Oklahoma Field Federal Safety and Health Council 13 July 2017 Maj Stephanie Brushett, Au.D.

Disclaimer The information presented and the opinions expressed herein do not necessarily reflect the position or policy of the Department of Defense, United States Air Force, or the United States Government. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government. The speaker does not have a financial relationship to disclose.

Overview Background Protection Audiometric Evaluation Education Appointment Management Record Keeping Questions

Did You Know? Noise is the most common workplace hazard Noise-induced hearing loss is the #1 occupational disability It is painless It is progressive over time It is permanent It is PREVENTABLE

Purpose Strive to prevent initial occupational hearing loss Preserve and protect remaining hearing Equip workers with the knowledge & hearing protection devices (HPDs) necessary to safeguard themselves Identify work area trends & shops at high-risk for hearing loss Use data to make improvements to the Hearing Conservation Program (HCP)

Employer’s Responsibilities Measure noise levels 8 hour time-weighted average (TWA) of equal or greater to 85 dB = HCP Provide free annual hearing exams, hearing protection, & training Conduct evaluations of the adequacy of the HPDs in use Noise survey conducted to measure the average amount of noise you are exposed to on a regular day. The noise survey consists of 2 parts- first a stationary sound level meter reading of the process (may use historical data if it is regular process, usually only conducted on new processes), then noise dosimetry is used to measure the average amount of noise a typical person doing that job is exposed to during a regular 8 hr work day. If you see them taking sound level measurements or are asked to wear a noise dosimeter, complete the process as you normally would- looking for TRUE measure of your noise exposure. 85 dB is the magic number for OSHA: If noise dosimetry averages are above 85dB, those in the work area are assigned to the hearing conservation program. OSHA 29 CFR 1910.95(c)(1): The employer shall administer a continuing, effective hearing conservation program, as described in paragraphs (c) through (o) of this section, whenever employee noise exposures equal or exceed an 8-hour time-weighted average sound level (TWA) of 85 decibels measured on the A scale (slow response) or, equivalently, a dose of fifty percent. For purposes of the hearing conservation program, employee noise exposures shall be computed in accordance with appendix A and Table G-16a, and without regard to any attenuation provided by the use of personal protective equipment.

How Loud is Too Loud? Weapons fire 120-140 dB Power tools 110-120 dB Construction Equipment 85-90 dB Loud music: concerts, stereos 130 dB Powered lawnmowers 95-100 dB Aircraft/Helicopters 100-110 dB Jet Planes 120-140 dB Fire engines/Ambulance Sirens 130 dB

Protection Administrative Controls: Engineering Controls: How we buy equipment How buildings are set up Administrative Controls: How equipment is set up in shop Training How long you work in an area What you do to protect your hearing on a day-to-day basis determines what we see on your annual hearing test. There are 3 ways we protect your hearing at work: 1- Engineering Controls: Any physical barrier, improvement or modification used to decrease exposure 2- Administrative Controls: Action taken to reduce exposure that does not involve the use of engineering controls or PPE But most of you know about are hearing protection devices and how they reduce sound

Hearing Protection Devices The best type of HPD is the one that is worn appropriately & used consistently. Made to block out sound by sealing off the ear before sound enters it Should create a “vacuum” or plugged effect--your own voice will sound louder What determines what kind of hearing protection you have supplied in your shop I’ll give you a hint- it has nothing to do with me, or your hearing test 1- The results of the noise survey: Require a certain amount of protection called an NRR (noise reduction rating), assigned for each process. It’s a safe bet to stick with the highest required NRR when performing any duties in your shop 2- sometimes, just ear plugs OR ear muffs will not be enough to block out enough sound to bring it down to a non-hazardous level. Double or Dual hearing protection may be required- still has a minimum NRR for at least 1 of the HPDs. Cannot add NRRs together, it’s an additional 3-7 dB extra protection

Good Fit vs. Bad Fit The best type of hearing protection is the type you can (and will) wear effectively!

Acoustical Check

Individual Fit Testing Individual fit testing has the potential to serve several positive purposes in hearing conservation programs: Can be a valuable training tool Can assist with the OSHA required audiometric testing follow-up procedures Can provide useful documentation regarding HPD adequacy & training Can enable the hearing conservationist to match the employee’s hearing protector attenuation to his/her noise exposure level Can aid in the selection of appropriate HPDs for new hires OSHA Required Audiometric test follow-up procedures: require that when the evaluation of an audiogram indicates an STS, employees already wearing hearing protectors must be refitted and retrained in their use and provided with hearing protectors offering greater attenuation if necessary (29 CFR 1910.95 (g)(8)(ii)(B)) and Individual fit testing protocols will validate the amount of attenuation afforded by the individual user’s hearing protector and will enable the employer to better fulfill this requirement to provide a hearing protector with greater attenuation if necessary.

