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Year : 2021  |  Volume : 23  |  Issue : 108  |  Page : 11--20

The audiologist’s role in university hearing conservation programs: Gaps and opportunities in U.S. universities

Tonya M.H Veith 
 School of Communication Sciences and Disorders, University of Wisconsin-Stevens Point (UWSP), Wisconsin, USA

Correspondence Address:
Tonya M.H Veith
School of Communication Sciences and Disorders, University of Wisconsin-Stevens Point (UWSP), Doctor of Audiology (AuD), CCC-A, UWSP School of Communication Sciences and Disorders, 1901 Fourth Avenue, Stevens Point, Wisconsin 54481
USA

Abstract

Introduction: All universities that meet state and/or federal requirements for employees’ noise exposure must have a hearing conservation program (HCP). Universities with HCPs and Doctor of Audiology (AuD) programs could reap a range of benefits from interprofessional collaboration between these programs, including enhanced learning opportunities for AuD students; however, it is unclear whether this collaboration occurs consistently in different university settings. Despite a relatively robust literature around occupational audiology and the audiologist’s role in hearing conservation in general, few studies examine this subject in the university setting. Aim: This study seeks to provide insights into the role of the university audiologists in university HCPs that could help inform further exploration and potential pilot studies to enhance university-based occupational HCPs, ultimately supporting more rigorous professional training in occupational audiology in AuD programs. Method: This study’s primary method was a survey questionnaire delivered to audiologists at U.S. universities. Survey questions explored university audiologists’ role, involvement with their universities’ HCPs, and benefits and barriers to collaboration with the HCPs. Results: The results indicate that although audiologists report that they have participated in hearing conservation generally at their universities, the majority of respondents were not actively involved with occupational HCPs. Conclusion: Further research is needed to understand how university HCPs are managed and how effective they are. With greater awareness of audiologists’ contributions to university HCPs, their role in this important workplace program could merit expansion.



How to cite this article:
Veith TM. The audiologist’s role in university hearing conservation programs: Gaps and opportunities in U.S. universities.Noise Health 2021;23:11-20


How to cite this URL:
Veith TM. The audiologist’s role in university hearing conservation programs: Gaps and opportunities in U.S. universities. Noise Health [serial online] 2021 [cited 2021 Jul 28 ];23:11-20
Available from: https://www.noiseandhealth.org/text.asp?2021/23/108/11/311494


Full Text



Key Messages:

This study is one of a very few that have looked at university-based audiologists’ role in hearing conservation programs. It reflects an early exploration into potential synergies between Doctor of Audiology programs and university hearing conservation programs that could—with further research—benefit audiology students and university workforces alike.

 INTRODUCTION



The World Health Organization[1] reports noise-induced hearing loss as one of “the most common occupational diseases,” a fact that is echoed by the U.S. Centers for Disease Control and Prevention[2] and other institutions. In the United States, nearly one-quarter (24%) of hearing loss among workers is attributed to their employment.[3],[4],[5] Masterson et al.[6] have found that despite declining risk for hearing loss in some industries, construction workers, for example, remain in the higher-risk category. A 2013 study by Masterson et al.[7] recommends “better engineering controls for noise and stronger hearing conservation strategies” to combat this issue.

Occupational hearing conservation programs in the United States

Hearing conservation programs (HCPs) became a requirement of the Occupational Safety and Health Administration (OSHA) in 1983[8] and were established to protect employees’ hearing in high-noise environments. These programs are meant to provide noise measurement, noise control, hearing protection, audiometric monitoring, worker training and motivation, recordkeeping, and program evaluation. In the United States, OSHA requires an HCP whenever workers’ noise exposures equal or exceed an 8-hour time-weighted average sound level of 85 dBA in general industry or when levels exceed 90 dBA in construction.[9]

