The Crisis in Occupational Hearing Conservation in America
By George Cook, Au.D., CCC-A
Presented at the National Hearing Conservation Association Conference Presentation in Tucson, AZ, on February 25, 2005
Recent changes in OSHA regulations and OSHA enforcement policies have resulted in a significant decrease in hearing conservation activities in America. Hundreds of thousands of employees who were in a hearing conservation program in the past are being excluded today. Companies are fearful of increased incidence rates and look for every avenue to reduce possible Standard Threshold Shift recordables. Occupational hearing conservation programs in America were healthier 3 years ago. The situation that exists is few companies are willing to conduct wellness hearing testing, and testing those at-risk or with intermittent exposure because of the threat of increasing their OSHA illness incidence rate. Occupationally related hearing loss will occur within these select groups increasing company liabilities through decreased worker productivity and worker's compensation costs. The challenge is to encourage companies to expand their hearing testing activities and be proactive in dealing with any work-related hearing changes. There should also be consideration for lowering the Action Level to 80 dBA TWA.
Recording in the past
Prior to January 1, 2003, in all but five states (NC, SC, TN, MI, and CA), recording hearing loss on the OSHA 200 was indicated when the changes in hearing exceeded 25 dB average at 2, 3, 4K Hz from baseline, plus aging. The criteria for recording was not related directly to the occurrence of an STS, except in the five states mentioned above. In all states, changes in hearing for employees exposed to levels meeting or exceeding the 85 dBA TWA Action Level were presumed to be work related. Therefore, hearing testing on employees with exposure less than 85 dBA TWA were presumed to be non-work related and not recordable.
Recording in the present
As of January 1, 2003 the criteria for recording on the OSHA 300 changed. Recording is directly associated with the occurrence of an STS. When an STS occurs and the current audiogram thresholds exceed normal (25dB HTL average) at 2, 3, 4K Hz, the change in hearing is considered a possible recordable. The company decision to record can be guided by the review of a "licensed health care professional" on a case-by-case basis. The professional's scope of practice must allow the professional to determine work-relatedness for hearing changes as does an audiologist or physician. Noise exposure to 85 dBA TWA and greater is not presumed to cause a work-related hearing loss and cases with exposure less than 85 dBA are not presumed to be non-work related.
In the "Discussion" to the new recording criteria, it was determined to be different in three ways.
- In cases of occupational noise exposure to levels in excess of 85 dBA, the presumption of work-relatedness is not justified in all cases. Work-relatedness is to be determined on a case-by-case basis.
- The final rule (1904.10) is consistent with the general principle that work-relatedness is to be determined on a case-by-case basis with the guidance of a professional.
- No comments to the docket supported the presumption of work-relatedness when exposure exceeded 85 dBA TWA.
The "Discussion" to 1904.10 gives additional considerations in determining work-relatedness by the professional reviewer:
- Prior occupational and non-occupational noise exposure
- Evaluation of calibration records
- The audiometric environment
- Investigation of related activities
- Personal medical conditions
- Age correction
- Effectiveness of hearing conservation program
- Attenuation of hearing protection
- Improper use of hearing protection
- Consistent use of hearing protection
This list is general and non-specific. It would be difficult to hold any professional accountable for judgment decisions concerning work-relatedness.
It is important to note that 1910.95 Noise Standard requires hearing testing when employees exceed the Action Level of 85 dBA TWA or 50% dose. The noise standard does not require hearing testing below 85 dBA. Therefore, if testing is provided on employees below the Action Level and an STS occurs that meets the threshold criteria and the case-by-case evaluation determines it is work-related, the loss becomes recordable.
How recording increases incidence rates (IR)
The illness and injury incidence rate is generally defined as the number of recordable illnesses and injuries occurring among 100 full-time workers over the time period of one year. The formula is as follows:
No. of Injuries or Illnesses X 200,000 / No. hours worked = Incidence Rate (IR)
- No. of Injuries and Illnesses is taken from totals on OSHA 300A form
- 200,000 represents 100 employees working 40 hrs/wk for 50 weeks/yr = standard base for IR
- Hours worked are from payroll or time records. Does not include non-work time as vacation or sick leave.
14 illnesses X 200,000 = 2,800,000/ (600x2080=1,248,000) = 2.24
2.24 workers in every 100 had a recordable illness over the period of one year. The published OSHA incidence illness rate for poultry processing in 2003 was 2.35. The rate for the poultry processing industry was published in the high incidence list.
