How occupational health practitioners can address noise at work

More young people are starting work with damaged hearing, which is a challenge for employers seeking to control the risk of noise at work. Sarah Silcox reports.

New research among US teenagers concludes that growing numbers of 12- to 19-year-olds have damaged hearing, which some commentators attribute to increased use of personal music players (PMPs), such as iPods. This highlights the role of effective baseline assessments in a comprehensive hearing health surveillance programme, particularly in the case of employees exposed to workplace noise at or above the action levels set out in the Control of Noise at Work Regulations 2005.

Health surveillance begins at recruitment stage

Employers must provide hearing checks for all employees who are likely to be frequently exposed to noise levels above the legal upper exposure action values, or crucially, who are at risk because they already suffer from hearing loss or are particularly sensitive to damage.

Health surveillance for hearing loss typically includes regular hearing checks, but employers also need to ensure that these checks are followed by a medical examination in cases where damage is detected. The purpose of hearing checks should be to warn the organisation that an employee might be suffering from the early signs of hearing damage. HSE guidance suggests that ideally “you would start the health surveillance before people are exposed to noise (ie for new starters or those changing jobs)”.

An HSE spokesperson told Occupational Health that the regulator is “reviewing its general messages on health surveillance to provide clearer and more consistent advice”, and is aware of the issues surrounding the adequacy and quality of hearing health surveillance in particular. An HSE noise and vibration control project between 2006 and 2008 found that a high proportion of dutyholders who should have surveillance in place did not, and identified a number of weaknesses in OH provision in this area.

For example, HSE guidance was misinterpreted and there was confusion over diagnosis and referral. In particular, smaller OH providers lacked specialist training, policies and protocols, and “provided hearing health surveillance at incorrect intervals, failed to refer affected persons on for specialist advice and failed to provide adequate advice to management”, according to the spokesperson.

OH profession’s role

Occupational health (OH) services should have a vital role to play in designing workplace audiometry. The HSE guidance points out that hearing checks need to be carried out by a professional with appropriate training, and the whole health surveillance programme needs to be under the control of an OH professional. For example, any staff recruited into a job role that is identified as exposing them to the risk of high noise levels should be referred to the OH service early after appointment.

Following such a referral, the OH professional will typically recommend a range of actions, depending on the predicted level of exposure. Those appointed into these high-risk roles should have a baseline audiometric test on starting work, or within a reasonable period of starting work, followed by regular subsequent checks as part of ongoing health surveillance. One-off hearing checks may be required in the event of an adverse noise event, for example, a loud peak of sound through a loudspeaker or as a result of machinery malfunction.

Initial checks should be followed by tests at regular intervals, usually annually for the first two years of employment and then at three-yearly intervals. However, checks may need to be carried out more frequently if a hearing problem is detected, or where the risk of damage is especially high owing to the nature of the work.

The OH team can also perform a useful role by feeding back aggregated data on hearing health surveillance to relevant managers to aid evaluation of noise control measures.

Lifestyle helps identify problems

George Horton, director of audiometric services company, Occupational Audiometry believes it is important to check employees early in their employment to determine the extent of any hearing loss before any exposure to noise in the workplace.

Horton says questions for a baseline assessment should include: “Did they come in with bad hearing, is any noise exposure being screened out, and are the individuals aware of the potential damage if they do not wear hearing defenders?” He adds that his consultants will always point out to employees on clients’ sites that it is their responsibility to use any personal protective equipment (PPE) provided.

The emergence of hearing loss is often a “slow slide”, reinforcing the need to carry out regular testing on a yearly or biannual basis, starting with a baseline assessment, Horton states. Occupational Audiometry uses a lifestyle questionnaire, asking new recruits for information on their activities outside work, details of any injuries or incidents before joining the employer that might have affected their hearing and any genetic information relating to a family history of hearing loss.

“We build up a potted history of lifestyle and work factors, for example, have they previously worked in a noisy environment and, if so, did they use ear defenders”, Horton adds.

The baseline assessment includes a traditional hearing check, incorporating an inspection of the eardrum and a series of booth tests. Results are cross-referred to the levels that should be expected depending on age and gender. Hearing loss is similar to stress in some ways, in that it is difficult to demonstrate that any damage is specifically caused or made worse by work, or by lifestyle behaviours outside work. “Employers and professionals cannot control what happens outside the workplace, but can act to control exposure to noise within it, and seek to educate and train people to use the protective equipment provided”, Horton concludes.

Personal music players risk factors

The use of personal mucic players has grown faster than our ability to assess their potential health consequences, according to Ann Gallagher, director of OH medical services at Capita Health Solutions. This lack of evidence has implications for workplace noise health surveillance, “since we base risk assessments on our long-standing experience of noise-induced hearing losses with adult industrial workers”.

However, she adds: “We are yet to see whether or not larger volumes of employees will come through the OH route during health surveillance with noise-induced hearing loss due to listening to music via PMP headphones. Currently, there have been few documented cases of significant hearing loss that can be linked to this.”

Capita endeavours to provide a common sense solution in the face of a lack of guidance. It advises and educates employees on the risks from loud noise – in and outside work – and on taking better care of their hearing generally. For example, workers are advised to use hearing pro-tection when using noisy tools at work, and to keep volumes on PMPs “to the minimum comfortable volume, particularly if used with headphones for long periods of time”.

Noise: what the law says

The Control of Noise at Work Regulations 2005 require employers to take specific action when noise levels in any part of the workplace reach certain “action values”. These relate to both the levels of exposure to noise experienced by employees (averaged over a working day or week), and the maximum noise (expressed as peak sound pressure) to which employees are exposed on a working day.

Lower exposure action values: 80dB daily or weekly exposure, and a peak sound pressure of 135dB.

Upper exposure action values: 85dB daily or weekly exposure, and a peak sound pressure of 137dB.

There are also maximum noise exposure levels, which must not be exceeded, taking into account any reduction in exposure provided by hearing protection: 87dB daily or weekly exposure, and a peak sound pressure of 140dB.

Actions that employers must take if noise levels reach or exceed any of these exposure values include:

Employers must provide hearing protection, and establish hearing protection zones, if noise levels in the workplace reach or exceed 85dB (daily or weekly average exposure).

Organisations must assess the risk to health and provide workers with information and training if noise levels at work touch 80dB.

A maximum exposure limit of 87dB is also set in the Regulations, above which workers must not be exposed, taking account of any reduction in exposure provided by hearing protection.

The Regulations also require employers to carry out health surveillance for workers regularly exposed to noise levels above 85dB.

The primary aim of the Regulations – which are based on European Union Directives – is to ensure that workers’ hearing is protected from excessive noise at work, which could cause them to lose their hearing and/or suffer from tinnitus. The legal limits and protections described in the Regulations do not apply to members of the public exposed to noise during non-work activities, or when they choose to go to noisy venues, for example, concerts and gigs.

“Noise at work: guidance for employers on the Control of Noise at Work Regulations 2005”.

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