Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-14 (of 14 Records) |
Query Trace: Stephenson MR[original query] |
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Evaluating earplug performance over a 2-hour work period with a fit-test system
Gong W , Murphy WJ , Meinke DK , Feng HA , Stephenson MR . Semin Hear 2023 44 (4) 470-484 Workers rely on hearing protection devices to prevent occupational noise-induced hearing loss. This study aimed to evaluate changes in attenuation over time for properly fit devices when worn by workers exposed to hazardous noise. Earplug fit testing was accomplished on 30 workers at a brewery facility with three types of foam and three types of premolded earplugs. The personal attenuation ratings (PARs) were measured before and after a 2-hour work period while exposed to hazardous noise levels. The minimum acceptable initial PAR was 15 dB. Average decreases in PAR ranged from -0.7 to -2.6 dB across all six earplug types. Significant changes in PAR were observed for the Foam-1 (p = 0.009) and Premold-3 (p = 0.004) earplugs. A linear mixed regression model using HPD type and study year as fixed effects and subject as random effect was not significant for either fixed effect (α = 0.05). Ninety-five percent of the final PAR measurements maintained the target attenuation of 15 dB. Properly fitting earplugs can be effective at reducing worker's noise exposures over time. The potential for a decrease in attenuation during the work shift should be considered when training workers and establishing the adequacy of protection from hazardous noise exposures. © 2023 Thieme Medical Publishers, Inc.. All rights reserved. |
Population-based age adjustment tables for use in occupational hearing conservation programs
Flamme GA , Deiters KK , Stephenson MR , Themann CL , Murphy WJ , Byrne DC , Goldfarb DG , Zeig-Owens R , Hall C , Prezant DJ , Cone JE . Int J Audiol 2019 59 1-11 Objective: In occupational hearing conservation programmes, age adjustments may be used to subtract expected age effects. Adjustments used in the U.S. came from a small dataset and overlooked important demographic factors, ages, and stimulus frequencies. The present study derived a set of population-based age adjustment tables and validated them using a database of exposed workers.Design: Cross-sectional population-based study and retrospective longitudinal cohort study for validation.Study sample: Data from the U.S. National Health and Nutrition Examination Survey (unweighted n = 9937) were used to produce these tables. Male firefighters and emergency medical service workers (76,195 audiograms) were used for validation.Results: Cross-sectional trends implied less change with age than assumed in current U.S. regulations. Different trends were observed among people identifying with non-Hispanic Black race/ethnicity. Four age adjustment tables (age range: 18-85) were developed (women or men; non-Hispanic Black or other race/ethnicity). Validation outcomes showed that the population-based tables matched median longitudinal changes in hearing sensitivity well.Conclusions: These population-based tables provide a suitable replacement for those implemented in current U.S. regulations. These tables address a broader range of worker ages, account for differences in hearing sensitivity across race/ethnicity categories, and have been validated for men using longitudinal data. |
Comment on "Concerns with amplitude variation in calibrated audiometer systems in clinical simulations"
Byrne DC , Themann CL , Stephenson MR . Noise Health 2015 17 (76) 172 Barlow and colleagues addressed the important question of variation in pure-tone audiometric thresholds within and across audiometers in their article entitled “Concerns with Amplitude Variation in Calibrated Audiometer Systems in Clinical Simulations.”[1] We agree that the reliability of thresholds obtained across test systems and individuals is a vital concern when monitoring hearing health. However, we believe that a few important details are missing, which limits the validity of this study. | The authors reported, “Each of the audiometers had recently undergone certified traceable calibration by its recommended laboratory, meaning that the tone presentation from each should theoretically be identical” [page 300]. Ideally, this would be the case; however, it is not necessarily true. An audiometer is considered “in calibration” when its output is within a certain tolerance range. The International Electrotechnical Commission (IEC) 60645-1 standard allows a deviation of ± 3.7 dB from the indicated value at test frequencies from 125 Hz through 4000 Hz, and ±6.2 dB up to and including 8000 Hz. This means, for example, that an audiometer set to generate a 50-dB HL tone at 6000 Hz could produce anywhere from 43.8 dB HL to 56.2 dB HL and be considered “in calibration.” In some cases, the ±3.7 dB calibration tolerance (i.e., 7.4 dB range) at frequencies below 6000 Hz is close to the range of variation reported for the audiometers in this study. Without verifying that all four audiometers actually produced identical outputs, the measured differences cannot be assumed to be solely due to earphone placement. (Note: The allowable deviation according to American National Standards Institute (ANSI) standard S3.6 is ±3 dB at test frequencies from 125 Hz through 5000 Hz, and ± 5 dB at 6000 Hz and higher.) |
