ÿWPC\ ä f×ì˜8ñ#àfN‹­Çè( ©’€T©òÄÆhñ#a–X“.w¨9HÃÀH¤¡1ؽ"!XH– 1_ÞÆ= 0D 0KG D+’ A½ 0NZE¨aª 0t¾a2 F BP m w 0L BÍ 04êa 2 @ N˜HP LaserJet IID,È,ðð,,È0(ÖÃ9 Z ‹6Times New Roman RegularX($¡¡*+ÿjrf3John Franks “ D” • D– — ˜ ™ Eš › œ E•¹p$x„ ” X„ ô3|xœ  ÿU‹ÿÀÀÀNORA Team #4 Draft 1 Report Page ù of &ù1, 2, 3,Level 1Level 2Level 3Level 4Level 54#*&2Quick 1.ÚƒÚÚ  Ú.à0 àÛ€Û<jÿÿ:Default ParaÔ€&&&ÔÔQ€ô\  `$Arial NewRomanQÔ$ÿÿ35=EMU]em1 I. 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I&mage <=8ÿÿÿÿÿÿÿÿÿÿCÿÿ HKKKK(ÍO$——ÔÿÔòòóóÔÿÔTABLE A(L’…$´´Ô2ÿÿÔ€Ú  ÚIÚ  Ú.Ô3  Ôà0  àTABLE BN_1_ dN_2_N_3_>c$"Small Circleð"ðà0 àöÿ  d(†·$ÍÍò òò òó óó óTABLE CèN_1_èN_2_èN_3_Ý ƒ!ÝÝ  ÝÔ_ÔÔ‡XÕ XXXÔÓÓÑ8€Õ XXdìdÈ8ÑÑ€ÃØÑÓ  ÓOccupational€Hearing€Loss€„€NORA€Team€#ñ” ñ5ñ” ññ• ñ4ñ• ñ€ReportÐ ° ÐÓ¥ÓÓ  Óñ— ñApril€4,€1998ñ— ññ˜ ñ,€ñ˜ ññ™ ññ˜ ñDraftñ˜ ññ™ ññš ñWorking€Draftñš ññ– ñFebruary€19,€1998,€Albuquerque,€New€Mexico€Meetingñ– ñÌNational€Occupational€Research€Ô_ÔAgendñœ ññ› ñdñ› ññœ ñaÔ_ÔÌÓ  ÓÌHearing€loss€is€ubiquitous.€€It€is€every€where.€€Everyone€has€a€parent,€grandparent,€aunt,€uncleÏwho€has€a€hearing€loss,€who€canððt€participate€in€family€events€or€who€is€Ô_ÔamusedlyÔ_Ô€tolerated,€whoÏeither€isnððt€getting€much€help€from€a€hearing€aid€or€refuses€to€get€one.€€Everyone€expects€toÏbecome€that€parent,€grand€parent,€aunt,€or€uncle.€€If€noise€at€work€doesnððt€deafen€you,€age€will.ÌÌThere€is€no€other€ailment€that€is€so€widely€accepted€as€just€part€of€living.€€Occupational€blindness,Ïwhich€is€no€where€near€as€prevalent€as€hearing€loss,€was€dealt€with€long€ago.€€Weldersðð€Ô_ÔglogglesÔ_ÔÏwere€developed€before€the€turn€of€the€century€so€that€the€bright€light€couldnððt€burn€the€retina.€€AsÏeach€new€light€source€comes€long,€the€blindness€prevention€strategies€and€tools€are€introducedÏwith€it€or€soon€afterward.€€ÌÌOccupational€asthma€and€repetitive€stress€disorders€such€as€carpel€tunnel€disease€are€on€theÏnational€agenda.€€Everyone€knows€some€one€who€has€had€one€or€the€other.€€Steps€are€being€takenÏto€prevent€both€and€regulations€are€being€drafted.€€All€that€is€slowing€the€pace€is€the€reluctance€ofÏcorporate€America€and€those€who€provide€disability€insurance€to€accept€responsibility.€ÌÌThe€NIOSH€NORA€Hearing€Loss€Team€has€been€charged€with€developing€a€national€researchÏagenda€for€the€prevention€of€occupational€hearing€loss.€€As€such,€the€team€has€developed€thisÏdocument€that€highlights€the€areas€still€in€need€of€attention€before€all€of€the€knowledge€andÐ @-(, ÐÑÃØÑâ âÑ€ÑÑ8€Õ XXdìXXdì8ÑØØâ âÑ  Ñresultant€tools€are€available.€€And,€the€team€has€reviewed€the€barriers€that€have€prevented€creatingÏthe€necessary€sense€of€urgency€for€preventing€occupational€hearing€loss€that€will€change€the€publicÏattitude.ÌÌWe€all€have€the€right€to€not€sacrifice€our€hearing€for€a€job.€€We€all€have€to€right€to€expect€goodÏhearing€from€cradle€to€grave.€€We€just€donððt€know€it€yet.ÌÌThe€prevention€model€has€many€aspects,€each€of€which€are€considered€by€the€Hearing€Loss€team.€ÏPrevention€of€occupational€hearing€loss€begins€with€control€of€the€agents€of€hearing€loss,€noiseÏand€other€agents€such€as€solvents,€vibration,€and€heat.€There€are€unanswered€questions€forÏexposure€control€of€noise,€be€the€controls€applied€at€the€source€or€by€personal€protectiveÏequipment.€€There€are€more€unanswered€questions€about€the€effects€on€hearing€of€the€interactionÏof€noise€with€other€physical€and€chemical€agents.€€€There€is€no€national€agenda€for€noise€control,Ïoccupational€or€environmental.€ÌÌIn€the€absence€of€controlling€noise,€those€who€are€exposed€to€noise€must€be€protected€otherwiseÏand€it€is€critical€to€document€the€success€or€failure€of€hearing€loss€prevention€measures€that€mustÏwork€in€spite€of€the€noise.€€Successful€interventions€can€be€disseminated€while€unsuccessfulÏinterventions€can€be€stopped.ÌÌOne€key€aspect€that€will€determine€the€success€of€interventions€is€the€assignment€of€people€to€aÏhearing€loss€prevention€program.€€There€is€much€debate€about€how€this€should€be€done€and€theÐ h+¸&* Ðteam€has€considered€a€variety€of€approaches.ÌÌThose€exposed€to€potentially€harmful€noise€at€work€must€be€protected€by€personal€protectiveÏequipment.€€While€the€concept€probably€dates€back€thousands€of€years,€we€still€have€not€been€ableÏto€develop€protectors€that€are€comfortable€to€wear,€donððt€interfere€with€hearing€important€workÏsounds,€and€enhance€the€intelligibility€of€speech,€particularly€from€worker€to€worker.€€And,€weÏhavenððt€been€able€to€convince€each€and€every€worker€that€using€protection€is€in€their€own€long„¼range€best€interest.ÌÌ€ÌAnother€key€element€is€the€testing€of€hearing€of€exposed€workers.€€A€successful€intervention€willÏresult€in€no€changes€of€hearing€attributable€to€occupational€exposures.€€This€is€measured€oneÏworker€at€a€time.€€ÌÌThere€are€other€areas€also€in€need€of€research.€€Two€that€the€hearing€loss€team€considered€were:Ïdetermining€what€jobs€are€hearing€critical€and€certification€that€people€can€hear€well€enough€toÏhold€them,€and€evaluation€of€the€impact€of€impaired€communication€on€the€cause€of€accidents.ÌÌò òEngineering€Noise€Controls€and€Personal€Protective€Equipmentó óÐ à%0!$ ÐBackground:ÌÌWhen€Federal€regulations€to€protect€workers'€hearing€were€enacted,€the€legislators€intended€for€Ð h+¸&* Ðengineering€/administrative€control€to€be€used€to€reduce€the€noise€exposures€of€workers€to€safeÏlevels.€€It€was€clear€that€engineering/administration€controls€were€the€preferred€method€and€thatÏpersonal€protective€equipment€(Ô_ÔPPEÔ_Ô)€was€to€be€used€only€as€an€interim€measure€if€neitherÏengineering€nor€administrative€controls€were€feasible.ÌÌThe€issue€of€feasibility€was€the€focus€of€much€litigation€as€industry€contested€citations€on€theÏgrounds€that€engineering€control€were€neither€economically€nor€technically€feasible.€€When€OSHAÏproposed€new€regulations€in€the€mid€70's,€there€was€a€great€deal€of€concern€about€whether€or€notÏthe€proposed€lower€limits€were€reasonable€or€even€possible€in€view€of€the€economic€and€technicalÏaspects€of€current€engineering€control€technology.