hearing conservation theresa y. schulz, phd. lt. col. usaf (ret.)

Hearing ConservationTheresa Y. Schulz, PhD.Lt. Col. USAF (ret.)

Topics

Noise And Acoustics

Motivating Workers

Noise Reduction

Reducing Costs for Hearing Loss

Noise + Acoustics

Noise-Induced Hearing LossCauses no pain

Causes no visible traumaLeaves no visible scars

Is unnoticeable in its earliest stagesAccumulates with each overexposure

Takes years to notice a change

Is Permanent + 100% Preventable

Noise + Acoustics

Noise-induced hearing loss is the most common permanent and preventable occupational injury in the world.

World Health Organization

Noise + Acoustics

Worker’s Compensation

In many countries, excessive noise is the biggest compensable occupational hazard. Cost of NIHL to developed countries ranges from 0.2 to 2% of its GDP. NIHL is on the rise globally. (Source: WHO)

Noise + Acoustics

United States Statistics

Most common occupational injury in the United States. 22 million US workers are exposed to hazardous noise at work on a daily basis. Approx. 8 million Americans suffer from NIHL. (Source: NIOSH, 2009)

Noise + Acoustics

Non-Occupational Occupational

Noise + Acoustics

Noise Measurement Devices

SOUND LEVEL METER

Sound is measured immediately in a

specific area

PERSONAL DOSIMETERSound “averaged”

throughout day for sample employee/job

IN-EAR DOSIMETER

Collects personal noise dose – the only real

measure of risk

NOISE AND ACOUSTICS ~ Hierarchy of Controls

ADMINISTRATIVE CONTROLS

• Rotate Workers

• Extended Breaks

•2nd/3rd Shift

ENGINEERING CONTROLS

• Buy Quiet

• Vibration Pads

• Enclosures

• Barriers

• Isolation

PERSONAL PROTECTIVE EQUIPMENT

Noise + Acoustics - Hierarchy of Controls

• Ototoxic by themselves• Synergistic effect with noise• Large differences in sensitivity• Recommend: increased frequency

of audiometric testing

Synergistic Ototoxics• Carbon Monoxide• Hydrogen Cyanide

NOISE

NOISE AND ACOUSTICS ~ Hierarchy of ControlsNoise + Acoustics

Ototoxic ChemicalsConfirmed Ototoxics

Ethyl BenzeneLead and inorganic

compounds (as Pb)StyreneToluene

Trichloroethylene

PossibleCarbon disulfide

n-HexaneXylene

Noise Reduction Rating(NRR)

Hearing Protection Selection

ComfortNoise ReductionSizeCommunicationJob RequirementsHygieneUse with Other PPE

Hearing Protection Selection Factors• The right hearing

protector should feel comfortable

• One protector may not satisfy all workers

• Offer a variety of earplugs or earmuffs to meet varying worker needs and preferences

• Selecting HPDs with suitable attenuation for noise environment

• Avoid overprotection in marginal noise environments

• Consider banded earplugs for intermittent noise or electronic earmuffs for impact noise.

• Every ear canal has its own shape and size

• Ensure proper fit with variety of earplug sizes and shapes

• Sized multiple-use earplugs

• Low-pressure foam earplugs for smaller ear canals

• Keep workers connected to their environment

• Uniform attenuation allows speech/signals to be hear more naturally

• Sound amplification earmuffs for workers with hearing impairment

• Consider job requirements in HPD selection

• Detectable earplugs for process industries

• Hi-visibility earmuffs for dark/high traffic areas

• Dielectric HPDs for electrical environments

• Proper care and maintenance can extend life and performance of HPDs

• Examine and clean all multiple-use earplugs daily

• Clean and replace ear cushions on earmuffs every 4-6 months

• Select HPDs that can work with other PPE without compromise

• Cap-mounted earmuffs for hard hats

• Multiple-position earmuffs for full-brim hard hats

• Ultraslim neckband earmuffs with welding shields

How much noise is reaching the ear of the worker ?

That is completely unknown …

Noise Level = 100 dB

Noise Reduction Rating = 30 dB

(55 – 104 dB)

Noise Reduction Rating

How much protection?