Scientific rigor required for a re-examination of exchange rate for occupational noise measurements Re: Dobie, R.A., & Clark, W.W. (2014) Exchange rates for intermittent and fluctuating occupational noise: a systematic review of studies of human permanent threshold shift, Ear Hear, 35, 86-96
Morata TC , Themann CL , Byrne DC , Davis RR , Murphy WJ , Stephenson MR . Ear Hear 2015 36 (4) 488-91 Dobie and Clark’s recent article “Exchange rates for intermittent and fluctuating occupational noise: A systematic review of studies of human permanent threshold shift” aimed to compare the suitability of a 3-dB versus 5-dB exchange rate (ER) in predicting hearing loss from non-impulsive intermittent or fluctuating noise exposures by reviewing studies of human noise-induced permanent threshold shift. The authors concluded that 3-dB ER systematically overestimates the risk of noise-induced hearing loss for intermittent or fluctuating noise. We contend that the authors did not arrive at their conclusions through an appropriate investigation. The article used flawed methodologies in the treatment and analysis of the data/studies and drew conclusions that were not substantiated by the cited data. | The authors indicated that their review did not aim to make recommendations for regulation of occupational noise, but suggested that their review provided evidence for a re-examination of recommendations in their concluding remarks. The National Institute for Occupational Safety and Health (NIOSH) maintains its recommendation of the 3-dB ER to provide sufficient protection for the many variations of continuous, intermittent and fluctuating noise exposure scenarios encountered in the workplace. In view of the advances in noise measurement and the studies’ other weaknesses, we question the suitability of revisiting a narrow segment of the human evidence (excluding robust animal studies and temporary threshold shift studies) based on outdated methodologies to address such an important issue. |
Stimulus and transducer effects on threshold
Flamme GA , Geda K , McGregor KD , Wyllys K , Deiters KK , Murphy WJ , Stephenson MR . Int J Audiol 2015 54 Suppl 1 S19-29 OBJECTIVE: This study examined differences in thresholds obtained under Sennheiser HDA200 circumaural earphones using pure tone, equivalent rectangular noise bands, and 1/3 octave noise bands relative to thresholds obtained using Telephonics TDH-39P supra-aural earphones. DESIGN: Thresholds were obtained via each transducer and stimulus condition six times within a 10-day period. STUDY SAMPLE: Forty-nine adults were selected from a prior study to represent low, moderate, and high threshold reliability. RESULTS: The results suggested that (1) only small adjustments were needed to reach equivalent TDH-39P thresholds, (2) pure-tone thresholds obtained with HDA200 circumaural earphones had reliability equal to or better than those obtained using TDH-39P earphones, (3) the reliability of noise-band thresholds improved with broader stimulus bandwidth and was either equal to or better than pure-tone thresholds, and (4) frequency-specificity declined with stimulus bandwidths greater than one equivalent rectangular band, which could complicate early detection of hearing changes that occur within a narrow frequency range. CONCLUSIONS: These data suggest that circumaural earphones such as the HDA200 headphones provide better reliability for audiometric testing as compared to the TDH-39P earphones. These data support the use of noise bands, preferably ERB noises, as stimuli for audiometric monitoring. |
Commentary on (1) 'Application of the health belief model: development of the hearing beliefs questionnaire (HBQ) and its associations with hearing health behaviors' (International Journal of Audiology, 2013; 52, 558-567), and (2) 'Development and evaluation of a questionnaire to assess knowledge, attitudes, and behaviors towards hearing loss prevention' (International Journal of Audiology, 2014; 53, 209-218)
