From the Guidelines
When reviewing an abnormal audiogram in a hearing conservation program, occupational medicine physicians should follow a systematic approach that prioritizes early detection and prevention of noise-induced hearing loss, as outlined in recent studies 1. This approach should include comparing the current audiogram with baseline and previous tests to identify any significant threshold shifts, typically defined as a change of 10 dB or more at 2000,3000, and 4000 Hz in either ear.
- Conduct a thorough medical history focusing on noise exposure (both occupational and recreational), ototoxic medication use, ear infections, head trauma, and family history of hearing loss.
- Perform a physical examination of the ears, including otoscopy to assess for cerumen impaction, tympanic membrane abnormalities, or middle ear pathology.
- Consider referring patients with significant threshold shifts or concerning findings to an audiologist or otolaryngologist for further evaluation.
- Temporary threshold shifts should be confirmed with repeat testing after 14 hours of noise-free conditions, as suggested by recent research 1.
- For confirmed permanent threshold shifts, implement additional hearing protection measures, consider workplace accommodations, and provide education on hearing conservation, as recommended by recent guidelines 1.
- Document all findings, interventions, and follow-up plans thoroughly, ensuring that the approach is tailored to the individual's needs and risk factors, as emphasized by studies 1. This systematic approach is supported by recent studies, including a 2020 study published in the International Journal of Occupational and Environmental Medicine, which highlights the importance of early detection and prevention of noise-induced hearing loss 1. Another study published in 2020 in the same journal discusses the potential benefits of monitoring temporary threshold shifts in workers exposed to high levels of noise, as a means of preventing permanent hearing loss 1. A 2020 study published in the same journal also emphasizes the need for personalized medical guidelines for the prevention of noise-induced hearing loss, taking into account individual factors determining susceptibility to noise 1. More recent guidelines, such as the 2024 clinical practice guideline on age-related hearing loss, also support the importance of comprehensive diagnostic evaluation, including pure tone thresholds, speech audiometry, tympanometry, and acoustic reflex testing, in detecting and managing hearing loss 1.
From the Research
Approach for Reviewing Abnormal Audiogram
When reviewing an abnormal audiogram in a hearing conservation program, the occupational medicine physician should consider the following steps:
- Evaluate the type and degree of hearing loss, as well as the configuration of the audiogram, to determine the underlying cause of the hearing loss 2
- Use pure-tone audiometry, tympanometry, and acoustic reflex testing to characterize the hearing loss and inform the differential diagnosis 2
- Consider the symmetry of the sensorineural hearing loss, as asymmetry may indicate a retrocochlear lesion, such as vestibular schwannoma 2
- Incorporate the results of audiologic testing into the evaluation to perform a more informed search for the structural cause of hearing loss 2
Role of the Occupational Medicine Physician
The occupational medicine physician plays a crucial role in the supervision of audiometric surveillance conducted under the auspices of hearing conservation programs 3
- The physician should be familiar with the regulatory and scientific basis for audiometric testing and hearing conservation programs 3
- The physician should review and interpret audiogram results to identify potential hearing loss and determine the need for further evaluation or referral 2, 3
- The physician should also provide guidance on the prevention and management of occupational hearing loss, as well as the implementation of hearing conservation programs in the workplace 3