0 dB 0 dB33 dB

EAR #1EAR #2

EAR #3

-10

125

250

500

1000

2000

3150

4000

6300

8000

Frequency in Hz

90

80

70

60

50

40

30

20

10

0

Atte

nuat

ion

in d

B

Max Poor FitNRR = 0dB

Max Good FitNRR = 33dB

Good Fit vs Bad FitFitting Tips

Noise Reduction Rating

Noise Reduction Rating• A laboratory estimate

of the amount of attenuation achievable by 98% of users when properly fit

• A population-based rating ― some users will get more attenuation, some will get less

The NRR is only a population estimate,

not a predictor of individual attenuation.

A test subject in the Howard Leight Acoustical Lab, San Diego, CA, accredited by the National Voluntary Laboratory Accreditation Program (NVLAP)

Noise Reduction Rating – Determining an NRR

• 10 human subjects tested in a reverberant room

• Tested with ears open/occluded at nine frequencies

• Each subject tested 3x• NRR calculated to be

population average

NRR

Attenuation

Num

ber o

f tes

t sub

ject

s

14 18

1

2

3

4

1920 22 2423 25

28 30 322627

5

Noise Reduction Rating – Determining an NRR

NRR

From Kevin Michael, PhD and Cindy Bloyer “Hearing Protector Attenuation Measurement on the End-User”

192 users of a flanged reusable earplug ~ 27 NRR

Retraining and refitting

resulted in an average

14 dB improvement for this group

Real user

attenuation

<0 to 38 dB

302010

0

-10

Atte

nuat

ion

in d

B

40

50NRR = 27 Multiple-Use Earplug

Real-World Attenuation ≠ NRRNoise Reduction Rating

NIOSH

EarmuffsNRR – 25%

Formable EarplugsNRR – 50%

All Other EarplugsNRR – 70%

OSHA

NRR ÷ 2(feasibility of engineering

controls)

CSA

ClassA up to 100B up to 95C up to 90

Noise Reduction Rating

De-Rating Methods

Fit Test

Noise Reduction Rating

Noise Reduction Rating• The EPA recently made an announcement about

a proposed change to the Noise Reduction Rating [NRR]

• This is the first change in hearing protector regulation in nearly 30 years

• 20 human subjects tested in a simulated industrial room

• Subject trained then fits their own earplugs

• Tested with ears open / occluded at 9 frequencies

• Each subject tested 2x

• NRR calculated to be population average

Noise Reduction Rating

Determining New NRR

New NRR (NRsa)

Attenuation

Num

ber o

f tes

t sub

ject

s

11 14 18

1

2

3

4

1920 22 2423 25 27

30 33

5

20% achieved > 26 dB80% achieved > 20 dB

2826

Current NRR Label Mock-up of New Label

80th %Minimally-

trained

20th %Proficient

Users

Noise Reduction Rating

Noise Reduction Rating

How to Apply the New LabelTwo-number range displays the estimated protection achievable by minimally-trained users [80%] versus proficient users [20%].

A wider range indicates greater variability in the fit of that HPD. Smaller ranges indicate more consistency of fit. For example, earmuffs will usually have a tighter fitting range than earplugs, and may have a smaller NRR range.

80% 20%

1.FIT 2. WEAR TIMEA worker who selects an earplug with an NRR of 30

effectively reduced his 8-hour NRR to just …

but then removes that HPD for just …

30 dB

5 min 10 min 30 min15 min

26 dB 24 dB 22 dB 18 dB

In noise exposures, small intervals of no protection quickly void large intervals of adequate protection.

Noise Reduction Rating

Factors in Achieving the NRR

Noise Reduction Rating

What Can I Do Now?

• Evaluate Noise Spectra to determine if spectral balance corrections will be necessary

• Update HC Training Program on proper fit of hearing protectors. Hold a “Toolbox Training” and hold a refresher fit training session.

Although the new labeling regulation takes effect whenever the final rule is published by the EPA, there are a number of actions you can take now to prepare your Hearing Conservation Program for the change.