Stephenson MR , Stephenson CM . Int J Audiol 2014 54 (1) 1-3 Saunders et al recently published two manuscripts regarding the use of the Health Belief Model (HBM) to develop a survey capable of addressing hearing health behaviors— particularly those associated with hearing loss prevention. (CitationSaunders et al, 2013, Citation2014). Both of these are fine articles but we also call your attention to earlier reports describing the use of the Health Belief Model and the development and application of a survey tool in a program designed to positively influence attitudes, beliefs, and behavioral intentions regarding hearing health behaviors. Given those earlier efforts, statements from CitationSaunders et al (2013, Citation2014) that they were the first to have developed a psychometrically valid survey in the context of a comprehensive application of the HBM might mislead some readers. | NIOSH initiated a research program in this area in the early 1990s, focusing on the application of health communication / health promotion theory to prevent noise-induced hearing loss. The program includes research (partly funded by NIOSH grants) by Dr. Sally Lusk and her colleagues regarding the use of Health Promotion models to prevent occupational hearing loss (CitationLusk et al, 1994, Citation1995, Citation2003; CitationKerr et al, 2002) along with an extensive body of intramural research conducted by NIOSH scientists. |
Early prognosis of noise-induced hearing loss: prioritising prevention over prediction
Themann CL , Byrne DC , Davis RR , Morata TC , Murphy WJ , Stephenson MR . Occup Environ Med 2014 72 (2) 83-4 Moshammer and colleagues (1) have recommended routine implementation of a temporary threshold shift (TTS) screening test to identify workers particularly at risk of developing noise-induced hearing loss (NIHL) from occupational exposure to hazardous noise. Their work addresses an important occupational health problem. NIHL ranks among the most common work-related injuries in many countries, with an estimated global annual incidence of 1.6 million cases and accounting for approximately 16% of disabling adult hearing losses worldwide (2,3). Individuals vary in their susceptibility to the damaging effects of noise and no suitable method currently exists to predict the susceptibility of a particular worker. | In their study, Moshammer et al. measured TTS in newly-hired employees following exposure to a 20-minute, high intensity, low frequency experimental noise. They then followed the workers over time to see who ultimately developed a permanent threshold shift (PTS). The authors report that a TTS of 14 dB or more measured 2.5 minutes after the experimental exposure identifies workers at greater risk for PTS. They recommend routinely using this procedure to screen for susceptibility to noise in workplace hearing loss prevention programs. | However, this recommendation is premature in view of the study results. The TTS measure had a sensitivity of 82%, meaning that 18% of those who developed PTS were not identified by the TTS screening – a high false negative rate, particularly as we already know how to prevent PTS through reduction of noise exposures and consistent use of properly-fit hearing protection. Specificity was 70% at best, corresponding to a false positive rate 30%. If this procedure were implemented, approximately a third of the workers would be told that they are particularly at risk for NIHL when they aren’t, raising unnecessary alarm and opening the door to potential discrimination in work assignments, promotions, etc. |
Short-term variability of pure-tone thresholds obtained with TDH-39P earphones
Flamme GA , Stephenson MR , Deiters KK , Hessenauer A , Vangessel DK , Geda K , Wyllys K , McGregor KD . Int J Audiol 2014 53 Suppl 2 S5-s15 OBJECTIVE: To estimate the short-term variability and correlates of variability in pure-tone thresholds obtained using audiometric equipment designed for occupational use, and to examine the justification for excluding 8 kHz as a mandatory threshold in occupational hearing conservation programs. METHOD: Pure-tone thresholds and other hearing-related tests (e.g. noise dosimetry, otoscopy, middle-ear assessment) were conducted with a group of 527 adults between 20 and 69 years of age. Five measurement visits were completed by participants within 14 days. RESULTS: The 50% critical difference boundaries were - 5 and 0 dB at 4 kHz and below and - 5 and 5 dB at 6 and 8 kHz. The likelihood of spurious notches due to test-retest variability was substantially lower than the likelihood of failing to detect a notched configuration when present. Correlates of variability included stimulus frequency, baseline threshold, acoustic reflectance of the ear, average noise exposure during the previous eight hours, age, and the tester's level of education in audiology. CONCLUSION: The short-term variability in 8-kHz pure-tone thresholds obtained with the TDH-39P earphone was slightly greater than at other frequencies, but this difference was not large enough to justify the disadvantages stemming from the inability to detect a 6-kHz notch. |