Individual Fit Testing

Audiometric Evaluations A reference hearing test is to be done within 6 months of an employee’s initial exposure to hazardous noise 14 hours noise free 1910.95(g)(1) The employer shall establish and maintain an audiometric testing program as provided in this paragraph by making audiometric testing available to all employees whose exposures equal or exceed an 8-hour time-weighted average of 85 decibels. 1910.95(g)(5)"Baseline audiogram." 1910.95(g)(5)(i)Within 6 months of an employee's first exposure at or above the action level, the employer shall establish a valid baseline audiogram against which subsequent audiograms can be compared. 1910.95(g)(5)(ii)"Mobile test van exception." Where mobile test vans are used to meet the audiometric testing obligation, the employer shall obtain a valid baseline audiogram within 1 year of an employee's first exposure at or above the action level. Where baseline audiograms are obtained more than 6 months after the employee's first exposure at or above the action level, employees shall wear hearing protectors for any period exceeding six months after first exposure until the baseline audiogram is obtained. 1910.95(g)(5)(iii)Testing to establish a baseline audiogram shall be preceded by at least 14 hours without exposure to workplace noise. Hearing protectors may be used as a substitute for the requirement that baseline audiograms be preceded by 14 hours without exposure to workplace noise.

Annual Exams A hearing test is to be done annually for as long as the worker is exposed to hazardous noise The annual evaluation is compared to the reference test to determine if there is a decrease in hearing 1910.95(g)(7)(i)Each employee's annual audiogram shall be compared to that employee's baseline audiogram to determine if the audiogram is valid and if a standard threshold shift as defined in paragraph (g)(10) of this section has occurred. This comparison may be done by a technician. 1910.95(g)(10)"Standard threshold shift." 1910.95(g)(10)(i)As used in this section, a standard threshold shift is a change in hearing threshold relative to the baseline audiogram of an average of 10 dB or more at 2000, 3000, and 4000 Hz in either ear. 1910.95(g)(10)(ii)In determining whether a standard threshold shift has occurred, allowance may be made for the contribution of aging (presbycusis) to the change in hearing level by correcting the annual audiogram according to the procedure described in Appendix F: "Calculation and Application of Age Correction to Audiograms." We look closely at the high pitch sounds (2-4k Hz) because that is where hearing loss first appears when someone is over exposed to hazardous noise Notes on testing concerns: -hearing booths are not sound PROOF, just very very quiet (required to be under certain ambient sound level- tested annually), hearing noises/voices outside the booth during testing will not interfere with the results as long as you continue to press the button when you hear the beep -audiology in general uses beeps instead of words because it is the best way for us to compare hearing tests (across time and across people) -the computer tests each pitch multiple times and will re-test pitches at random to verify correct responses; an intermittent noise (cough, breathing etc.) will not show up as a hearing loss -because it is a human test, some variability is allowed “wiggle room”

Required Follow-up Exams 1910.95(g)(8)"Follow-up procedures." 1910.95(g)(8)(i)If a comparison of the annual audiogram to the baseline audiogram indicates a standard threshold shift as defined in paragraph (g)(10) of this section has occurred, the employee shall be informed of this fact in writing, within 21 days of the determination. 1910.95(g)(8)(ii)Unless a physician determines that the standard threshold shift is not work related or aggravated by occupational noise exposure, the employer shall ensure that the following steps are taken when a standard threshold shift occurs: 1910.95(g)(8)(ii)(A)Employees not using hearing protectors shall be fitted with hearing protectors, trained in their use and care, and required to use them. 1910.95(g)(8)(ii)(B)Employees already using hearing protectors shall be refitted and retrained in the use of hearing protectors and provided with hearing protectors offering greater attenuation if necessary. 1910.95(g)(8)(ii)(C)The employee shall be referred for a clinical audiological evaluation or an otological examination, as appropriate, if additional testing is necessary or if the employer suspects that a medical pathology of the ear is caused or aggravated by the wearing of hearing protectors.

Audiology Evaluation After follow-up test, if the decrease in hearing is determined to be a Permanent Threshold Shift (PTS), additional training and medical referrals may be required 1910.95(g)(7)(iii)The audiologist, otolaryngologist, or physician shall review problem audiograms and shall determine whether there is a need for further evaluation.

