Hearing Conservation Program

Question 1

Noise-Induced Hearing Loss is preventablenot preventable?

Answer 1

Preventable

Question 2

What type of hearing loss is noise-induced hearing loss?

Answer 2

Sensorineural

Question 3

Previous NIHL makes the ear more sensitive to future noise exposure.

Answer 3

No

Question 4

What occurs to hearing loss once the exposure to noise is discontinued? What does this mean with respect to compensation?

Answer 4

Once exposure to noise ceases, there is no progression of the hearing loss. Therefore cannot claim years after separation that hearing loss is service connected when the pt had normal testing on separation.

Question 5

Beyond what decibel level is noise considered harmful? What is a good rule of thumb for this level?

Answer 5

85 dB. Rule of thumb– having to shout to communicate at 3 ft

Question 6

If there is a difference of 30 dB, how many times greater is the sound?

Answer 6

1000 (10^3)

Question 7

If two machines of the same decibel amount are started next to each other, the resulting sound level is?

Answer 7

3 dB higher (i.e. 90 dB + 90 dB = 93 dB)

Question 8

What is the term of expression for a daily noise dose?

Answer 8

time weighted average (TWA)

Question 9

At what time weighted average noise dose does the DoD require people be on the hearing conservation program?

Answer 9

85 dB over 8 hours TWA

Question 10

For each 3 dB above the 85 dB, what happens to the safe exposure time?

Answer 10

The safe exposure time is cut in half (i.e. 88 dB is 4 hrs, 91 dB is 2 hrs).

Question 11

The best hearing protection devices are?

Answer 11

Whatever device is worn consistently and properly.

Question 12

What should you say to someone who states that they don’t wear hearing protection secondary to not being able to hear with them in?

Answer 12

It is difficult to hear with hearing protection if there is no noise, but you will actually hear better in a noisy environment.

Question 13

What levels are looked at to determine if there has been a threshold shift?

Answer 13

If there has been an average decrease of 10 over 2k, 3k and 4k (add the three then divide by 3)

Question 14

If a patient has a threshold shift on annual exam, what is the sequence of follow-up steps?

Answer 14

1. Repeat audiogram w/in 30 days. This repeat exam must be after 14-hr noise free. 2. If threshold shift on that exam, then repeat immediately. 3. If after those two tests the threshold shift persists, then the patient must be referred to HCDC audiology. 4. A new reference must then be established for comparison in future studies.

Question 15

If the 14-hr noise free audiogram is normal following the initial abnormal audiogram, what does it tell you about the patient?

Answer 15

They are not using hearing protection.

Question 16

What is the role of OSHA when there has been a permanent threshold shift?

Answer 16

It is OSHA reportable.

Question 17

What os the role of the PCM/FS if someone has a permanent threshold shift?

Answer 17

Perform a medical exam

Question 18

Name 5 things that the PCM/FS should look for on their exam

Answer 18

1. URI 2. Allergies 3. Impacted cerumen 4. Ear infection 5. Acoustic neuroma

Question 19

What is the side-to-side pattern of noise induced hearing loss?

Answer 19

Is typically symmetric.

Question 20

What does normal bone conduction tell you?

Answer 20

That the inner ear is functioning properly

Question 21

If the bone conduction is normal but the ear shows hearing loss across all frequencies, what is the diagnosis?

Answer 21

This is conductive hearing loss, meaning that the abnormality is in the middle or outer ear.

Question 22

What is this pattern of hearing loss?

Answer 22

High frequency bilateral SNHL. Knotch pattern in high freq is indicative of long-term noise exposure wthout protection

Question 23

Where is the lesion in SNHL?

Answer 23

Cochlea or beyond

Question 24

What is this pattern of hearing loss?

Answer 24

Conductive hearing loss.

Question 25

What is this pattern of hearing loss?

Answer 25

Mixed hearing loss.Noise induced hearing loss along with a confounding factor such as ear infxn that worsens the hearing loss

Now we have a difference between the ears. The right ear has much more of a hearing loss. The seperation between the air conduction threshold of the right ear and the bone conduction threshold of the right ear tells us that there is a conductive hearing loss. But since both ears have a high frequency hearing loss with the bone conduction scores being equal to the air conduction scores, we call this a mixed hearing loss because it has both conductive and sensorineural hearing losses.

Question 26

What pattern of hearing loss is this?

Answer 26

Unilateral SNHL in left ear.unilateral sensorineural hearing loss in the left ear. Most often if there is damage in the inner ear causing hearing loss, it will be the same in both ears, so this audiogram may indicate something beyond the inner ear, such as an acoustic neuroma.

Question 27

What step must occur if a person has a second threshold shift?

Answer 27

Fitness and Risk Assessment

Question 28

Name the 3 aspects of a fitness and risk assessment.

Answer 28

1. The capability to perform job given the loss of hearing.
2. The risk of returning the worker back to the hazardous noise environment (i.e. risk of further hearing loss)
3. The risk the worker and his co-workers are placed at secondary to the patient’s hearing loss

Question 29

Who determines the scope of the fitness and risk evauation? What 3 items are taken into consideration?

Answer 29

Typically the FS with consideration for clinical status, job capability and job safety.

Question 30

What is the best way to determine functional impairment?

Answer 30

Visit the workplace (i.e. speech and noise test while flying). Need audiologist assistance as two people with the same physical impairment may function differently in the workplace).