Promoting hearing loss prevention in audiology practice
Byrne DC , Themann CL , Meinke DK , Morata TC , Stephenson MR . Perspect Pub Health Iss Rel Hear Bal 2012 13 (1) 3-19 An audiologist should be the principal provider and advocate for all hearing loss prevention activities. Many audiologists equate hearing loss prevention with industrial audiology and occupational hearing conservation programs. However, an audiologist's involvement in hearing loss prevention should not be confined to that one particular practice setting. In addition to supervising occupational programs, audiologists are uniquely qualified to raise awareness of hearing risks, organize public health campaigns, promote healthy hearing, implement intervention programs, and monitor outcomes. For example, clinical audiologists can show clients how to use inexpensive sound level meters, noise dosimeters, or phone apps to measure noise levels, and recommend appropriate hearing protection. Audiologists should identify community events that may involve hazardous exposures and propose strategies to minimize risks to hearing. Audiologists can help shape the knowledge, beliefs, motivations, attitudes, and behaviors of individuals toward self-protection. An audiologist has the education, tools, opportunity, and strategic position to facilitate or promote hearing loss surveillance and prevention services and activities. This article highlights real-world examples of the various roles and substantial contributions audiologists can make toward hearing loss prevention goals. |
Typical noise exposure in daily life
Flamme GA , Stephenson MR , Deiters K , Tatro A , van Gessel D , Geda K , Wyllys K , McGregor K . Int J Audiol 2012 51 S3-S11 OBJECTIVE: Identify the distribution of typical noise levels present in daily life and identify factors associated with average sound levels. DESIGN: This was an observational study. STUDY SAMPLE: Participants (N = 286) were 20 to 68 year old men and women, drawn from the general population of Kalamazoo County, Michigan. A total of 73,000 person-hours of noise monitoring were conducted. RESULTS: Median overall daily average levels were 79 and 77 dBLeq(A,8,equiv) , with average levels exceeding EPA recommended levels for 70% of participants. Median levels were similar between the hours of 9 a.m. and 9 p.m., and varied little across days of the week. Gender, occupational classification, and history of occupational noise exposure were related to average noise levels, but age, educational attainment, and non-occupational noise exposures were not. CONCLUSIONS: A large portion of the general population is exposed to noise levels that could result in long-term adverse effects on hearing. Gender and occupation were most strongly related to exposure, though most participants in this study had occupations that are not conventionally considered noisy. |
Measuring, rating, and comparing the real ear attenuation at threshold of four earplugs
Murphy WJ , Stephenson MR , Byrne DC . J Acoust Soc Am 2011 130 (4) 2435 The effect of training instruction, whether presented as the manufacturer's printed instructions, a short video training session, specific to the product, or as a one-on-one training session, was evaluated using four hearing protection devices with eight groups of subjects. The Howard Leight Fusion and Airsoft premolded earplugs and the Moldex PuraFit and EAR Classic foam earplugs were tested. Naive subjects were recruited and tested using three different forms of training: written, video, and individual training. The differences between group averages for A-weighted attenuation were not statistically significant when compared between the video or the written instruction conditions, regardless of presentation order. The experimenter- trained A-weighted attenuations were significantly greater than the written and video instruction for most of the protectors and groups. For each earplug, the noise reduction statistic for A-weighting (NRSA) and the associated confidence intervals were calculated for the 90th and 10th percentiles of protection. Across subject groups for each protector, the differences between NRSA ratings were found to be not statistically significant. Several comparisons evaluating the order of testing, the type of testing, and statistical tests of the performance across the groups are presented. [Portions of this work were supported by the U.S. EPA Interagency Agreement DW75921973-01-0.]. |
Effects of training on hearing protector attenuation
