UPDATEThe Newsletter of the Council for Accreditation in Occupational Hearing Conservation

by Susan Cooper Megerson, MA CCC-ACAOHC Chair, Representative of the American Speech-Language-Hearing Association

VOLUME 10 • ISSUE 3 • FALL 1999

continued on page 9

Chair's Message

What’s Inside?Content PageOHC Corner 3

NHCA Brochure 5

Audiometric Testing 7

Conservation For Children 8

Hearing Conservation: Internet Information& Training Resourcesby Merrie L. Healy, RN MPHCAOHC Representative of the National Safety Council

Anyone who has responsibility for an occupational hearing conservation programis aware of the need to obtain up-to-date information and training materials. In aneffort to support that, this article will provide a summary of resources. Bearing in mindthat not all persons have Internet access, addresses and phone numbers will beprovided whenever possible. (The inclusion of the following organizations andresources are not meant to be an endorsement by CAOHC.)

It’s hard tobelieve thattwo years havepassed since Iassumed theposition ofCouncil Chair.It has been myprivilege to

serve with an extremely talented anddedicated group of volunteers andstaff. Due to the input from manyCourse Directors and OHCs and thetireless contributions of CAOHC’sExecutive Committee, CommitteeChairs, Council members andExecutive staff, we haveaccomplished a great deal. I wouldlike to thank this team ofextraordinary individuals for theirdistinguished efforts towardimproving Occupational HearingConservation Programs. Be assuredthat CAOHC’s “next generation” ofofficers and committee chairs areequally committed to CAOHC’smission and goals.

Much of the material in ourprevious issues of UPDATE has

focused on topics germane to yourOccupational Hearing ConservationProgram. We hope that you have foundCAOHC to be a beneficial source ofassistance with your daily practice ofpreserving hearing in the workplace.This month, however, we ask you toconsider broadening your reach. As atrained hearing conservationprofessional, you have the opportunityto spread your knowledge to those whotypically do not have access toinformation on noise and hearingconservation. Why not consider servingas a resource and providing training forthe general public?

Hold a training class for your localneighborhood, civic or religious group.Many people are still uninformed aboutthe hazardous effects of noise andstrategies for protecting their hearing.

Participate in National NoiseAwareness Day (see our Spring 1999UPDATE and the CAOHC Website forfacts on this effort to increase publicawareness).

Provide information for those whosehearing is critical to their hobby orlivelihood, such as singers, bird-

watchers, hunters, or music-lovers(see the enclosed reprint of NHCA’spublic information brochure entitled“Hearing Loss Prevention forMusicians”).

Spend some time with kids! Howoften have you found that youngpeople entering your workforce havelittle or no knowledge of noise andhearing protection? (See the articleon page 8 regarding the “Crank itDown” program for grade schoolchildren).

In order to assist you inpromoting good practices of hearingconservation on the job, and nowbeyond the walls of your workplace,CAOHC routinely provides listingsof references and training materialsavailable through variousgovernment and private sources.Please read on for Merrie Healy’smost recent summary of availableresources.

It has been my pleasure servingyou. Best wishes for much continuedsuccess with your efforts to conservehearing!

Page 2 Fall 1999

CAOHCUPDATE

Published by the Council for Accreditation inOccupational Hearing Conservation, a not-for-profit organization dedicated to theestablishment and maintenance of trainingstandards for those who safeguard hearing inthe workplace.

Articles should be submitted, with a blackand white photograph of the author. TheUPDATE is available to individuals notcertified by CAOHC at an annual subscriptionrate of $15. Payment must accompany request:

611 E. Wells StreetMilwaukee, WI 53202-3816Phone (414) 276-5338Fax (414) 276-3349E-mail: info@caohc.org

• Executive DirectorJanet L. Haynes

• Assistant Executive DirectorBarbara Lechner

• Administrative AssistantChris Whiting

• Publications Committee:Chair & Contributing EditorMerrie Healy, RN MPH

Elliott Berger, MS INCE Brd. Cert.Susan Megerson, MA CCC-AStephen Roth, PEPeter Weber, MD

Opinions expressed in the UPDATE are thoseof the authors, and do not necessarily reflectofficial CAOHC policy. © CAOHC 1999

UPDATE

Printed on recycled paper

OHC CertificationCAOHC Certification is valid

5 years from the date of the original20 hour course. Recertificationthrough an 8 hour course must bemade by the expiration date ofyour CAOHC issued certificate.Your application must be filed withthe CAOHC office to be valid.Contact CAOHC staff to verifycertification or to locate anapproved CAOHC course bycalling 414/276-5338...or locatecourses at CAOHC’s website:www.caohc.org.

If you wish to have your name removed frommail solicitations from vendors who havepurchased the CAOHC database, pleasenotify CAOHC staff via fax at 414/276-3349; or e-mail to info@caohc.org.

New Appointment to CAOHC CouncilThe CAOHC Council is pleased to announce that Paul

J. Brownson, MD will represent the American College ofOccupational and Environmental Medicine (ACOEM) onthe Council effective July 1999. Dr. Brownson replaces Dr.Alex Sanchez as the ACOEM representative.

Dr. Brownson is the Corporate Medical Coordinator forThe Dow Chemical Company in Indianapolis, Indiana, andhas been employed by Dow since 1975. He is a graduate ofthe University of Michigan Medical School and School ofEngineering. Dr. Brownson serves as a member of the

ACOEM Noise Committee and participates in several organizations, among them arethe National Hearing Conservation Association and Acoustical Society of America.

He will be attending his first Council meeting in Atlanta, Georgia on November9, 1999. The CAOHC Council welcomes Dr. Brownson as the ACOEM representativeand looks forward to working with him on CAOHC projects and objectives.

Dear UPDATE Editor:“In your last CAOHC UPDATE, Vol.

10, Issue 2, there is some confusinginformation. In the OHC Corner feature,it states that Standard Threshold Shift(STS) should be recorded on the OSHA200 Log. An STS is generally consideredto be a 10 dB change; I believe OSHArequires recording of a 25dB change.Please clarify.”

