Dr. Risson is a fellow of our college and clinical associate professor of OUHCOM, Ohio University Heritage College of Osteopathic Medicine. She's the assistant medical director for on-site and wellness services with Ohio Health Employer Services. They also have an acronym, at Ohio Health of Columbus, Ohio. She has been in occupational preventive medicine since 2001 with a special clinical focus on providing annual evaluations for executives and their spouses, especially in the Japanese community. She graduated from a bunch of places, including the West Virginia College of Osteopathic Medicine, and she's president of our college. So be kind to her and we'll make certain, you might pitch this so that your face is framed. Okay. Oh, that looks like that works. I'll give you a clicker. Okay. This is forward and back. Okay, good. All right. Good morning and welcome and glad all of you are joining us. The first topic of our basic course is noise-induced hearing loss and hearing conservation programs. Had a little, at Ohio University, they had a group of us come down and they gave us disabilities of aging. It was more in terms of gerontology at that time. Many, many years ago. And I was surprised that they give vision loss by making it macular degeneration type of vision loss. They put earphones on you and put static in it. You couldn't hear for some people. And they put, they wrapped fingers in gauze and then you couldn't manipulate and put buttons on. One of the shockers to me was they said the most socially isolating disability anyone can get, and I would have guessed sight, not able to read, not able to see faces, et cetera, is hearing. Loss of hearing people, it becomes too tired and too hard to socially interact and they become more and more isolated. So noise-induced hearing loss, to me, becomes a very important topic. I have no disclosures and I will not be discussing any off-label use. Course objectives, you will have those in your slides. I won't go through those. Price of hearing loss. Loss of hearing is a major socially isolating, which I just discussed. Odds of hearing impairment increases threefold with every decade of life. And later on, I will tell you, show you a slide with different ages of what percentage of people tend to be, tend to be, have hearing loss. And the estimated cost to hearing loss from loss of productivity, buying equipment to help with a premature retirement is 105 billion annually, according to WHO. And that was the latest figure I could actually find from them. So here's an example. As you can see, it quadrupled between 45, that should say 45 to 55. I did not screen those slides well enough. And notice at the bottom, it is the higher frequencies. And it turns out that that is especially sensitive where it goes around the curve in the cochlea. So the higher frequencies are the frequencies that typically you lose hearing in. By the way, that's going to be an important thing to know that the higher frequencies also sounds, and I had an example from an audiologist, sounds like S's are high pitched. So therefore we tend not to hear some of the consonants as we get hearing loss. For truck drivers and bus drivers, we check lower frequencies because most voices are in that 500 to 2,000. So for this lecture, you're going to hear me discuss when we're testing for noise-induced hearing loss, remember I said it tended to be more the higher frequencies, you're gonna see me check 2,000 and 3,000 and 4,000 because that's the higher pitches. So hearing in the workplace, they're involved, you have multiple roles and Dr. Warren knows that about every talk I give, I put this up there, the unique part of being a occupational medicine specialist compared to a family doctor, when I was in family practice for 20 years and top was my patient, I took care of my patient and I fought battles for my patient. When you're in occupational medicine, you actually are fighting for the health of three different entities. Number one is public, you're protecting the public and that trumps all cards. If you've got to protect someone, you protect the public, the bigger group. You also protect your patient and we learned that early in med school and we almost automatically do that. And then the third one is we work with employers to let them know what are the standards? How do we help you protect your workers? So the DOT exam, bus driver physicals, that's protecting the public. Hearing evaluations for employers to show that there is not hearing losses at that present and that their program's working well. And then of course, we protect the employers with advising on the rules and we're protecting the employees with the hearing evaluation. And this is basically what I just said. I did point out that for bus drivers, truck drivers, we check the lower frequencies because we want them to be able to hear children talking on the bus if there's an alert or an alarm, et cetera. So, but for noise induced hearing loss, we check 2000, 3000, 4000. Normal hearing is a minus 10 to 25 decibels. And that's important because later on, we talk about standard threshold shift. Is, has there been a hearing loss? And that is how it's expressed. And if that's 10, then it can be reportable. But if it goes from five to 15, that's 10, but it's normal hearing. So the person cannot claim they got hearing loss because they're still hearing in the normal range. So that's a significant thing. Again, when you're advising. And that, that shows you how we, how we grade them. Again, we talked about the 105 billion dollars. They think 22 to 30 