€€ÌÌIn€an€effort€to€answer€the€question€of€technical€feasibility€of€engineering€noise€controls,€OSHAÏfunded€Bolt,€Ô_ÔBeranekÔ_Ô€and€Newman€to€conduct€a€broad€assessment€of€the€status€of€availableÏengineering€controls.€€On€an€industry-by-industry€basis€Ô_ÔBBNÔ_Ô€catalogued€those€machines€requiringÏnoise€control€for€the€19€categories€in€general€industry€(SIC€20€through€39).€€For€eachÏmachine/process€Ô_ÔBBNÔ_Ô€also€identified€the€expected€degree€of€difficulty€in€quieting€them€withÏengineering€controls.€€The€following€categories€were€employed€to€define€the€status€of€the€existingÏtechnology:ÌÓC€  ï$##CÓÝ ‚'’… ÝÝ  ÝÝ‚'’…xÝÔ2ï$ÔððÔ3  Ôà0  àÝ  Ýoff-the-shelf€treatment݃'’…x£ÝŒÐà%0!$(#(# ÐŒÝ  ÝÝ ‚'’… ÝÝ  ÝÝ‚'’…CÝÔ2ï$ÔððÔ3  Ôà0  àÝ  Ýsubstitution€of€quieter€machines/processes݃'’…Cn݌и'#&(#(# ÐŒÝ  ÝÝ ‚'’… ÝÝ  ÝÝ‚'’…!ÝÔ2ï$ÔððÔ3  Ôà0  àÝ  Ýcustom€retrofit€using€existing€technology݃'’…!LÝŒÐ)à$((#(# ÐŒÝ  ÝÝ ‚'’… ÝÝ  ÝÝ‚'’…þÝÔ2ï$ÔððÔ3  Ôà0  àÝ  Ýredesign€of€machines/processes€using€existing€technology݃'’…þ)ÝŒÐh+¸&*(#(# ÐŒÝ  ÝÝ ‚'’… ÝÝ  ÝÝ‚'’…êÝÔ2ï$ÔððÔ3  Ôà0  àÝ  Ýbreakthrough€required݃'’…ê݌а(#(# ÐŒÝ  ÝÌThe€last€category€recognized€the€fact€that€certain€equipment/processes€were€not€amenable€toÏengineering€controls.€€Some€examples€included:ÌÓC€  ï$##CÓÝ ‚'’… ÝÝ  ÝÝ‚'’…‚ÝÔ2ï$ÔððÔ3  Ôà0  àÝ  Ýengine€test€stands€previously€treated€for€noise€reduction,݃'’…‚­ÝŒÐ `(#(# ÐŒÝ  ÝÝ ‚'’… ÝÝ  ÝÝ‚'’…pÝÔ2ï$ÔððÔ3  Ôà0  àÝ  Ýcertain€maintenance€operations€in€which€maintenance€personnel€must€work€for€longÐ è 8  Ðperiods€of€time€in€high€noise€areas€not€normally€occupied€by€workers,݃'’…p›ÝŒÐ (#(# ÐŒÝ  ÝÝ ‚'’… ÝÝ  ÝÝ‚'’…Æ ÝÔ2ï$ÔððÔ3  Ôà0  àÝ  Ýcertain€riveting€and€grinding€operations,€and€Ýƒ'’…Æ ñ ݌Иè (#(# ÐŒÝ  ÝÝ ‚'’… ÝÝ  ÝÝ‚'’…¨!ÝÔ2ï$ÔððÔ3  Ôà0  àÝ  Ýspecialized€equipment€such€as€oxygen€lances,€rock€drills,€weaving€looms,€spot-weldingÐ pÀ Ðequipment€and€painting€spray€guns.݃'’…¨!Ó!݌Р(#(# ÐŒÝ  ÝÌA€similar,€but€more€focused€and€detailed,€technical€assessment€of€feasible€engineering€controls€forÏmining€equipment€was€published€by€the€former€Bureau€of€Mines€in€1983.€€Again,€as€in€the€OSHAÏstudy,€some€machines/processes€were€identified€for€which€further€development€was€required,€butÏin€the€main€technology€was€deemed€feasible.€€€More€recently,€Ô_ÔMSHAÔ_Ô€as€part€of€its€ongoing€ruleÏmaking€activities€related€to€occupational€noise€has€determined€that€engineering/administrationÏcontrols€are€feasible:€òòThe€Agency€has€concluded€that€the€coal€mining€industry€as€a€whole,€and€theÐ 0"€  Ðmetal€and€non-metal€industry€as€a€whole,€can€meet€this€requirement€at€a€Ô_ÔPELÔ_Ô€set€at€a€TWAòòòò8óóóó€ofÐ $X" Ð90€Ô_ÔdBAÔ_Ô.óóÐ à%0!$ ÐÌIn€support€of€Ô_ÔMSHAÔ_Ô's€conclusion,€the€noise€exposures€of€coal€miners€collected€by€Ô_ÔMSHAÔ_ÔÏinspectors€from€1986-1992€were€recently€analyzed.€€For€both€the€1993€Ô_ÔMSHAÔ_Ô€study€and€the€1976Ð h+¸&* ÐÔ_ÔBBNÔ_Ô€study€for€OSHA,€the€following€distribution€of€daily€noise€doses€were€revealed.ÌTable€1.€€Percent€of€coal€miners€(Ô_ÔMSHAÔ_Ô,€1993)€and€manufacturing€sector€workers€(Ô_ÔBBNÔ_Ô,€1976)Ïexposed€to€noise.¹Ô*qƒ*& dd Xdd Xdd X°(#°(#qÔÔ,dd ÔÔ,dd ÔÔ,dd ÔÔ,dd ÔÔ+  ÔÐ # 8 ˆ „„……#ÐÓ  ÓDaily€Noise€DoseÌ(%)Ð +!t Ä   „„……+ÐEquivalent€TWAÌ(Ô_ÔdBAÔ_Ô)Ð +!t Ä  „„……+ÐPercent€of€CoalÏMinersÌExposedÐ +!Lœ  „„……+ÐPercent€of€WorkersÏExposed€(€SICÏ20-39)Ð +!Lœ  „„……+Ð<€100Ð +!Ì " „„……+Ð<€90¹Ó  ÓÐ +!¤ô  „„……+Ð76.5Ð +!Ì 3 „„……+Ð77.8Ð +!Ì 3 „„……+Ð100-200Ð +!$t" „„……+Ð90-95Ð +!$t" „„……+Ð19.5Ð +!$t3 „„……+Ð13.9Ð +!$t 3 „„……+Ð200-300Ð +!¤ô!" „„……+Ð95-98Ð +!¤ô"" „„……+Ð3.0Ð +!¤ô#3 „„……+Ð5.4Ð +!¤ô$3 „„……+Ð>300Ð +!$t%" „„……+Ð>98Ð +!$t&" „„……+Ð1.0Ð +!$t'3 „„……+Ð2.9Ð +!$t(3 „„……+ÐÐ +!¤ô)" „„……+ÐTotalÐ +!¤ô*" „„……+Ð100.0Ð +!¤ô+3 „„……+Ð100.0Ð"¤ô,3  "ÐÌSimply€put,€these€data€show€that€compliance€with€a€Ô_ÔPELÔ_Ô€of€90€Ô_ÔdBAÔ_Ô€can€be€achieved€for€96%€ofÏthe€coal€miners€with€a€reduction€of€5dB,€or€less,€and€for€99%€of€the€miners€with€a€reduction€of€8ÏdB,€or€less.€€The€Ô_ÔBBNÔ_Ô€study€projected€that€the€application€of€"best€effort"Ïengineering/administration€control€procedures€would€achieve€compliance€with€the€90€Ô_ÔdBAÔ_Ô€TWAÏ(8€hours)€for€99.4%€of€the€workers€in€those€industries€represented€by€the€19€SIC€codes.€Ô_ÔBBNÔ_ÔÏstated€further€that€it€was€not€unrealistic€to€expect€that€these€levels€of€reduction€are€achievableÏwith€engineering€controls.ÌÌYet,€by€the€mid-80's€policies€had€begun€to€evolve€in€both€OSHA€and€Ô_ÔMSHAÔ_Ô€that€effectivelyÏreversed€the€preferred€hierarchy€of€controls.€€In€1983,€OSHA€policy€(Ô_ÔCPLÔ_Ô€2.45A€CH-12)Ð 0+€&@ Ðprovided€that€if€an€effective€hearing€conservation€program€is€in€place,€no€Standard€Threshold€ShiftÏhas€been€detected,€and€adequate€hearing€protectors€are€utilized,€no€citation€will€be€issued€for€noiseÏup€to€a€TWA8€of€100€Ô_ÔdBAÔ_Ô€if€the€costs€to€implement€the€hearing€conservation€program€are€lessÏthan€those€of€engineering€or€administrative€controls.€€€A€disparate€policy€with€regard€to€miningÏsector€developed€within€Ô_ÔMSHAÔ_Ô:€while€continuing€to€require€the€metal€and€non-metal€miningÏindustry€to€consider€engineering€controls€for€compliance,€Ô_ÔMSHAÔ_Ô€began€permitting€the€coal€miningÏindustry€in€1985€to€use€hearing€protectors€in€lieu€of€engineering€controls.€€ÌÌFinally,€the€demise€of€U.S.€Environment€Protection€Agency's€Office€of€Noise€Abatement€andÏControl€signaled€a€lack€of€commitment€at€the€Federal€level€to€the€development€of€quieter€productsÏin€this€country.€€It€is€not€surprising€that€since€the€mid€80's€little€effort€has€been€expended€byÏindustry€in€fostering€the€development€and€implementation€of€inherently€quieter€machines€andÏprocesses€to€achieve€compliance€with€workplace€noise€regulations.ÌÌThe€regulatory€agencies€need€to€revisit€and€reassess€their€policies€on€the€use€of€engineeringÏcontrols.€€It€is€encouraging€that€Ô_ÔMSHAÔ_Ô€in€its€current€Ô_ÔrulemakingÔ_Ô€is€proposing€to€reestablish€theÏprimacy€of€engineering/administrative€controls.€Is€not€encouraging€that€Ô_ÔMSHAÔ_Ô€will€maintain€aÏÔ_ÔPELÔ_Ô€of€90€with€a€5-dB€exchange€rate.