CAOHC Study Guide: Noise Induced Hearing Loss (NIHL), Exams of Nursing

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CAOHC Study Guide

NIHL (Noise Induced Hearing Loss) - Answer-22 - 28 million US workers exposed to harmful levels of noise. Manufacturing accounts for most. Noise exposure - Answer-major cause of tinnitus. Tinnitus - Answer-is usually a high pitched sound that person hears, others usually cannot hear. Major warning sign of NIHL. What are the auditory effects of noise (NIHL)? - Answer-- hearing loss, high freq, usually bilateral, 1st seen at 3kHz-6kHz

• tinnitus
• communication interference, backgound noise in loud room, causes difficulty hearing
• damage to Inner Ear/COCHLEA, permanent and progressive. What are the non-auditory effects of noise? - Answer-- effects job performance
• irritability
• trouble sleeping
• concentration
• increased BP & pulse.

What are the lasting effects of NIHL (noise induced hearing loss) - Answer-Lasting effects of NIHL: High frequency hrg loss/damage to the Inner Ear- Cochlea. Usually has tinnitus, has difficulty understanding speech especially in noisy situations, social withdrawal, depression, effect on private life. At which level(s) does NIHL (noise induced hearing loss) first appear? - Answer-- appears somewhere between 3kHz and 6kHz

• you see a Noise "notch" on the audiogram and with further exposure
• the notch deepens and widens because it progresses. What is seen on an audiogram between 3kHz and 6kHz that gets deeper and wider as it progresses due to further exposure? - Answer-noise "notch" What is CAOHC? - Answer-Council for Accreditation in Occupational Hearing Conservation formed in the mid 1960's. What is CAOHC PRIMARY role? - Answer-- provides resources/guidance/training to OHCs (Occupational Health Conservationist)
• facilitates practice of hearing loss prevention through standardized training
• provides training to CDs and PSs. Which organizations or disciplines are on the CAOHC council? - Answer-CAOHC consists of 2 Reps from each organization; -There are 9 organizations:
  1. American Academy of Otolarygology-Head and Neck Surgery
  2. American Academy of Audiology;
  3. American Association of OHNs;
  4. American Coll. of Occupational and Environmental Medicine;

5. American Industrial Hygiene;
6. American Society of Safety Engineers;
7. American Speech-Language-Hearing Association;
8. Institute of Noise Control Engineering;
9. Military Audiology Association Role of OHC - Answer--can do audiometric pure tone air conduction only Role of Audiologist - Answer- Role of Nurse - Answer- Role of Physician/Audologist - Answer-- serves as PS

• must supervise audio monitoring of HCP
• can also be the HCP Mgr but does not have to be Role of Safety Engineer - Answer- Role of IH (Industrial Hearing) - Answer- Role of Management - Answer- What is the Hearing Conservation Law/Amendment - Answer-The Regulation is CFR 1910.95. NIOSH (National Institute of Safety and Health) - Answer-- determines BEST PRACTICE with no consideration to cost

OSHA (Occupational Safety and Health Administration) - Answer-- writes regulations

• enforces & issues citation
• considers economic impact to companies OHC (Occupational Health Conservationist) - Answer-- must follow the most STRINGENT standard of the Hearing Conservation Law
• According to OSHA, takes care of RECORDKEEPING What is PEL? - Answer-- any sound above 90 dBA 8 hour TWA
• needs HP (Hearing Protection) What is the Action Level? - Answer-- 85dBA or greater 8 hour TWA
• requires employer to start HCP and make HPDs available. What is the Exchange Rate - Answer-- 5dB US
• 3dB Europe and some professional groups Hearing Conservation Amendment - Answer-The Regulation is CFR 1910.95. When does HCP (Hearing Conservation Plan) begin? - Answer-- if you cannot engineer noise out down below AL
• if exposure is 8 hr-TWA at 85dBA or greater What are the elements of a HCP (Hearing Conservation Plan)? - Answer-- Noise measurement, noise control
• audiometric monitoring,

• HPDs (Hearing Protection Devices)
• Worker training
• Recordkeeping
• Program Evaluation dBC scale - Answer-- more linear and
• used for determinations of NRR (Noise Reduction Rating) and
• used for determinations of community noise What is a PS (Program Supervisor) - Answer-- An Audiologist/Physician
• supervises audio monitoring of HCP (Hearing Conservation Program)
• can also be the HCP Mgr but does not have to be

15. State and local requirements - Answer-must MEET or EXCEED federal standards OHC/Employers - Answer-must follow MOST federal standards DoD - Answer-- different than OSHA-

• more proactive;
• 3 dB Exchange Rate
• lower PEL.
  • Answer-State and local requirements must MEET or EXCEED federal standards. OHC/Employers must follow MOST

DOD different than OSHA- more proactive; 3 dB Exchange Rate, lower PEL.