million are exposed to noise and the five to 10 are at risk. It, this is an important thing. It is the second most common occupational illness. I think the first is dermatologic problems, but this is the second most common occupational illness. And it's a hundred percent preventable. That is the good news and the sad news. The good news is it can be prevented. The sad news is many times it is not. And I have a slide later describing carpenters, how even if you give them the information, they tend not to protect. And it shows that a 25 year old can have the hearing of a 55 year old at that much loss. And noise induced has NIOSH, which is more the, to me, the academic research type people of advising has noise induced hearing loss as one of 21 priority areas of research. Again, I pointed up it's preventable. So the four Ps with noise induced hearing loss, as opposed to age induced hearing loss, it's painless, it's progressive, it's permanent and it's preventable. Again, the amount of money that is spent and why does it cost so much? I listed there the disability, they have to change jobs, surgeries and interpreters. Do hearing conservation programs save money? Well, the US Army actually did a study and they focused on combat armed personnel and they saved $504 million between seven and 20 years with working on that noise induced hearing loss and a $25 million net savings per year. Anatomy and physiology. Oh, I don't know if I've got a clicker. Oh, can you see this? Yeah. So conductive hearing loss, let's just find that. So this is the outer ear and of course the waves come through, they hit the tympanic membrane here and it conducts to your incus and stapes and anvil, all of those we learned to this oval window right here. So that's how it helps you define what is conductive loss. It is that sound waves conducting through from there on through to there. Okay, so conductive hearing loss and then there's going to, we will go through that. The auditory nerves, notice the cochlea there and of course we have the vestibular apparatus for balance. So the next one is, there we go. Okay, so ultimately we get down to this part where this thing goes to the nerves and the little cilia here that are affected. Interpreting audiograms, there's a booth in my office and you do a pure audiogram, you do a threshold test, that's the baseline. Please tell them when you think you hear the sound, if they wait till it's loud enough that they're absolutely sure they are going to look like they're deaf. So indicate when you think you maybe heard the sound and the booth, you want very little ambient, you want no ambient noise and that is one disadvantage of going onsite with a portable audiometer because there's a lot of noise a lot of times and the employee gets really frustrated. Again, they marked how you could, well, what was a normal tone and you notice it's at 20. Typically the pediatricians don't think of putting in tubes till about 40 decibels. And that's because at 40 decibels with that much hearing loss, children start having problems just discerning different speech patterns. So that's the reason 40 decibels is we want people to be able to hear at least that well and you'll see that again later. Speech notice, it says 500 to 3000. My voice may be a little higher than 1000 because I tend to have a higher pitch voice. Noise estimates to let you know, and I want you to notice that between 30 and 40 is a soft whisper because one of the things we do for our DOT exam is at five feet, see if they can hear a forced whisper. So again, if we did an audiometer, we would want it to be less than 40. If we do a forced whisper, that's at about 30 to 40. So each of those are actually a little bit different are actually testing at about the same level. Notice how many of these, let's look at a heavy trucks. That's about 85 and that number is going to be significant to you. Audiograms is an acute. They do red for right ears if you send them to an audiologist and round for right ears. And so that's a typical thing of what audiologists do. And then of course, not red or not round is the blue. So that would be the left ear and the red and the round would be the right ear. Types of hearing loss. Already gave this lesson. You can tell I taught school before I went to medical school. So conductive hearing loss, dysfunction of the outer or middle ear, basically a deficit in loudness, often reversible, i.e. irrigate the ears and get rid of the cerumen that's blocking the sound, a foreign body. One of the things that's not reversible usually is otosclerosis. But again, I made the big point as I introduced the anatomy that conductive are the incus, anvil and stapes so if those get arthritis of those bones, they do not conduct well. So, and then perforation of the TM, again, wouldn't conduct as well. Typically maintains a normal speaking voice and they can tell speech discrimination. You just have to be very loud to try to get past either the earwax or whatever. And this one uniquely will show low frequency loss. Remember I said the noise induced hearing loss is typically high pitched and it may be flat and flat can be a sign also of malingering where they're claiming they don't hear anything where typically people will have a loss at different pitches. Sensorineural hearing loss is going to affect the nerve as opposed to the tympanic membrane or the bones of that middle ear. So this is a dysfunction of the inner ear or the auditory nerve. It's usually irreversible because the damage is done. And this distorts hearing. So I mentioned, I tell