John Justin, OHC

Dear John:You are correct. The statement

regarding STS in our last issue isconfusing. In June 1991, OSHA’sDirectorate of Compliance Programsissued a memorandum instructingregional offices to cite companies forfailure to record work-related shifts inhearing of 25 dB or more at 2000, 3000,and 4000 Hz. Several state-run programslater issued more stringent policies,including California, Michigan, NorthCarolina, Oregon, South Carolina,Tennessee, and Washington. For furtherinformation on this often confusing topic,please see “Noise in Washington overHearing Loss Recordability” by SusanMegerson, UPDATE, Vol 6, Issue 1,April 1995 (or view on our website atwww.caohc.org). Thank you for being adiscerning reader of the UPDATE andbringing this to our attention.

Dear UPDATE Editor:“I would like to respond to the

article “Professional SupervisorCourse Held at AOHC” by MichaelHolthouser, MD (UPDATE, Vol. 2,Issue 1, Summer 1999). I takeexception with Dr. Holthouser’sstatement that Hearing ConservationPrograms (HCP) must have a“designated professional supervisor”(an audiologist or physician). Myreading of 29 CFR 1910.95 indicatesthat an audiologist, otolaryngologistor physician must be responsible forthe audiometric portion of a HCP.However, I find no mention in 1910.95that an HCP must be supervised byone of these professionals. CAOHCneeds to clarify this issue and explicitlydefine what it means by “professionalsupervision.”

Edward W. Korabic, PhD CCC-AFAAACAOHC Course Director

Dear Dr. Korabic:CAOHC regrets any misunder-

standing which may have resultedfrom Dr. Holthouser’s summary of aCAOHC-sponsored workshop at theAmerican Occupational HealthConference. You are correct thatCAOHC’s use of the term“professional supervisor” refers tothe audiologist or physician involvedwith managing the audiometric portion

Letters to the Editor

continued on page 8

Fall 1999 Page 3

CAOHCUPDATE

The Role That the Occupational HearingConservationist Plays in Determining theWork-Relatedness of Hearing LossMichael G. Holthouser, MD MPHCAOHC Representative of the American College of Occupational & Environmental MedicineOHC C

orner

continued on page 4

The determination of whether ahearing loss is work-related or not ismade by the professional supervisorof a hearing conservation program.However, this determination can begreatly facilitated by the occupationalhearing conservationist. The reliabilityand amount of supporting informationand the quality of the audiometric datato be reviewed by the professionalsupervisor in the process of makingthis determination can be influencedto a great extent by the OHC.

Being sure that baselineaudiograms are obtained as soon aspossible after employment andassuring that they are obtained after atleast 14 hours of no exposure to noiseabove 85 dBA is fundamental in gettingthe most accurate pre-exposureaudiometric baseline thresholds fornew employees. In addition to this, Isuggest asking about activities that arerelevant to noise exposure within the14 hour “quiet period”, including:transportation to work, recreationalactivities, work activities, use ofhearing protection to attenuateworkplace noise to below 85 dBA, andknowledge of any medications thatmay have been used during the required14 hour period preceding the test. Iwould not accept as a baselineaudiogram one that did not satisfy therequirement that there was really a 14hour “quiet period” preceding theexamination. The initial baselineexamination is one of the mostimportant audiometric examinationsas it serves as the primary referenceexamination for future comparisonsand for disability determinations.

Also, during the pre-placementmedical screening process, whenhearing loss is not usually an issue, Iadvise obtaining a thorough otological

history. Obtaining unbiased otologicalhistory is more difficult once hearingloss becomes an issue. This informationis critical for the professional supervisorin determining work-relatedness ofhearing loss. Forms for the otologicalhistory are available from many sources.One form that I like is contained inChapter 12, of “Medical-LegalEvaluation of Hearing Loss,” by RobertA. Dobie, M.D. Other good otologichistory forms can be found in AppendixVIII of the “Council for Accreditation inOccupational Hearing Conservation(CAOHC) Hearing ConservationManual,” 3rd Edition by Alice Suter. Ifhearing loss develops at a later time, asubsequent or interval otologic historyshould be obtained. This should becompared with the pre-placementotologic history to look for discrepanciesand new developments. Since thesehistories contain medical informationthey must be managed like other medicalrecords under OSHA requirements

To complement the otologic historyand audiometric testing, good pre-placement and pre-audiometric testingotoscopy are important informationelements. Knowing about pre-existingconditions is important in determiningwhether and what kind of hearingprotection would be advisable, whetherreasonable accommodation might beneeded, whether referral to theemployee’s primary care or otherphysician may be indicated and whetherany observed medical abnormality is anew finding or a pre-existing condition.This information must also be maintainedin the employee’s medical record.

The OSHA Occupational NoiseExposure Standard requires that only the500, 1000, 2000, 3000, 4000 and 6000Hz frequencies be tested. Manyotologists and audiologists also

recommend the addition of the 8000Hz frequency in audiometric testing.Although not always, the 8000 Hzthreshold is frequently useful indetermining whether high frequencyneurosensory hearing loss is due tonoise or other causes such aspresbycusis. The cost is minimal forthe information obtained in testing theadditional 8000 Hz frequency.

The OSHA Standard also permitsan “age correction” to be made to themost recent audiogram for the 1000-6000 Hz frequencies to correct for theeffects of aging. Using the “agecorrection” option for the purposes ofOSHA recording is a common practicebecause it helps to keep OSHA-recordables down. There are somedrawbacks, however. If the primaryfocus of the hearing conservationprogram is indeed on conservinghearing and not merely reducingOSHA Form 200 recordability, theprocess of finding temporary thresholdshifts and lower level losses in hearingis made less sensitive by “agecorrection”. “Age correction” shouldnever be used in audiograms beingconsidered for the medical referralprocess since it assumes that all earsare “average” and it essentially pre-diagnoses presbycusis before theprofessional supervisor or referralotologist or audiologist has had theopportunity to properly evaluate thecase.