The Council for Accreditation in Occupational Hearing Conservation (CAOHC) exists “to educate, inform and guide industry and those serving industry on successful implementation of occupational HCPs to prevent occupational hearing loss.”[10] CAOHC provides training for people managing the audiometric monitoring programs of HCPs, professional supervisors and occupational hearing conservationists (OHCs). Professional supervisors are the professionals with the qualifications and licensing to interpret audiological results and make determinations regarding audiological findings in HCPs. In this context, professional supervisors may be audiologists, otolaryngologists, or physicians who establish and supervise an audiometric testing program under the HCP. They review problematic audiograms and perform baseline revisions, determine work relatedness, conduct follow-up for work-related auditory disorders, and manage audiometric databases.[11],[12]

OHCs are certified by CAOHC and trained to help manage the audiometric monitoring program of an HCP. OSHA regulation 1910.95(g)(3) states:

Audiometric tests shall be performed by a licensed or certified audiologist, otolaryngologist, or other physician or by a technician who is certified by the Council for Accreditation in Occupational Hearing Conservation or who has satisfactorily demonstrated competence in administering audiometric examinations, obtaining valid audiograms and properly using, maintaining and checking calibration and proper functioning of the audiometers being used.[13]

Although OHCs play a significant role in the audiometric monitoring program, they are not qualified (through CAOHC certification only) to establish policies or protocols for the program. As indicated in their scope of practice,[14] OHCs complete hearing health histories, visual inspections of the ears, audiometric testing, identify problem audiograms, refer employees for further testing or medical evaluation, maintain the audiometric equipment, notify employees of standard threshold shifts, ensure the employer is keeping accurate records of noise exposure measurements and audiometric tests, and provide education, training, and counseling on the effects of noise on hearing, hearing protectors, and the purpose of annual testing and test procedures. Although they are trained to manage a significant portion of the audiometric monitoring program, they are under the supervision of a professional supervisor unless licensed as audiologists, otolaryngologists, or physicians.

Audiologists play a number of different roles in HCPs. An audiologist might be actively involved by serving in the capacity of a professional supervisor, overseeing the audiometric testing portion of the program, or working as an occupational hearing conservationist, conducting baseline and annual testing of employees and determining whether threshold shifts have occurred. An audiologist might also participate less actively in an HCP, functioning as a consultant or educator to help employees understand hearing conservation and protection or ensure they are wearing appropriate hearing protection. Audiologists have the training and licensure to handle any part of the audiological testing program, including professional supervision, yet it is not a given that they will be involved at all. It is not necessarily a job requirement of an audiologist to be involved in the occupational HCP.

Hearing conservation and the audiologist’s role in the university setting

The university represents a unique setting for HCPs, with its range of employees whose occupations expose them to noise often working in relative proximity to individuals (audiologists) who have the necessary training to help mitigate and respond to noise-induced hearing loss. Universities are large workplaces, employing a broad range of staff — many exposed to noise in their work. Yet, this setting has yet to be studied in depth in the HCP supervision context.

University audiologists’ specialized combination of knowledge, skills, and training means they are well positioned to participate in HCP supervision or, at the very least, to provide audiometric testing or education about noise-induced hearing loss for the university’s occupational HCP.[15],[16],[17],[18],[19] The most obvious place in the university workplace for these two groups to interact would be the university HCP; yet, there are few data on how, or even whether, this occurs.

One of the only recent studies involving university HCPs is a 2018 article by Ariel Leshchinsky,[20] investigating the impact of annual audiograms on employees’ awareness of noise-induced hearing loss and hearing protection habits. Leshchinsky’s article similarly notes that “few studies have focused on the diverse range of occupations” in the university workplace and/or the effects of HCPs in that context.

With 77 clinical AuD programs at universities in the United States,[21] and Council for Clinical Certification in Audiology requirements that audiology students acquire strong professional competencies in occupational audiology and interprofessional collaboration,[22] this apparent gap in the literature is intriguing. Universities with HCPs and AuD programs could benefit from this cooperative relationship, given the overlap of a clear workplace need and a cadre of professionals trained to meet that need. However, information is lacking on whether these U.S. universities have HCPs and whether the universities’ audiologists have a role in the HCPs. This study seeks to fill that information gap and help clarify the role university audiologists have in HCPs at U.S. universities.

 METHODS



This study primarily used an online survey to examine the role, if any, of university audiologists in their universities’ HCPs. The design was selected in an effort to maximize responses across a broad sample of potential respondents in the United States. This study was approved by the Institutional Review Board of the author’s home institution to ensure ethical treatment of human subjects participating in research.

