Pure Tone Audiometry Evaluation Method Effectiveness in Detecting Hearing Changes Due to Workplace Ototoxicant, Continuous Noise, and Impulse Noise Exposures

Objectives: The purpose of this retrospective cohort study was to compare the relative risks (RR) of hearing impairment due to co-exposure of continuous noise, impulse noise, metal ototoxicants, and organic solvent ototoxicants using several pure tone audiometry (PTA) evaluation methods. Design: Noise and ototoxicant exposure and PTA records were extracted from a DoD longitudinal repository and were analyzed for U.S. Air Force personnel (n = 2372) at a depot-level aircraft maintenance activity at Tinker Air Force Base, Oklahoma using an historical cohort study design. Eight similar exposure groups based on combinations of ototoxicant and noise exposure were created: (1) Continuous noise (reference group); (2) Continuous noise + Impulse noise; (3) Metal exposure + Continuous noise; (4) Metal exposure + Continuous noise + Impulse noise; (5) Solvent exposure + Continuous noise; (6) Solvent exposure + Continuous noise + Impulse noise; (7) Metal exposure + Solvent exposure + Continuous noise; and (8) Metal exposure + Solvent exposure + Continuous noise + Impulse noise. RR of hearing impairment compared to the Continuous noise-exposed reference group was assessed with five PTA evaluation methods including (1) U.S. Department of Defense (DoD) Significant Threshold Shift (STS), (2) Occupational Safety and Health Administration (OSHA) age-adjusted STS, (3) National Institute for Occupational Safety and Health (NIOSH) STS, (4) NIOSH Material Hearing Impairment, and (5) All Frequency Threshold Average. Results: Hearing impairment was significantly worse for SEG (2) combined exposure to continuous noise and impulse noise only for the PTA evaluation method (2) OSHA Age Adjusted with an RR of 3.11, [95% confidence interval (CI), 1.16–8.31] and was nearly significantly different using PTA evaluation method (4) NIOSH Material Hearing Impairment with an RR of 3.16 (95% CI, 0.99–10.15). Despite no significant differences for SEGs with an ototoxicant exposure, PTA evaluation method (3) NIOSH STS was most sensitive in detecting hearing changes for SEG (8) Metal exposure + Solvent exposure + Continuous noise + Impulse noise as demonstrated by a RR of 1.12 (95% CI, 0.99–1.27). Conclusions: Results suggest that a single PTA evaluation technique may not be adequate in fully revealing hearing impairment risk due to all stressors and tailoring the PTA evaluation technique to the hazards present in the workplace could better detect hearing impairment. Additionally, results suggest that PTA may not be effective as the sole technique for evaluating hearing impairment due to ototoxicant exposure with continuous noise co-exposure.