According to the OSHA Standard,certain information must be includedwith the audiogram (I suggest on theaudiogram form, for simplicity): thename and job classification of theemployee tested, the date of the test,the examiner’s name, the date of thelast acoustic or exhaustive calibration,

Page 4 Fall 1999

CAOHCUPDATE

the employee’s most recent noiseexposure assessment and thebackground noise levels in the audiotest rooms. This is all very importantinformation for the professionalsupervisor as he or she works throughthe process of determining accuracy,validity, reliability of the audiogramsin question and the work-relatednessof measured hearing loss. Regrettably,however, this information is often notincluded with many audiograms that Iam asked to evaluate. This is notsurprising when one considers therecordkeeping requirements of theOSHA Occupational Noise ExposureStandard. For example, OSHArequires that noise exposureinformation be kept for only two yearsand audiometric testing reports foronly the duration of employment. Ifthese records are disposed of, aspermitted by OSHA, and since noiseinduced hearing loss often occurs overa significant number of years, muchcritical information will be unavailableat a later date when work-relatednessis often being determined. Notknowing what the employee’s noiseexposures were 5, 10 or 15 years ago,or in which job an individual workedwithin a given facility, makesdetermining work-relatedness ofhearing loss very difficult. OSHAholds employers responsible forproviding a safe and healthy workplaceas evidenced by compliance withestablished regulations. The burdenof proof about noise exposure levels,for example, lies with the employernot the employee who has aneurosensory hearing loss. Withoutnoise exposure and other keyinformation, the professionalsupervisor should give the employeethe benefit of the doubt and decide inhis or her favor, i.e., work-relatedhearing loss rather than declaring it amedical or sociocusis caused loss,unless he or she had solid informationto the contrary. I recommend recordingand keeping this information in an

organized form for the same length oftime as other medical records underOSHA Standards, i.e., employment plus30 years. Having this information whenthe questions arise can make the OHC areal hero in their company and to theprofessional supervisor.

If abnormalities are discoveredthrough the otologic history, the otoscopicinspection or the audiometric testing andanalysis performed by the OHC, theprofessional supervisor then determineswhat the problem is and whether or not itis work-related. External specialtyconsultation is often indicated for hearinglosses meeting the American Academy ofOtolaryngology/Head and Neck SurgeryReferral Criteria; for those employeeswith medical problems that may affecthearing and about which the professionalsupervisor is unsure; for continuinghearing loss that cannot be explained onthe basis of history, exposure or otoscopy;and for medical pathologies of the ear thatare caused or aggravated by wearinghearing protection. To keep things inproper perspective, these are rare cases inmost hearing conservation programs, butnot handling them correctly can causevery serious consequences for employeesand employers.

Developing a referral network,usually with the help of the professionalsupervisor, and key referral process toolslike form letters can save much time andbe very helpful in the referral process.For instance: having pre-establishedreferral otolaryngologists/otologists andaudiologists with whom you have anunderstanding about costs and fees,(including how non-work-relatedmedical work-ups are to be billed; whoshould receive the final and interimreports; how records should be managed;who will pay the bill and to whom tosend it; which specific questions theprofessional supervisor would like tohave addressed; what additionalinformation is included for the referralspecialist’s review and how follow-upissues should be handled can reallystreamline the process and assure thatwhat is needed from the referral is actuallyobtained the first time around. Doingthis important piece of staff work well

will also be greatly appreciated by thehealth care provider to whom theemployee is sent. Be sure that youhave a signed authorization from theemployee to release medicalinformation selected by theprofessional supervisor to be sent tothe referral otologist or audiologist asyou would for any other medicalinformation being released to a thirdparty. Keeping employees informed,in writing, about how the process worksin your program avoids later confusion.

Making the determination of work-relatedness can be difficult under thebest of circumstances. Havingaccurate, valid and reliable audiometricinformation is very important, but sois having accurate information aboutear pathology and the otologic history.Maintaining hearing conservationprogram records to meet the spirit, aswell as the letter of the law, providessignificant dividends for all involved.Putting all this information togetherinto a seamless package, under thedirection of the professionalsupervisor, results in a reliable andeffective process that hopefully willhelp to conserve employee hearing.

OHC Cornercontinued from page 3

Address Updating Newon the CAOHC Website!

For your convenience, you maynow update your mailing name,address, company name, phonenumber, fax number, etc. viaCAOHC’s website address atwww.caohc.org. Click on the buttonentitled “ADDRESS UPDATE”.Your mailing changes will beforwarded directly to our office e-mail system.

For those of you withoutinternet access, please see page2 for CAOHC’s address,phone, or fax number whenforwarding address changes tothe CAOHC office.

http://www.caohc.org

Not Just for Rockers

Keep H

earing thatRock and Roll

For more inform

ation, contact:N

ational Hearing Conservation Association

9101 E. Kenyon Ave., Ste. 3000, Denver, CO

80237303-224-9022 (V), 303-770-1812 (F)nhca@

gwam

i.com (E-m

ail)http://w

ww

.hearingconservation.org (Internet)

Printed on recycled paper

NH

CA thanks Alan Segal of M

iami Valley H

ospital in Dayton, O

hio andM

arshall Chasin of the Centre for Hum

an Performance and H

ealth Promotion

in Toronto, Ontario for their contributions to this project.

5.97 version

Musicians say it’s all in the feeling —

the raw surge

of power from

the sound that makes you feel at

one with the m

usic and the crowd. T

he down side is

that too many decibels can result in perm

anentdam

age to your ears. Your local audiologist orhearing health professional can suggest w

ays ofenjoying the loud sensation of the m

usic while

playing at a less damaging level.

Musicians are in the business of sound, but m

any areat risk of dam

aging their ability to do the work they

love due to noise-induced hearing loss. Ted Nugent,

Pete Townsend, Lars U

lrich, and countless othersare living testim

ony to the damage that high sound

levels can do to unprotected ears.

This guide is intended to help m

usicians protectthem

selves from the effects of excessive exposure

to sound by providing information and education

about noise and hearing.

While rock m

usicians get their share of the blame for

playing too loud, significant exposure to noise canoccur in m

any other musical settings.

Symphony m

usicians, who in m

any cases put in longhours of rehearsal, m

ay be exposed to sound levelsthat exceed O

SHA

permissible lim

its. Research has

found sound levels exceeding 100 dBA

average, basedon location and acoustical properties of the rehearsal

and perfor-m

ance venues.

The high pow

erof professionalpublic address

systems m

akes noentertainer, crew

, orconcert goer im

mune

to the effects of noise.

