Making Sense of OSHA's Final Rule

Employers puzzled by the final rule on recording hearing loss will find help in these practical applications.

• By Maurice H. Miller, Ph.D.
• Mar 01, 2004

THE final rule on recording hearing loss (HL) was published in the Federal Register on July 1, 2002. It is a revision of 29 CFR 1904, Occupational Injury and Illness Recording and Reporting Requirements, as they pertain to recording HL. Details are reported in the Federal Register (Vol. 67, #126, pp. 44037-44038). Major provisions are the following:

1. The effective date of the final rule on recording HL is Jan. 1, 2003.

2. The criterion for recording is Standard Threshold Shift (STS), as defined in 29 CFR 1910.95(g)(10)(1), a change in hearing threshold (HT) relative to the most recent audiogram for the employee of an average of 10 dB or more at 2000, 3000, and 4000 Hz in one or both ears if the STS results in HTs of 25 dB or greater at the above frequencies. The 25 dB level is re: Hearing Threshold Level (HTL), (i.e., an average HL of 25 dB or greater: audiometric zero, without age adjustments).

3. HL meeting these criteria must be recorded on OSHA Form 300 within seven calendar days of determination. An optional 30-day retest is allowed to determine persistence of the STS. If the STS is not persistent on the retest, the "occurrence" may be "erased" or "lined out" on Form 300. Age adjustments may be applied to the annual retest based on Appendix F-1 or F-2 of 29 CFR 1910.95.

4. The STS is recorded when the change in hearing is work-related. HL is presumed to be work-related if the employee is exposed to workplace noise at the OSHA "action level" (i.e., an 8 hour time weighted average of 85 dBA or greater or a total noise dose (noise-dosimetry) of 50 percent or greater. The determination of work-relatedness is made by the supervising professional (i.e., physician or audiologist). The workplace noise exposure must have caused, contributed to, or significantly aggravated the hearing loss. When the employee is not exposed to the "action level," the rules in 1904.5 are used to determine whether the HL is work-related. STS shifts not related to workplace noise exposure are not recorded on Form 300, but the employee must be informed in writing of the occurrence.

5. State plans must adopt federal criteria. More stringent criteria are not allowed.

6. OSHA delayed implementation of a separate column for HL recording to January 2004 and has opened a comment period on the need for separate tracking of HL cases.

Examples of OSHA Recordability of HL: When to Perform the Repeat Audiogram
Recommendations of recordability have been made by a number of organizations, including the Council for Accreditation in Occupational Hearing Conservation, National Hearing Conservation Association, and NIOSH. Some of these recommendations have not been adopted by OSHA, although they may be at some time in the future.

A requirement for two audiometric tests six months apart is an example. While a retest may be performed as early as six months after the previous test, most occupational hearing conservation programs (OHCPs) perform the repeat audiometric test annually, and we recommend the repeat test be an annual retest, not one performed at a six-month interval.

Is the baseline adjustment only for the ear on which the STS has occurred, or is it for both ears? Apparently, OSHA has published two letters on this question. In one letter, OSHA states the employer cannot revise the second ear's baseline (the ear on which the STS has not occurred); the other, more recent directive, states the employer may do so. Based upon communication with NIOSH and other personnel, we recommend that only the baseline for the ear on which the STS has occurred be revised and updated, not the ear on which no STS has occurred. OSHA is preparing a new directive indicating only the ear on which the STS has occurred should be updated.

The baseline also can be revised by the reviewing audiologist or physician when significant improvement in measured audiometric thresholds has occurred. This improvement is of the nature of 5-10 dB on subsequent tests and should occur at multiple frequencies. It usually reflects the practice or learning effect, as the tested employee becomes more acclimated to responding to pure-tone stimuli, which occur infrequently in the real world.

Recordability Enigmas
OSHA has ruled that the employer must compare current audiograms to the original baseline or a previously revised updated audiogram. The initial test is usually the audiogram obtained before entry into the OHC Program, i.e., the pre-employment audiogram. However, if no appropriate (satisfactorily performed in an acoustic environment that conforms to the current ANSI standards for permissible noise levels using calibrated audiometric instrumentation) pre-entry audiogram exists, the baseline is the first audiogram obtained after entry into the OHCP. Each subsequent audiogram is reviewed to detect improvement in the "OSHA average" (average of thresholds at 2, 3, and 4 kHz) and to detect OSHA STS (worsening of thresholds by an average of 10 dB or greater). Audiometric thresholds are updated to reflect improvement or work-related STS.

Designation and maintenance of the "recordability baseline" may not prove to be a simple task (Megerson, S.C. OSHA's Final Rule for Recording Occupational Hearing Loss, pp. 8-10 in Spectrum, 19:4 Oct. 2002). The determination may depend upon which criterion that company has used in the past, e.g., has the company recorded any STS? Only 25 dB shifts in hearing? Only shifts determined to be work-related? The professional reviewer should be in direct and ongoing communication with the employer to maintain employee baselines and case history data for the purpose of identifying recordable shifts.

