimmer was just 2 years old, she was playing outside and wandered onto the roof of a neighboring church. Her panicked parents knew talking her down was not an option, as Zimmer was deaf since birth. Scared of heights, they summoned a student from nearby Arizona State University to bring their adventurous toddler to safety.

“I think that was the moment when I was first inspired to climb mountains,” said Zimmer, who became the first deaf woman to reach the top of Mt. McKinley in 1991, after which she proudly unfurled a banner reading, “DEAF WOMAN, A PARADE THROUGH THE DECADES” (a play on words from the book, “Deaf Women: A Parade Through the Decades, co-authored by Mabs Holcomb and Sharon Wood, that was published two years earlier).

She reached the summit of Mt. Elbrus three years later and Mt. Kilmanjaro two years after that. While her deafness was considered genetic, Zimmer has since been diagnosed with Usher’s Syndrome, a leading cause of deaf-blindness in adults, but she still plans to overcome the obstacles and seek the funding necessary to reach all seven summits.

Aside from a personal goal, climbing mountains stands as a metaphor for all athletes with obstacles, such as full or substantial hearing loss.

Many others—most notably 1984 gold-medal swimmer Jeff Float, 10-time WNBA all-star Tamika Catchings (MVP, 2011), three-time motocross champion Ashley Fiolek, and record-setting distance runner—turned—congressman Jim Ryun (1968 silver medal)—have succeeded, but that height of success is born of humble beginnings rooted in a history of intolerance.

Back around the turn of the prior century, for example, several baseball players—including accomplished pitcher Luther Taylor and outfielder William Hoy—were called “Dummy,” even in newspapers, in place of their first names.

Jack Ulrich played ice hockey in the forerunner to the NHL, the NHA, in the World War I era of outdoor rinks. He detested being called “Dummy” in print to the extent that he penned a letter of protest to the Toronto World about it and received an apology, after which he was referred to by his preferred nickname of “Silent” Jack Ulrich.

See full article here.

Music from and for Your Ears

January 25, 2018 In the News

Jacob Kirkegaard, sonic artist extraordinaire, hailed for his work inspired by natural phenomena and scientific explorations is making music out of the sounds your ears make. Originally trained at the Academy of Media Arts in Cologne, Germany, the Denmark-born artist has numerous critically acclaimed exhibitions and permanent installations under his belt. Starting with recordings of underground geysers or caving of glaciers or even empty rooms in Chernobyl, Kirkegaard has created musical pieces combining the natural acoustics with layers of artistic magic.

As part of his recent residency as the first Sound Artist at St. John’s College (University of Oxford), Kirkegaard used spontaneous otoacoustic emissions as inspiration for a composition he named Eustachia—for 20 voices. While at Oxford, Kirkegaard recorded spontaneous otoacoustic emissions (emissions recordable without any external stimulation) from individuals at the university. Each of these recordings would have contained at least one, but perhaps more than one, spontaneous emission at different frequencies. Kirkegaard analyzed, filtered, and then interpreted groups of these recordings to create a piece first performed by Aarhus Pigerkor in August 2017.

Apparently, the creative process was easy but the composer was worried that the human voice would not be able to hold a set of notes for a substantial period of time. Each performer was given a tuning device to use as a point of reference during the performance. It worked beautifully. You can hear an excerpt and even watch a brief video of Aarhus Pigerkor rehearsing.

See full article here.

Chemo-induced Hearing Loss: Help Patients Cope with the Aural Effects of Cancer Treatment

Tumolo, Jolynn

The Hearing Journal: January 2018 – Volume 71 – Issue 1 – p 26,27,28

As if the cancer isn’t enough. Families preparing for certain types of chemotherapy at Montefiore Health System in the Bronx meet early on with an audiologist, tasked with delivering even more unwelcome news: The treatment that could save your child’s life may also cause hearing loss.

“We often receive the patients and their families when they’re still in shock. We very compassionately offer that information,” said director of audiology Laura Tocci, AuD.


Tocci sighed.

“The best way we can.”

For many patients with cancer, platinum-based chemotherapy agents like cisplatin and the less-common carboplatin can be literal lifesavers. However, a significant number of survivors (estimates range from about half up to nearly two-thirds) experience permanent hearing deficits.

“Essentially, the chemotherapy and chemotherapy byproducts seem to injure the hair cells within the ear, and patients initially lose very high-frequency hearing,” said Adam Levy, MD, pediatric oncologist at the Children’s Hospital at Montefiore. “Then, as the chemotherapy is given further, more damage occurs to the hair cells, and lower-frequency hearing is lost.”

Depending on the patient and the treatment protocol prescribed, oncologists can sometimes adjust chemotherapy if hearing loss occurs, Levy explained. That’s why audiologists and pediatric oncologists work so closely at Montefiore—children receiving cisplatin get regular audiograms, and Levy receives the results via email within the hour. Unfortunately, lowering the cisplatin dose or holding off on the agent completely isn’t an option for every patient. “There’s such a great fear of the cancer not being cured when you lower the dose,” he said.