Respondents and sampling approach

An appropriate sample was sought by first seeking to identify the field of accredited audiology doctoral programs in the United States. This was done by searching the directory of programs on the Council on Academic Accreditation website.[23] Two graduate assistants searched university webpages to identify email contact information for audiology faculty and clinical staff. They complied a list of 539 individuals, who each received an emailed invitation to participate in the survey.

Of these 539, there were 23 undelivered, bounced, or duplicate contacts, bringing the overall total of contacted individuals to 516. Of these, 88 consented to participate in the study (17.05%) and 80 completed the survey (90.9% of consenting respondents, or 15.5% of the sample).

Survey questionnaire

The study used an online questionnaire to gather data from respondents on whether and how university audiologists in the United States were participating in their universities’ occupational HCPs. The respondents were emailed an anonymous survey link through an online survey platform, Qualtrics, along with a brief explanation of the study. The survey was open for 30 days. Two weeks after the initial email was sent, a reminder email was sent to anyone on the list who had not yet completed the survey.

The questionnaire consisted of 16 questions [Table 1] in three main sections, beginning with an informed consent statement. Two questions allowed open-ended responses; the other 14 required single- or multiple-choice selections, including one Likert scale rating. Open-ended questions were designed to enrich the more quantitative information collected by eliciting insights about the respondents’ experiences as audiologists participating in university occupational HCPs.{Table 1}

A brief section on demographics asked respondents about their work settings, experience, and occupational audiology course offerings. The final section was limited to only those respondents who reported that they were actively participating in occupational HCPs for their universities, with questions about their role, any barriers to HCP participation, and individual experiences related to participating in the university HCP.

The questions were based on the scope of practice documents for professional supervisors and OHCs in the CAOHC Hearing Conservation Manual.[24] Two colleagues reviewed the survey instrument for content and clarity, and the questionnaire was revised based on that feedback before being distributed to potential respondents.

 RESULTS



Respondents

Eighty audiologists from 28 states and the District of Columbia participated in this study by completing the survey questionnaire ([Figure 1]). The majority of respondents (77.5%) reported working at universities with a student population greater than 10,000 students. Forty percent reported that they actively participated in their university’s occupational HCP. Of that subset of respondents, a majority (87.5%) reported supervising audiology doctoral students in the university clinic. Eighty-six percent of all respondents reported that their students were taught about occupational audiology in stand-alone courses, with about 56.7% reporting that clinical experiences were available. Just 4% reported being CAOHC-certified professional supervisors.{Figure 1}

Roles of university audiologists

As [Table 2] illustrates, a majority of respondents reported that their role in the occupational HCP included completing testing, reviewing problem audiograms, and educating employees about hearing protection devices and/or noise exposure risk (62–97%, depending on the role[s] they selected). About half (50–59%) reported that their role included ensuring equipment and testing environment met standards, planning prevention strategies for workers with shifts in hearing thresholds, supervising audiometric testing, and managing the audiometric database for their university HCP. Less than half (43.75%) reported that their role included determining the work relatedness of the threshold shifts.{Table 2}

With one exception, respondents reported that the role of students in the HCP was similar to theirs. (The exception relates to reviewing problem audiograms, which respondents reported as their third most common role, but fourth for their students, as would be expected among AuD students under supervision.) When asked the open-ended question “What additional or different services do you provide for the university hearing conservation program other than those listed above,” 10 respondents (31% of the 32 HCP-participating respondents; those who reported not actively participating in HCPs were not asked this question) reported additional services that they or their students provide for their HCPs.

Respondents reported a relatively wide variety in their roles related to the HCP. Two respondents reported that they scheduled students in clinical experiences involving hearing conservation or supervised students working in HCPs during a clinical practicum. Another stated that they trained their AuD students “in instrumentation, calibration, and hearing conservation measurements of noise levels,” while three others reported conducting noise measurements on campus. Three respondents reported offering custom hearing protection devices for staff and/or campus departments, and another reported that their program dispensed “non-custom musician’s earplugs to all incoming students in the University’s marching band.” Collaboration with music departments was reported in a few cases:

We have worked to implement a hearing conservation program that includes education and screening within our University music program. −HCP participant

One respondent reported that in addition to many other services for the HCP, they conduct “Hearing protection evaluation; that is, we test the efficacy of hearing protection and make recommendations based on the results.” Another reported comprehensive follow-up testing and consultation with safety personnel.