23. • Answer-You have 6 months to establish a baseline but if you use a mobile service, you have ONE YEAR to establish the baseline!
24. • Answer-PEL - 90 dBA 8 hour TWA- above that needs HP; Action Level:-85dBA or greater 8 hour TWA -requires employer to start HCP and make HPDs available. Exchange Rate - 5db US; 3dB Europe and some professional groups. Physics of Sound/Anatomy: - Answer-
25. • Answer-To find out an individual's noise exposure, DOSIMETRY is best.
26. • Answer-Weighting scales when measuring noise: dbA-used for regulatory OSHA compliance in hearing conservation
27. • Answer-Sound is described by its frequency, amplitude and temporal characteristics (steady state, intermittent, impact/impulse),
28. • Answer-Frequency is measured in cycles per second (cps) or Hertz; Amplitude of Sound Pressure Level is measured in decibels (dB).
29. • Answer-If you are exposed to greater than 90dBA, youi must wear hearing protection. If you have a shift, different hearing protection must be fit and employee must be retrained in their use. If you are exposed to between 85-90dBA, you are in HCP but do NOT have to wear HP UNLESS you have a shift in hearing. Then you MUST be fit and trained to use hearing protection.
30. • Answer-The Eustachian tube provides drainage and keeps pressure equal with the outside.

32. • Answer-The semi-circular canals control your balance. Also called labrynth. AUDIOGRAM: - Answer-
33. • Answer-Decibels are NOT linear and cannot be added. Two sound sources cannot be added nor 2 HPDs..
34. • Answer-Aubible frequencies at birth 20-20,000 cps. Audible amplitude level approx 0 dB to 120 dB.
35. • Answer-Who diagnoses ear disease? ....An ENT!
36. • Answer-Outer ear (pinna/auricle) collects sound and provides resonant amplification. Middle ear (ossicles- hammer, anvil, stirrup) is an acoustic transformer, provides pressure equalization and protects inner ear. Inner Ear codes intensity and frequency of sound on basilar membrane and sends signal to brain up 8th Cranial Nerve -Auditory Nerve.
    • Answer-
37. • Answer-Audiometric tests provide the cornerstone to your HCP.
38. • Answer-Conductive loss - usually treatable; usually flat wave form and worse in lower frequencies. Sensorineural is usually NOT treatable, except for TTS (Temporary Threshold Shift), usually a sloping wave form worse in the higher frequencies. Mixed hrg loss - combination. - Answer-

34. • Answer-Medical causes of hearing loss: Cerumen, Infection, Eustachian tube dysfunction, diseases of the ossicles -otosclerosis. These cause CONDUCTIVE LOSSES. Inner ear hearing loss from: Noise, Presbycusis Ototoxic meds, acoustic neuroma, childhood illness, genetics. - Answer-
35. • Answer-Presbycusis: hearing loss as a result of age. Sociocusis/loss from noisy society. Hyperacusis/overly sensitive to sound..
36. • Answer-Audiometry is the term used to describe formal measurement of hearing.
37. • Answer-Visual exam NOT required before audio but GOOD PRACTICE id. Contraindications for performing test, documents size and shape of ear canal for earplug fitting..
38. • Answer-Best hearing - 1-4kHz, Speech - 250-4000Hz, Required test frequencies -500Hz - 6kHz (8kHz is BEST PRACTICE); NIHL - 3-6kHz.
39. • Answer-Give examples of some questions you need to ask on a aural history form?
40. • Answer-The two axes on a audiogram are FREQUENCY and SOUND PRESSURE LEVEL measured in cps and dB.
41. • Answer-Hearing testing is a means of evaluating an individual's overall hearing function
42. • Answer-Too much background noise will affect your results in the low frequencies i.e. 500 Hz.
43. • Answer-If you have normal hearing in one ear but are deaf in the other, REFER to -Physician + Audiologist.