my patients, once I find out they've got hearing loss at the higher frequency, I tell my patients, make sure if you're negotiating for money over a contract, you put that person on the better ear, because you may not hear the difference between fit or, you know, the guy had a seizure and he had a, quote, a fit versus sit or some of the others, because those are high pitched. So actually to discern what's being said in terms of consonants, it's a good idea to make sure you use the better ear. Medications could cause this physical trauma, a blast where there's just irreversible damage. And this shows at the cilia level, the hair damage that is done and it's irreversible. And it uniquely tends to happen at 4,000 or 6,000. And the ones I've seen mostly are at 4,000. Typically with noise induced hearing loss, and again, this is significant if you are going to advise your employer, is if it is noise induced hearing loss, again, we saw the cilia, usually it's like one little cluster or whatever, it will go down and then it will go back up. As opposed to hearing loss of aging, it will just keep going down. And a lot of times that lower part, the one of the most hearing loss, it seems to be 4,000. I had some who had been in service and we associated that with the shooting of the guns. So anyway, so recovery at least five decibels in the higher frequency is your alert that it's a noise induced hearing loss as opposed to just hearing loss of aging. If no recovery, then it's not noise induced hearing loss. And here's a nice, simple little first grade look at what it would look like if it were perfect. It would go down and then it will start back up. Excuse me. So an audiogram typical of noise induced hearing loss, again, shown on there. Presbycusis, and they said, sociocusis, which goes back to my first comment about going down to a high university and getting quite the disability. They gave it to me of hearing, and I can tell you, I think they did it deliberately because after a while, it's just not worth talking to somebody because you can barely hear them. And I was exhausted by that time. I went through that hour with them. So it is socially isolating and it's a gradual drop and there is not a recovery. And so that's how that would look if it's due to aging as opposed to noise induced hearing loss. Temporary threshold shift, I mentioned earlier, you're looking to see how much has hearing changed since the last time you monitored them. And it's thought to happen as the outer hair cells become stiff and exhausted if it's temporary. So you want to give your employee or a little bit of time of not having a lot of loud noises because it may be temporary and that one you don't worry about. It's where it's becoming permanent. So you don't test on a Monday because you don't know what they did all weekend. Otosclerosis, remember we mentioned malingering or where there is just no change and it tends to be flat line because again, if those ossicles are sclerosed and they can't move at all, then it just is flat line throughout. Sources of noise, I think we had these at different times. I checked on a lawnmower and if it is a gas powered lawnmower, like one of those push, I'm pretty sure that was at 90 to 95, which is why we should always be telling people if they mow their own lawn to use hearing protection because that's about the level of a jackhammer. So again, whether or not it's happening at work or happening at home, a lot of people have have hobbies or daily living type things that that happens. Now here's an example of the carpenter noise exposure. Notice that a hand drill was find D is that almost 115 and anything over 85 and 90 is allowed, but constantly hearing something above 90 can actually cause permanent damage. So look at all of these that people do all the time and most of them are above 90. Natural history of workplace noise. Again, look at the 25-year-old carpenter. He's already starting down. Look at normal hearing of a 50-year-old, which is right there. So a 25-year-old carpenter has about the same hearing as a 50-year-old who just had loss of hearing from just from aging. So and then at 55, notice how much hearing loss there is. Hearing conservation programs. Hearing conservation in the workplace, the employer must have a hearing conservation program if an employee has a sound exposure equaling eight hours at or above 85. So that is called an action level and that you will find throughout and that is a significant bit of information and it's a significant number to remember. 85 decibels is OSHA's requirement that you have an action level. In other words, you need to have done something. You need to have taught them. If you're going to hear more noise than this, you need to have start educating and start thinking of monitoring because, okay, you've got this. We need to protect. So lower action level for longer shifts. So what are a hearing conservation program that they would need to put in? They might start monitoring noise because they know they've had some place in their plant that's 85. So you need an action plan. Controlling noise. Those of you who are going to be taking the CAQ and those of you who are looking at the overview, you are going to see engineering, administrative, and personal protective devices, I think, in every module we have because, again, if you're in occupational medicine, the best is engineering that you surround it with a wall and you can't hear the noise then. So that's the ultimate. But it may be administrative that they are only in that level of noise protected for so