12 hearing loss cases or 2% change;
26 X 200,000 = 5,200,000/1,248,000 = 4.1
4.1 workers in every 100 had a recordable illness over the period of one year.
This example summarized for a poultry processing plant, already identified in 2003 as a high incidence industry, would be as follows:
It is apparent that the addition of hearing loss recordables has significantly affected the company incidence rate.
At least three consequences of a high incidence rate are 1) increased workers compensation rates 2) adjustment to management incentive or bonus program and 3) possible OSHA enforcement visit. The business function of the safety, occupational health and medical programs is to reduce worker's compensation costs. If these programs cannot accomplish a reduction in overhead costs, then they would not be cost justified. Workers compensation costs come directly out of profits. A competitor may have the same outside costs for labor, raw materials, physical plant space, etc. but one significant inside controllable cost is worker's compensation. In this case, a dollar saved is truly a dollar earned. Savings in worker's compensation costs are added directly to the bottom line.
Management incentive and bonus programs are as varied as the industries themselves. The central theme is a reduction in the number of recordables. The bonus may be for the Plant Manager only or for the entire key management staff. Undue pressure is present in many plants as recordable incidents occur.
OSHA has announced on a number of occasions that the priority for enforcement visits is industries and plants with high incidence rates.
How industry addresses the problem
The most direct method to reduce possible recordable hearing loss cases is not to test employees with TWAs not exceeding the 85 dBA Action Level. The following are not tested:
- Employees with intermittent exposure. This would include employees that walk through noise areas, operate noisy equipment on occasion, or who are otherwise exposed to significant noise during the course of a day, week, month or year but who are not suspected of having an 85 dBA TWA on any given day.
- Employees who are at-risk. This would include employees with ototoxic chemical exposure as toluene in the printing industry or heavy metals and who work intermittently in noise or in low levels of noise. Another category of at-risk persons are those with health conditions or medications which may predispose them to hearing loss in noise. Many times these conditions are sub-clinical and may not have a diagnosis.
- Hearing testing for wellness. Administration/office workers that once were on a 3, 5, or 10 year retest schedule are no longer tested. Employers may not test any worker who is not in the OSHA required hearing testing program.
Another method of reducing possible recordable hearing loss cases is to align the company with a reviewer that may not have a background in occupational hearing and becomes over directed by the list of "additional considerations" found in the discussion to 1904.10.
The results of not testing
The hearing aid market has been reported to be at least 10 percent of the population. At least 20 percent of the U.S. population over the age of 50 years and without noise exposure, have been identified as having significant hearing loss. Between 3 and 4 percent of the population have changes in hearing each year. Hearing loss can be an early indicator or accompany a multitude of health problems as neurological damage caused by aeromatic solvents, diabetes, acoustic neuroma and balance disorders. Hearing loss accounts for poor employee performance, social handicap, and human error costing the employer in inefficiencies and profit dollars.
In a profit oriented company, every employee should have a hearing test on a periodic basis. Those in a wellness program could have a retest schedule of every 3, 5, or even 10 years. However, never should persons in the workplace only receive a baseline or receive no test at all.
In the recent past, annual hearing testing was used to monitor employees who were at-risk. An example of the monitoring process is a sewing operation where 100 seamstresses, each operating a sewing machine would be tested annually to monitor their hearing. Each sewing machine produces a different exposure level from 78 to 88 dBA TWA. Most sewing machines yield a TWA less than 85 dBA. However, one or two machines may at any given time yield a higher level or at-risk employees could show changes in hearing. Therefore, employee hearing was monitored with annual hearing testing as a hearing conservation measure. In the event occupational hearing loss occurred, steps were taken to protect employees. Without hearing testing, monitoring is not possible.
Increased hearing loss
Without monitoring the hearing of at-risk and intermittently exposed employees, hearing loss will occur and neither the company nor the employee will be alerted in the early stages to stop the progression. Employees will not be notified of changes in hearing, will not be educated concerning the effects of noise on or off the job, and will not be encouraged or have hearing protection wearing enforced. Those with medical problems will not be identified and therefore will not have early detection of medical pathologies or treatment of acute conditions. Ignoring the at-risk or intermittently noise exposed employee will not reduce the occurrence of hearing loss.
Liability for hearing loss that may have occurred because of exposure to significant noise on the job exists in most states. Significant exposure does not necessarily mean an 85 dBA TWA or greater. Employees can be exposed to levels over 100 dBA and not have an 85 dBA TWA. An employee who is predisposed to noise induced hearing loss may have hearing changes in which noise is a significant contributor. This occurs in some medical conditions or with additional exposure to ototoxic chemicals or medications. Not testing the at-risk and intermittently exposed employee will add to the worker's compensation liability without the company being aware of the accruing liability. It would be better to test and deal with the issues of work-relatedness and address hearing changes in early stages than to blindly acquire liability.