Noise Reduction Rating

What Can I Do Now?• Evaluate Current HPD

Selection to determine whether they are appropriate for your noise environment. Use the Howard Leight Hearing Protector Selector for recommendations.

• Upgrade to One-on-One Training research studies confirm that one-on-one training is superior to group training

Noise Reduction Rating

Earplug Fit TestingProvides an accurate, real-world picture of your employees’ hearing protector effectiveness.

Identify if your employees are:• Receiving optimal protection• Require additional training• Need to try a different earplug style

Noise Reduction Rating

Earplug Fit TestingAs a problem solver:• Derating Schemes• One-on-One Training• HPD Selection• NRR Change

Noise Reduction Rating

In-Ear DosimetryAs a Problem Solver• Continuously monitors

in noise level at the workers ear

• The only true measure of the hazard!

Reducing Costs of Hearing Loss

Reducing Costs of Hearing Loss

Jurisdiction One Ear(Max)

Both Ears (Max)

Comments

NC $37.2k $80k + aidsSC $38.7

(80 wks)$80k (165 wks)

*NMER

TN $38.6k $77.2k + aidsDOL -LSA 52 wks 200 wks + aids

Sample HL Compensation*

*Source: AIHA Noise Manual

*NMER= No minimum exposure required

Indicators for Hearing Loss:• Standard Threshold Shift• Temporary Threshold Shift• Recordable Hearing Loss• Dosimetry• In-ear Dosimetry• Personal Attenuation Level (PAR)• Hearing Loss Compensation

Reducing Costs of Hearing Loss

Lagging Indicators vs. Leading Indicators

Reducing Costs of Hearing Loss

Indicators for Hearing Loss:• Standard Threshold Shift• Temporary Threshold Shift• Recordable Hearing Loss• Dosimetry• In-ear Dosimetry• Personal Attenuation Level (PAR)• Hearing Loss Compensation

Reducing Costs of Hearing Loss

Fit Testing In-Ear Dosimetry

Reducing Costs of Hearing Loss

In-ear dosimetry measures/records worker’s actual noise dose, with and without protection

Provides real-time monitoring and alerts when worker approaches/exceeds safe limits

Only metric with direct potential to measure and prevent further progression of occupational hearing loss

Reducing Costs of Hearing Loss

Research > Alcoa Intalco Works

• Mean Hearing Threshold (2k, 3k, 4kHz): 2000 – 2007 (N = 46)

• Employees using continuous in-ear dosimetry starting in 2005

Mean hearing threshold (2,3, and 4 kHz) Employees using continuous ESP starting in 2005

2000 - 2007 (N=46)

0

5

10

15

20

25

30

35

40

45

50

2000 2001 2002 2003 2004 2005 2006 2007

Year of test

Mea

n HTL

3,4,6kH

z

ESP Introduced trend line

Reducing Costs of Hearing Loss

Preventive Action After NIHLIn practice, an OSHA-recordable STS is not a preventive action

It is documentation of a hearing loss after the fact.How soon will an employee suffering NIHL be re-fit / re-trained ? “Best case scenario” per Hearing Conservation Amendment

0 2 4 6 8 10 12 14 16 Months

• Audiometric test • Retest • Notification

Reducing Costs of Hearing Loss

In-ear dosimetry “worst case” scenario … 1 Day

In-ear dosimetry as a Problem Solver

Employees with Documented Noise-Induced Hearing Loss or Standard Threshold Shift [STS]

Employees At-Risk for NIHL

Employee Training + Sampling

Dual-Protection/Extreme Noise Exposure

Engineering Controls

Reducing Costs of Hearing Loss

In-ear monitoring as a Problem Solver

Real-Ear Attenuation at

Threshold(R.E.A.T.)

Loudness Balance(Real-Ear Attenuation Above

Threshold)

Microphone in Real-Ear(M.I.R.E.)

In-Ear Dosimetry

Reducing Costs of Hearing Loss

Audiometric FitCheck EARfit VeriPRO

REAT REAT MIRE REAAT

Sound booth Very Quiet Room Quiet Room Anywhere

PAR PAR Derived PAR PAR

Any earplug Any earplugSelected modified earplugs

Any earplug

Special training required

Special training required

Special training required

Anyone can perform

Ear plug fit-testing methods

OSHA Alliance: Best Practice Bulletin

www.hearingconservation.org

Additional Information

www.howardleight.com

Reducing Costs of Hearing Loss

“How well can users predict their attenuation after a short fit-testing

training session?"