long and then they're pulled out. And then, of course, everybody should have access to the personal protective devices. Elements of a conservation program. You evaluate. You give hearing protection devices. You educate. And you keep a record. It doesn't... The higher frequencies I've already mentioned are the more sensitive. So the human here does not respond equally to all frequencies. And higher frequencies are more damaging. So there is something called an A filter. And it's called decibel level A. That's monitored. An A filter takes into consideration what frequency it's at. As opposed to a C, DBC, which doesn't take into consideration that the same level of loudness at a lower frequency does not do the harm as the higher frequency. And where that's important is the DBC is what's used for noise reduction equipment. So you're kind of not exactly doing oranges to oranges. Noise measurements are an integration of continuous, intermittent, and impulsive sounds. So here's an example where A is at the lower frequency even at a level is not as damaging as that higher. Measuring noise by OSHA standard. Monitoring shall be repeated. And any noise lasting greater than one second is considered a continuous steady state noise. And it should never exceed 140. What about exposure for less than a full day? Again, the action level was to get a program in. But they thought a permissible level is at 90 for eight hours. But if it's going to be higher than that, then you've got to not be in it. Remember where I mentioned administrative that you can actually take them out of the environment then and not have them in as long. So if you're going to be in longer, and notice that five decibel difference half the time. So I found that a nice number to remember. So if you go from 90 to 95, you've gone from an eight hour day to a four hour day. If you go from 95 to 100, you go from a four hour exposure to two hour. And time weighted average is the TWA. And this gives it if you're going to work longer hours as to what level becomes an action level and what level becomes a permissible exposure. Audiometry, you get a baseline. It's done within six months of higher or the first exposure that you know you're going to have somebody in a place that has that higher, that 90, or above the action level, the 85. If you may not get it done at exactly that time, apparently they give an exception if you have a audiometric van come around periodically. So you don't have to have it done within six months, I guess if it comes once a year. It's preceded by a 14 hour period of rest. Remember we talked about that temporary threshold shift. So you want some quiet before you're actually getting your baseline audiogram. So you wouldn't want them done on a Monday because that may be the weekend they went hunting or that they made a rocking chair for their granddaughter. And we've already seen what level that's at. So the annual audiogram performed on all employees exposed at or above action level. I do a lot of let's go out on the branch type thing. I had one plant that they were monitoring every single employee, including the reception. Everybody got a yearly audiogram. The problem with that for the employer is that if you monitor and then they lose weight, they're going to claim they're getting their testing at work. They lost hearing and they're going to say you're going to pay for my hearing aids and my batteries as long as I live. So I said to them, you need to test only where the noise level is 85 or higher. You need to know when that is. And I mean, think of the thousands or millions you could save by not testing. Because again, if they're getting tested at work for hearing loss, they are going to expect if they get hearing loss. And we've seen that with age, it tends to go down. Standard threshold. Yes. Make sure they don't ride a motorcycle to work. Exactly. Yes. Just I'm serious. You were testing me. And when you know that this guy had a motorcycle helmet with him to get to work because I rode my motorcycle. Yes. Dr. Clark is saying to make sure they didn't the day you're doing your audiograms, ride a motorcycle to work. Because again, the loudness of that, they certainly did not get to rest. So that could be a temporary shift, but you've got it on record the following year when you're taking it. And now, quote, there's a hearing loss. And then you go 30 days. I think I have that somewhere in here. But yeah, when Dr. Clark brought that up, that is one thing too. I try to throw out examples. You know, did you make something at work? Did you go hunting? I just throw and I go, I cannot know everything that would be loud noises in your environment. However, I try to give them ideas to clue me in. Otherwise, you can miss it. So you would ask that. That would be a great question to ask. So again, I pointed out earlier, you do 2,000, 3,000, 4,000. Where you're going to lose hearing from noise induced hearing loss is higher frequency. And if you take the DOT course, you need to know it's 500, 1,000, and 2,000. And the reason I throw that out here is all of this is occupational medicine. And I said, one of the things we try to do with these courses is to give you an overview. So I, for example, I may be telling an employer what are the rules, help them with the rules for OSHA. But then I may, part of my day, be doing exams on commercial motor vehicle drivers. But for noise induced hearing loss, these are the frequencies, these three frequencies, no matter if you've got the whole gamut, it's only the 2,000, 3,000, 4,000 that you're going to