42. • Answer-Never test someone with hearing aids in. Take out and test.
43. • Answer-Hearing results are graphed with X"s (Left) and O's (Right) on an AUDIOGRAM.
44. • Answer-What type of stimulus should you use when testing someone with tinnitus?
45. • Answer-Difference between HL, HTL and SPL. HL means the sound came through an audiometer. HTL is measured in decibels.
46. • Answer-Pure tones are used for hearing tests (easy to calibrate). (Versus complex tones like speech).
47. • Answer-Definition of Threshold: Softest level someone can hear a tone 50% of time.
48. • Answer-Which is the BETTER hearing threshold? 25 dBHL or 5 dBHL?
49. • Answer-When determine someone's threshold (the softest sound they can hear) , decrease by 10dB and go up in 5 dB steps
50. • Answer-Difference between asymmetric and unilateral hearing loss. TTS and STS: - Answer-
51. • Answer-When should you test manually? What can cause audiograms to be invalid?
52. • Answer-Who should REVISE BASELINES?

Calibration: - Answer-

59. • Answer-How do you do a functional/listening check?
60. • Answer-The best "treatment" for TTS is at least 14 hours rest, and then retest.
61. • Answer-A STS is an average shift of 10 dB at 2k, 3k and 4kHz in either ear from current audiogram to baseline. Who determines a shift? Who determines work-relatedness?
62. • Answer-What are some symptoms of an STS? Tinnitus, muffling of sound, difficulty understanding speech in noise. NOT vertigo/headache.
63. • Answer-Acoustic calibration= Annual calibration.
64. • Answer-Listening Check = FUNCTIONAL CHECK.
65. • Answer-What is a Biological calibration?
66. • Answer-Earphones are weakest part of audiometric equipment; must be calibrated to machine.
67. • Answer-Know SPL octave band limits for OSHA and ANSI (best practice-try to meet). NOISE and HPDs: - Answer- resistance; Occlusion Effect- hear your own voice which sounds odd/plug not in far enough. - Answer-

Annual Training of HCP Participants: - Answer-

65. • Answer-What is the only calibration where someone would go inside the audiometer to fix? Exhaustive.
66. • Answer-Who determines ambient noise levels? Sound engineer/IH in plant setting. Calibration company would do it for hearing booth.
67. • Answer-Doing annual hearing conservation training is BEST done one on one or in SMALL GROUPS.
68. • Answer-Who would reduce the noise in the workplace? The noise ENGINEER would make first steps.
69. • Answer-Why measure noise? Determines whether hazards to hearing exist, who needs in HCP/enables selection of HPDs.
70. • Answer-3' Rule of Thumb - Have to raise your voice at 3' to be understood, noise is TOO loud and need HPDs
71. • Answer-NRR - over-inflated; Derating methods - OSHA (NRR divide by 2); NIOSH - NRR - 7 dB and then divide by two.
72. HPDs reduce noise at ear level and ultimately reduce risk of NIHL. - Answer-
73. BEST HPD? The one that is worn and/or the one employee has a choice in picking! - Answer-

72. Double HPDS -CANNOT add the NRRs of the two products together! Add 5 dB. to higher NRR product. - Answer-
73. How to tell if HPD in correctly - foam - not visible as behind tragus, Tug test - good seal has formed vacuum so when you pull on plug, should feel - Answer-
74. • Answer-How to effect changes in human behavior; simulations of hrg loss, job restriction/loss/threat/gift cards.
75. If a worker has dirty hands, the foam roll-down plug would NOT be good to use. - Answer-
76. • Answer-Most earplugs can be washed with soap and water. Make sure they are DRY before inserting..
77. • Answer-Teaching/motivating workers INDIVIDUALLY is the most effective training method.
78. • Answer-Annual HC employee training topics: Effects of Noise on hrg, purpose, pros/cons of HPDs, purpose of hearing testing. What's the BEST hearing protection a person can use? - Answer-The HPD (Hearing Protection Device) that a person will wear and have a choice in chosing. How often can or should you do a Biological Calibration - Answer-Calibrate Daily What margin of error that would trigger an - Answer- if audiometric test shows - Answer-send to ENT

What's the occlusion effect and how can you use it with a patient in your hearing conservation program?

• Answer-Closing off the ear canal with a hearing protection device. the patient feels like they're getting protection but really not enough from noise exposure. OSHA's permissable noise exposure - Answer-90 dB; Industrial Hygienist would measure hearing on which scale - Answer-"A" scale dBA "C" scale - dBC - room or community noise What is the function of the middle ear? - Answer-(MIS) malleus/Incus/Stapes; acoustic transformer; provides drainage (into Eustacian Tubes) and equalizes pressure. According to OSHA, where does STS occur, - Answer-btw 2-4khz exhange rate according to OSHA in the USA - Answer-