Pre and Post-TestFit-Testing as a Training Tool

Pre and Post-TestFit-Testing as a Training Tool

Ability to Predict Noise Reduction

0

2

4

6

8

10

12

14

16

18

20

Within 5 dB category

+/- 7.5 dB(one Category off)

+/- 12.5 dB (2 categories off)

Num

ber o

f Ear

s (E

ach

subj

ect e

stim

ated

atte

n. fo

r eac

h ea

r)

56%

32%

12%

Variation from Published NRR

-30

-25

-20

-15

-10

-5

0

5

10

0 10 20 30 40 50 60 70 80 90 100

Workers

Diffe

renc

e in

dB Published

NRR

Distribution of PARs

0

2

4

6

8

10

12

Variation from Published NRR

Wor

kers

Reducing Costs of Hearing Loss

Distribution of PARs

0

2

4

6

8

10

12

Variation from Published NRR

Wor

kers

Personal Factors Gender Age Years in Noise Ear Canal Size Familiarity Model of Earplug

Program Factors # Group Trainings # Personal Trainings

Reducing Costs of Hearing Loss

Difference on 2nd / 3rd Test

-30

-25

-20

-15

-10

-5

0

5

10

Subjects

Varia

tion

from

NR

R Published NRR

Trying a second earplug often improves attenuation

REDUCING COSTS / CLAIMSReducing Costs of Hearing Loss

Earplug fit-testing as a Problem Solver

• Training tool for noise-exposed workers• Train-the-trainer tool• Follow-up on significant threshold shifts in hearing• Documentation of HPD adequacy• Assessment of overall HCP effectiveness• Match HPD to worker’s specific noise level• Selection of appropriate HPDs for new hires

• Benefits per Best Practices Bulletin (OSHA Alliance)

Reducing Costs of Hearing Loss

PROS• Estimate Measure• NRR obsolete• Fulfills OSHA compliance• Eliminates need for de-ratings• Medico-legal cases• Delineates non-occupational• Eliminates double protection• Provides employee feedback• (HPD Inventory control)

CONS• Cost• Time Investment• Not standardized

Reducing Costs of Hearing Loss

Tools for HCP Prevention Metrics

Training + Motivation

Common Objections to Wearing HPDs

“Hearing protectors are uncomfortable to wear.”

“I don’t need them! I am used to the noise.”

“I already lost some of my hearing, so why should I wear them?”

“I can’t hear my co-workers if I wear them.”

“I can always get fit with a hearing aid.”

“Can I hurt my eardrums if I insert an earplug to deeply.”

“My machine sounds different.”

“Won’t I get an ear infection?”

Training + Motivation

Show, Don’t Tell• Provide copy of annual audiogram

to worker• Use personal examples to

demonstrate consequences of hearing loss

• Ask questions:• What is your favorite sound?• What sound would you miss the

most if you couldn’t hear?• What sounds connect you to people

and your environment?

Training + Motivation

Personalize Hearing Loss

Training + Motivation

Training Materials• www.hearforever.org• www.hearingconservation.org• atl.grc.nasa.gov/

HearingConservation/Resources/index.html

• www.cdc.gov/niosh/topics/noise• www.dangerousdecibels.org

Demonstrate Future Risk

www.hearforever.org/ILCA2010

Training + Motivation

Send Clear Message On + Off JobHC Part of Everyday Life• Include recreational hearing

conservation in annual training• Provide extra HPDs for home

use• Promote Hearing Conservation

at company/family events

Training + Motivation

Remove Barriers to HPD UseMake HPDs Available• Highlight “where to find HPDs” in

annual training• Make sure HPDs are well-stocked

and accessible• Include group of workers in

selection process for increased acceptance

• Offer wide variety to match comfort, job requirements

Listen Up!Hear Forever

Make Hearing Conservation a Part of

Your Everyday Life

HearForever.org