Professional Supervisor of the Audiometric Monitoring Program^©

Background:
CAOHC has previously developed a scope of practice document for OHCs that outlines the appropriate roles for the OHC. The Professional Supervisor Scope of Practice document is designed to complement the OHC Scope of Practice document.

The CAOHC Hearing Conservation Manual, 4th Edition, makes the following statement:

"Following is an outline of the responsibilities of the audiometric testing program's professional supervisor, who must be an audiologist, otolaryngologist, or other physician. This person's role is to supervise the audiometric testing conducted by the OHC, recommend follow-up procedures, manage the audiometric database, and determine the work-relatedness of an employee's hearing loss. . . . A clear understanding of each person's role will enhance the effectiveness of the hearing conservation program."

The 1983 OSHA hearing conservation standard (25 CFR 1910.95) makes several comments about the role of the Professional Supervisor in the audiometric portion of the hearing conservation program. These include:

1910.95(g)(3) Audiometric Testing Program
"Audiometric tests shall be performed by a licensed or certified audiologist, otolaryngologist, or other physician, or by a technician who is certified by the Council for Accreditation of Occupational Hearing Conservation…A technician who performs audiometric tests must be responsible to an audiologist, otolaryngologist, or physician."

1910.95(g)(7) (iii) Evaluation of audiogram
"The audiologist, otolaryngologist, or physician shall review problem audiograms and shall determine whether there is need for further evaluation. The employer shall provide to the person performing this evaluation the following information:
1910.95(g)(7)(iii)(A)
A copy of the requirements for hearing conservation as set forth in paragraphs (c) through (n) of this section;
1910.95(g)(7)(iii)(B)
The baseline audiogram and most recent audiogram of the employee to be evaluated;
1910.95(g)(7)(iii)(C)
Measurements of background sound pressure levels in the audiometric test room as required in Appendix D: Audiometric Test Rooms;
1910.95(g)(7)(iii)(D)
Records of audiometric calibrations required by paragraph (h)(5) of this section."

1910.95(g)(8) Follow-up Procedures
"1910.95(g)(8)(i)
If a comparison of the annual audiogram to the baseline audiogram indicates a standard threshold shift as defined in paragraph (g)(10) of this section has occurred, the employee shall be informed of this fact in writing, within 21 days of the determination.
1910.95(g)(8)(ii)
Unless a physician determines that the standard threshold shift is not work related or aggravated by occupational noise exposure, the employer shall ensure that the following steps are taken when a standard threshold shift occurs:
1910.95(g)(8)(ii)(A)
Employees not using hearing protectors shall be fitted with hearing protectors, trained in their use and care, and required to use them.
1910.95(g)(8)(ii)(B)
Employees already using hearing protectors shall be refitted and retrained in the use of hearing protectors and provided with hearing protectors offering greater attenuation if necessary.
1910.95(g)(8)(ii)(C)
The employee shall be referred for a clinical audiological evaluation or an otological examination, as appropriate, if additional testing is necessary or if the employer suspects that a medical pathology of the ear is caused or aggravated by the use of hearing protectors.
1910.95(g)(9)
"Revised baseline" An annual audiogram may be substituted for the baseline audiogram when, in the judgment of the audiologist, otolaryngologist, or physician who is evaluating the audiogram:
1910.95(g)(9)( i)
The standard threshold shift revealed by the audiogram is persistent; or
1910.95(g)(9)( ii)
The hearing threshold shown in the annual audiogram indicates significant improvement over the baseline audiogram."

Similarly, the MSHA Noise Regulation (30 CFR Part 62) states that an audiometric technician must be under the supervision of a physician or an audiologist (62.170)[3].

In summary, CAOHC believes that the role of the Professional Supervisor is an important part of a Hearing Conservation Program, and is essential to the proper functioning of the Occupational Hearing Conservationist. The following provides further details about the recommended scope of practice of the Professional Supervisor.