The tables from the CAOHC update provide an Example Protocol for determining STS recordability (CAOHC Update 14:3, Fall 2000, pp. 10-11). A key guideline for evaluating the baseline reference audiogram to determine whether a recordable STS has occurred requires a comparison between the current hearing test results and the employee's baseline audiogram. If the employee has never experienced an STS, then the original baseline is used as a reference. If the employee has previously experienced an STS, then the current results are compared to the previously updated audiogram, i.e., the employee's "revised baseline."

Organization Resources Counselors Inc. (ORC, 1910 Sunderland Place NW, Washington, DC 20036) has developed a decision tree for assistance in determining "Recording Criteria for Hearing Loss." ORC also has developed a Webcast PowerPoint presentation titled "The New and Improved OSHA Recording Rule: From Theory to Practical Application" (Newell, S., and Ament, W. Jan. 29, 2000).

Practical Applications
The ORC PowerPoint presentation includes examples of employees presenting questions of recordability.

Example 1
An employee has the following audiometric test results (ignore age adjustment):

--In 2001: an average of 2 dB below audiometric zero

--In 2002: an average of 13 dB above audiometric zero--has STS and revised baseline

--In 2003: an average of 24 dB above audiometric zero--has STS and revised baseline

Are there recordables? Under federal OSHA rules: No!

--Although there was a standard threshold shift in 2002, federal OSHA required a 25 dB loss from original baseline

--In 2003, there was a 25 dB loss from 2001, which would have been recordable under the old federal rule, but the new rule's 25 dB or more above audiometric zero requirement was not met

Under state plan states (or employers) that used the 10 dB rule:

--Recordable in 2002, but not 2003

--In 2002, there was an STS

--In 2003, the new rule's 25 dB or more above audiometric zero requirement was not met

If the old federal rule had remained in effect, there would be a recordable in 2003 because of a 26 dB loss as compared to the 2001 level. If the old 10 dB rule were in effect, there would be a recordable in both 2002 and 2003. If the new rule had been in effect all along, there would have been no recordables because the 25 dB or more above audiometric zero requirement would not have been met.

Other Rules for Recording Hearing Loss

• "Licensed health care professional may determine that hearing loss is not work-related or significantly aggravated by occupational noise exposure"--not recordable
• May adjust for age in determining STS but not whether 25 dB or more above audiometric zero
• Retesting allowed
• Jan. 1, 2004--OSHA has decided to include a hearing loss column on the face of the 300 Log

In Example 1, there are no OSHA recordables because in 2002, a 25 dB shift from the original baseline was required and a shift of only 11 dB occurred. In 2003, there was a 26 dB shift compared with 2001, but the new rule requiring a "starting level" of 25 dB HTL was not met. Therefore, no OSHA recordables for this employee.

Example 2 also represents changes in hearing that do not require OSHA recordability. Although the baseline was revised in 2002 and 2003 because of an STS in each of these years, the average in 2004 was 32 dB, representing a shift of 8 db, not 10 dB--i.e., no new STS. Recordability starts at 25 dB HTL, and the 8 dB shift does not reach the STS criterion.

Example 2
An employees has the following audiometric test results (ignore age adjustment):

--In 2002: an average of 13 dB above audiometric zero--has STS and revised baseline

--In 2003: an average of 24 dB above audiometric zero--has STS and revised baseline

--In 2004: an average of 32 dB above audiometric zero

Would there be a recordable in 2003? No!

--There was a revised baseline in 2002 of 24 dB above audiometric zero. The calculation of whether hearing loss is recordable begins with that level. It does not matter whether or not the prior hearing loss was recordable!

--The hearing loss in 2004 was only 8 dB measured from the revised baseline in 2002--there was no new STS.

A "problem scenario" is shown below.

Problem Scenario:
An employees has the following audiometric test results (ignore age adjustment):

--In 2000: an original baseline of an average of 2 dB above audiometric zero

--In 2001: an average of 24 dB above audiometric zero--has STS and revised baseline

--In 2002: an average of 28 dB above audiometric zero

--In 2003: an average of 35 dB above audiometric zero--has STS and revised baseline

Are there recordables in any of these years? Yes! In federal states:

--The hearing loss is recordable in 2002 because the loss is 25 dB or more above the original baseline in 2000

--The hearing loss is recordable in 2003 because there is a new STS. The loss is recordable even though the loss from the prior recordable is only 7 dB. This occurs because the calculation for determining recordability is measured from earlier revised baseline, not the earlier recordable level.

Pure tone averages in this case increase from 2 dB in 2000 to 34 dB in 2003. The HL in 2003 is recordable because there is a new STS. Even though the prior recordable shows a shift of only 7 dB, not the required 10 dB for an STS, the calculation for determining recordability is measured from the earlier revised baseline (11 dB shift, not the earlier recordable level).

Some confusing issues remain, but following a transitional period, the new OSHA recordkeeping procedures should facilitate a more uniform industrywide procedure for baseline revision and OSHA recordability.

This article originally appeared in the March 2004 issue of Occupational Health & Safety.