€€€In€the€Ô_ÔBBNÔ_Ô€study€was€a€projection€of€what€percentage€ofÏworkers€would€be€exposed€to€hazardous€noise€for€two€different€target€controls€levels:€90€Ô_ÔdBAÔ_Ô€orÏless€as€compared€to€85€Ô_ÔdBAÔ_Ô€or€less.€Also€shown€in€Table€2€are€the€NIOSH€estimates€of€theÏpercent€of€workers€at€risk€of€developing€material€hearing€impairment€over€their€working€lives.€IfÏnoise€controls€were€implemented€for€noise€levels€of€85€Ô_ÔdBAÔ_Ô€and€above,€fully€96.4%€of€workers€inÐ h+¸&* Ðthe€19€industrial€segments€would€be€exposed€to€noise€levels€of€85€Ô_ÔdBAÔ_Ô€or€less.€ÌÌIn€order€for€a€research€agenda€for€control€technology€to€have€a€customer€base,€regulatoryÏpressures€need€to€be€reasserted.€€The€first€step€would€be€to€eliminate€the€approach€to€protectingÏworkers'€hearing€through€the€sole€use€of€Ô_ÔPPEÔ_Ô.€€When€other€types€of€health€and€safety€hazards€areÏpresent€in€the€workplace,€engineering/administrative€controls€are€always€utilized€as€the€first€line€ofÏdefense€to€eliminate€or€minimize€the€potentially€harmful€effects€of€the€hazards.€€Yet,€a€peculiarÏrationale€for€noise,€in€effect€a€double€standard€for€noise,€has€been€adopted€in€addressing€theÏproblem€of€noise-induced€hearing€loss:€preservation€of€workers'€hearing€is€not€important€enoughÏto€require€the€same€level€of€protection€provided€to€them€for€other€hazards.€Although€they€areÏintended€to€be€an€interim,€temporary€element€in€a€hearing€loss€prevention€strategy,€hearingÏprotectors€have€become€the€only€strategy€available€to€at€least€two€generations€of€AmericanÏworkers.€€The€problems€with€total€reliance€on€hearing€protectors€are:ÌÌTable€2.€Percent€of€workers€that€would€be€exposed€for€two€noise€reduction€targets:€90€Ô_ÔdBAÔ_Ô€andÏ85€Ô_ÔdBAÔ_Ô.€€Also€shown€are€the€percentage€of€workers€expected€to€develop€hearing€impairmentÏfrom€a€work-life€exposure€to€the€noise€levels.¹Ô*‚ƒ*( dd dd dd dd *&°(#°(#‚ÔÔ,ždd ÔÔ,ždd ÔÔ,ždd ÔÔ,ždd ÔÔ+  ÔÐ # $X" „„……#ÐÐ +!l$¼# „„……+ÐÓ  ÓPercent€of€WorkersÐ +!l$¼$0 „„……+ÐExposedÐ +!l$¼% „„……+ÐÐ +!l$¼& „„……+ÐNoise€LevelÐ +!ì%€105Ð +! d" „„……+ÐnilÐ +! d" „„……+ÐnilÐ +! d" „„……+Ð95òò3óóÐ" d3  "ÐÌPersonal€Protective€EquipmentÌÌWorkers€are€reluctant€to€use€hearing€protectors€because€they€are€uncomfortable,€interfere€withÏcommunication,€interfere€with€hearing€critical€machine€operations,€and€cut€the€workers€off€fromÏtheir€environment.ÌÌPresent€EPA€Noise€Reduction€Rating€scheme€over€estimates€the€amount€of€protection€reallyÏavailable€to€the€average€wearer€by€as€little€as€40%€and€by€as€much€as€2000%.€€The€deratingÏstrategies€of€OSHA€and€NIOSH€have€high€face€validity,€but€have€not€been€evaluated€in€the€fieldÏto€see€whether€they€help€or€not.ÌÌManagement€relies€upon€hearing€protection€to€the€extent€of€assuming€that€if€hearing€protectorsÏare€used,€there€is€no€òònoise€problemóó.Ð ($x. ÐBecause€of€1,€2,€and€3€above,,€the€hearing€conservation€program€becomes€a€hearing€lossÏdocumentation€program.ÌÌBest€Estimate€of€Present€SituationÐ ˆ+Ø&6 ЇIn€the€1980's€National€Occupational€Exposure€Survey,€NIOSH€found€that€companies€did€notÏapply€all€aspects€of€a€hearing€conservation€program€evenly.€€Table€3€shows€that€more€companiesÏprovided€hearing€protection€than€provided€noise€monitoring€and€more€companies€provided€noiseÏmonitoring€than€provided€audiometer.€€The€trend€was€similar€for€all€business€sizes,€small,€medium,Ïand€large.ÌÌTable€3.€Prevalence€of€Hearing€Conservation€Program€Elements€by€Company€Size.ÌPercent€of€Companies€Providing€Element¹Ô*‚ƒ*0  ždd ždd ždd ždd *(°(#°(#‚ÔÔ,ždd ÔÔ,ždd ÔÔ,ždd ÔÔ,ždd ÔÔ+  ÔÐ # pÀ „„……#ÐCompany€SizeÐ +!Ô$" „„……+ÐAudiometry€Ð +!Ô$" „„……+ÐMonitoring€Ð +!Ô$" „„……+ÐHearing€ProtectionÐ +!Ô$" „„……+ÐSmallÐ +!T¤" „„……+Ð0Ð +!T¤3 „„……+Ð0Ð +!T¤3 „„……+Ð16.5Ð +!T¤3 „„……+ÐMediumÐ +!Ô$" „„……+Ð5.2Ð +!Ô$3 „„……+Ð4.5Ð +!Ô$3 „„……+Ð37.9Ð +!Ô$3 „„……+ÐLargeÐ +!T¤" „„……+Ð18.7Ð +!T¤3 „„……+Ð29.5Ð +!T¤3 „„……+Ð83.5Ð"T¤ 3  "ÐÌThe€elements€audiometry€and€hearing€protection€are€only€implemented€if€the€results€of€monitoringÏshows€workers€being€exposed€above€the€permissible€exposure€limit€and€no€noise€control€elementsÏhas€been€introduced.€€Yet,€it€is€unlikely€that€controls€will€be€introduced€when€hearing€protectorsÏare€being€dispensed€to€workers€whose€noise€exposures€are€unknown€in€the€first€place.ÌÌThere€is€the€wide-spread€expectation€that€hearing€conservation€programs€can€be€as€effective€inÏpreventing€hearing€loss€as€can€noise€control€programs€that€reduce€the€noise€to€less€harmful€levels.€ÏThis€implies€that€a€noise€control€capable€of€reducing€the€exposure€level€by€10€dB€will€be€no€moreÏeffective€than€a€hearing€protector€that€reduces€the€noise€exposure€level€by€10€dB;€the€hearingÏprotector€is€certainly€less€expensive€than€noise€control.€€The€flaw€of€this€expectation€is€that€a€noiseÐ à+0'4 Ðcontrol€outcome€affects€all€persons€in€the€area€which€a€hearing€protector€provides€more€than€10ÏdB€of€noise€reduction€for€some€workers€and€less€than€10€dB€of€noise€reduction€for€others.ÌÌIn€1976,€Ô_ÔBBNÔ_Ô€provided€additional€data€about€the€cost€of€a€hearing€conservation€program.€€TheÏresults€are€displayed€in€Table€4€expressed€in€1997€dollars.€€Also€shown€in€Table€4€are€OSHA'sÏestimates€from€a€cost€analysis€done€in€1983€and€from€a€penalty€assessment€action€in€1992.ÌßA€*%) °°xdtE°lxAßÓ  ÓTable€4.€Costs€per€worker€of€hearing€conservation€program€elementsÐ À  ÐÓ  ÓòòÔ_ÔBBNÔ_Ô€Cost€Impact€AnalysisóóÐ ˜è  Ð$70€per€worker€($26€for€monitoring,€$44€for€audiometric€testing)ÌòòOSHA€1983€AnalysisóóÐ H˜ Ð$63€per€worker€($28€for€monitoring,€$15€for€hearing€protection,€$20€for€training)ÌòòÔ_ÔUSDOLÔ_Ô€1992€AnalysisóóÐ øH Ð$87€per€worker€(distributed€between€monitoring,€audiometry,€hearing€protection,€and€training)ÌßA€*%) °°xdtE°§xAßÐ ¨ø ÐÌThere€are€30+€million€American€workers€exposed€to€noise€levels€in€excess€of€85€Ô_ÔdBAÔ_Ô€and€a€largeÏproportion€of€them€are€not€in€hearing€conservation€programs€providing€any€elements.