# Presentation: 911962

## VA Safety and Health ProgramOccupational Safety and Health

- <date/time>

**VA Safety and Health Program****Occupational Safety and Health**

***Hearing Loss Prevention***

**Notes:**
Slide Number: 1
Course Title: Hearing Loss Prevention 
Presentation Time:
Employees enrolled in the facility hearing conservation program must complete this portion of the training.
The presenter should have examples of hearing protection provided at the facility.
The video, Hearing Protection - Sounds Good to Me (14 min), can be shown at this point as a part of this section.

## Local Facility Information

***Audiologist  ______________***
- Telephone Number _________
***Industrial Hygienist ______________***
- Telephone Number ____________________
***Records Maintained _____________***
***Protective Equipment Located at ______***

**Notes:**
Slide Number: 2
Slide Title: Local Facility Information 
This slide must be revised by the presenter to provide the necessary information.

## Components of a Hearing Conservation Program

- Assessment and monitoring of workplace noise and noise exposure
- Control of workplace noise and noise exposure
- Measurement of hearing
- Employee education and training

## Professional Team

**Professionals typically involved in the hearing loss prevention/hearing conservation program at the local level:**
***Audiologist***
***Industrial Hygienist***
***Safety Officer***
***Employee Health Care***

**Notes:**
Slide Number: 4
Slide Title: Professional Team
The presenter should revise this slide and insert the names of the people who are involved in the hearing loss prevention/hearing conservation program at the facility.

## Hearing Protectors

**Must***** *****be***** available****** *****if: **
***Exposed to 85 dB or greater  for eight-hour TWA***
**Must be *****worn***** if:**
**No baseline audiogram has been established**
**Hearing threshold has changed an average of 10 dB or more at 2000, 3000, or 4000 hertz in either ear**

**Must be *****worn***** if:**
**Duration****	****       Sound Level**
**(hours per day)****	****(dBA)**
**8****	****	****	****90**
**6****	****	****	****92**
**4****	****	****	****95**
**3****	****	****	****97**
**2****	****	****	****100**
**1.5****	****	****102**
**1****	****	****	****105**
**0.5****	****	****110**
**0.25 or less****	****115**

**Notes:**
Slide Number: 5
Slide Title: Hearing Protectors 
This slide summarizes the requirements concerning hearing protection. Based on OSHA requirements, employees can be exposed to the same noise level, but the requirements concerning noise protection could be different.
If the noise level is 85 dBA or greater for an 8-hour TWA but less than the values specified in the table on the right, hearing protection must be available; it does not have to be worn.
Hearing protection must be evaluated for the specific noise environments in which it will be used.
Hearing protection must protect against short and constant noise exposures. Instantaneous or short duration (less than one second) exposures to very high level of noise can cause immediate damage. Such sounds may result from explosions, gunshots, or impact driven machinery. In addition to instantaneous noises, exposure to lower levels of constant or slowly varying noise for prolonged periods of time can lead to hearing damage.

## Locations Requiring Noise Protection

*(Insert appropriate locations)*

**Notes:**
Slide Number: 6
Slide Title: Locations Requiring Noise Protection

## Types of Hearing Protectors 

**Canal Caps**
**Earplugs**
**Earmuffs**

**Notes:**
Slide Number: 7
Slide Title: Types of Hearing Protectors 
This slide lists the three major categories of hearing protection - canal caps, earplugs, and earmuffs.
The Noise Reduction Rating (NRR) developed by the Environmental Protection Agency is indicated on hearing protector packages. When limitations or precautions are indicated by the manufacturer of hearing protection, they should be communicated to the user and those limitations or precautions should be strictly observed by the user.

## Canal Caps

**Flexible tips**
**Do not extend into the ear canal**
**Only cover canal opening**

**Notes:**
Slide Number: 8
Slide Title: Canal Caps 
This slide describes the Canal Cap type of hearing protector.

## Earplugs

**Lightweight**
**Comfortable for long periods of time**
**Made of soft fibers or foam (self-forming)**
**Disposable or reusable**
**Preformed, pre-molded, or custom molded**

**Notes:**
Slide Number: 9
Slide Title: Earplugs 
This slide lists describes Earplug type of hearing protector.

## Earmuffs

**Easily put on or removed**
**Require entire ear to fit inside cup (seat)**
**May interfere with glasses or goggles**
**Can be designed for use with hard hats**

**Notes:**
Slide Number: 10
Slide Title: Earmuffs
This slide describes the Earmuff type of hearing protector.

## General Considerations

**Proper initial fit required**
**Must be used correctly**
**Must receive training in the use and care of hearing protectors provided**
**Must be allowed to select hearing protectors from a variety of suitable hearing protectors provided by employer**
**Must be replaced as necessary**

**Notes:**
Slide Number: 11
Slide Title: General Considerations
The presenter should demonstrate the proper techniques for wearing earplugs and/or earmuffs. Attendees should spend some time in learning and practicing the proper techniques.
The presenter should discuss facility procedures for obtaining and replacing hearing protection.