How

Did T

hisH

appen to Me?

The part of the hearing system

thatconverts sound w

aves (a physical effect) into nerveim

pulses for your brain to handle (electrical signal) iscalled the cochlea. T

he actual conversion takes placew

hen fluid, excited by sound waves conducted

through the ear, puts the hair cells inside yourcochlea into m

otion.

The hair cells in your ear act like the grass in your

lawn —

walk on them

a little, and they recover. Walk

on them too m

uch, and the damage is perm

anent.R

epeated and excessive exposure to noise is likew

alking on the grass too much. D

ead hair cells won’t

let you hear, they won’t grow

back, and you can’tre-seed your ear.

How

Loudis Too Loud?

How

to be Loudand Safe

On the G

ig and Off

The hum

an hearing mechanism

is amazingly sensitive.

Along w

ith the ability to hear a pin drop (literally!), it canaccom

modate extrem

e sound pressures like gunshotsand explosions.

Dam

age starts to occur with extended exposures to

sound levels of around 85 dBA

. The higher the sound

level, the greater the risk of damage; the longer the tim

eof exposure, the greater the risk.

How

can you tell when the sound around you, be it

industrial, musical, or otherw

ise, is reaching the pointw

here it isdangerous to yourhearing? H

ere area couple of cluesto help figure outif the noise is toom

uch for yourears.

Tinnitus or

ringing in the earsis a sign of potential dam

age. If you hear a ringing or arushing sound in your ears after playing, it w

as too loud.

Temporary T

hreshold Shift —

after exposure toloud noise, you m

ay lose some hearing, then recover

after a rest period in quiet. If, after exposure to noise,conversation sounds m

uffled or unclear, it’s likely thatyou overloaded your hearing system

.

Raise your voice —

if you must strain your voice to be

heard at a distance of about three feet, sound levels arelikely approaching the dangerous range.

■■ ■■■ Turn dow

n. Let the PA carry the load; keep stage

volume at a m

inimum

to protect your hearing.

■■ ■■■ M

onitor yourm

onito

rs. Using

custom earm

old (orin-the-ear) m

onitorscan help reducelevels on stage.

■■ ■■■ P

rotect yourears. C

omm

onlyavailable industrialearplugs m

ay not bew

ell suited form

usical applicationsdue to their strongreduction of treblefrequencies. Severalm

anufacturersprovide m

usician’s plugs (like ER-15, ER

-25, and thevented/filtered type), designed to protect relatively equallyat all frequencies, m

aking the music sound natural. Each

plug has a different effect, and each may be suitable for

different musicians in different situations. C

ontact youraudiologist or hearing health professional for m

ore details.

■

■

■

■

■ E

quipment positioning. Position speaker cabinets so

that your ears do not get the full force of the acousticalenergy. If custom

earphone monitors are not available,

position side fills and floor wedge m

onitors as far away as

practical.

■

■

■

■

■ S

ave it for the gig. The tim

e you spend in rehearsaladds to your total noise dose. R

ehearse at moderate

volume levels. Talk to the drum

mer about using sm

aller orsofter tip sticks for rehearsal.

You only get

one set of ears —

treat them right!

A Q

uick Hearing Test

Pick a quiet place to park yourcar on the w

ay into a concert,rehearsal hall or club. Set thevolum

e on your radio so it isjust barely audible. T

hen,w

ithout adjusting the volume,

see if you can hear the radioafter the show

or rehearsal.If not, you are experiencing atem

porary threshold shift—

which w

ith repeatedexposures, m

ay become

permanent.

Your ears can’t tell the difference between the sound

you expose yourself to in rehearsal and performance

from the noise involved w

ith the rest of your day.Total cum

ulative noise dose is the final word on how

your hearing will last over tim

e.

Lots of thingscan contrib-ute to yourdaily noisedose. A

dayjob in a noisyfactory;operatingnoisy law

n orw

oodworking

equipment;

boom cars;

firearms use;

and many

othercom

mon

activities canresult inpotentialdanger toyour ears.

This chart w

illshow

you therange of som

ecom

mon

sounds.

Chart courtesy of

E-A-R

/AEA

RO C

ompany.

Page 7Fall 1999

CAOHCUPDATE

Recently the CAOHC office hasreceived inquiries as to the correctprocedure for audiometric testing.OHCs are instructed in accordancewith the CAOHC HearingConservation Manual by Alice Suter,3rd Edition based on ANSI S3.21-1978 (located on page 136 of themanual. A copy of the standard maybe ordered via the internet atwww.cssinfo.com/asa/s3.html).

The CAOHC manual outlines theaccepted procedures for thresholddetermination as described below (orsee pages 52-54 of the manual).*NOTE: within the standard there arechoices in those instances when a changein procedure does not significantly affecttest results. Specifically, two optionsare given for the familiarizationprocedure, and the order of frequenciesmay be altered slightly.

“Administering the PureTone Test”

...Although it is not essential, it is agood idea to begin the test in the betterear. Rather than look at the previousaudiogram, which may bias the results,it is best to ask the employee which ishis or her better ear.

The OHC should start byfamiliarizing the employee with a testtone at 1000 Hz, presented at an easilyaudible level, such as 30 or 40 dB. Ifthere is no response, the tone should bepresented again at 50 dB, and if therestill is no response, the hearing leveldial should be raised in 10 dB stepsuntil the employee responds.

Once an initial response has beenestablished, the OHC may begin thedetermination of threshold. The levelof the first presentation should be 10dB below the level of the responseduring the familiarization procedure.The level of each succeedingpresentation depends on whether ornot the employee responded to the onebelow. After a response, the hearing

level dial is decreased by 10 dB, and ifthe employee fails to respond, the levelis increased in 5 dB steps until a responseoccurs. Then move down 10 dB and up5 dB, “bracketing” the employee’sthreshold. Hearing threshold level isdefined as the lowest hearing level wherethe subject hears at least 50 percent of thetones, with a minimum of two out ofthree responses required at a single level.

