February 23, 2006
Dr. Lois Joellenbeck
Institute of Medicine, Keck 775
500 Fifth Street, N.W.
Washington, DC 2001
Re: National Institute for Occupational Safety and Health (NIOSH) Hearing Loss Research Program
The American Association of Occupational Health Nurses, Inc. (AAOHN) is pleased to submit our comments to the Institute of Medicine (IOM) Committee on NIOSH Hearing Loss Research Program.
General Comments
Approximately 28 to 30 million Americans have some degree of hearing loss, and one-third attributes their hearing loss to noise [noise-induced hearing loss (NIHL)]. Therefore, two-thirds of the hearing loss could be attributed to the aging process, injury and/or illness, disease, etc. Since most NIHL is preventable, it is appropriate for NIOSH to include noise-induced hearing loss as a research focus.
Many improvements have been made in the prevention of NIHL, i.e., hearing protection devices, audiometric testing, acoustic/noise damping screens and/or walls, manufacturing of quieter tools and machinery, safety features, education, etc. Most of these are the result of NIOSH research initiatives and data from its partnerships with professional organizations, other governmental agencies, and private industry. Therefore, occupational and environmental health nurses (OHNs), the primary health care provider in the workplace, look to NIOSH to define best practices guidelines in hearing conservation. Since AAOHN is interested in the affects of hearing loss on the employee’s health (physical, mental, behavioral, etc) and safety, and has a partnership with NIOSH, the Association is pleased to provide comments that address the following categories: effective hearing loss prevention programs; hearing protection devices and use of engineering controls to reduce noise exposure; major research challenges over the past 10 years; and significant emerging research challenges in hearing loss and noise control.The following specific comments are provided for each category.
Specific Comments
1. Hearing loss prevention programs:
Through the years, NIOSH has made strides in hearing loss prevention through activities and products related to hearing loss and noise control, i.e., Preventing Occupational Hearing Loss: A Practical Guide (1996); Occupational Noise Exposure: Revised Criteria for a New Standard (1998); and Compendium of Hearing Protection Devices – Online Version (June 2003). In addition, NIOSH has moved hearing loss prevention to the World Wide Web, http://www.cdc.gov/niosh/topics/noise/ (Noise and Hearing Loss Prevention) and NIOSH staff has been a valuable resource to OHNs and their interdisciplinary partners.
Although everyone should know and understand noise exposures and how to use best practices in health protection and prevention strategies, that is not always the case because of influencing variables, which ultimately effect the results of the hearing program. Therefore, areas of a hearing loss program that need to be considered in research and program development and implementation are:
- The rate at which employees learn and retain information (adult education),
- Language and cultural barriers, and
- Life styles and genetic influences.
2. Hearing Protection Devices and Engineering Controls
NIOSH areas of research are important and timely to work toward the challenges of hearing loss prevention. An important resource and guide for OHNs and OHN researchers is the National Occupational Research Agenda (NORA), initiated by NIOSH and its partners in 1996.
Although a primary research area of NORA has focused on hearing loss, other governmental agencies (Environmental Protection Agency, Occupational Safety and Health Administration, National Institute of Health, Institute of Medicine) and private agencies (Hearing Loss Association of America, American Speech-Language Hearing Association, Audiologist Associations) have also contributed to hearing loss research and interventions, which have helped to generate the following:
- Use of appropriate hearing protection devices such as earplugs, earmuffs, etc.,
- Use of hearing protection and/or engineering controls at what recommended hazardous noise levels (decibels),
- Need to fit test for consistency of use and right fit of hearing protection devices,
- Need to perform audiometric testing (annually, follow-up, periodic, etc),
- Improvements in hearing protection devices and engineering controls, and
- Effects of hazardous noise exposure, intensity of noise, duration of exposure, types of noise (impulse, continuous, etc.)
But, with all the advances, there are still additional issues related to reduction of noise exposure and use of hearing protection devices and engineering controls that should be addressed. The following are two such issues:
- What effect, if any, does the workings of the inner earhave on prevention and treatment strategies for NIHL, and
- What are the effects of hazardous noise exposure on the nervous system, over all health and longevity based on the length and intensity of noise exposure.
3. Major Research Challenges and Significant Emerging Research Needs or Opportunities
Over the past 10 years, major challenges for the OHN have been understanding factors affecting hearing health behavior and identifying effective interventions to promote hearing health. OHNs can now apply this information in educating employees on the importance and use of the new recommended protective devices and convincing them to use the appropriate devices.
The next ten years will be challenging for research because of the changing workforce (aging, youth, and diversity) and work environment (not typical office/industry work site). Emerging research needs will range from development of hearing loss programs for the aging workforce who will experience hearing loss as a progression of aging plus the potential for work exposure to hazardous noise; the increasing diversity of the workforce who have different work ethics, cultures, and language barriers; and finally the youth, many of whom already have a degree of hearing loss from social and recreational environmental exposures to hazardous noise, who will join the workforce. The opportunity will be to produce and disseminate evidence-based interventions that can be used by practicing OHNs and their interdisciplinary partners.
AAOHN appreciates the opportunity to provide comments to the IOM committee. As always, we will continue to support NIOSH and IOM in promoting a safe and healthful work environment.
Sincerely,
Susan A. Randolph
President, AAOHN
cc: AAOHN Board of Directors
Ann R. Cox, AAOHN Executive Director