Participation in the university’s occupational HCP

When asked to identify the outcomes of participating in the university’s occupational HCP, a strong majority of respondents selected “Hands-on experience for students in occupational audiology” (96.55%) and “Continuity of service” (93.10%) for university employees [Figure 2]. Many also agreed that their role resulted in “Visibility within the university (86.2%), “Interprofessional collaboration” (82.75%), and “Flexibility for university employees” (82.75%). Cost savings and income for the university and direct patient care were reported by approximately two-thirds of the respondents.{Figure 2}

The questionnaire specifically asked all respondents to select from a list of barriers hindering their active participation in the occupational HCP. The most frequent selection, from the options given in the questionnaire, was “Coordination of services between departments” [Figure 3]. Other barriers included time commitment, scheduling, and lack of personnel available to manage the program. A few respondents reported that they were unaware of whether their university had an HCP. Paperwork and “Confidence in Occupational Audiology practices” were the least common selections.{Figure 3}

Some respondents used the final open-ended question (“If you have anything else you would like to share …”) to provide more detail on the topic of barriers, many citing individual or clinical workload and time constraints, among other factors:

I would love to convince the university to implement a hearing conservation program in the future, but the time, money, and personnel necessary will be obstacles, particularly since it is not “required” by the state or federal government. −Non-HCP participant

Participation from employees in the hearing conservation program dwindled and it was difficulty to schedule based on their workload, work schedule and clinic schedule. −Non-HCP participant

… unfortunately, a majority of employees end up going to an occupational health doctor for services due to insurance reasons. −HCP participant

Two respondents specified that the lack of an HCP was either because the state did not have an OSHA-approved plan or because the employees covered by OSHA were contracted employees, with hearing conservation being the responsibility of their employers.

I work at a state university … to my knowledge, our university does not have a hearing conservation program. Employees at state and local government agencies are not covered by Federal OSHA, and [this state] does not have an OSHA-approved state program, so there are no required occupational hearing conservation practices for our university. −Non-HCP participant

OSHA covers industries governed by the U.S. Department of Labor. My university does not have a hearing conservation program because all work falling under OSHA is contracted out and is the responsibility of the employer. I suspect this is the case at many universities. −Non-HCP participant

A few respondents also reported that although they were not involved in the university occupational HCP, one or more of their colleagues participated in the program. Several respondents indicated that they would like to implement HCPs for university faculty, staff, and students who are exposed to levels of noise that could cause or contribute to noise-induced hearing loss.

My largest concern is actually for students in the trade programs (i.e. welding, aircraft maintenance, diesel mechanics, etc). Since they are not “employees” they are not regulated through OSHA even though they may be exposed to hazardous noise during their training. These are the individuals we target to provide training on hearing conservation practices. I feel that these students make up a population of individuals who should be enrolled in a hearing conservation program, but are missed since they do not fall under OSHA regulation as an “employee.” −Non-HCP participant

 DISCUSSION



Given this study’s interest in how occupational HCPs are organized and regulated at different levels, this study achieved a relatively strong national coverage. Respondents represented 28 U.S. states and the District of Columbia. There are AuD programs in 35 states plus Washington, D.C. The responses thus comprise nearly 78% of states with accredited audiology programs.[25] Importantly, the survey results indicated that less than half of respondents (40%) were actively involved in their universities’ HCP, meaning that they described performing specific occupational hearing conservation activities through the HCP.

Roles of audiologists in university HCPs

This study indicates that a majority of university audiologists are performing hearing conservation services similar to the roles of a professional supervisor, as defined by CAOHC. However, determining work relatedness of threshold shifts was the service respondents least reported providing (43%). There are numerous potential reasons for this gap in the university audiologist’s role, as relates to occupational hearing conservation. For example, this might be because of perceived or actual conflicts of interest, in that university audiologists and the people they are serving in HCPs are employees of the same institution.