The duration of each tone presentationshould be 1 to 2 seconds, and the intervalbetween tones should never be shorterthan the duration of the tone itself. TheOHC must be careful to vary the silentinterval between tones so that theemployee does not pick up a rhythmicpattern and give “false” responses totones that are not actually perceived.Needless to say, the OHC should nevergive the employee overt cues during orafter presenting the tones.

According to ANSI standard S3.21(reprinted as Appendix V in this manual),the order of frequencies should be 1000Hz first, then 2000, 3000, 4000, 6000,and 8000 Hz (if this frequency is to beincluded), after that a retest of 1000 Hz,and finally 500 Hz. If the retest of 1000Hz shows a difference of more than 5 dB,the lower threshold may be accepted andat least one other test frequency shouldbe retested. If the difference at 1000 Hzis significant (more than 10 dB), theentire audiogram should be repeated.

Many hearing conservationprofessionals advocate (and manymanufacturers of computerizedaudiometers use) a slightly differenttesting order: 1000, 5000, 1000 Hz,followed by the higher frequencies. Thisorder enables the tester to detectdifferences between the first and secondtests of 1000 Hz more quickly andtherefore to determine the necessity ofreinstructing the employee and repeatingthe test. The extent to which the OHCdeparts from the ANSI standard’srecommended procedure should be thedecision of the OHC’s professionalsupervisor.

Each time a threshold is determined,the OHC should record it on anaudiogram form. If symbols are used,an “X” represents the left ear’s thresholdand an “O” represents the right ear.”

Because annual audiograms arecompared to the baseline it is importantthat testing be conducted in astandardized fashion to eliminatethreshold shifts due to test artifact. Formore information, contact your CourseDirector or the professional supervisorof your audiometric program.

Audiometric Testing—Review the BasicsMyrna M. Stephens, PhDCAOHC Representative of American Speech-Language-Hearing Association

Course DirectorWorkshop Scheduledor Fall 1999

The Fall Course DirectorWorkshop is scheduled forMonday, November 8, 1999 atthe Hilton Hotel Airport~Atlanta,Georgia. If you are interested inbecoming a Course Director andmeet the qualifications describedin the “Course DirectorCertification and RecertificationRequirements” brochure andhave your application approvedby the Screening Committee, youmust then complete a one-dayCourse Director workshop.

You may contact theExecutive staff at 414/276-5338for more information, or accessthe CAOHC web page at http://www.caohc.org

Course Directors presentlycertified who wish to recertifyvia the workshop method mayalso attend.

Seeking EmploymentCAOHC certified technician

looking for an opportunity in the L.A.,California area. Currently enrolled inuniversity studies Health Sciences.Contact CAOHC office for resume.

Page 8 Fall 1999

CAOHCUPDATE

Hearing Conservation Education Now ReachingThousands of ChildrenSubmitted by Dorie Watkins, CAOHC Course DirectorPleasanton, CA

of the HCP. Although the term“professional supervisor” is notmentioned in the body of the standard,29 CFR 1910.95, the qualificationsand duties of this individual are well-defined in the preamble to the hearingconservation amendment and supportdocuments from OSHA. For moredetailed information on this topic,please see “Who is Your ProfessionalSupervisor” by Barbara Panhorst, EdDRN in the UPDATE, Vol. 8, Issue 2,Summer 1997, and “Developing aCurriculum for SupervisingProfessionals in Hearing ConservationPrograms” by Alex Sanchez, Jr., MD,UPDATE, Volume 9, Issue 2, Summer1998 (or view on our website atwww.caohc.org). Thank you forclarifying this issue for our readers.

Letters to the Editorcontinued from page 2

In an article titled Our Children areat Risk of Noise Trauma, [NHCAwebsite “Crank it Down”], author KrisEnglish, PhD writes, “Our society is anoisy one, and the noise is ubiquitous -- in the shopping mall, on the road, in theclassroom -- to the point where webecome unaware of its presence. Yet,the presence and intensity of noise hasbecome so excessive that approximately10 million persons in our country nowlive with Noise Induced Hearing Loss(NIHL) [National Institutes of Health,1990]. Except in the case of head injuryor accidental acoustic blast, NIHL isalways preventable. Unfortunately,children usually are not aware thatexcessive noise levels can be consideredan environmental pollutant and a hazardto their hearing health.”

You might be interested to note thefollowing statistics:

Is there something I can do aboutthis? Yes! Certified OccupationalHearing Conservationists (COHC) and

Course Directors (CD) can be instrumentalin educating young people. Age-appropriate information can be providedto children at an early age to help studentsrecognize the presence of high noise levels,understand the consequences of excessiveexposure to high noise levels, and mostimportantly, learn to change their ownbehaviors in order to prevent NIHL”

What resources are available to me?The CRANK IT DOWN! hearing

conservation education program andnewsletter were designed to educate gradeschool age children and to inform andassist educators regarding the preventionof childhood hearing loss due to excessivenoise exposure.

Where do I buy the CRANK ITDOWN! program?

You don’t buy the program. Thanks toa grant provided by the Hedco Foundationalong with ongoing support from theSERTOMA Club and the National HearingConservation Association, a loaner libraryhas been established. The program packetincludes the lesson plans and scripts foreach activity, the Know Noise video, theUnfair Hearing Test audio cassette and theE•A•R Audio Cassette #1 as well as formsand master handout tips that ensure thesuccess of the program. This program wasdesigned to be easy to teach. No fancyequipment is required - items easily foundaround the house such as uncookedspaghetti, playdough, stereo headset andaudio cassette player. Learning thecurricula is easy and the training is fun!

Regardless of whether you create yourown program, or use portions of theCRANK IT DOWN! program, it isrecommended that the program be simple,repetitive, interesting and fun. Programstypically should include: 1) basic anatomy

of auditory pathway; 2) the nature ofsound, including sound levels of normalconversation, the threshold of pain andspecific activities; 3)the effects ofexcessive noise levels on the hair cellsof the inner ear, as well as thepsychological and physiological effectsof noise; and 4) procedures to protectone’s hearing.

My desire is that you will catch thepassion of how important it is to savethe hearing of our future adults and thenshare that passion by becoming involvedin the education of our youth regardingthe harmful effects of excessive noiseexposure.