## Hearing Safety

**If you have to shout to talk to someone within 2 or 3 feet - Wear hearing protection**
**Off-the-job activities (woodworking, shooting, etc.) can hurt your hearing - Hearing protection is recommended**
**Never remove hearing protection in high noise areas**
**Do NOT share hearing protection with others**

**Notes:**
Slide Number: 12
Slide Title: Hearing Safety
This slide lists general hearing safety guidelines. The presenter should emphasize that hearing damage can also occur away from workplace -- while pursuing hobbies or other activities.

## Decibels and Hertz

**Hertz (Hz)**
- Frequency
- Pitch
**Decibels (dB)**
- Amplitude
- Loudness

**Notes:**
Slide Number: 13
Slide Title: Decibels and Hertz
The frequency of a sound refers to the number of cycles per second (cps) of the waveform and is measured in Hertz (Hz) (1 Hz = 1 cps).  Pitch is the psychological correlate of frequency.  The amplitude (volume) of a sound is expressed in decibels (dB). In the measurement of hearing these units are referred to as decibels hearing level (dB HL).  Loudness is the psychological correlate of amplitude.

## Degrees of Hearing Loss

**Notes:**
Slide Number: 14
Slide Title: Degrees of Hearing Loss
This slide depicts an audiogram with the degrees of hearing loss superimposed upon it.
Although the amount of hearing loss is quantified in decibels, the following five descriptors are used to describe the pure-tone hearing loss (see the above slide): 
1. 0- to 25-dB HL--normal hearing,
2. 26- to 40-dB HL--mild hearing loss,
3. 41- to 55-dB HL--moderate hearing loss,
4. 56- to 70-dB HL--moderately-severe hearing loss,
5. 71- to 90-dB HL--severe hearing loss, and
6. >90-dB HL or no response--profound hearing loss. 

[Note: no response means that no response was obtained from the patient at the output limits of the audiometer].

## Audiogram with Levels of Speech and Environmental Sounds Superimposed

**Notes:**
Slide Number: 15
Slide Title: Audiogram with Levels of Speech and Environmental Sounds 
The frequency of a sound refers to the number of cycles per second (cps) of the waveform and is measured in Hertz (Hz) (1 Hz = 1 cps).  Pitch is the psychological correlate of frequency.  The amplitude (volume) of a sound is expressed in decibels (dB). In the measurement of hearing these units are referred to as decibels hearing level (dB HL).  Loudness is the psychological correlate of amplitude.
To relate the audiogram to our everyday acoustic environment, the audiogram in the slide above has been altered to include examples of speech and common environmental sounds that cover the gamut of both the frequency (Hz) and level (dB Hearing Level) domains. The levels for many of the speech sounds are depicted at their approximate frequency ranges with normal conversational speech occurring at about 50-dB HL. For comparison, a whisper is around 25-dB HL and a shout is in the 80- to 90-dB HL range. The levels for environmental sounds range from the sand flowing in an hourglass at 0-dB HL, to a watch ticking at 30-dB HL, to a vacuum cleaner at 60-dB HL, to a dog barking at 75-dB HL, to a jet plane at >110-dB HL.

## Causes of Hearing Loss

**Noise Exposure**
**Congenital Disorders**
**Genetic Causes**
**Infections**
**Ototoxic Drugs**
**Head Trauma**

**Notes:**
Slide Number: 16
Slide Title: Causes of Hearing Loss

## Types of Hearing Loss

**Conductive Hearing Loss**
***Involvement of Outer and/or Middle Ear***
**Most often this is medically or surgically treatable.**
**Sensorineural Hearing Loss**
***Inner Ear***
**Most often is permanent and not medically/surgically treatable.**
**Treatment usually involves aural rehabilitation which includes the fitting of amplification devices.**