There is … absolutely no reason that you could not be the PS [professional supervisor] for the [hearing conservation] program. And quite honestly, as an audiologist you are qualified, the PS simply gives you a little more “leg” to stand on should anything come into question. There is no conflict of interest, for supervision of the program. The only time it may become issue would be if you were doing work relatedness determinations associated with the filing on the OSHA form 300. −Personal communication with an audiologist who trains professional supervisors for CAOHC (not a survey respondent)

Given the range of responses about the audiologist’s role, statements like this raise potentially important question about the role of the university audiologist in occupational HCPs. However, such questions were outside the scope of this study.

University audiologists reported filling a number of roles in their university HCPs. In some cases, their roles closely represent the CAOHC’s scope of practice document for professional supervisors,[26] in that they supervise audiometric testing programs and make work-relatedness determinations. Some audiologists provide baseline and annual audiometric testing and educate employees about noise-induced hearing loss, similar to an OHC’s scope of practice.[27] The roles many respondents report is a blending of those scopes, including AuD student supervision.

Some university audiologists are stretching those boundaries in different ways. In some universities, other departments coordinate the HCP and bring in mobile units, or have the employees tested elsewhere. Meanwhile, one respondent described a comprehensive suite of services that extended beyond the campus boundaries:

We run a best-practice, NIOSH [National Institute for Occupational Safety and Health]-based program with advanced technological applications such as HPD [hearing protection device] fit-testing etc. … The additional services we supply to the university is [sic] much larger and involved more than just the university staff, we provide programs for faculty and students, including other coursework as well. Our students also provide mobile services to local industries. We provide noise dosimetry studies, and teach an additional undergrad course … many more items than can be itemized here. −HCP participant

This broader level of service provision is notable, in that it does not appear to be typical of the university audiologist’s role (acknowledging the relatively limited information from this study and the general literature around university AuD programs and HCPs). This could merit further exploration in terms of the organizational structures, staffing, and funding model/sources, with a view toward potential replication in other university settings.

Respondents reported a number of benefits to participating in the university occupational HCP. Several noted specific benefits to AuD students in terms of hands-on experience in occupational audiology, although some added that they did not perceive occupational screenings as being as beneficial to students, compared to other aspects of their practical experience.

We conduct personal attenuation rating (PAR) testing for employees with custom HPD to verify efficacy. This has been a great educational experience for the AuD students. … The AuD students are also taught how to apply and hand-calculate age corrections when applicable. −HCP participant

Our students get the most benefit/experience when we see the follow-up appointments identified from the screenings rather than do the occupational screenings. There is little educational benefit to our students for the screenings. −HCP participant

Some programs reported good working relationships between departments involved in the HCP. Based on the open-ended responses in this study, these programs appeared to be more established and have greater staffing support.

We are fortunate to work with an excellent Environmental Health Group who are very interested in hearing conservation and supportive of hearing loss prevention not just hearing conservation. However from the standpoint of cost to the departments enrolled in the HCP, audiometric monitoring that meets the minimal legal requirement and is provided by large commercial outfits has benefits in terms of schedule disruption and out of pocket short term cost. –HCP participant

Barriers to HCP participation

Of 80 respondents in this study, fewer than half (40%) reported taking part in their university’s occupational HCP. Why are 60% not participating? Respondents reported clear benefits to participation and/or coordination in the university’s HCP, but participants and non-participants alike also noted some clear barriers to doing so. Two respondents specifically reported that they did not participate because their universities were not required by OSHA to provide an occupational HCP. It is important to note here that OSHA does not cover state and local government agencies unless there is an OSHA-approved state plan:

The OSH Act covers most private sector employers and their workers, in addition to some public sector employers and workers in the 50 states and certain territories and jurisdictions under federal authority. State Plans are OSHA-approved job safety and health programs operated by individual states rather than federal OSHA. Section 18 of the OSH Act encourages states to develop and operate their own job safety and health programs and precludes state enforcement of OSHA standards unless the state has an OSHA-approved State Plan.[28]

The top three barriers to participation reported by those already involved in an HCP were scheduling, interdepartmental coordination of services, and time commitment. For those not participating, the top three reported barriers were similar: interdepartmental coordination, time commitment, and lack of personnel.