€€A€1995ÏMichigan€Department€of€Public€Health€found€that€45%€of€companies€employing€workers€withÏnoise-induced€hearing€loss€had€no€hearing€conservation€program.ÌÌA€recent€market€analysis€found€that€$180€million€are€expended€annually€for€hearing€protectors€andÏthat€$120€million€are€expended€for€Ô_ÔaudiogramsÔ_Ô.€€So€little€is€spent€on€noise€monitoring€and€noiseÏcontrol€that€it€is€not€possible€to€track€expenditures.€€If€a€full€hearing€conservation€program€wereÐ †+Ö&, Ðavailable€to€all€occupational€noise€exposed€American€workers,€the€market€should€be€approachingÏ$1.9€billion€per€year€for€every€year€that€noise€control€is€not€on€the€national€agenda.€€Instead,€$320Ïmillion€is€spent€going€through€the€motions,€less€than€17%€of€what€is€needed.ÌÌRecommendations:€Research€&€Related€Activities€for€Noise€Control€and€Hearing€ProtectionÌ€ÌThe€following€recommendations€are€tentatively€offered:ÌÌ1.€Current€and€legacy€noise€control€technologies€should€be€evaluated€in€terms€of€their€applicationsÏ-€some€materials€used€25€years€ago€may€not€be€available€or€may€have€proven€to€haveÏhealth-hazardous€properties.ÌÌ2.€A€database€of€control€technologies€that€work€should€be€created.€€The€database€would€apply€toÏretro-fitting€noise€controls.ÌÌ3.€Information€management€research€could€develop:€ÌÌà0  àà0` (#(#àà  àa.€€a€user-friendly€computer-based€model€to€guide€those€responsible€for€compliance€(plantÏengineers,€safety€officers,€industrial€hygienists)€through€the€intricacies€ofÏidentifying,€selecting€and€implementing€engineering€noise€controls.€€Such€a€modelÏwould€also€permit€the€user€to€evaluate€alternatives€to€arrive€at€an€optimal€controlÏstrategy.€Ðh+¸&*` (#` (# Ðà  àà0 ` àà  àb.€€a€computer-based€system€that€contained€a€database€of€new€products€that€are€alreadyÏavailable.Ð ` (#` (# ÐÌ4.€€Health€Communication€research€could€focus€educating€management€(especially€the€financialÏtypes)€and€the€general€public€about€the€benefits€of€a€quiet€workplace.ÌÌ5.€€On€an€industry-by-industry€basis:€ÌÌà  àà0 ` àà  àa.€€Establish€a€knowledge€base€of€current€noise€control€technology,€publicize€it,€and€makeÏit€readily€available.€Identify€technology€gaps€that€are€either€true€barriers€to€theÏdevelopment€of€quiet€machines/processes,€or€will€further€enhance€theÏtechnical/cost€effectiveness€of€current€technology.Ð ` (#` (# ÐÌà  àà0 ` àà  àb.€€Conduct€joint€research/demonstration€projects€to€fill€the€technology€gaps€and€evaluateÏnew€emerging€technology.Ð ` (#` (# ÐÌà  àà0 ` àà  àc.€€Adopt€voluntary€noise€standards€to€label€products€used€in€the€workplace.Ð ` (#` (# ÐÌà  àà0 ` àà  àd.€€Provide€Federal€funds€to€jump€start€the€activities€identified€above,€or€to€match€otherÏsources€of€funding€for€there€activities.Ð ` (#` (# ÐÌ6.€€Initiate€research€methods€for€active€noise€control€of€stationary€and€mobile€noise€sources.Ð h+¸&* ЇÌ7.€€Develop€hearing€protection€devices€that€employ€active€noise€control,€active€level-dependentÏattenuation€technologies,€and€communication€functions.ÌÌ8.€€Develop€hearing€protection€devices€on€the€basis€on€wearer€comfort€and€enhanced€speechÏunderstanding.ÌÌÔ% ‡1 Ô1.€Ô%†1ájÔ€From€Ô_ÔBBNÔ_Ô€Economic€Analysis€Report€3246,€April€1976ÌÔ% ‡2 Ô2.€Ô%†2VkÔ€From€NIOSH€1972€Noise€Criteria€DocumentÌÔ% ‡3 Ô3.€Ô%†3 kÔ€Based€on€extrapolation€from€NIOSH€1972€noise€criteria€documentßA€*%) °°xdtE°ôxAßÐ H˜ ÐÓ  ÓÔ#†XÕ XXXÕ +#ÔÔ‡XÕ XXXÕ ÔÌò òExposure€Assessment:€ó óAll€workers€exposed€to€an€8„hour€time„weighted€average€of€82€decibelsÐ øH Ðor€greater€must€be€placed€in€a€Hearing€Loss€Prevention€Program.€€Proper€identification€of€theseÏworkers€is€the€key€element€in€a€hearing€loss€prevention€process.€€The€application€of€a€time„¼weighted€average€to€noise€dose€is€related€to€the€selection€of€a€criterion€level,€an€exchange€rate,Ïand€a€threshold€level€below€which€sounds€arenððt€considered.€€When€the€exchange€rate€is€3€dB€andÏthere€is€no€threshold,€the€time€weighted€average€is€the€same€as€the€equivalent€level:€Ô_ÔdBAÔ_Ô€TWAòò8óóÐ 8"ˆ  Ðequals€Ô_ÔdBAÔ_Ô€Ô_ÔLòòeqÔ_Ô(8)óó.€Ð $`" ÐÌSelection€ConsiderationsÌÓ  ÓÌThe€challenge€is€to€correctly€identify€those€at€risk€according€to€the€following€matrix.€€Ð p+À&* Ðà  àAssigned€(from€one€of€the€measurement€methods)€ÌÓC€  ÿÿ$#CÓà  àtime„weighted€average€noise€exposureÌÓC€  ÿÿ$$CÓÌÓC€  ÿÿ$$CÓà  àà ` àà ¸ àà  à<€85€Ô_ÔdBAÔ_Ôà À à=or>€85€Ô_ÔdBAÔ_ÔÐ 8 ˆ ÐÓC€  ÿÿ$$CÓÌÓC€  ÿÿ$$CÓà  àà ` àà ¸ àà  à€negativeà À à€€false€positiveÐ è 8  ÐÓC€  ÿÿ$$CÓà  à<€85€Ô_ÔdBAÔ_Ôà ¸ àà  à€€€€OKà h àà À à€€€€€€€€OKÐ À  ÐÓC€  ÿÿ$$CÓà  àActual€à ¸ àà  ànot€in€Ô_ÔHLPPÔ_Ôà À à€€€€€in€Ô_ÔHLPPÔ_ÔÐ ˜è  ÐÓC€  ÿÿ$$CÓà  àworkerÌÓC€  ÿÿ$$CÓà  àat€riskÌÓC€  ÿÿ$$CÓà  àgroupà ` àà ¸ àà  àà h àà À àfalse€negativeà p à€€€€€positiveÐ  p ÐÓC€  ÿÿ$$CÓà  àà ` àà ¸ à=or>€85€Ô_ÔdBAÔ_Ôà h àà À à€€€NOT€OKà p à€€€€€€€€OKÐ øH ÐÓC€  ÿÿ$$CÓà  àà ` àà ¸ àà  àà h àà À à€€not€in€Ô_ÔHLPPÔ_Ôà p à€€€€€in€Ô_ÔHLPPÔ_ÔÐ Ð  ÐIdentifying€a€worker€at€risk€who€is€not€at€risk€and€including€that€worker€in€a€Hearing€LossÏPrevention€Program€is€an€acceptable€outcome€of€an€exposure€measurement€strategy.€€However,€aÏdirect€financial€penalty€and€potential€liability€issue€presents.€€On€the€other€hand,€not€identifying€aÏworker€because€of€assigning€an€incorrect€exposure€which€results€in€a€false€negative€is€anÏunacceptable€outcome€of€a€measurement€strategy.ÌÓC€  ÿÿ$$CÓÌÓC€  ÿÿ$$CÓMeasurement€StrategiesÌÓC€  ÿÿ$$CÓÌÓC€  ÿÿ$$CÓSeveral€methods€are€used€to€quantify€personal€occupational€noise€exposures€and€thus€identifyÐ h+¸&* Ðworkers€for€inclusion€in€a€Hearing€Loss€Prevention€Program.ÌÓ XÓÓ?+ ` ¸ hÀpÈ xÐ (#°œX?ÓÓ ¨ýÓÓC€  ÿÿ$$CÓÐ ˆØ ÐÔ..ÔÓC€  ÿÿ$$CÓà  àð"ðà ` àWhen€the€daily€noise€exposure€includes€periods€of€varying€noise€levels,€the€Ð `° Ðà ` àcombined€effects€of€the€varying€levels€can€be€summed.€€The€formula€is€C1/T1€+€¼à ` àC2/T2€+€....€+€Ô_ÔCnÔ_Ô/Tn.€€Ô_ÔCnÔ_Ô€indicates€the€total€time€of€exposure€at€a€specified€noise€¼à ` àlevel,€and€Tn€indicates€the€total€time€of€exposure€permitted€at€that€level.€€A€value€¼à ` àgreater€than€one€indicates€an€overexposure.