How do I get started?Simply contact the National Hearing

Conservation Association Executiveoffice at 303/224-9022

• The incidence of NIHL among 8thgraders has tripled in the last 10years (Montgomery & Fujikama,1992)

• NIHL has been detected in childrenas young as nine years old (Peppard& Peppard, 1992).

• Children’s toys such as toy guitarshave been found to produce noiselevels of 120dB (Shoemaker, 1996).

• Approximately 1% of the schoolage population may have NIHL.(Blair & Benson, 1996) One percenttranslates into more than 400,000children.

®

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CAOHCUPDATE

Internet Informationcontinued from page 1

CAOHC Website Links:(www.caohc.org/related-websites.html)

The CAOHC website (www.caohc.org)provides information that includes adefinition of CAOHC; lists theComponent Professional Organiza-tions (CPO); and provides directionson certification for occupationalhearing conservationists and coursedirectors. Resource informationprovides a sampling of past UPDATEnewsletters and ordering of the HearingConservation Manual. A new section,supplementary course directoreducational materials, has been added.Links to related websites provideadditional resource access. Thisarticle begins with a summary of thosewebsite links:

Acoustical Society of America (ASA)2 Huntington QuadrangleMelville, NY 11747-4502516/576-2360FAX: 516/576-2377www.asa@aip.org

The website offers a “Listen toSounds” program; and an availablecompact disc of auditory demon-strations.

Hearing Education Awareness forRockers (HEAR)P.O. Box 460847San Francisco, CA 94146415/773-9590FAX: 415/552-4296www.hearnet.com

Educational and information materialsinclude “Can’t Hear You Knocking”(VHS video); and sign songs. Devicesand gizmos include audio materialssuch as a CD self-hearing test and“Tinnitus Away!” (cassette). Postersand hearing protection orderinginformation is also available.

League for Hard of Hearing (LHH)71 W. 23rd StreetNew York, NY 10010-4162917/305-7700FAX: 917/305-7888TTY: 917/305-7999www.llh.org

This is the organization that sponsors anational “Noise Awareness Day” (seeUPDATE, Spring 1999 article). A packetof information regarding the impact ofnoise on hearing in a fun, easy format isavailable to promote this event.

National Hearing ConservationAssociation (NHCA)9101 Kenyon Avenue, Suite #3000Denver, CO 80237303/224-9022FAX: 303/770-1812www.hearingconservation.org

This organization offers educationalmaterials such as posters and slides.

National Institute for OccupationalSafety & Health (NIOSH)Hubert H. Humphrey Building200 Independence Ave. S.W.Room 715HWashington, DC 20201 1-800-356-4674www.cdc.gov/niosh/homepage.html

National Institute on Deafness & OtherCommunication Disorders (NIDCD)National Institute of Health31 Center Drive, MSC 2320Bethesda, MD 20892-2320www.nih.gov/nidcd

The following documents are availablefrom NIDCD and NIOSH:

NIOSH Criteria Document

NIDCD Fact Sheet on Noise-InducedHearing Loss

NIOSH: Preventing Hearing Loss -A Practical Guide (Note: thisdocument describes the elements ofan effective Hearing Loss PreventionProgram; and, has an appendix thatlists vendors with educationalmaterials, specifying video titles).

NIDCD book mark “How Loud isLoud” (English/Spanish)

NIDCD Book mark “Ten Ways toRecognize Hearing Loss”(English/Spanish)

NIDCD Directory of InformationResources for Human Com-munication Disorders

Combined Health InformationDatabase (CHID)http://chid.nih.gov

A search using “hearing conservation”elicited 153 citations.

Noise PollutionClearinghouse (NPC)P.O. Box 1137Montpelier, VT 05601-11371-888-8332www.nonoise.org

This site has a library of resources.

Occupational Safety & HealthAdministration (OSHA)U.S Department of Labor200 Constitution Avenue N.W.Room N-3647Washington, DC 20210202/219-8151FAX: 202/219-5986www.osha.gov

OSHA provides regulatory infor-mation related to compliance with thehearing conservation standard (29 CFR1910.95). A search using “hearingconservation” resulted in 184 citations.Program and services includeconsultation and education programs.OSHA also links other governmentand safety and health internet sites.

FYI: Other HearingConservation ResourcesAudiology Forum: Video Otoscopywww.li.net/~sullivan/ears.htm

This site offers a multitude ofeducational, informational articles andvisual materials which can be used asteaching aids.

continued on page 10

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CAOHCUPDATE

Navy Audiology Society Home Pagewww-nmcp.med.navy.mil/audio/nashome.html

This site offers PowerPointpresentations for hearing conservationprograms..

Military Audiology Associationwww.military/audiology.org

The Auditory Readiness InformationCenter offers a slide presentationeducational package.

Safe at Work517/349-5205www.safe-at-work.com

This site provides information aboutsound exposure monitoring andcontrol, and the hearing loss preventionprocess. Be sure to check the“REFERENCE” section. A slidepresentation “Hearing Loss Preventionas a Business Process” includesspeaker notes.

National Safety Council1121 Spring Lake DriveItasca, IL 60143-3201630/285-1121FAX: 630/285-1315www.nsc.org

The NSC library is a source of safetyand health information. Literaturesearches by topic are free for members.Nonmembers are assessed a fee forservices.

Aearo CompanyBerger, EH (1979-1993) E-A-R LogSeries of Technical Monographs onHearing and Hearing Protection, Nos.1-20. Contact Customer Service at 1-800-225-9038.

Film and videotape information:Contact Elliott Berger (317/692-3031)

Noise & Hearing Conservation-References for Good Practice:Standards, Regulations, andRecommended References Pertainingto Noise, Vibration, and Noise-InducedHearing Loss ( AIHA and NHCA),

This document was prepared by theAmerican Industrial HygieneAssociation (AIHA) and the NationalHearing Conservation Association(NHCA). It cites over 200 referencesorganized in the following sections:Overview; Hearing ConservationProgram Administration Guidelines;Quick References; ProfessionalOrganizations, Publications, and HomePages; TLVs; Guidelines, PositionStatements, and Criteria Documents;National and International Standards;Databases and Programs; Handbooks,Textbooks and Review Articles; U.S.Government Regulations and Reports;and Other Regulations and Reports.

