Geoff,
I wouldn't presume to attempt a marking of your valiant defence. I
don't claim any special knowledge (or even interest) in NIHL other
than that which I'm supposed to have for revalidation. I remain
sceptical about the value of audiometry other than as a baseline. I
agree that baseline screening, and appropriate clinical history
should allow the identification of those at increased susceptibility. I
share Sandy Elder's view that it is rare to exclude individuals on the
basis of audiometry alone. Certainly they should face disciplinary
action if not using PPE as directed by management.
I think there is a question of whether it meets criteria of health
surveillance since the action most of us probably take is to review
the position at the next scheduled audiometry or schedule it for
some intermediate period, and then we don't know what degree of
loss we would have expected anyway. The onset of any
symptomatic age related impairment will inevitably occur sooner as
the damage is done. Yes, using "threshold shifts" may help. To
quote the silver tongued Dale Archer, audiometry is to some extent
a form of "medical archaeology". Really it seems to me if we are to
use audiometry what needs to be established is, has the individual
or group got a rate of loss of hearing greater than would be
expected.
I'm not convinced it's an effective use of medical or nursing time to
inspect PPE. I accept that bringing people back every 2-3yrs? for
audiometry reinforces the need for PPE and NIHL, it possibly also
heightens their litigious attitude!
Gratified to have stirred up some discussion.
Send reply to: <[log in to unmask]>
From: "Geoff Helliwell" <[log in to unmask]>
To: <[log in to unmask]>
Copies to: "Anil ADISESH" <[log in to unmask]>
Subject: RE: Hearing tests
Date sent: Wed, 25 Apr 2001 12:36:24 +0100
Anil,
Sounds like a good AFOM paper 2 question !
Answer :
Allows identification of other causes of hearing loss (possibly treatable)
Gives opportunity for one to one health education about Personal Protective
Equipment use
Allows sensitive individuals to be identified and further educated
(Temporary Threshold Shift may identify)
Allows inspection of PPE (get them to bring it with them - dirt inside the
muffs = not worn)
Pooled results of audiometry will show overall effectiveness of policy (if
numbers under surveillance increase, or if deterioration in thresholds, then
policy is not effective no matter what the Hygiene measurements on the day
they were done)
None of the above have strict medico-legal uses, but all would form part of
a noise control policy - which does have medico-legal purpose.
Audiometry fulfils the HSE criteria for Health Surveillance :
Is there a disease that can be identified ?
Can it be identified before serious or permanent handicap ?
Is the technique sensitive and specific ?
Is the technique non-invasive and acceptable to employees ?
Geoff Helliwell
(did I pass Anil ?)
Regards
Anil
Dr. Anil Adisesh
Consultant in Occupational Medicine
Cardiff & Vale NHS Trust
University Hospital of Wales
Denbigh House
Heath Park
Cardiff CF14 4XW
Tel. 029 - 20743264
Fax. 029 - 20744411
email [log in to unmask]
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