Hearing Conservation Considerations in The Modern Workforce

Hello, everyone.

It’s a pleasure to be with you

virtually to discuss hearing

conservation considerations

in the modern workforce.

My name is Heather Malyuk.

I’m a doctor of Audiology

located in Northeast Ohio,

and I’m excited to talk about

this with you today.

I’m going to show you some data,

and we’re going to talk about

care of the modern workforce.

And I believe that these are

individuals who need

audiologists okay,

so it’s a very exciting topic to

me in terms of a little bit

of background on myself.

If you know me,

you probably know that I’m a

hyper specialist in

music audiology,

and I have been a music

audiologist for over a decade.

What you might not know is that

for quite a few years now,

gosh probably since 2016,

I’ve been working in

tele audiology.

And for the past about

three years or so,

I’ve really become sort of a

hyper specialist in that realm

as well.

I am a business owner.

I own a private practice called

Sound Check Audiology in

Cuyahoga Falls, Ohio.

And I have also found myself for

the past ten years involved with

a lot of organizations and on

a lot of research teams.

And I find that work very

exciting because I think it

moves our field forward.

And I really hope that if

there’s a researcher

listening today,

that you get inspired by this

topic and that you continue

research in this area.

And I wear a lot of other hats

in the field of audiology

as well.

Now,

I do want to disclose that I am

head of audiology for a tele

audiology company called Tuned,

and I am going to show data

today as sort of the meat and

potatoes of the presentation

that was collected through my

role at Tuned.

However,

I want to make it very clear

that this presentation

isn’t about Tuned,

it was not sponsored by Tuned,

and a lot of what I’m discussing

today can be completed in

clinics on other platforms.

It just so happens that Tuned

has a lot of patients from the

modern workforce because of how

the company is run as a benefit

for individuals.

Okay,

so audiology as a benefit.

So just wanted to make that

clear before moving on

our agenda today.

Introduction already done.

We’re going to do some

literature review and discuss

hearing conservation a little

bit in terms of the traditional

sense.

So a few slides on that.

I’m going to show you that

recent data that I mentioned.

So very interesting survey that

was conducted in the modern

working population.

And then I want to discuss care

of these individuals via

telehealth and what we can

really do for them.

I’m going to give you just some

little vignettes snippets

of some case studies,

some individuals I’ve seen and

what I have run into

in this population.

What I would like for you to be

able to do at the end of this

half hour is describe how this.

Population is using headphones,

earphones headsets.

So ear level devices and what

our role is as audiologists.

If you are an audiologist

listening to this,

I would like for you to end this

session with I have some really

concrete ideas of what I would

do with a patient who walked

into my clinic or saw me.

Via tele audiology,

listing potential risks

associated with ear level

devices and their use,

and then identifying a couple

of points of education for

individuals who wear ear

level devices for work.

Most of my appointments,

if you have ever worked with me,

you know I’m really

big on education.

I sometimes over educate

individuals,

but I really believe that this

is the heart of the matter.

Hearing loss prevention,

a huge portion of

it is education.

Okay?

So when I was getting

ready for this,

these are questions that popped

into my head that I wanted to

try and answer for you.

Because I think these are

questions that a typical

audiologist or someone working

in the hearing healthcare

field might ask.

What is our role?

Do they need us?

Does the modern workforce

need hearing care?

What do we even know about

this population?

How do we effectively reach this

population if they’re not

walking into our clinics?

And how do we effectively

care for them?

What are some new ways

of caring for them?

So I hope that these will be

answered by the end of today.

In terms of a literature review.

I have about four

slides on this,

and I want to preface the

literature review by saying

individuals who I am discussing

the modern workforce,

people in their twenty s to

fifty s who are wearing these,

who are white collar workers

wearing ear level devices,

there’s not a lot of research

on them.

Okay,

so I just want to give you an

overview of some papers

I found interesting.

I really found about 20 or 30

that could apply in some way.

But I’m just showing you

a smattering here.

And I do think that this is an

area where we need to take a

deeper dive.

So, of course,

I had to bring up the World

Health Organization statistics,

and they say that globally,

430,000,000 people have hearing

loss affecting their quality

of life.

