Use of historical data and a novel metric in the evaluation of the effectiveness of hearing conservation program components.

OBJECTIVES: To evaluate the effectiveness of hearing conservation programs (HCP) and their specific components in reducing noise-induced hearing loss (NIHL). METHODS: This retrospective cohort study was conducted at one food-processing plant and two automotive plants. Audiometric and work-history databases were combined with historical noise monitoring data to develop a time-dependent exposure matrix for each plant. Historical changes in production and HCP implementation were collected from company records, employee interviews and focus groups. These data were used to develop time-dependent quality assessments for various HCP components. 5478 male (30,427 observations) and 1005 female (5816 observations) subjects were included in the analysis. RESULTS: Analyses were conducted separately for males and females. Females tended to have less NIHL at given exposure levels than males. Duration of noise exposure stratified by intensity (dBA) was a better predictor of NIHL than the standard equivalent continuous noise level (L(eq)) based upon a 3-dBA exchange. Within this cohort, efficient dBA strata for males were <95 versus ≥ 95, and for females <90 versus ≥ 90. The reported enforced use of hearing protection devices (HPDs) significantly reduced NIHL. The data did not have sufficient within-plant variation to determine the effectiveness of noise monitoring or worker training. An association between increased audiometric testing and NIHL was believed to be an artifact of increased participation in screening. CONCLUSIONS: Historical audiometric data combined with noise monitoring data can be used to better understand the effectiveness of HCPs. Regular collection and maintenance of quality data should be encouraged and used to monitor the effectiveness of these interventions.

Development of a new standard laboratory protocol for estimation of the field attenuation of hearing protection devices: sample size necessary to provide acceptable reproducibility.

The mandate of ASA Working Group S12/WG11 has been to develop "laboratory and/or field procedure(s) that yield useful estimates of field performance" of hearing protection devices (HPDs). A real-ear attenuation at threshold procedure was selected, devised, tested for one earmuff and three earplugs via an interlaboratory study involving five laboratories and 147 subjects, and incorporated into a new standard that was approved in 1997 [Royster et al., "Development of a new standard laboratory protocol for estimating the field attenuation of hearing protection devices. Part I. Research of Working Group 11, Accredited Standards Committee S 12, Noise," J. Acoust. Soc. Am. 99, 1506-1526; ANSI, S12.6-1997, "American National Standard method for measuring real-ear attenuation of hearing protectors" (American National Standards Institute, New York, 1997)]. The subject-fit methodology of ANSI S12.6-1997 relies upon listeners who are audiometrically proficient, but inexperienced in the use of HPDs. Whenever a new method is adopted, it is important to know the effects of variability on the power of the measurements. In evaluation of protector noise reduction determined by experimenter-fit, informed-user-fit, and subject-fit methods, interlaboratory reproducibility was found to be best for the subject-fit method. Formulas were derived for determining the minimum detectable difference between attenuation measurements and for determining the number of subjects necessary to achieve a selected level of precision. For a precision of 6 dB, the study found that the minimum number of subjects was 4 for the Bilsom UF-1 earmuff, 10 for the E.A.R Classic earplug, 31 for the Willson EP100 earplug, and 22 for the PlasMed V-51R earplug.

Alternative field methods for measuring hearing protector performance.

In comparison with the mandatory noise reduction rating (NRR) testing of every hearing protector sold in the United States, real-world tests of hearing protector attenuation are scarce. This study evaluated data from three potential field-test methods as compared with the subject-fit data from Method B of ANSI S12.6-1997 for the E.A.R(R) Express trade mark Pod Plug trade mark. The new field-test methods were the FitCheck headphone (FCH) method, FitCheck in sound field (FCSF) method, and bone-conduction loudness balance (BCLB) method, all of which can be administered in small single-person audiometric booths such as are commonly found in industry. Twenty normal-hearing and audiometrically competent subjects naive to hearing protector use were tested with the laboratory and the three field-test methods in a repeated-measures design. Repeated-measures models with structured covariance matrices were used to analyze the data. Significant effects were found for method, frequency, and first-order frequency-by-gender and frequency-by-method interactions. These effects and interactions were expected given the different psychophysical tasks. The FCSF and BCLB methods provided attenuations that were not significantly different from those found with Method B. Although the attenuations measured for the FCH method were statistically different (greater) than the attenuations from the other methods, the differences were within the magnitude of acceptable test-retest audiometric variability. The results suggest that the FCH and FCSF methods were both feasible and reliable methods for field testing. The FCH method is limited to testing earplugs, and the FCSF requires additional equipment to outfit the test booth, but could be used for testing all types of protectors.

Hearing protector attenuation: models of attenuation distributions.

Current hearing protector rating standards estimate the protection performance for a given frequency as the mean attenuation minus a multiple of the standard deviation. Distributions of real-ear attenuation at threshold data are fit with maximum likelihood estimation procedures using both normal and mixed-normal models. Attenuations from six hearing protectors, Bilsom UF-1 earmuff, Bilsom Quietzone, E.A.R Classic, E.A.R EXPRESS Pod Plugs, Howard Leight MAX, and Wilson EP100 earplugs, measured with a subject-fit protocol are reported. The mixed-normal (bimodal) model provides a better fit to the empirical data than the unimodal model for most frequencies and protectors. Primarily, the bimodal model fits the shape of the distributions caused by data from poorly-fit protectors. This paper presents an alternative method for estimating the protection performance either with the more accurate bimodal model or directly from the empirical cumulative distributions of the attenuation data.

Oxidative DNA damage is associated with intense noise exposure in the rat.

Increasing evidence suggests that noise-induced hearing loss may be reduced or prevented with antioxidant therapy. Biochemical markers of reactive oxygen species (ROS)-induced damage can help elucidate possible treatment timing constraints. This study examined the time course of ROS damage following a 2-h, broad-band noise exposure resulting in permanent threshold shift in 35 Long-Evans rats. Cochlea, brain, liver, serum and urine were analyzed at 1, 3, 8, 72, and 672 h (28 days) after exposure. Oxidative DNA damage was assessed by measuring 8-hydroxy-2'-deoxyguanosine (8OHdG) by high performance liquid chromatography with electrochemical detection. Lipid peroxidation was measured via the thiobarbituric acid-reactive substances (TBARS) colorimetric assay for detection of aldehydes (e.g., malondialdehyde). Auditory brainstem response and distortion product otoacoustic emission thresholds showed progressive elevation for the 3- and 8-h groups, then notable recovery for the 72-h group, and some worsening for the 672-h group. 8OHdG was significantly elevated in cochlea in the 8-h group, and in brain and liver for the 72-h group. TBARS were significantly elevated in serum for the 72-h group. Based upon oxidative DNA damage present in cochlea following intense noise, we postulate that the first 8 h following exposure might be a critical period for antioxidant treatment.