I teach the hearing conservation course and specialize in research related to hearing conservation. I would love to convince the university to implement a hearing conservation program in the future, but the time, money, and personnel necessary will be obstacles, particularly since it is not “required” by the state or federal government. −Non-HCP participant

Workload appears to have been another important consideration; some audiologists teach the occupational audiology course and others supervise in clinic. Departments such as occupational health are contracting out hearing testing because, respondents report, it is easier to coordinate with employee schedules. In addition, respondents indicated that university audiologists who also teach have less availability for participation in the occupational HCP:

Participation from employees in the hearing conservation program dwindled and it was difficulty to schedule based on their workload, work schedule and clinic schedule. −Non-HCP participant

[There are] 1 full time clinical audiologist, 3 PhD teaching faculty and no time. I’m actually not sure the university has a hearing conservation program. −Non-HCP participant

For many years we have done the annual hearing evaluations in our clinic. We are overwhelmed with patients and [have] a long backlog for scheduling appointments. As a result, we are developing a system whereby those screenings are to be done by occupational health. We will then only see folks who need full evaluations either because of an STS [standard threshold shift] or hearing loss needing follow up. Educationally this is better for our students. Pure tone audiograms-only is of limited educational value for our AuD students compared to the people we see for more comprehensive services. −HCP participant

Study limitations

This study has two general limitations. One was in the ability to probe for details about barriers to HCP participation. Question 15 gave respondents two choices to indicate responses other than those listed, but there was not a follow-up probe to gather more information from those who selected “A reason other than those stated above.” Given this study’s focus on generating more general information and build awareness about audiologists’ role in university HCPs, such a gap is to be expected. Some respondents did provide this information in the final, open-ended question, and a future survey could benefit from probing more explicitly for this information.

Second, several respondents noted, in open-ended responses, that the questionnaire seemed to overemphasize OSHA requirements. This study selected OSHA because it is the organization responsible for enforcing the regulations for HCPs. Programs must meet or exceed the OSHA requirements. As these respondents aptly noted, this study offers an initial exploration of the possibilities for audiology in a wide range of university settings subject to a variety of state and federal requirements and funding contexts. Indeed, future examinations will be well advised to go deeper into this subject matter, acknowledging other recommendations (e.g., NIOSH) exist that might be well suited to guide best practice.

 CONCLUSION



FOUNDATIONS FOR FUTURE RESEARCH

The author’s hope in conducting this study is that with greater understanding of how a broad range of U.S. universities with audiology programs approach management of their OSHA-mandated HCPs, or HCPs based on NIOSH recommendations, opportunities will emerge that support the creation or deepening of links between these programs. Indeed, one respondent in this study explicitly mentioned having gained a new curiosity as a result of participating:

I am now curious what the University has in place and whether other faculty are involved in the program. Thank you for making me aware this possible need. −Non-HCP participant

Potential benefits of continued study in this area include interprofessional competencies of students as they prepare for their profession in audiology. One option is a series of pilot studies to explore cost-effective approaches to deepening interprofessional collaboration and building AuD students’ competencies in occupational audiology. These areas of study could have the associated potential benefits of supporting employees in the university workplace, streamlining university budgets related to hearing conservation, and supporting continuity of care for university employees participating in their workplaces’ occupational HCPs.

This study indicates that although many audiologists working at U.S. universities have some interaction with hearing conservation generally, most of the respondents reported that they are not actively involved, on a formal or ongoing basis, with OSHA-mandated occupational HCPs—the programs with which this study is primarily concerned. Given the reported barriers to active participation, this is a potentially important area of study to mitigate deficiencies in the university audiologist’s role. More research is needed to understand exactly how university HCPs are managed and how effective they are, with a view toward examining whether greater involvement by university audiologists would be beneficial. With greater awareness and understanding of audiologists’ current and potential contributions to university HCPs, their role in this important workplace program might merit expansion.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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