€ÌÓC€  ÿÿ$$CÓÐ ˜è  ÐÓC€  ÿÿ$$CÓà  àð"ðà ` àA€personal€dosimeter€can€be€worn€by€the€worker€to€monitor€sound€exposure€for€Ð pÀ Ðà ` àthe€full€shift€or€any€specified€portion€of€the€shift.€€¹ÓC€  ÿÿ$$CÓà  àð"ðà ` àA€task„based€assessment€can€be€made.€€The€sound€exposure€level€and€duration€Ð  p Ðà ` àof€each€component€task€of€the€worker's€job€is€determined.€€The€information€is€¼à ` àorganized€into€a€job€function€profile€which€is€used€to€calculate€the€sound€exposure.ÌÓ ¨ýÓÓ XÓÓB.°°` ¸ hÀpÈ xÐ (#ŒXBÓÓC€  ÿÿ$$CÓòòÌÓC€  ÿÿ$$CÓóóVariables€Affecting€Sound€ExposuresÐ €Ð ÐÓC€  ÿÿ$$CÓÌÓC€  ÿÿ$$CÓThe€dispersion€of€the€distribution€of€the€true€daily€noise€exposures€is€dominated€by€the€day„to„dayÏfluctuations€in€noise€exposures.€€Many€variables€account€for€the€day„to„day€differences€inÏexposure,€such€as:ÌÓC€  ÿÿ$$CÓÌÓ XÓÓ?+ ` ¸ hÀpÈ xÐ (#°°X?ÓÓ ¨ýÓÓC€  ÿÿ$$CÓà  àð"ðà ` àWorker€mobility€and/or€rotationÐ )à$( ÐÓC€  ÿÿ$$CÓÐ h+¸&* ÐÓC€  ÿÿ$$CÓà  àð"ðà ` àVarying€time€spent€at€various€tasksÐ ° ÐÓC€  ÿÿ$$CÓÐ ˆØ ÐÓC€  ÿÿ$$CÓà  àð"ðà ` àNon„routine,€non„scheduled€tasksÐ `° ÐÓC€  ÿÿ$$CÓÐ 8 ˆ ÐÓC€  ÿÿ$$CÓà  àð"ðà ` àRoutine€tasks€conducted€occasionallyÐ  ` ÐÓC€  ÿÿ$$CÓÐ è 8  ÐÓC€  ÿÿ$$CÓà  àð"ðà ` àTeam€assignments€€à h àÐ À  ÐÓC€  ÿÿ$$CÓÐ ˜è  ÐÓC€  ÿÿ$$CÓà  àð"ðà ` àExtended€Ô_ÔworkshiftsÔ_ÔÐ pÀ ÐÓC€  ÿÿ$$CÓÐ H˜ ÐÓ ¨ýÓÓ XÓÓB.°°` ¸ hÀpÈ xÐ (#ŒXBÓÓC€  ÿÿ$$CÓA€comparative€evaluation€of€the€sampling€and€measurement€methods€would€benefit€those€whoÏplan€and€conduct€the€exposure€sampling€program€and€Hearing€Loss€Prevention€Program.€ÏResearch€could€include€examination€of€the€various€methods€with€respect€to€their€reliability€andÏaccuracy€in€addressing€the€variables€associated€with€sample€collection.€€ÌÓ XÓÓ?+ ` ¸ hÀpÈ xÐ (#°°X?ÓÓ ¨ýÓÓC€  ÿÿ$$CÓÐ €Ð ÐÓ ¨ýÓÓ XÓÓB.°°` ¸ hÀpÈ xÐ (#ŒXBÓÓC€  ÿÿ$$CÓòòEfficient€Use€of€ResourcesÐ X ¨ ÐÓC€  ÿÿ$$CÓÌÓC€  ÿÿ$$CÓóóResearch€to€examine€the€value„added€components€of€the€methods€would€assist€decision„makersÐ $X" Ðwith€their€choice€of€strategy.€€Efficient€use€of€resources€lends€credibility€to€a€sampling€andÏmeasurement€protocol€in€the€eyes€of€management.€€Use€of€sound€exposure€data€for€purposesÏbeyond€HLPP€identification€would€provide€evidence€of€enhanced€value.€€ÌÓ XÓÓ?+ ` ¸ hÀpÈ xÐ (#°°X?ÓÓ ¨ýÓÓC€  ÿÿ$$CÓÐ h+¸&* ÐÓC€  ÿÿ$$CÓValue„added€benefits€include€the€following:ÌÓC€  ÿÿ$$CÓÐ ˆØ ÐÓC€  ÿÿ$$CÓà  àð"ðà ` àIdentification€of€noise€sources€for€engineering€controlsÐ `° ÐÓC€  ÿÿ$$CÓÐ 8 ˆ ÐÓC€  ÿÿ$$CÓà  àð"ðà ` àIdentification€of€the€relative€contribution€of€the€noise€to€a€worker's€exposure€value€Ð  ` Ðà ` àfor€prioritizing€engineering€controls€and€assigning€appropriate€hearing€protectionÌÓC€  ÿÿ$$CÓÐ À  ÐÓC€  ÿÿ$$CÓà  àð"ðà ` àComparison€of€data€over€time€to€determine€trendsÐ ˜è  ÐÓC€  ÿÿ$$CÓÐ pÀ ÐÓC€  ÿÿ$$CÓà  àð"ðà ` àIdentification€of€successes€and€failuresÐ H˜ ÐÓC€  ÿÿ$$CÓÐ   p ÐÓ ¨ýÓà ` àð"ðà ¸ àDevelopment€of€training€toolsÐ ° ÐÓC€  ÿÿ$$CÓÌÓC€  ÿÿ$$CÓà ` àð"ðà ¸ àCollection€of€data€for€management€and€worker€reportsÐ `° ÐÓC€  ÿÿ$$CÓÌÓC€  ÿÿ$$CÓà ` àð"ðà ¸ àProvision€of€data€for€epidemiological€studies.Ð  ` ÐÓC€  ÿÿ$$CÓÌÓ XÓÓB.°°` ¸ hÀpÈ xÐ (#ŒXBÓÓC€  ÿÿ$$CÓà  àð"ðà ` àSelection€of€areas€for€application€of€intervention€strategiesÐ À  ÐÓC€  ÿÿ$$CÓÌÓC€  ÿÿ$$CÓSuggested€variables€to€be€examined€within€the€sampling€and€measurement€protocols€includeÏconsistency€of€data€collection,€repeatability€of€samples,€time€required€to€conduct€surveys,€cost€ofÏmethod,€and€use€of€data€for€expanded€purposes€such€as€identifying,€tracking€and€reporting€trends.€ÌÓC€  ÿÿ$$CÓÌÓC€  ÿÿ$$CÓÝ‚ÿÿÿÝÔȘèÐ ÔÓ @ÓÔ€¼õL »XXÕ ÔÓ ð6@ÓÔ€¼}þ » »¼õLÔò òÔ  ÔÝ  ÝÔ‡X$ X »¼}þÔÔ#†XÕ X XX$…l#ÔÔ‡XÕ XXXÕ ÔÝ‚ÿÿÿC›ÝÝ  ÝÓC€  ÿÿ$$CÓÓ 0ð6ÓBiological€Monitoring݃ÿÿC›JœÝÔ Ñ›ÔŒÐ ˜è ЌԀXÕ XXXÕ ÔÓ 0ÓÔ€XÕ XXXÕ Ôó óÝ  ÝÔ#†¼õL »XXÕ é›#ÔÔ‡XÕ X »¼õLÔÔ#†XÕ XXXÕ +œ#ÔÔ‡XÕ XXXÕ ÔÓC€  ÿÿ$$CÓÌÝ‚ÿÿÿÝÔÈh ¸ ðÔÓ @ÓÔ€XÕ XXXÕ ÔÓ @@ÓÔ€X$ XXXÕ Ôò òòòÔ  ÔÝ  ÝÔ#†¼}þ » XX$™#ÔÔ‡X$ X »¼}þÔÔ#†XÕ X XX$Û#ÔÔ‡XÕ XXXÕ ÔÝ‚ÿÿÿ>žÝÝ  ÝÓ 0@ÓÓC€  ÿÿ$$CÓAudiometry:݃ÿÿ>žkŸÝÔ ÏžÔŒÐ h ¸ ЌԀXÕ XXXÕ ÔÓ 0ÓÔ€XÕ XXXÕ Ôó óóóÝ  ÝÔ#†¼õL »XXÕ Ÿ#ÔÔ‡XÕ X »¼õLÔÔ#†XÕ XXXÕ LŸ#ÔÔ‡XÕ XXXÕ ÔÓC€  ÿÿ$$CÓ„€Increasing€precision€and€accuracy€of€threshold€estimation,€and€reducing€test/retest€variability€hasÐ ˜"è Ðthe€potential€of€providing€a€more€sensitive€indication€of€the€onset€of€hearing€loss.€€EconomicÏbenefits€also€result€from€fewer€false„positive€Standard€Threshold€Shifts.ÌÓ XÓÓ<(4 4Œ ä <”ìDœôL¤ü!°°X<ÓÓC€  ÿÿ$$CÓIs€this€feasible€in€the€industrial€testing€environment?ÌÓC€  ÿÿ$$CÓWhat€would€be€the€effects€on€identification€of€changes€in€an€individualððs€hearing?ÌÓC€  ÿÿ$$CÓWhat€effects€would€this€have€on€evaluating€hearing€conservation€program€effectiveness?Ð Ð+ '( ÐÓC€  ÿÿ$$CÓHow€might€this€be€accomplished?ÌÓ XÓÓ?+Ü Ü4Œ ä <”ìDœôL¤ü!44‹X?ÓÓC€  ÿÿ$$CÓ„€The€professional€reviewer€of€industrial€Ô_ÔaudiogramsÔ_Ô€must€make€judgements€andÏrecommendations€without€participating€in€the€testing€process.€€Can€additional€informationÏregarding€the€reliability€of€the€test€results€be€economically€gathered€to€improve€the€professionalÏreview€process?ÌÓC€  ÿÿ$$CÓ„€What€are€the€real€effects€of€steady„state€and€transient€ambient€noise€in€the€test€chamber€on€testÏreliability?€€Do€octave€band€measurements€indicate€effective€masking€in€this€situation?€€How€wellÏcan€the€listener€separate€the€test€signals€from€the€ambient€noise?ÌÝ‚ÿÿÿÝÔÈ8ˆpÀÔÓ @ÓÔ€XÕ XXXÕ ÔÓ @@ÓÔ€X$ XXXÕ Ôò òòòÔ  ÔÝ  ÝÔ#†¼}þ » XX$³ #ÔÔ‡X$ X »¼}þÔÔ#†XÕ X XX$õ #ÔÔ‡XÕ XXXÕ ÔÝ‚ÿÿÿ¨ÝÝ  ÝÓ 0@ÓÓC€  ÿÿ$$CÓAre€there€other€measurements€for€susceptibility€to€hearing€loss€from€noise€exposure?݃ÿÿ¨-©ÝÔ ‘¨ÔŒÐ 8ˆ ЌԀXÕ XXXÕ ÔÓ 0ÓÔ€XÕ XXXÕ Ôó óóóÝ  ÝÔ#†¼õL »XXÕ Ì¨#ÔÔ#†¼õL » »¼õL©#ÔÔ‡¼õL » »¼õLÔÓC€  ÿÿ$$CÓ„€Acoustic€reflex:€does€latency€of€onset€or€offset€indicate€susceptibility€to€noiseÐ h¸ Ðdamage?ÌÓC€  ÿÿ$$CÓ„€Ô_ÔOtoacousticÔ_Ô€emissions:€what€information€can€they€provide?ÌÓC€  ÿÿ$$CÓ„€??ÌòòÌÌóóò òThe€Role€of€Education€and€Training€in€Hearing€Loss€Preventionó ó:€Education€andÐ X#¨ Ðtraining€elements€have€always€been€a€part€of€hearing€loss€prevention€programs.