Re-establishing Reference Audiogram Determined by Audiologist, ENT, or MD 1910.95(g)(9)"Revised baseline." An annual audiogram may be substituted for the baseline audiogram when, in the judgment of the audiologist, otolaryngologist or physician who is evaluating the audiogram: 1910.95(g)(9)(i)The standard threshold shift revealed by the audiogram is persistent; or 1910.95(g)(9)(ii)The hearing threshold shown in the annual audiogram indicates significant improvement over the baseline audiogram.

OSHA Recordable Following consideration of the comments received in response to the July 3, 2001 proposal to modify the hearing loss recording criteria, OSHA has decided to require employers to record audiometric results indicating a Standard Threshold Shift (STS) only when such STS cases also reflect a total hearing level of at least 25 dB from audiometric zero. The STS calculation uses audiometric results averaged over the frequencies 2000, 3000 and 4000 Hz, using the original baseline and annual audiograms required by the OSHA noise standard § 1910.95. The rule also allows the employer to adjust the employee's audiogram results used to determine an STS to subtract hearing loss caused by aging, allows the employer to retest the workers' hearing to make sure the hearing loss is persistent, and allows the employer to seek and follow the advice of a physician or licensed health care professional in determining whether or not the hearing loss was work-related.

Education 1910.95(k)(3)The employer shall ensure that each employee is informed of the following: Effects of noise on hearing Purpose of hearing protectors, the advantages, disadvantages, and attenuation of various types, and instructions on selection, fitting, use, and care Purpose of audiometric testing, and an explanation of the test procedures Access to information and training materials 1910.95(k)"Training program." 1910.95(k)(1)The employer shall train each employee who is exposed to noise at or above an 8-hour time weighted average of 85 decibels in accordance with the requirements of this section. The employer shall institute a training program and ensure employee participation in the program. 1910.95(k)(2)The training program shall be repeated annually for each employee included in the hearing conservation program. Information provided in the training program shall be updated to be consistent with changes in protective equipment and work processes. 1910.95(k)(3)The employer shall ensure that each employee is informed of the following: 1910.95(k)(3)(i)The effects of noise on hearing; 1910.95(k)(3)(ii)The purpose of hearing protectors, the advantages, disadvantages, and attenuation of various types, and instructions on selection, fitting, use, and care; and 1910.95(k)(3)(iii)The purpose of audiometric testing, and an explanation of the test procedures. 1910.95(l)"Access to information and training materials."

Noise-Induced Hearing Loss Noise-induced hearing loss destroys your ability to hear and understand speech, especially in background noise. It leads to permanent damage to the auditory system. Loss of sensitivity to high frequency (high pitch) sound. No medical or surgical treatment available; hearing aids only amplify sound!

How to Prevent Noise-Induced Hearing Loss Wear hearing protection during recreational noise exposure Lawnmower, firearms, concerts, snow blower, snowmobiles, motorcycles, power tools, etc Use hearing protection when hunting Affordable earmuffs available w/special technology to amplify soft sounds, but protect against impulse noise Do not use IPODS, MP3 players, personal stereo systems as a substitute for hearing protection Wear earplugs when riding your motorcycle Noise levels still exceed 100 dB even w/a helmet

Audiogram of Familiar Sounds

Tinnitus Handouts

Appointment Management Supervisors

STS Log

Record Keeping

2016 Year-End Trends and Data Total # of Annual Exams 2015: 6,826 2016: 9,321 Total # of TTSs 2015: 252 2016: 443 Total # of PTSs 2015: 250 2016: 347 Total # of OSHA Reportable 2015: 36 2016: 37 Average Age at Shift HCP: 50 Flyer/SHPE: 37 Average Years Since Baseline HCP: 10 Flyer/SHPE: 12 HPD Education 1,394

Dr. Stephanie Brushett, Maj, USAF Questions? Dr. Stephanie Brushett, Maj, USAF 405-734-3309 Stephanie.Brushett@us.af.mil

References https://www.osha.gov/SLTC/noisehearingconservation/hearingprograms.html http://www.caohc.org https://www.cdc.gov/niosh/topics/noise/default.html https://www.osha.gov/Publications/osha3074.pdf https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=FEDERAL_REGISTER&p_id=17313 USAFSAM “New Worker Hearing Conservation Training” Hill AFB’s “Annual Hearing Conservation Training”