Health Surveillance – Noise

Hearing Checks and Audiometric Testing

The purpose of hearing checks and audiometric tests is to provide early diagnosis of any hearing loss due to noise and to assist in the preservation of hearing in order to:

• Warn you when employees might be suffering from early signs of hearing damage,
• Give you an opportunity to do something to prevent the damage getting worse,
• Check that the control measures in place are effective and are working.

Occupational hearing loss happens gradually over time. Employee’s often fail to notice changes in their hearing ability until a relatively large change occurs. By comparing audiometric tests from previous years, early changes can be detected and appropriate protective measures can be implemented to prevent further damage. Such testing to detect early indications in order to prevent further damage is called ‘health surveillance’.

Ideally, the health surveillance should begin before people are exposed to noise (i.e. for new starters or those changing jobs), to give a baseline. It can, however, be introduced at any time for employees already exposed to noise. This would be followed by a regular series of checks, usually within a year of initial screening and then at three-yearly intervals (although this may need to be more frequent if any problem with hearing is detected or where the risk of hearing damage is high).

An employer must provide health surveillance for all employees who are likely to be regularly exposed to noise levels above the lower exposure action values, exposed to a combination of noise and or ototoxic substances, or are at risk for any reason, e.g. they already suffer from hearing loss or are particularly sensitive to damage.

What is involved in a Health Surveillance/ Audiometric Testing Programme?

• Regular hearing checks in controlled conditions,
• Telling employees about the results of their hearing checks
• Keeping health records
• Informing both the employer and employee of any actions or preventative measures necessary

“Preventive audiometric testing” strictly involves an audiometric screening test only.

The essential difference between a “hearing check” and “preventative audiometric testing” is that the former involves a more complete assessment, including taking of a medical history and an examination including otoscopy (examination of the external auditory canal and the tympanic membrane).

Regulation 131 of the General Applications sets down minimum standards, many employers will choose to perform “hearing checks” on all noise-exposed employees because the audiogram on its own is not as beneficial.

The testing / hearing checks needs to be carried out by a competent person. The whole health surveillance programme should be under the control of an occupational health professional (for example a doctor or a nurse with appropriate training and experience).

Advice to Employers and Employees

• Where hearing checks and preventive audiometric testing are made available, workers may avail of them if they wish, but they may choose not to have them.
• Employers need to consider the relative risk of noise-induced hearing loss (NIHL) in their workplace by having suitable noise surveys carried out.
• Detailed noise surveys (looking at various areas of the workplace) should be available to the person conducting hearing checks if requested.
• Employees need to be advised of a planned audiometric test, so that they can have a ‘quiet time’ of ideally 16 hours beforehand.   
• Workers using ear protection should be told to bring it along to the audiometric examination.
• Employers will need to keep records of the health surveillance and fitness-for-work advice provided for each employee (but not the confidential medical records which are kept by the medical practitioner).
• Employers should not have access to medical information on the employee, including that which may be in any questionnaire, without the expressed permission of the employee. The registered medical practitioner or health care professional in charge of the record is responsible for ensuring confidentiality is respected.
• Employees can ask the registered medical practitioner or health care professional for the information contained in their own health surveillance records to be made available, provided they give reasonable notice to them. The results should be explained by them to the employee. The employee is normally entitled to a copy of their individual test if requested.

Further information on hearing checks and audiometry:

• Frequently asked questions (FAQs) on Noise
• Guidelines on Hearing Checks and Audiometry – NOTE this publication is currently under review