€ÏHowever,€the€effectiveness€of€this€training€in€actually€leading€to€consistentÏbehaviors€that€reduce€or€eliminate€the€incidence€of€occupational€Ô_ÔNIHLÔ_Ô€has€variedÏwidely.€€Disappointing€results€post„training€have€prompted€considerable€researchÐ ,P'& Ðinto€more€effective€ways€to€communicate€with€and€motivate€workers€and€managersÏto€protect€hearing.Ì€€€€€Traditionally,€the€curriculum€for€most€programs€emphasized€gains€in€factualÏknowledge„„providing€workers€and€managers€with€copious€information€about€theÏphysics€of€sound,€normal€auditory€functioning,€how€noise€damages€the€ear,€and€howÏhearing€loss€can€be€prevented€through€engineering€controls€and€the€use€of€hearingÏprotection.€€The€information€was€often€presented€through€a€film€or€a€writtenÏpamphlet,€with€or€without€ð ðclassroomðð€discussion€of€the€topics.€€The€assumptionÏwas€that€employees€and€managers€who€understood€this€information€would€naturallyÏappreciate€the€value€of€protecting€hearing€and€would€logically€comply€with€hearingÏprotective€measures.€€Unfortunately,€follow„up€studies€sometimes€indicated€thatÏwhile€participants€demonstrated€a€considerable€gain€in€knowledge€about€noiseÏhazards€and€hearing€loss,€they€frequently€showed€minimal€or€only€short€termÏchanges€in€hearing€health€behaviors.€Ì€€€€€Another€axiom€for€hearing€loss€prevention€has€been€that€successful€hearingÏconservation€programs€should€result€if€management€makes€an€effort€to€integrate€theÏhearing€health€information€into€the€overall€health€and€safety€climate€of€theÏworkplace.€€While€there€certainly€can€be€training€sessions€devoted€specifically€toÏpreventing€hearing€loss,€the€hearing€conservation€program€as€a€whole€should€beÐ €+Ð&$ Ðtouted€as€an€essential€element€in€the€overall€health€and€safety€program.€€Indeed,€dataÏover€the€years€have€indicated€that€workers€and€managers€are€more€likely€to€ð ðbuy€inððÏto€a€hearing€loss€prevention€program€if€it€has€at€least€equal€status€with€other€safetyÏinitiatives.€€This€appears€to€be€especially€important€when€hearing€loss€prevention€isÏð ðcompetingðð€for€the€workers€attention€with€other€safety€initiatives€that€have€theÏpotential€to€prevent€painful€injury€or€death.€Ì€€€€€Drawing€from€the€early€ð ðoperant€conditioningðð€literature€and€the€success€ofÏð ðtoken€economiesðð€in€institutional€settings,€it€became€common€practice€forÏmanagement€to€reward€workers€who€practice€good€hearing€health€(e.g.€wear€theirÏhearing€protectors)€and€punish€those€who€do€not.€€More€recent€motivational€researchÏurges€caution€with€this€approach.€€In€some€situations,€reward€and€punishmentÏsystems€foster€destructive€competition€between€workers€within€a€group,€andÏfrequently€encourage€bitter€animosity€between€work€groups€and€the€managers€whoÏsupervise€them.€€For€example,€consider€two€different€groups€of€workers€at€one€plant.€ÏThe€first€group€may€work€in€conditions€where€there€are€many€barriers€(e.g.€heat,Ïcommunication€needs)€that€interfere€with€consistent€use€of€hearing€protectors.€€TheÏsecond€group€may€work€in€an€environment€where€these€barriers€are€not€present.€ÏWhat€if€management€then€adopted€a€strategy€of€using€competition€between€theÏgroups€to€increase€hearing€protector€compliance?€€It€would€be€easy€for€the€secondÐ €+Ð&$ Ðgroup€to€consistently€ð ðwinðð€this€competition,€resulting€in€the€first€group€of€workersÏbecoming€frustrated,€resentful,€and€apathetic.€€€€Ì€€€€€Initial€rewards€often€lose€their€appeal€over€time€and€must€be€periodicallyÏsupplanted€with€something€bigger€and€better€in€order€to€maintain€effectiveness.€€ÏReward€systems€that€are€designed€and€implemented€without€worker€input€can€beÏinterpreted€as€controlling€and€manipulative€by€employees,€and€this€may€damage€theirÏself„esteem€and€intrinsic€motivation€to€perform€quality€work.€€Studies€have€indicatedÏthat€this€can€lead€to€lowered€productivity,€declining€quality€of€work,€and€a€lack€ofÏmotivation€to€apply€oneself€in€the€work€situation„„€the€stereotypical€worker€whoÏsimply€puts€in€his/her€time€and€minimally€follows€the€rules.€€When€queried,€workersÏdisplaying€these€behaviors€have€reported€feeling€very€little€control€or€personalÏresponsibility€for€their€job€or€job€safety.€€This€type€of€apathy€emerges€from€negativeÏattitudes€toward€work€and€everything€associated€with€work,€including€the€hearingÏloss€prevention€program.€€Quite€simply,€rewards€sometimes€fail€to€maintain€desiredÏbehaviors,€even€in€a€heavily€supervised€work€environment,€because€workersÏperceive€that€they€are€being€manipulated€by€managementððs€system€of€doling€outÏrewards€and€punishments.Ì€€€€€à  àSimilarly,€there€are€well€documented€negative€side€effects€of€usingÐ X)¨$" Ðpunishment€tactics€to€discipline€workers€for€breaking€safety€rules€or€not€wearingÐ €+Ð&$ Ðtheir€personal€protective€equipment.€€Punishment€is€most€effective€when€used€toÏinstantly€stop€or€discourage€undesirable€behavior,€but€it€is€frequently€applied€in€theÏworkplace€as€a€threat.€€This€use€of€punishment€is€only€effective€when€behavior€canÏbe€òòclosely€monitored€and€corrected€immediately;óó€a€situation€that€is€unrealistic€forÐ ( x Ðmost€Ô_ÔworksitesÔ_Ô.€€It€is€critical€to€note€that€punishment€can€not€impart€desirableÏbehavior,€and€does€nothing€to€build€self„control€or€feelings€of€personal€responsibilityÏfor€oneððs€actions.€€Thus,€if€punishment€is€used€to€stop€undesirable€behavior,€such€asÏtaking€off€oneððs€hearing€protector€to€talk€to€a€buddy,€it€should€be€paired€immediatelyÏwith€clear€explanations€of€and€rewards€for€the€desirable€behavior.€€In€most€workÏsettings,€the€Ô_ÔpunisherÔ_Ô€is€also€the€person,€usually€a€supervisor€or€the€hearingÏconservation€program€director,€who€is€responsible€for€administering€rewards.€€ThisÏcreates€a€conflict€of€interest€that€might€seriously€diminish€the€effectiveness€ofÏrewards.Ì€€€€€à  àIf€management€chooses€to€use€an€incentive€system,€such€a€program€will€haveÐ ¸  Ðmore€potential€for€success€if€it€is€developed€and€managed€with€employeeÏparticipation.€€Effective€systems€are€designed€by€examining€the€barriers€thatÏdiscourage€safe,€desirable€behaviors.