The first three sections are availableon the NHCA website (previously

Internet Informationcontinued from page 9

CHARGE IT!Students who have successfully completed a CAOHC certification or

recertification course may now use their Mastercard or Visa credit card forCAOHC certification or recertification fees, or to order the CAOHC manual.Simply include your charge card number and expiration date on the applicationform, or the manual order form if you are purchasing the Hearing ConservationManual. You may also phone in your credit card number by contacting ChrisWhiting at the CAOHC office: 414/276-5338. (You may also continue to use acheck, cash or money order for these fees.)

We are working on adding this feature to the CAOHC website along with on-line forms. More information on this will appear in the Winter 1999 edition ofthe UPDATE.

COUNCIL MEETING& COURSE DIRECTOR WORKSHOP—SPRING 2000

The Spring 2000 Council meeting has been scheduled for Thursday, April13, 2000 in Philadelphia, Pennsylvania at the Embassy Suites Hotel,Philadelphia International Airport.

This meeting will be followed on Friday, April 14, 2000 with a CourseDirector Workshop. This workshop is for applicants completing the requirementsto become certified as a Course Director or CDs wishing to recertify via theworkshop method. Contact Barbara Lechner at 414/276-5338 on how to becomea Course Director or reference the CAOHC website at www.caohc.org.

mentioned in this article). The entiredocument is free to NHCA membersand can be purchased by non-members for $50.

Information Please!!Those of you “in the trenches”

involved with training and educationhave probably found some very usefulresources and tools. CAOHC requeststhat you share information about suchmaterials for publication in a futureUPDATE. We often learn best fromeach other! Information can be sentto:

UPDATE EditorCouncil for Accreditation inOccupational Health Conservation611 E. Wells StreetMilwaukee, WI 53202Phone: 414/276-5338FAX: 414/276-3349E-Mail: info@caohc.org

19991999199919991999

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CAOHCUPDATE

Upcoming OHC Certification and Recertification Courses*Approved as of September 1999

Date City Course Director Phone Date City Course Director Phone

Please contact the CAOHC office at 414/276-5338 for additional course availability. Publication dates may have precluded some course dates.

*The listed dates indicate day one of the scheduled classes; certification courses are 20 hours in length; recertification classes are 8 hours.

9/15 Ft.Hood, TX Johnson, Maj Jennifer (Army)10/4 Walnut Creek , CA Fankhauser, Charles 707/746-633410/4 Hanover, MD Moreland, Rebecca 410/646-212110/4 Portland, OR Atack, Rod 503/614-846510/5 Iwaku, Gullickson, Kimberly (Navy)10/6 St.Paul, MN Cary, Carolyn 651/736-208910/6 Owensboro, KY Etienne, Joseph 502/926-041810/6 Lindenwold , NJ Stepkin, Richard 609/435-720010/6 Los Angeles, CA Deppensmith, Kathryn 713/869-666410/6 St.Louis , MO Elmore, John 800/357-575910/6 Atlanta, GA Wolfe, William 770/475-205510/11 South Padre, TX Rhodes, Robert 713/869-666410/11 Omaha, NE Norris, Thomas 402/391-398210/12 Ft.Sam Houston , TX Byrne, Col.Clyde (Army)10/13 Buffalo, NY Swisher, Timothy 412/367-869010/13 Houston, TX Meloy, Melette 205/444-979710/13 Brookfield , WI Korabic, Edward 414/288-342810/13 Detroit, MI Simpson, Thomas 313/577-675410/13 Boca Raton , FL Greenberg, Herbert 561/750-210010/13 Denver , CO Harris, Dean 970/586-070210/14 Detroit, MI Rhodes, Robert 713/869-666410/18 Liberty, MO Ratliff-Hober, Linda 800/664-840110/18 Palm Beach , FL Elmore, John 800/357-575910/19 Torrance , CA McCall, Kirsten 800/334-547810/19 Oakbrook Terrace , IL Thunder, Thomas 847/359-106810/19 Atlanta, GA Russell, Charles 610/667-171110/19 Charlotte, NC Newman, Valerie 704/525-099910/20 Rochester, NY Rhodes, Robert 713/869-666410/20 Charlotte, NC Newman, Valerie 704/525-099910/20 Shelton, CT Sochrin, Phyllis 203/735-432710/20 Torrance , CA McCall, Kirsten 800/334-547810/20 Oakbrook Terrace , IL Thunder, Thomas 847/359-106810/21 Minneapolis, MN Deppensmith, Kathryn 713/869-666410/25 Beaufort , SC Faulkner Gischia, Carol (Navy)10/25 New Orleans, LA Rhodes, Robert 713/869-666410/27 Tampa, FL Abrams, Harvey 727/398-939511/1 Worcester, MA Hengen, Garth 508/832-848411/2 Atlanta, GA Moore, A.Gregg 770/953-469911/2 St.Louis , MO Bellamy, McKenna 314/968-471011/3 Atlanta, GA Moore, A.Gregg 770/953-469911/3 Birmingham , AL Meloy, Melette 205/444-979711/3 Somerset , NJ Rhodes, Robert 713/869-666411/3 St.Louis , MO Deppensmith, Kathryn 713/869-666411/3 Salt Lake City , UT Cronin, Pamela 801/566-830411/3 Little Rock, AR Prince, Jane 870/972-116611/3 Fairfield, ME Giroux, Anne 207/873-327711/3 Springfield, MA Hengen, Garth 508/832-848411/8 Liberty, MO Ratliff-Hober, Linda 800/664-840111/8 Colorado Springs , CO Elmore, John 800/357-575911/8 Phoenix, AZ Deppensmith, Kathryn 713/869-666411/8 Hillside , IL Stukas, Natalie 630/241-099011/9 Indianapolis , IN Jerome, James 317/841-106511/9 Houston, PA Thompson, Tami 816/471-390011/10 Houston, TX Rhodes, Robert 713/869-666411/10 Ft. Hood , TX Johnson, Maj. Jennifer (Army)