By 2050,

we can potentially expect that

number to increase

to 700 million.

However,

over half could be preventable.

That’s really good news.

I do think our role in that is

huge.

And in terms of the USA,

I’m not sure if you are aware

over half of the counties in the

United States don’t have

an audiologist.

I think the exact

number is 56.6%.

This is very interesting.

When you work in the hearing

healthcare field and when

you work in audiology,

you feel like you see it

everywhere and that your whole

life is audiology.

But when you think about

the general population,

we’re not around for them.

We’re a very small field.

So how can we be more effective.

Active in reaching more people.

To me,

over half of the county’s not

having an audiologist is sad.

How can we grow?

How can we grow into that area?

There was an interesting study

done last year in 2022 comparing

normal hearing participants with

white collar workers

with hearing loss.

And they found that white collar

workers with hearing loss had

increased odds of nonoptimal

work performance.

Additionally,

this paper reported that women

confirmed not doing jobs

properly due to hearing loss,

more so than men.

So just an interesting

tidbit there.

In 2016,

there was a study done looking

over at over half a million

individuals ages 55 to 64.

They had to have a

classification code

of hearing loss.

And what they did was they

tracked the healthcare billing

of these individuals

for 18 months.

So they found a couple of

interesting points.

If you have time to actually

look at this paper,

I highly recommend it.

I thought it was fascinating,

but two main points here that I

found most interesting was that

individuals with hearing loss

who received hearing services

had lower overall mean costs in

terms of healthcare billing than

patients with hearing loss who

did not receive hearing

services.

Additionally,

payments were significantly

lower for patients without

hearing loss than with

rick Knightsl and colleagues

back in 2017 published a paper

and it estimated that hearing

loss affects more than 13% of

the working population of the

causes of hearing loss.

If the 20% of hearing loss cases

from noise exposure

were prevented,

the economic benefit would

have a core estimate

of 123,000,000,000.

They did state that this

estimate is conservative.

So this says noise exposure.

There are a lot of papers

looking at noise exposure.

I tend to say sound exposure

because individuals using

headsets for work,

maybe they’re on meetings for

a number of hours a day.

It’s not really considered

noise.

However,

it still can be a damaging

or injuring stimulus.

So let’s look at traditional

hearing conservation

for just a moment.

If you work as a hearing

conservation audiologist,

you can zone out for

maybe 2 minutes.

But I do think this applies,

and here’s why.

I believe that anytime we look

at a new area of care or a new

way of caring for people,

we need to go back to

the roots first.

And traditional hearing

conservation is the family tree

that we are budding from in

terms of this conversation.

So traditional hearing

conservation is thought to be

only for those who are regulated

by the Occupational Safety and

Health Administration.

It is a legal liability kind of

thing and also protective thing

protecting workers.

I do think that hearing

conservation.

However, is for everyone.

But it will stem from this

regulated aspect.

If someone is under a hearing

conservation program or enrolled

in one because they are noise

exposed to the point of needing

a hearing conservation program,

that workplace must follow the

OSHA Code of Federal

Regulation 1910.95.

So many audiologists are

familiar with the OSHA scale,

the Safety scale,

and it does differ from the

National Institute of

Occupational Safety and Health

scale, the NIOSH scale.

I have both listed here for

an eight hour workday,

OSHA starts at 90 DB and has

a five DB exchange rate.

So when you go up to 95 DB,

you’ll cut your safety time

in half, et cetera.

NIOSH starts at 85 DB for

an eight hour period.

Every three DB you add,

the safety time gets

cut in half.

And I just realized I’m

only saying DB,

and that doesn’t mean much.

It is a weighted dbaspl.

So why do I have these here?

And why am I showing you this?

Every time I meet with a patient

and they ask me about protecting

their hearing,

I teach them these scales and I

teach them the concept of not

just intensity or what they

perceive as volume of sound,

but their length of exposure.

I find that in the appointments

with individuals who are wanting

to learn about protecting

themselves,

this is an eye opener for them,

especially when they’re using

ear level devices.

And they say,

Well,

I didn’t realize that I would be

at risk based on my length of

exposure.