€€Management€and€employees€should€discussÏthese€barriers€and€agree€upon€specific€approaches€that€will€be€used€to€surmountÏthem.€€Whenever€possible,€the€affected€workers€should€set€up€the€system€andÐ €+Ð&$ Ðenforce€it€among€themselves.€€Peer€pressure€to€conform€to€the€rules€and€regulationsÏestablished€as€a€norm€by€the€group€as€a€whole€is€often€enough€to€assure€stableÏcompliance€with€the€program.€€Through€involvement€and€ð ðownershipðð€of€theÏincentive€program,€workers€can€be€encouraged€to€assume€as€much€responsibility€asÏfeasible€for€their€health€and€their€work€environment.€€This€approach€is€more€likely€toÏbuild€camaraderie€and€a€group€commitment€to€maintaining€a€strong€safety€cultureÏthan€a€traditional€management„centered€approach.€Ì€€€€€à  àIt€is€clear€that€training€and€motivation€programs€must€consist€of€more€thatÐ È Ðshowing€a€film€and€passing€out€a€pamphlet.€€To€be€effective,€training€must€equipÏworkers€and€management€so€that€they€feel€empowered€to€overcome€barriers.€LiveÏdiscussions€led€by€enthusiastic€and€knowledgeable€speakers€and€hands„on€practiceÏsessions€in€small€groups€with€noise€controls€and€hearing€protection€devices€haveÏbeen€successful.€€Testimonials€from€respected€peers€and€modeling€of€appropriateÏsafety€behaviors€by€supervisors€and€peers€can€be€particularly€influential.Ì€€€€€à  àIt€has€been€puzzling€to€note€that€some€workers,€despite€participation€inÐ à"0 Ðapparently€quality€safety€programs,€simply€fail€to€protect€themselves.€€In€the€past,Ïpopular€models€of€health€behavior€such€as€the€Health€Belief€Model,€HealthÏPromotion€Model,€and€the€Theory€of€Reasoned€Action€have€been€invoked€to€explainÏthis€phenomenon€by€tending€to€emphasize€characteristics€and€beliefs€of€theÐ €+Ð&$ Ðindividual€worker€that€set€him€or€her€apart€from€the€workers€that€cooperate€with€andÏparticipate€in€the€safety€directives.€€While€understanding€individual€differences€inÏattitude,€belief,€and€intention€is€still€useful,€the€person„centered€models€have€notÏadequately€incorporated€many€other€factors€now€known€to€contribute€to€safe€workÏbehavior.€€Ì€€€€€à  àNewer€models€of€health€behavior€stress€interdisciplinary€viewpoints€and€mayÐ xÈ  Ðcontain€parameters€that€focus€on€the€interaction€of€environmental,€psychological,Ïand€social€determinants€of€behavior.€€These€may€include€social€factors€such€asÏshared€values€and€beliefs,€peer€pressure,€and€both€physical€and€culturalÏcharacteristics€of€the€work€environment.€€Safety€culture€or€safety€climate€can€beÏbroadly€defined€as€the€general€level€of€safety€awareness€and€commitment€within€anÏorganization.€€Safety€culture€guides€relevant€behavior€in€the€workplace€by€serving€asÏa€central€point€of€reference€for€decision„making€by€workers€and€management€aboutÏsafety€concerns.€€While€the€construct€of€safety€culture€is€still€somewhat€ambiguous,Ïit€is€anticipated€that€ongoing€research€(e.g.€in€work€organization€factors)€willÏsuccessfully€define€many€of€the€relevant€factors€that€constitute€a€safe€workplaceÏwith€safety€conscious€workers.€€We€know€that€written€company€safety€policiesÏcoupled€with€expedient€and€positive€responses€to€safety€concerns€voiced€by€workersÏare€important.€€Worker€characteristics€(such€as€knowledge€about€health€risks),Ð €+Ð&$ Ðconvenient€availability€of€personal€protective€equipment€in€the€work€areas,€provisionÏfor€prompt€employee€feedback,€and€€a€health„conscious€social€and€physicalÏenvironment€also€contribute€to€worker€adherence€to€safety€practices.€€MaximalÏcompliance€depends€upon€establishing€in€each€workplace€an€organizational€safetyÏclimate€that€is€fully€embraced€by€òòbothóó€workers€and€management.€€Prior€studiesÐ P   Ðdesigned€around€the€health€belief/health€promotion€models€have€noted€thatÏòòperceivedóó€barriers€are€as€important€as€actual€barriers€in€influencing€workplaceÐ  ð  Ðsafety.òò€óó€€Actual€or€perceived€barriers/job€hindrances€have€often€been€the€strongestÐ È Ðpredictors€of€safety€behavior.€Ì€€€€€à  àMost€hearing€conservation€professionals€agree€that€passive€protection€ofÐ h Ðworkers€from€hearing€loss€by€applying€engineering€controls€to€diminish€the€noiseÏhazards€in€the€workplace€is€the€preferred€approach€that€should€be€stressed€in€aÏhearing€loss€prevention€program.òò€€óó€However,€the€reality€is€that€in€many€settingsÐ à Ðtoday,€protecting€the€workforce€from€hearing€loss€and€other€occupational€hazardsÏultimately€depends€upon€personal€protective€equipment€(such€as€hearing€protectors)Ïand€the€voluntary€actions€of€the€hazard„exposed€workers.€€Hearing€loss€preventionÏtraining€programs€for€these€workers€continue€to€be€very€important,€but€theÏexpanding€research€findings€noted€previously€suggest€that€such€programs€may€needÏto€include€much€more€than€multi„media€factual€presentations€about€mechanismsÐ €+Ð&$ Ðinvolved€in€hearing€loss€and€how€to€properly€wear€hearing€protectors.€€TrainingÏprograms€in€the€future€may€increasingly€emphasize€1)€modifying€the€organizationalÏclimate€to€facilitate€the€productivity,€health,€and€safety€of€the€workforce,€and€2)Ïproviding€workers€and€managers€with€the€skills€and€strategies€they€need€to€takeÏresponsibility€for€managing€their€own€health€by€collectively€uncovering€and€reducingÏbarriers€to€safe€work€behavior.Ì€€€€€Ìò òÌOther€Topic€Areas:ó ó€Workersðð€hearing€ability€interacts€with€the€environment€inÐ ð@ Ðwhich€they€find€themselves.€€Communication€is€essential€in€all€work€situations;Ïhowever,€it€may€be€more€critical€in€certain€jobs€where€communication€is€much€moreÏof€an€integral€part€of€the€job€requirements.€€Examples€of€these€hearing„critical€jobsÏinclude€fire€fighters,€police€officers,€air€traffic€controllers,€and€school€crossingÏguards.€€How€workers€are€able€to€hear€and€interpret€signals€will€directly€influenceÏhow€they€function€in€their€job.€€Missed€supervisory€directions,€lost€acoustic€signalsÏfrom€machinery,€isolation€from€fellow€co„workers,€and€ignored€warning€signals€canÏbe€the€result€of€a€permanent€hearing€loss€of€varying€degrees.