Audiometric data analysis for prevention of noise-induced hearing loss: A new approach.

Compliance with noise regulations in the past three decades has significantly reduced workplace noise exposures, particularly in the loudest industries and occupations. However, the overall effectiveness of hearing conservation programs in preventing occupational noise-induced hearing loss remains uncertain and unquantified, while the incidence and cost of occupational hearing loss remain inexplicably high. This review/commentary critically explores this paradox by examining why the billions of annual audiograms conducted worldwide have not been aggregately utilized or applied to predict early NIHL in groups of workers or to measure the efficacy of exposure controls. Principal contributory reasons include regulation of noise as a safety standard rather than as a health standard, the inherent complexity of audiometric data, and the lack of a standardized method of interpretation for audiograms. The unsuccessful history of efforts to develop and adopt methods and tools to analyze aggregate audiometric data is described. Consequently, the Standard Threshold Shift-a regulatorily defined, lagging indicator of individual, irreversible hearing loss that is not an effective preventive metric-remains the de facto standard of care. A population-based Best Practices approach is proposed to leverage the raw audiometric data already available and turn it into actionable data for effective secondary prevention to strategically manage and reduce occupational hearing loss risk. This approach entails statistical methods and information management tools necessary to transform audiometry from a compliance-driven, individual screening test with limited preventive capability into a medical surveillance process directly linked to aggregate corrective and prevention actions.