**Notes:**
Slide Number: 17
Slide Title: Type of Hearing Loss
Basically, there are two types of hearing loss which are categorized according to anatomic site of lesion along the auditory pathway: 
CONDUCTIVE 
Conductive hearing loss results from an obstruction to the flow of acoustic energy in either the outer ear or in the middle ear. Common etiologies of conductive hearing loss in the outer ear include blockage of the external auditory canal by cerumen, by foreign bodies, by external otitis, or by congenital or acquired atresia of the external canal. Common etiologies of middle-ear obstruction include otitis media, fixation or disarticulation of the ossicular chain, and trauma to the tympanic membrane and other middle-ear structures. Nearly all pathologies in the outer and middle ear are responsive to medical and/or surgical intervention; most patients with conductive hearing loss also respond well to amplification when necessary. 
SENSORINEURAL 
Sensorineural hearing loss results from pathology involving the sensory end organ in the cochlea and/or pathology to the auditory branch of the eighth cranial nerve. Common etiologies include presbycusis, exposure to intense noise, systemic diseases, ototoxic drugs, infection of the inner ear labyrinths, heredity, space-occupying lesions, demyelinating disease, or infection; vascular lesions may also present with this type of hearing loss.  Intervention requiring medical/surgical or audiological measures is dictated by the site of the lesion and the underlying pathology. Some sensorineural pathologies are medically and/or surgically treatable (Ménière's Disease, space-occupying lesions, autoimmune disorders); most, however, are not. Patients with sensorineural hearing loss typically respond well to amplification.

## Audiogram

## Definition:  Standard Threshold Shift

**A standard threshold shift is a decrease 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.**

**Notes:**
Slide Number: 19
Slide Title: Definition:  Standard Threshold Shift
Discussion with participants

## Standard Threshold Shift (1)

-    **What happens when a decrease in hearing (Standard Threshold Shift or STS) is detected in the annual audiometric evaluation:**
***Employee is informed of STS in writing within 21 days (29 CFR 1910.95 g 8 i).  ***
***Employee is retested within 30 days to verify STS (29 CFR 1910.95 g 7 ii).***
**(Continued on the next slide)**

**Notes:**
Slide Number: 20
Slide Title: Standard Threshold Shift (1)
Discussion on Hearing Threshold Shift continued.

## Standard Threshold Shift (2)

**If STS verified and is work related then:**
***If not using hearing protection employee shall be fitted and trained in the use and care of PPE (29 CFR 1910.95 g 8 ii A).***
***If employee is using hearing protection the employee shall be refitted and retrained (29 CFR 1910.95 g 8 ii B).***
***The employee shall be referred for a clinical audiological or otological evaluation, as appropriate (29 CFR 1910.95 g 8 ii C).***
**(Continued on the next slide)**

**Notes:**
Slide Number: 21
Slide Title: Standard Threshold Shift (2)
Discussion on Hearing Threshold Shift continued.

## Standard Threshold Shift (3)

**Employee is informed of the need for an otological examination if a medical pathology of the ear that is unrelated to the use of hearing protectors is suspected.**
** ****(29 CFR 1910.95 g 8 ii D)**

**Notes:**
Slide Number: 22
Slide Title: Standard Threshold Shift (3)
Discussion on Hearing Threshold Shift continued.

## Test Yourself to Recognize Hearing Loss (1)

***The following questions will help you determine if you need to have your hearing evaluated by a medical professional*****: **
**Do you have a problem hearing over the telephone?           [Yes]  [No]**
**Do you have trouble following the conversation when two or more people are talking at the same time?  [Yes]  [No]**
**Do people complain that you turn the TV volume up too high? **** [Yes]  [No]**
**Do you have to strain to understand conversation?            [Yes]  [No]**
**Do you have trouble hearing in a noisy background?         [Yes]  [No]**
**(Continued on the next slide)**

**Notes:**
Slide Number: 23
Slide Title: Test Yourself to Recognize Hearing Loss (1)

## Test Yourself to Recognize Hearing Loss (2)

**Do you find yourself asking people to repeat themselves?  [Yes]  [No]**
**Do many people you talk to seem to mumble (or not speak clearly)? ****[Yes]  [No]**
**Do you misunderstand what others are saying and respond inappropriately?  [Yes]  [No]**
**Do you have trouble understanding the speech of women and children?  [Yes]  [No]**
**Do people get annoyed because you misunderstand what they say?  [Yes]  [No]**

**Notes:**
Slide Number: 24
Slide Title: Test Yourself to Recognize Hearing Loss (2)

## Test Yourself to Recognize Hearing Loss (3)

**If you have answered "****yes****" to three or more of these questions, it is suggested that you consult an otolaryngologist (an ear, nose, and throat specialist) or an audiologist for a hearing evaluation. **
**The material on Slides 14-16 is for general information only and is not intended for diagnostic or treatment purposes. A doctor or some other health care professional must be consulted for diagnostic information and advice regarding treatment.**

**Notes:**
Slide Number: 25
Slide Title: Test Yourself to Recognize Hearing Loss (3)
The presenter must emphasize that Test Yourself to Recognize Hearing Loss  is for general information only and is not intended for diagnostic or treatment purposes. A doctor or some other health care professional must be consulted for diagnostic information and advice regarding treatment.