What to do
The logic of recording changes in hearing that are work-related even when employee exposure is less than 85 dBA TWA is sound. It should not be presumed that all losses employees experience when exposed to 85 dBA TWA or greater are work-related. Nor should it be presumed that all changes in hearing of employees not having an 85 dBA TWA are not work-related. However, the unintended consequences of a non-presumptive policy is that employees that have less than an 85 dBA TWA are not tested, and therefore changes in hearing are not identified when work-related.
Two options for dealing with this are: 1) encourage companies to test for wellness and to test the at-risk and intermittently exposed and to deal directly with any changes in hearing. Early identification and red-flagging occupationally related changes in hearing would reduce liabilities and identify hazardous conditions for correction or enforcement of hearing protection wearing. 2) Lower the Action Level to 80 dBA TWA. The unintended consequences of a non-presumptive policy has resulted in employees with less than 85 dBA TWA not being tested to reduce recordables. This consequence gives major impetus and a new dimension to efforts to lower the Action Level.
Prior to January 1, 2003, there was a presumption of work-relatedness for OSHA 200 Log recording when employees were exposed to 85 dBA TWA. Since that date, there is no presumption of work-relatedness for exposure levels. Work-relatedness of a qualifying Standard Threshold Shift is now determined for the company with the assistance of a professional (audiologist or physician) on a case-by-case basis. The professional is allowed to use additional considerations in making the determination. Recordables for hearing can significantly increase a company's incidence rate. To avoid recording on the OSHA 300 form, industry has drastically reduced the number of employees they test. Since the Noise Standard does not require testing of employees below the 85 dBA TWA Action Level, the intermittently exposed and at-risk employees are not tested. Wellness programs do not include hearing testing. It is estimated that hundreds of thousands, perhaps millions of employees are being dropped from the hearing conservation testing schedule. Hearing loss and eventual handicaps still occur with select employees and the liability for worker's compensation increases in a non-visible manner. The challenge is to encourage companies to expand their hearing testing activities and be proactive in dealing with any work-related hearing changes. There should also be consideration for lowering the Action Level to 80 dBA TWA.
Calculating Incidence Rates
American Academy of Otolaryngology. (1997). Otologic Referral Criteria for Occupational Hearing Conservation Programs, Medical Aspects of Noise Subcommittee of American Academy of Otolaryngology.-Head and Neck Surgery, Washington, DC.
American Speech-Language Hearing Association. (2004). The Audiologist's Role in Occupational Hearing Conservation and Hearing Loss Prevention Programs: Technical Report. ASHA Supplement 24, in press.
Berger, E. H., Royster, L. H., Royster, J. D., Driscoll, D. P., and Layne, M. (2000). The Noise Manual, (5th ed.). American Industrial Hygiene Association Press: Fairfax, VA.
Burns, W. (1968). Noise and Man. JB Lippincott: Philadelphia, PA.
Cary, R., Clarke, S., and Delic, J. (1997). Effects of combined exposure to noise and toxic substances: Critical review of the literature. Annals of Occupational Hygiene 41, 455-465.
DiSogra, R.M. (2001) Adverse drugs reactions and audiology practice. Audiology Today. September, Special Issue, 2-19.
Health Standards for Occupational Noise Exposure; Final Rule, 30 CFR Part 62, 64, Occupational Safety and Health Administration, Federal Register.§ 49458-49634, §49636-49637 (1999).
Occupational Injury and Illness Recordkeeping and Reporting Requirements, Safety and Health Administration, Federal Register. 66 (13) (2001).
Occupational Injury and Illness Recordkeeping and Reporting Requirements; Final Rule, Occupational Safety and Health Administration, Federal Register. 67, §44037-44048 (2002).
Occupational Noise Exposure: Hearing Conservation Amendment; Final Rule, Occupational Safety and Health Administration, 29CFR1910.95 Federal Register 46 (162), §42622-42639 (1983).
Morata, T.C., Dunn, D. E., Kretshchmer, L.W., Lemasters, G. K., and Keith, R. W. (1993). Effects of occupational exposure to organic solvents and noise on hearing. Scandinavian Journal of Work Environmental Health 19 (4), 245-254.
Rybak LP (1992). Hearing; The effects of chemicals. Otolaryngology Head Neck Surgery 106, 677.