Early intervention

Hand holding a recording microphone

Early intervention for noise-related ill health is a key aspect of ensuring the best outcome for both workers and the employer.

Helping an individual with signs of noise-induced ill health

Immediate medical advice

Reviewing the risk management system

Health surveillance programme

Audiometric evaluations

It is important to identify potential problems before they occur, or at an early stage. The earlier you notice an individual is experiencing signs of hearing loss, the sooner you can take steps to help them. An early intervention programme can monitor minor changes in hearing and prevent deterioration to the point where it is permanent. It also improves the overall health and safety culture of the organisation and promotes the workplace as being supportive and committed to the health and wellbeing of the workforce.

Helping an individual with signs of noise-induced ill health

Early intervention for noise-induced ill health is a key aspect of ensuring the best outcome for both workers and employer. Not all hearing loss cases are due to occupational factors, so an employer needs to consider whether the worker’s condition has resulted from occupational noise exposure or has been made worse by work. It’s essential to protect an individual who has a suspected or diagnosed hearing loss condition from further exposure while the causes of the signs or symptoms are investigated. If the existing noise controls are not sufficient or changes to the work process can’t reduce exposure enough, then the employer should consider moving the individual to a different area or changing their duties.

Immediate medical advice

Various signs and symptoms can indicate the onset of hearing loss and if a worker develops any sign of hearing loss, expert medical advice should be sought as soon as possible. The worker should be put in touch with an occupational health professional. If the employer doesn’t provide these facilitates, they should advise the individual to consult their own physician. It’s important that the worker can provide information about their work and the noisy equipment they work with or their exposure to a noisy environment. The physician needs this information to assess the cause of any hearing loss and provide advice or treatment accordingly.

Reviewing the risk management system

If any problems are detected in the workplace, employers should review the existing risk management system they use to control noise exposure to the workforce, or develop a hearing protection programme if they don’t have one already. Such a programme may cover:

  • initial assessment
  • noise assessment
  • control measures
  • health surveillance
  • education and training.

Any noise risk assessment undertaken should be reviewed at regular intervals, or when there are changes in the work process or workers’ health. Workers identified as being at risk from exposure to noise should be placed on a suitable health surveillance programme. Consideration should be given on whether specific risks identified are likely to make the individual’s condition worse.

Health surveillance programme

Health surveillance is an important part of a noise risk management programme. It is used to monitor the health of workers who have been identified as being at risk from noise exposure and allows early identification of ill health and helps identify any corrective action needed. It provides numerous benefits to the business, including the protection of the workforce from noise-induced ill health.

Employers should use their noise assessment to identify any need for health surveillance because a one-size-fits-all programme may not be appropriate and may waste resources. The surveillance should be appropriate to the occupational risks in different parts of the organisation and should only be introduced where necessary.

It must be remembered that health surveillance is not intended to be a control measure in itself, but to check that the control measures in place are functioning. It takes different forms, depending on the nature of the hazard and the level of risk to the workforce. A comprehensive health surveillance programme includes individual and collective health assessments, surveys, investigations and disease recording and notification.

Ideally, the health surveillance programme should be put in place before individuals are exposed to noise to give a baseline. However, it can be introduced at any time for workers already exposed to noise. The general objectives of a noise-specific health surveillance programme include:

  • establishing baseline health parameters
  • detecting hearing loss at an early stage
  • ongoing monitoring of health deterioration in the workforce
  • monitoring failures or shortfalls in the implemented control measures
  • increasing awareness among workers of the risks involving noise exposure
  • enabling workers to raise concerns about how work affects their health.

The simplest form of health surveillance involves workers checking themselves for any symptoms or signs of hearing loss. A nominated person such as a line manager, first aider or workers’ representative can be trained to make routine basic checks, but for more comprehensive assessments, help may be required from an occupational health professional who can perform the audiometric evaluations.

Audiometric evaluations

Audiometric evaluations (also known as audiometry) are one of the main elements of health surveillance for workers exposed to noise. They consist of a programme of systematic health checks to identify early signs of work-related hearing loss. The purpose of audiometry carried out as part of health surveillance is to provide early diagnosis of any hearing loss and to assist in the preservation of workers’ hearing.

Audiometric evaluations are crucial to the success of the health surveillance programme since they are the only way to determine the effectiveness of noise controls and whether work-related hearing loss is being prevented. They involve the measurement of hearing performance in order to detect noise-induced hearing loss. The most commonly used assessment of hearing is measuring the threshold of audibility, which is the level of sound required for individuals to hear. This level can vary from one individual to another, but this exercise helps to monitor the potential health effects to the individuals from exposure to noise. During the audiometric evaluations, it’s important to obtain information about an individual’s past medical history: not just the existing hearing condition but also other medical conditions that may influence the possible hearing loss detected by an audiometric test.

The audiometry is carried out using an audiometer. Whether it is automatic or manual, ultimately the test procedures are the same. The accuracy of audiometric evaluations can be affected by a number of factors:

  • technical limitations – the extent to which frequency and hearing level can be measured
  • worker co-operation – detection level is subjective and relies on the co-operation of the individuals undergoing the hearing test
  • headphone fitting – detection of sound depends on how the headphones are fitted on the individual
  • background noise – the impact of additional noise from the environment in which audiometry takes place
  • learning effect – the individual undergoing hearing test becomes more proficient at detecting the threshold.

It is essential for employers to provide appropriate information to workers and encourage their full co-operation to ensure that they are aware of the reasons behind audiometric evaluations being carried out. This will not only remove any unnecessary concerns but will also inform the workforce about their duties. Occupational health professionals carrying out the audiometry can explain the nature of hearing loss affects and the aims of the health surveillance further.

Any person responsible for performing the audiometric evaluation should:

  • be competent and have a good understanding of its objectives
  • be able to carry out otoscope examinations of the ear
  • be capable to carry out the test procedure in an appropriate environment
  • know how to assess and present results
  • know when and how to seek further medical assistance.

Keeping health records

Employers should keep a health record for all workers going through the health surveillance programme as it helps to monitor any links between noise exposure and adverse health effects over time. As a minimum, employers should make sure that the following are incorporated in their personnel file:

  • health assessment/screening details
  • information, instruction and training received
  • details of acute exposure situations.

Clinical information should only be shared with an individual’s consent. It’s worth mentioning that health records are different from clinical records and don’t contain confidential clinical details, so they can be kept securely with other confidential personnel records.

It is also good practice to offer workers a copy of their health record when they leave employment so that their case history can be taken into account at their next job.