evaluate. So if someone hands you where it's 500 up to 6,000, you are going to just look at 2,000, 3,000, 4,000. You're going to compare it to the baseline that you got when they started. If the difference exceeds 10 decibels, hearing loss, then it is a standard threshold shift. Every occupational medicine specialist should know that, you should know that one. And actual reading is unimportant. At this point, it's how much is the shift. So here's an example. Notice we have 500, that 1,000, 2,000, 3,000, 4,000, 6,000, and 8,000. Where are we going to look? We're only going to look at 2,000, 3,000, 4,000. And we see what is the change. So in this case, it is 25. Do the math. Divide it by 3. The average loss, now that's another important thing. You do the average loss of those three. It's 8.3. Has this person had a standard threshold shift that you have to report? They went from 30 to 40, and 40 getting on that. And the answer is no. The average is 8.3. So there is no standard threshold shift. Verify the audiogram makes sense. Again, are they malingering, that flat line? Is there another disease process that might not be the noise? Review the math. If all's OK, then follow the STS protocol. Repeat the audiogram in 30 days. Again, to Dr. Clark's point, if they rode a motorcycle and it's like you bring them in, I don't want you doing any chainsaws. I don't want you mowing your lawn. I want to test you next week and see if this truly is permanent. And you would retest and see if it still has a shift. And you may need to get stricter in what they use, start monitoring, and saying you have to use the hearing protection if you're going to work here because it already looks like you're losing some hearing. And what happens if it's documented? One of the things is you retrain them, you give them better protection, and refer for clinical evaluation. STS is only recordable if the average is above 25 decibels. Remember early on, I made the point that up to 25 decibels is considered normal hearing. So if they went from 5 to 20, and that's a 15, but 20 is normal hearing, you do not let that be a standard threshold shift. Until they truly have hearing loss, you do not consider it as recordable. Based on the concept, there is no impairment below the 25 decibel. OK, here's an example. Again, I think it's important to be able to do the math and explain it to your employer and the employee. So if the baseline was at 5, went to 15, again, that's all normal hearing. They're 10 to 25, all normal hearing. 4,000, remember I said that's the most sensitive we feel, is 15 to 40. So you go through, and they're 27 divided by 3, or 50. Actually, I think it's 51. It comes out to 17. OK, so yes, this would be a standard threshold shift, and it would be recordable. Here's an example. Again, the change was 12. If you look at that bottom number, if you do the math, you've got 10, 20, 35 divided by 3, 12. So again, the non-occupational specialist, they'd say, hey, 10 decibel. And again, that 10 decibel loss is the STS criteria. However, if you look at the average, it's below 25. So that would be considered normal hearing. And so this would not be recordable, even though it says 12. Old age, hearing loss, there are tables which we've already talked about. There are tables that you can apply to your readings, and some employers do that and some don't. And here's a table where you can remove that standard, that shift, and subtract that, and then do your math. But then you would do it for all employees. You don't just do it to the one you don't want to have to pay on. So you can say across the board, we're going to account for aging, and then we will take the numbers from there. Record keeping, this is why most employers will hire a hearing organization. They do that monitoring, and then they keep the records, because the records have to be kept the full time of the worker's employment. And if you sell the company, then they have to keep it until that employee is no longer working there. So a lot of companies will hire someone that that's all they do, and then they agree to make sure those records are available. And the first one, exposure measurements, is companies are supposed to do that. If the worker has a confirmed standard threshold shift, you reset the baseline, because otherwise you'd be having to record report every year. But if you started protecting them and they have no more laws, you don't continue to have to send recordables to OSHA saying, oh, we're a lousy company, we don't protect our employees, and they get worse and worse every year. So you reset the baseline. Hearing protection, they must be made available to employees. They have to have more than one type offered to them so they can select what they want. If a standard threshold shift has occurred, they have to wear them. It's not a choice. And even if the noise level is below 90, because they are getting in trouble with their hearing, and eight hour, 90 decibel, it's provided at no charge, and they can choose. And what you choose is according to how bad the noise is and what your preference. Earplugs, obviously, is what most companies have, and it tells why. But again, removing them, getting dirty, and sometimes they barely get them in there, and that probably doesn't help with noise at all, and it's their fault. But nevertheless, they've been wearing them. And if they get a standard threshold shift, it can become a workers' comp disability. HPDs, the pros, but again, the sweating, uncomfortable, et cetera, so I've listed there. These are not considered good, and you'll