Murphy WJ , Stephenson MR , Byrne DC , Witt B , Duran J . Noise Health 2011 13 (51) 132-41 The effect of training instruction, whether presented as the manufacturer's printed instructions, a short video training session specific to the product, or as a one-on-one training session was evaluated using four hearing protection devices with eight groups of subjects. Naive subjects were recruited and tested using three different forms of training: written, video, and individual training. The group averages for A-weighted attenuation were not statistically significant when compared between the video or the written instruction conditions, regardless of presentation order. The experimenter-trained A-weighted attenuations were significantly greater than the written and video instruction for most of the protectors and groups. For each earplug, the noise reduction statistic for A-weighting (NRS A ) and the associated confidence intervals were calculated for the 80 th and 20 th percentiles of protection. Across subject groups for each protector, the differences between NRS A ratings were found to be not statistically significant. Several comparisons evaluating the order of testing, the type of testing, and statistical tests of the performance across the groups are presented. |
Hearing loss prevention for carpenters: part 1 - using health communication and health promotion models to develop training that works
Stephenson CM , Stephenson MR . Noise Health 2011 13 (51) 113-21 In phase 1 of a large multiyear effort, health communication and health promotion models were used to develop a comprehensive hearing loss prevention training program for carpenters. Additionally, a survey was designed to be used as an evaluation instrument. The models informed an iterative research process in which the authors used key informant interviews, focus groups, and early versions of the survey tool to identify critical issues expected to be relevant to the success of the hearing loss prevention training. Commonly held attitudes and beliefs associated with occupational noise exposure and hearing losses, as well as issues associated with the use or non-use of hearing protectors, were identified. The training program was then specifically constructed to positively shape attitudes, beliefs, and behavioral intentions associated with healthy hearing behaviors - especially those associated with appropriate hearing protector use. The goal was to directly address the key issues and overcome the barriers identified during the formative research phase. The survey was finalized using factor analysis methods and repeated pilot testing. It was designed to be used with the training as an evaluation tool and thus could indicate changes over time in attitudes, beliefs, and behavioral intentions regarding hearing loss prevention. Finally, the training program was fine tuned with industry participation so that its delivery would integrate seamlessly into the existing health and safety training provided to apprentice carpenters. In phase 2, reported elsewhere in this volume, the training program and the survey were tested through a demonstration project at two sites. |
Hearing loss prevention for carpenters: part 2 - demonstration projects using individualized and group training
Stephenson MR , Shaw PB , Stephenson CM , Graydon PS . Noise Health 2011 13 (51) 122-31 Two demonstration projects were conducted to evaluate the effectiveness of a comprehensive training program for carpenters. This training was paired with audiometry and counseling and a survey of attitudes and beliefs in hearing loss prevention. All participants received hearing tests, multimedia instruction on occupational noise exposure/hearing loss, and instruction and practice in using a diverse selection of hearing protection devices (HPDs). A total of 103 apprentice carpenters participated in the Year 1 training, were given a large supply of these HPDs, and instructions on how to get additional free supplies if they ran out during the 1-year interval between initial and follow-up training. Forty-two participants responded to the survey a second time a year later and completed the Year 2 training. Significant test-retest differences were found between the pre-training and the post-training survey scores. Both forms of instruction (individual versus group) produced equivalent outcomes. The results indicated that training was able to bring all apprentice participants up to the same desired level with regard to attitudes, beliefs, and behavioral intentions to use hearing protection properly. It was concluded that the health communication models used to develop the educational and training materials for this effort were extremely effective. |
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