While survival trumps hearing in cancer treatment, chemo-induced hearing loss is by no means getting a free pass. Scientists are making advances in efforts to quell the ototoxic effects of chemo while preserving its tumor-fighting power. Hearing professionals, meanwhile, are coaching patients and other health care providers on how, in the wake of chemo-caused hearing deficits, to maintain as much function as possible.

“It’s a very active area of interest,” Levy said. “How to prevent long-term side effects from the chemo that we give.”

See full article here.

2018 First Quarter CAOHC & NIOSH Course Dates are published




Workplace INTEGRA announces 1st quarter 2018 NIOSH and CAOHC class dates.
See below for our course offerings for the first quarter of 2018 for Hearing Conservation and Pulmonary Function Technician Training:

CAOHC Occupational Hearing Conservation Certification

• January 3-5, 2018 (Toledo, OH)

• January 10-12, 2018 (Greensboro, NC)

January 17-19, 2018 (Ontario, CA)

• January 31-February 2, 2018 (Louisville, KY)

• February 7-9, 2018 (Greenville, SC)*

• February 28-March 2, 2018 (Indianapolis, IN)

• March 7-9, 2018 (Greensboro, NC)

• March 14-16, 2018 (Macon, GA)

• March 14-16, 2018 (Bloom-Norm, IL)

• March 27-29, 2018 (Sacramento, CA)

CAOHC Occupational Hearing Conservation Recertification

• January 4, 2018 (Toledo, OH)

• January 11, 2018 (Greensboro, NC)

• January 18, 2018 (Ontario, CA)

• February 1, 2018 (Louisville, KY)

• February 8, 2018 (Greenville, SC)*

• March 1, 2018 (Indianapolis, IN)

• March 8, 2018 (Greensboro, NC)

• March 15, 2018 (Macon, GA)

• March 15, 2018 (Bloom-Norm, IL)

• March 28, 2018 (Sacramento, CA)

*Greenville classes held at Greenville Technical College

NIOSH Spirometry Initial Training

• January 16-17, 2018 (Greensboro, NC)

• March 13-14, 2018 (Greensboro, NC)

NIOSH Spirometry Refresher Training

• March 15, 2018 (Greensboro, NC)

Our full calendar schedule is here.

A Guide to Industrial Noise, Hearing Loss, NRR and Ear Protection

by: Holly B. Martin

Source: MSC Industrial Direct

Do you know the noise level in the workplace and if it is damaging workers’ ears? From sound-level meters, NRR and noise-dampening materials, get a better understanding of the tools and PPE needed to avoid permanent ear damage.

Ear damage caused by exposure to high noise levels at work can be insidious–it may start out gradually, and if not caught early, can result in permanent hearing loss that is not fully evident until a worker retires.

“Hearing loss from noise is very slow, but very cumulative,” says Dr. Cheryl Nadeau, AuD, senior occupational audiologist at Workplace Integra. “The hair cells [sensory cells] within your cochlea do not ever forget that they have been assaulted by noise.”

The Occupational Safety and Health Administration (OSHA) officially recognized the need to protect workers from noise exposure when it published its Hearing Conservation Standard (29 CFR 1910.95) back in 1983. Since that time, scientific studies and advances in testing and hearing protection technologies have prompted further standards and guidance from OSHA and other agencies, such as the American Conference of Governmental Industrial Hygienists (ACGIH).

What Are the Health Effects of Noise in Manufacturing?
In addition to causing permanent hearing loss, loud noise is known to negatively affect the entire body, actually increasing blood pressure, changing blood chemistry and decreasing productivity, Nadeau says.

“Noise puts the body into a fight or flight mode, which can wreak havoc on your hormones,” she says. “Studies have shown that people in a high-noise production area exhibit more anti-social behavior and are less likely to help one another because of the seemingly never-ending noise.”

See full article here.

Construction Workers Most Exposed to Loud Noise


Source: OHS online Sep 29, 2017.

Workers in construction and extraction occupations were mostly exposed to loud work (49.6 percent of jobs) or very loud work (7.9 percent) in 2016, according to BLS.

Workers in 75.0 percent of U.S. civilian jobs were exposed to moderate noise levels at work during 2016, and another 13.3 percent were exposed to loud noise levels and 0.7 percent to very loud levels, BLS reported, saying the data come from the Occupational Requirements Survey.

Workers in construction and extraction occupations were mostly exposed to loud work (49.6 percent of jobs) or very loud work (7.9 percent), according to the agency, and more than 7 in 10 carpenters and operating engineers and other construction equipment operators were exposed to loud work environments that year.

Food preparation and serving-related occupations also are exposed significantly to noise: 16.5 percent of jobs were exposed to loud work environments and 82.1 percent were exposed to moderate noise during a typical work day. Bartending jobs were about evenly split between workers exposed to a loud work environment (44.7 percent) or a moderate noise environment (46.7 percent) in 2016.

See full article here.