What’s a Problem Audiogram?

By: Theresa H. Small, Contributor

In hearing conservation programs, Occupational Hearing Conservationists often are tasked in selecting problem audiograms to send to a Professional Supervisor (PS). One might ask, what is a problem audiogram, and which audiograms need to be selected for further review?

Problem audiograms are often interpreted as those with a standard threshold shift (STS). The STS is calculated by finding an average change of 10dB or more at 2, 3 and 4kHz from the baseline hearing test. Depending on the regulation, there are specific steps that must be taken when this change occurs, and there is a point when a regulatory agency must be notified of that change. However, STS is not the only test that should be selected and evaluated further by the PS.

Figure 1: New Hearing Loss

Figure 2: Invalid Erratic Pattern

Figure 3: Asymmetrical 4k Hz Notch

Problem audiograms should also include invalid, inconsistent and questionable hearing tests, as well as hearing loss that has not been previously evaluated and/or that meets referral criteria. An OSHA letter of interpretation dated December 19, 2017, states that “problem audiograms may include invalid audiograms; audiograms manifesting ear pathologies; audiograms that show large differences in hearing thresholds between the two ears; and audiograms that show unusual hearing loss configurations that are atypical of noise-induced hearing loss. If a technician’s preliminary review of an audiogram indicates a problem audiogram or an audiogram of questionable validity, the technician must refer the employee to the audiologist, otolaryngologist or physician for further evaluation.”

See the three figures for example problem audiograms. There are several sources for referral criteria, such as the American Academy of Otolaryngology-Head and Neck Surgery and the Council for Accreditation in Occupational Hearing Conservation, which provide details on when a hearing loss meets the point of referral. Problem audiograms are more than STS, so connect with the PS to further clarify, define and identify problem audiograms.

Theresa H. Small, Associates in Audiology, is an Audiologist and National Hearing Conservation Association (NHCA) Expert.  Visit NHCA at: https://www.hearingconservation.org/