see we put a do not over that, because you cannot get a good fit of those muffs to protect you if they're just hanging down from a helmet. So these are not recommended. Remember earlier in the lecture, I talked about that those are C-level devices. They recommend if the earmuffs, if they claim this will reduce noise by 50%, NIOSH recommends you subtract 25% from that 50% and say, actually, they only reduce noise by 50%. Only reduce noise 25%. So if you're at 100, figuring out how to get it down to where you need it. And as you can see with those molded earplugs, they suggest you immediately, if they claim this will reduce it by 40%, that you subtract 50% from that. So it would be like they're not protecting at all. So just to be aware of that. And for very high noise levels, use double hearing protection. Education, effects of noise on hearing, purpose of HPDs, this is what you need to let them know. The education, here are some choices, here's what they do, this is how you fit them, et cetera. But this is interesting. If you educate people, so non-noise induced exposed workers, about 6% will have tinnitus. If you have noise exposed workers, like up to 80% will have tinnitus. Let's educate them. Percentage of time hearing protectors are worn when they say most of the time I wear them. The hearing conservation, the one who knows and teaches this, about 80%. Now remember, they said most of the time I wear them, and this is the teacher, 80% of the time. The carpenter, the trainers, wear them about 45% of the time, even though they say I wear them most of the time. The carpenters themselves wear them less than 20% of the time, even though they say I wear them most of the time. And I find that fascinating. It's like even those who know don't wear them as much as they think they do. These are some resources. OSHA, by the way, is a great resource. If you go on there, they've got page after page, and it explains a lot of this. So you may want to go on site and just read that. And I thank you, and think how sad your world would be if you could not hear music or hear a waterfall. Are there any questions? And I will ask Dr. Iverson if there's anything in the chat, because I am not that tech savvy. Anything. Correct me if I'm wrong, Sharon. OK. There was one about, let me pull up the chat. There's one about motorcycles earlier. OK. OK. So for the group, there's STS impairment. OK. Hearing standards for law enforcement. If y'all would like to unmute yourself and expand on your question, I know there's one about motorcycles earlier, STS hearing impairment. Y'all have a question about how an infantry guy, 48, needs hearing aids. I could answer that personally. But anyway, go ahead. OK. So I don't know what the question was on motorcycles. Can someone? So you can ask Dr. Lange to unmute, but his question was, is it more dependent on the type of motorcycle, like Harley, or the noise from the ambient noise from riding, like the wind? Well, my thought would be that you protect. I would judge if a lawnmower is at 95 and 90 causes damage, that I think the ideal thing for that is that I don't know how loud wind would be, but if it's over 90, and you can do noise monitoring, you could actually get a device to see what the noise level is. But if it's 90 or higher, it will do damage. That's. That's. Riders to a stereo blasting in there. Right. And it has to be loud enough to be louder than the engine noise and road noise. So I think that they do themselves more damage from their radio. Right. Yes. And your piece of equipment is making a lot of noise, but also the support equipment, so to say a manufacturing press gets to an air compressor. Right. If either one of them exceeds the time limit, well, I think that's where he's getting at, which one is it? Protect from? Oh, it doesn't matter. If however you're getting above the 90 decibel level, you are harming your hearing. And you will lose hearing, and you won't probably. For example, a concert is at about, I think, if I remember correctly, about 130. And a lot of the young people love the louder that boom can be at a concert, the better. But there is, and remember, we said noise-induced hearing loss is permanent. So being aware of that. A question regarding STS versus impairment. Dr. Lamb, can you unmute yourself and tell me? There is a difference. One of the things, and I'll just tell you one thing I know, and you can tell me if that's what you had in mind. I looked up for Social Security. If the person's hearing for Social Security disability, to get that hearing impairment, the last time I looked, their hearing level had to be at 90 decibels. And you will remember, in other words, someone would have to be hearing louder than a jackhammer. That's how loud I would have to scream for that person to hear. And then it would be considered impairment by Social Security. And my understanding is the payment for that, now this was a couple of years ago, is $6,000 a year. That's what they got for having a hearing level at 90 decibels, which meant every family member would have to be screaming at the level of a jackhammer for them to hear. And they would, I think the disability impairment allowed was $6,000 for that to be permanent hearing loss. And did she say 1-IS-3? No, 10 standard threshold shift is what's recordable. But remember, it also has to be above that 25 decibels because otherwise it's considered normal hearing.

Noise-Induced Hearing Loss

Hearing Conservation

Occupational Illness

Hearing Protection

Audiograms

Standard Threshold Shifts

Tinnitus

Noise Monitoring