Scope of Practice: Professional Supervisor of the Audiometric Monitoring Program^©

General Description The Professional Supervisor of the Audiometric Monitoring Program© hereafter known as Professional Supervisor (PS) may be an audiologist, or other qualified physician who has experience and expertise in hearing and hearing loss. The PS plays a critical role in ensuring the effectiveness of a hearing conservation program. Working in conjunction with other professionals, including nurses, Occupational Hearing Conservationists (OHCs), Industrial Hygienists, Safety professionals, employers, and employees and their representatives, the PS assumes responsibility for the following activities:

1. Establishment and Supervision of the Audiometric Testing Program
   The PS will:
   
   
   1. Establish policies for adequate testing and appropriate use of audiometric and hearing-related questionnaire information.
   2. Establish policies for adequate training and CAOHC certification of all individuals performing testing.
   3. Ensure adequacy of test equipment and environment with reference to ISO, ANSI, OSHA and other applicable standards and regulations.
   4. Ensure proper protocols for testing.
   5. Ensure that OHC's correctly perform functional checks of equipment, and routinely communicate with their PS.
   6. Ensure proper protocols for review of audiograms by OHC to detect and refer Standard Threshold Shifts (STS) and other problem audiograms, including retesting if indicated.
   
   
2. Review of Audiograms
   The PS will:
   
   
   1. Review problem audiograms, including a comparison of the baseline and subsequent audiograms.
   2. Review test environment sound levels and audiometric calibration, and determine whether the test environment is adequate.
   3. Ensure that age correction is applied correctly, as appropriate.
   4. Based on the above, determine whether there is a need for further evaluation.
   5. Determine whether baseline revision is indicated.
   
   
3. Determination of Work-Relatedness
   The PS will:
   
   
   1. Review the audiometric history and information regarding the adequacy of the test environment and performance.
   2. Review the medical history and determine whether additional medical evaluation is indicated. If such an evaluation is required, either performs the evaluation or makes appropriate referral for such testing, and then reviews the test results.
   3. Review the exposure history to occupational and non-occupational noise, ototoxins, and use of hearing protection devices.
   4. Judge the likelihood contribution of occupational exposures, make appropriate follow-up referrals, and provide employee notification on a case-by-case basis.
   5. Determine whether hearing loss is recordable or reportable to applicable regulatory agencies.
   
   
4. Follow-up of Work-Related Auditory Disorder(s)
   The PS will:
   
   
   1. Plan preventive strategy for individuals who have experienced a hearing shift from baseline. Strategies may include reduction of exposures, improved use of personal protective equipment, and/or work restriction.Determine other appropriate follow-up actions and communicate, as appropriate, with supervisors, health and safety personnel.
   
   
5. Management of the Audiometric Database
   The PS will:
   
   
   1. Oversee the management and integrity of the audiometric database, including record keeping and electronic record management, in order to ensure that audiograms are being correctly tracked and maintained in accordance with applicable standards and regulations.
   2. Ensure policies are in place to adequately safeguard the privacy and confidentiality of records in the audiometric database.
   3. Periodically evaluate the audiometric database using methods such as audiometric data base analysis (ADBA), to determine whether test-test variability is acceptable, and whether an unacceptable level of hearing loss is occurring.
   4. Determine whether the results of these analyses indicate that further preventive action is warranted.

Sources:

1. Suter, A., Hearing Conservation Manual. 4th edition. Edited by E.H. Berger. 2002, Milwaukee: Council for Accreditation in Occupational Hearing Conservation. P. 5.
2. CAOHC: Scope of Practice Document for OHCs (effective July 1, 2004) www.caohc.org/ohc/scopeofpractice.php
3. OSHA, 1910.95 CFR Occupational Noise Exposure: Hearing Conservation Amendment (Final Rule), in 48 Federal Register. 1983. P. 9738-9785.
4. MSHA Noise Regulation 30 CFR Part 62, in Federal Register Vol. 64 No. 176. 1999.
5. FRA 49 CFR Parts 227 and 229 Occupational Noise Exposure for Railroad Operating Employee: Final Rule.

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