€€Little€research€hasÏbeen€conducted€in€this€area€to€determine€guidelines€or€standards€on€how€muchÏhearing€can€a€worker€sustain€and€still€be€safe€and€effective€in€the€workplace.€€Also,Ð ˆ+Ø&$ Ðwith€changing€technology€in€hearing€protection€devices€and€hearing€aids,€research€isÏalso€needed€in€the€area€of€Ô_ÔaccomodationÔ_Ô€of€workers€who€have€sustained€noise„¼induced€hearing€loss€with€the€goal€of€returning€these€workers€to€their€employment.ÌÌSome€basic€Ô_ÔreseachÔ_Ô€is€needed€to€develop€standardized€tests€which€will€predict€howÏwell€a€worker€will€perform€in€the€job€with€Ô_ÔvaringÔ_Ô€degrees€of€hearing€loss.€€TheÏamount€of€hearing€loss€and€the€pattern€of€the€loss€are€Ô_ÔinportantÔ_Ô€variables€which€needÏto€be€addressed.€€Also,€the€environmental€variables€such€as€background€noise€andÏthe€kind€of€acoustic€signal€necessary€in€the€job€must€be€investigated.€€The€testingÏdevices€must€be€shown€to€be€predictive€of€the€job€deficiencies€that€result€from€levelsÏof€the€variables€shown€above€in€a€population€of€experienced€and€new€workers.€ÏOnce€such€test€devises€are€designed€and€validated€in€the€laboratory,€they€must€thenÏbe€taken€into€an€actual€workplace€and€used€to€verify€that€it€is€predictive€of€workerÏbehavior€necessary€to€do€the€job€which€the€employee€has€been€assigned.ÌÌOnce€reliable€and€predictive€tests€are€devised,€research€can€begin€to€investigateÏways€that€workers€can€be€Ô_ÔaccomodatedÔ_Ô€in€the€workplace€to€overcome€theÏdeficiencies€discovered€through€the€testing€program.€€These€Ô_ÔaccomodationsÔ_Ô€canÏinclude€the€types€of€hearing€protection€devices€that€are€most€beneficial€to€theÐ €+Ð&$ Ðhearing€impaired€worker,€the€types€of€aural€amplification€devices€that€would€allowÏthe€worker€to€safely€and€efficiently€perform€their€work,€and€other€changes€in€theÏworkplace€that€would€lessen€the€emphasis€on€the€acoustic€signal.€€The€research€mustÏconsider€the€practicality€and€the€cost€factor€associated€with€the€Ô_ÔaccomodationÔ_Ô€asÏwell€as€the€workersðð€acceptance€of€the€change€in€their€environment.ÌÌAnother€research€area€should€include€the€surveillance€of€workplace€accidents€withÏan€emphasis€on€the€noise€at€the€accident€location€and€the€hearing€abilities€of€theÏparties€involved.€€This€is€an€area€of€research€in€accident€investigation€that€has€beenÏlargely€ignored€in€the€past.€€Questioning€of€witnesses€about€the€acousticÏenvironment€and€how€it€may€have€contributed€to€the€accident€need€to€beÏsystematically€documented€in€order€to€determine€if€noise€and€hearing€in€any€wayÏcontributed€to€the€Ô_ÔsenarioÔ_Ô.€€One€often€sees€that€breakdowns€in€communication€areÏlisted€as€contributing€factors€in€a€workerððs€death,€but€the€specifics€of€the€acousticÏsignals€and€hearing€characteristics€of€the€worker€population€are€not€included.€ÏAccidents€investigations€that€include€information€on€noise€and€hearing€will€fill€inÏthis€missing€part€and€lead€to€future€research€on€ways€to€alter€the€environment€toÏreduce€the€risk€of€future€accidents€and€occupational€deaths.ÌÔ#†¼õL » »¼õLáª#ÔÓ  ÓÐ €+Ð&$ Ðñ‘ ñÓ  Óñ‘ ññ’ ññŠ ñÔ‡¼õL » »¼õLÔòòñŠ ññ’ ññ“ ññŠ ñÔ‡XÕ X »¼õLÔñŠ ññ“ ññ’ ññŠ ñÔ#†XÕ XXXÕ #ì#ÔñŠ ññ’ ññ“ ññŠ ñÔ‡¼]‰» »¼õLÔñŠ ññ“ ñRecords€ManagementÌÌÓŠv°&` ¸ hÀpÈ xÐ (#€%Ø'0*ˆ,à.813è5@8˜:ð<H? AøCPF¨HKXM°OR`T¸VYh[ÜÜŒXŠÓÓ hÓñ’ ññŠ ñóóñŠ ññ’ ñA€research€agenda€will€be€dictated€by€selection€among€competing€programÏevaluation€methodologies,€costs,€and€by€current€regulatory€requirements€for€recordsÏmanagement,€(i.e.,€available€data).€€We€are€currently€Ô_ÔtransitioningÔ_Ô€to€the€use€ofÏelectronically„stored€records€of€data€bases€fed€by€microprocessor€audiometers€fromÏpaper„based€record€systems€fed€by€manual€audiometry.€€For€now,€descriptiveÏstatistics€are€readily€produced€on€processes€and€outcomes€for€measures€of€programÏparticipation,€quality€assurance€and€program€effectiveness.€€How€would€weÏstandardize€statistical€treatment€of€such€data€base€information?€€Who€wouldÏdecide/enforce€such€standards?€€Occupational€Hearing€Conservation€researchÏappears€to€be€at€a€crossroads€in€the€selection€of€a€preferred€methodology.€€ShouldÏthe€focus€of€program€evaluation€be€on€the€individual€or€on€the€audiometric€data€perÏse?€€In€other€words,€should€we€take€a€more€traditional€epidemiological€approachÏusing€for€example,€relative€risk€assessment,€or€should€we€adopt€the€AmericanÏNational€Standards€Institute€(ANSI)€draft€S12.13„1991€focus€on€audiometricÏvariability€or€both?€€The€former€approach€will€involve€more€integration€of€other€dataÏbases,€pose€more€questions€concerning€relevant€data€elements€and€raiseÏstandardization€issues,€e.g.,€variable€naming€conventions€for€data€dictionariesÐ €+Ð&$ Ð(number,€character,€etc).€€Who€would€decide/enforce€such€standards?€€Many€hearingÏconservation€programs€are€plagued€by€disconnects€between€audiometric€data€basesÏand€industrial€hygiene€exposure€data€bases.€€What€are€the€links€required€forÏintegration?€€Will€legislation€be€required€to€forge€these€links?€€Some€factions€of€theÏhearing€loss€prevention€community€are€modeling€efforts€of€the€clinical€care€andÏmanaged€care€communities€moving€toward€a€public€health,€population„basedÏpreventive€care€management€strategy.€€Effective€use€of€outcome€measures€can€guideÏconcentration€of€provider€effort€more€cost€effectively€and€guide€continuous€qualityÏimprovement€through€statistical€quality€control.€€We€need€to€develop€the€publicÏhealth€statistical€skills€requisite€to€such€applications.€€This€will€require€basicÏresearch€to€determine€the€most€relevant€epidemiological€statistical€models€and€theÏmost€appropriate€supporting€data€models.€€Applied€research€will€also€be€required€toÏtemper€the€basic€research€with€some€real€world€constraints€on€resources.€€TheÏapplied€research€activity€has€to€also€consider€the€real€world€availability€ofÏnetworked€computer€resources€like€the€world„wide€web,€Ô_ÔinternetÔ_Ô/Ô_ÔintranetÔ_Ô€capability,Ïdistributed€mass€storage€of€data€and€data€security€concerns.ÌÓ hÓÓ! °°¤X!ÓÌñ“ ññŠ ñÔ#†¼õL »»¼]‰úì#ÔÔ#†¼õL »XXÕ ì#ÔñŠ ññ“ ñ