1999

200020002000200020002000

11/10 Indianapolis , IN Lyon, Melissa 765/662-170211/10 Indianapolis , IN Jerome, James 317/841-106511/10 Toledo , OH Greenberg, Herbert 561/750-210011/10 Pittsburgh , PA Swisher, Timothy 412/367-869011/11 Cleveland, OH Snyderwine, Carol 216/692-746611/15 Chicago, IL Deppensmith, Kathryn 713/869-666411/16 Chapel Hill, NC Stewart, Andy 919/967-222811/16 Richmond , VA Russell, Charles 610/667-171111/17 Dallas , TX Harris, Dean 970/586-070211/17 Ontario, CA McCall, Kirsten 800/334-5478 (NR)11/17 Chapel Hill, NC Stewart, Andy 919/967-222811/17 Cleveland, OH Wolfe, William 770/475-205511/17 Houston, TX Elmore, John 800/357-575911/17 Portland , OR Fairchild, Michael 503/232-164611/18 Bethel Park, PA Angelelli, Roger 412/831-043011/30 Greenville , SC Guryan, Stephen 864/235-968912/1 Bellevue , WA McDaniel, Mary 425/746-0735 (NR)12/1 Atlanta, GA Wolfe, William 770/475-205512/1 Des Moines , IA Garrett, Barbara 319/369-756912/1 Houston, TX Meloy, Melette 205/444-979712/1 Piscataway , NJ Kelly, Ellen 732/238-166412/1 Kenner , LA Seidemann, Michael 504/443-567012/2 Nashville, TN Deppensmith, Kathryn 713/869-6664 12/4

12/4 Portland, OR Atack, Rodney 503/614-846512/6 Bremerton, WA Johnson, Lt. Christopher (Navy)12/6 Portland , OR Atack, Rodney 503/614-846512/7 Oakbrook Terrace , IL Thunder, Thomas 847/359-106812/7 Philadelphia , PA Chiarello, Joseph 610/667-171112/7 Kansas City, MO Bloyer, Cindy 816/471-390012/7 Greensboro , NC Juarez, Omar 336/665-181812/8 Oakbrook Terrace , IL Thunder, Thomas 847/359-106812/8 Marlbrough , MA Gordon, Pamela 781/891-912412/8 Piscataway , NJ Kelly, Ellen 732/238-166412/8 Boca Raton , FL Greenberg, Herbert 561/750-210012/8 Tampa, FL Rhodes, Robert 713/869-666412/8 Birmingham , AL Meloy, Melette 205/444-979712/8 Greensboro , NC Juarez, Omar 336/665-181812/9 Houston, TX Elmore, John 800/357-575912/10 Brooks AFB , TX Waldo, Tressie (Air Force)12/13 Liberty, MO Ratliff-Hober, Linda 800/664-840112/13 Baton Rouge, LA Rhodes, Robert 713/869-666412/13 Normal , IL Pollock, Gail 309/266-9949

1/10 Ft.Sam Houston , TX Byrne, Col.Clyde (Army)1/11 So.Charleston, WV Harris, Gary 304/766-65551/28 Ft.Hood, TX Johnson, Maj Jennifer (Army)3/2 Montgomery , AL Smith, Curtis 334/887-63024/14 Ft.Hood, TX Johnson, Maj Jennifer (Army)4/26 Worcester, MA Hengen, Garth 508/832-84845/3 Concord, NH Hengen, Garth 508/832-84845/8 Ft.Sam Houston , TX Bryne, Col.Clyde (Army)6/7 Rochester, NY Hengen, Garth 508/832-84846/30 Ft.Hood, TX Johnson, Maj Jennifer (Army)8/3 Montgomery , AL Smith, Curtis 334/887-6302

INTERNET

CAOHC Council Members and Their Represented Organizations

BULK RATEU.S. POSTAGE

PAIDMILWAUKEE, WI

PERMIT NO. 5438

ChairSusan Cooper Megerson, MA CCC-AAmerican Speech-Language-Hearing AssociationU.S. HealthWorksKansas City, MO

Vice ChairCOL Richard W. Danielson, PhD CCC-AMilitary Audiology AssociationArmy Audiology & Speech CenterWalter Reed Army Medical CenterWashington, D.C.

Secretary-TreasurerRobert A. Dobie, MDAmerican Academy of OtolaryngologyHead & Neck SurgeryUniversity of Texas Health Science CenterSan Antonio, TX

James D. Banach, MBAAmerican Industrial Hygiene AssociationQuest Technologies, Inc.Milwaukee, WI

Elliott H. Berger, MS INCE, Brd. Cert.American Industrial Hygiene AssociationE•A•R Hearing Protection ProductsIndianapolis, IN

Paul J. Brownson, MDAmerican College of Occupational &Environmental-MedicineThe Dow Chemical CompanyIndianapolis, IN

John Erdreich, PhDInstitute of Noise Control EngineeringOstergaard Acoustical AssociatesWest Orange, NJ

Linda Frye, COHN-S MPH RNAmerican Association of OccupationalHealth NursesE.I. DuPont DeNemours & Co.Richmond, VA

Merrie L. Healy, RN MPHNational Safety CouncilMarsh, Inc.Minneapolis, MN

Michael G. Holthouser, MD MPHAmerican College of Occupational &Environmental MedicineNortonSM Health Care, Inc.Louisville, KY

Council for Accreditation inOccupational Hearing Conservation611 East Wells Street Milwaukee, WI 53202-3816

Address Service Requested

http://www.caohc.org

or e-mail our officeat info@caohc.org

Look for CAOHCon the

Sara Joswiak, MPHNational Safety CouncilItasca, IL

Stephen I. Roth, PEInstitute of Noise Control EngineeringRoth Acoustical AssociatesPittsburgh, PA

Lt. Col. Theresa Y. Schulz, USAF, PhD MABS CCC-AMilitary Audiology AssociationAberdeen Proving Ground, MD

Myrna M. Stephens, PhDAmerican-Speech-Language-Hearing AssociationAudiology Consultants, Inc.Davenport, IA

Constance M. Tatman, MS RN CCM COHN-SAmerican Association of OccupationalHealth NursesQuality Managed CareEnglewood, CO

Peter C. Weber, MDAmerican Academy of OtolaryngologyHead & Neck SurgeryMedical University of South CarolinaCharleston, SC