Could self-reporting really replace hearing tests?
Updated: Aug 5, 2020
Covid-19 is becoming not so much of a bad dream, so much as an ongoing nightmare. One area that has been particularly hard hit is – possibly surprisingly – Occupational Health and certain sectors of Health & Safety.
Does more safety mean less health?
Given the health implications of SARS-COV-2, it may seem counter-intuitive that many healthcare providers are experiencing low demand for their services. But the reality is that the response to C-19 is seriously disrupting the valuable health checks that many workers rely on to ensure wellbeing over the long term.
The UK HSE and other organisations were quick to recommend postponing non-safety critical testing early in the C-19 outbreak. As such, face to face procedures and tests or on-site visits from Occupational Health professionals as part of surveillance was permitted to be deferred for 3 months. This has since been extended to 6 months.
Potentially half a million hearing tests will be put off due to C-19.
This figure of 500,000 is based on the UK HSE’s figures of 2 million workers at risk from noise in the UK – and this also means that perhaps 1 million tests need doing in just 6 months after that to catch up.
All this from a hard-pressed workforce who are not sure if they will be allowed on site or to conduct hearing tests in the way they used to. Plus other difficulties including staff absenteeism, other demands on their time and justifiable concerns for their own health in the C-19 world (link).
A common response has therefore been to use management reviews based on self-assessments to inform surveillance. These self-assessments are instead of objective physical tests, such as hearing tests, skin tests, vision tests and so on.
So is this a case of short term protection risking long term harm?
What is self reporting?
Management surveillance (sometimes called “paper tests”) generally use questionnaires as the basis of a management review – often including an interview. These days this can often be by phone or by video conference.
In this process, the key point of note is that patient’s subjective self-reporting forms the basis of subsequent interventions.
Are Questionnaires Questionable?
Questionnaire-based management reviews are attractive, because they can process a lot of different information about a lot of patients in many different locations fast. And social distancing can be measured in miles, not just in metres.
So that’s sorted…..
Except (now the loo roll emergency is over) there is a fundamental problem with paper testing: questionnaires are notoriously difficult to get right – whether by design, implementation or control. More specifically, self-assessment of your hearing ability is a notoriously poor way to evaluate hearing ability. According to a paper in the Journal of Family Practice
“Neither of the questionnaires was clinically sensitive enough to be recommended for use”
According to Action on Hearing Loss, on average, an individual takes 10 years before the onset of a hearing loss becomes intrusive enough to take action. That’s 10 years of degraded hearing, with the associated safety, social and professional impacts.
The audiologist’s rule of thumb is that most people will struggle to discern a difference in volume of 3dB. Sound energy doubles every 3dB, so this means that humans struggle to perceive the difference between significantly different amounts of noise. Most people will therefore be unable to notice degraded hearing.
The HSE guidelines may permit hearing surveillance every 3 years, in which case patients will be casting their mind back 3 years to compare their hearing ability.
And finally - in the real world - seniors may complain that “children mumble”, whilst new parents make the opposite complaint. And yet the same seniors will often claim their hearing is “fine” in their judgement, implying some level of delusion.
Hearing loss moves slowly, but surely
Most importantly, hearing loss is generally a gradual process. This means that a questionnaire is asking an individual to make an accurate assessment of their hearing ability, for a relatively small – yet significant – change, over a long period of time.
Dr Lorraine Gailey, Founder of Hearing Partners says: 'It's impossible to overestimate how important our hearing is in the workplace; frustratingly, it's equally impossible to fully appreciate how much we depend on our hearing ... until something goes wrong with it. When that happens, we have to work harder just to figure out what people are saying, which leads directly to fatigue, irritability, memory disruption, risk of injury, and the uneasy feeling of missing things and being left out of conversations.
"Sadly, because these changes happen slowly we fail to notice when things start going wrong – sometimes years pass before the light dawns.
"The best way to make sure our hearing is working at its best, now and forever, is to build in regular checks as a routine part of working life. That way, everyone can be sure that to able to devote their full energies to the work itself, meaning greater satisfaction and best performance.'
Most of us can't remember what we ate last weekend...so it could be viewed that with self-reports, OH professionals may be asked to make healthcare decisions based upon an individual’s subjective evaluation of their hearing across an extended period. During this time (in all likelihood) patients will have noticed no discernible change, and are subject to an evaluation procedure vulnerable to influence by their recent experiences.
Consistent data is essential to generate an informed picture of an individual’s health over a period of time. Data consistency and the standards used to collect data are therefore important. Holes in the data, different data sets or alternative methods to collect data compromise consistency and intelligibility of the data.
5 Reasons self-reporting hearing assessments presents challenges
All of which means self-reported questionnaire/ paper-based hearing surveillance programmes present unique challenges for Occupational Health and Safety:
Reports of changes to hearing ability may not be trustworthy
Reports of no change in hearing may not be trustworthy
Increased opportunities to mislead or spoil data
Gaps in the quantitative data set
Compromised objectivity of results
Introducing the gold standard for hearing tests…..
Audiometry goes back as far as 1879, when David Edward Hughes created a device with audiocups. Although things have been updated since then, the world-with COVID is a clear demonstration why audiometry and audiometric testing is the gold standard for hearing tests around the world today:
Audiometry is Quantitative
Audiometric tests are Accurate
Audio tests are reliable & repeatable
Audiometric hearing tests are sensitive, quick, accessible and well understood, which makes them perfect for hearing surveillance and occupational health.
Hearing Assessment Options in the C-19 world
Hearing surveillance in the workplace therefore has a few options in the world-with-covid:
Ignore the risks of C-19 and continue to do hearing tests as before. Until there is guidance to the contrary, this should not be seriously considered.
Questionnaires and self-report hearing assessments. At WorkScreen, we’d argue there are better alternatives
Standard audiometric tests with PPE and safeguards. Even if this is technically feasible, many providers are looking for lower-risk solutions that reassure their staff and patients.
Wait until Covid is a distant memory. Relaxation of COVID protocols is not guaranteed. Meanwhile, the requirement for surveillance continues.
No-contact testing. WorkScreen was created to make tests, easier, faster, lower lost and more accessible. By happy coincidence, WorkScreen’s user-operated approach can also form the basis of no-contact hearing testing.
To find out more about contactless hearing tests with WorkScreen or to see how we could help you implement contactless testing in your organisation, click here
About Hearing Partners:
'Hearing Partners delivers a specialist programme to equip staff to use their hearing effectively so they can perform at their absolute best in the workplace, whatever their natural level of hearing. The programme covers personal strategies, understanding the acoustic environment, and the use of cutting-edge technology, all tailored to the individual’s unique hearing profile and their role at work. www.hearingpartners.co.uk '