Or they might say,

Well, I’m not a factory worker,

but why are my ears

feeling tired?

What am I dealing with here?

You say, well, gosh,

you’re using these 8 hours

a day at 100% volume.

You might be hurting yourself.

And so I think it’s really

important for individuals

to learn both of these.

Reason being is NIOSH will

be more protective.

I like for them to know

what OSHA states.

But we know that OSHA will

protect about three quarters

of the population,

where NIOSH is more like

92% of the population.

So if someone can follow

the NIOSH scale,

I think it’s a good thing.

Looking at

the goals of traditional

hearing conservation,

of course,

the goal is to prevent noise

induced hearing loss.

Those of us who work in

the field, though,

it’s much more than that.

We’re trying to lessen the

incidence of tinnitus,

hyperacusis and other disorders

or maybe prevent them

from worsening.

And we also think of things like

cochlear synaptopathy,

and I put maybe on here because

of course we know it’s still

being researched.

Maybe one day we’ll find that

exact diagnostic marker and

exactly how we can prevent it.

But I think it’s worth

mentioning and keeping in mind

when someone is following a

traditional hearing conservation

program,

there are seven parts to the

program in that code of

federal regulation.

So monitoring noise exposures,

looking at engineering controls

and work practices, making sure.

The employee has hearing

protectors with an adequate

noise reduction.

Training and education,

of course, that’s huge.

Baseline and annual audiometry

procedures for preventing

further hearing loss if an

occupational loss is identified.

And then of course,

record keeping.

And don’t zone out here.

There’s a reason I’m going

through all these parts.

You really can do each part of

this with an individual patient.

It for the past

six, seven years,

I’ve been doing orchestra

programs where we follow

much of this.

What can you do most easily,

though?

If you have someone walk into

your office or meet with

you via telehealth,

there are pieces here that

are low hanging fruit.

And even though I think

you can do everything,

these might be the points that

you can hit most easily.

So looking at work practices,

training and education,

baseline and adding annual

audiometry or screening,

basic screenings,

even a questionnaire screening,

depending on who it is and

what you’re doing,

just looking for red flags,

that kind of thing.

Procedures for preventing

further occupational hearing

loss and then record keeping.

Okay,

so the modern patient

population, who is it?

I think these pictures kind of

represent individuals that I am

seeing from this population.

People who are working,

they’re on calls many hours

a day since the pandemic.

They’re working remotely

or in a hybrid fashion,

and they’re fairly young.

What can we do with them?

So this is the study I mentioned

that came from tuned.

Part of my role with tuned.

We really wanted to try and get

to know these folks and dove

into the literature.

There really wasn’t a

lot of information,

so we put a survey together,

and we were trying to determine

a couple of things their access

to hearing health via

their employer,

and then also personal

hearing practices.

In terms of respondents,

we had 355 individuals from

a variety of job types,

which you can see here on this

pie chart.

Engineers,

we had people from finance, HR,

it,

sales, management, operations,

support, data, other.

I think this is pretty

representative of a white

collar workforce.

We also had a wide range

of demographics.

We focused on the United States,

but every part of the United

States was represented.

We had people from all

over the country,

about 30% identified

as non white.

We had ages 20 to 65 years

old represented,

and we had a wide range of

socioeconomic status.

You can see salary ranges here.

So everywhere from between

15,000 to 30,000 annually

to over 150,000.

It’s a pretty good spread there.

They were asked about the effect

of a hearing issue

on their work.

So if they were dealing

with a hearing issue,

how is it affecting what they

were doing?

About 47%, no issue,

not affecting anything.

Okay,

but otherwise we’ve got 10%

leaving work early,

9% calling in sick,

14% taking an extra break,

8% failing to complete a task

and then 12% completing a

task incorrectly.

Okay,

so there is some effect

going on here.

In this population of

355 individuals,

67% could define audiology.

So I thought that was pretty

high, actually.

However,

it still up 33% who really

had no clue.

And this was an open ended

response and you should have

seen some of the responses,

just no clue what an

audiologist was.

Some of them were kind of funny

people trying to guess

at what it might be.

Over half had not seen

an audiologist.

I think we probably could have

guessed that, honestly,

over half not seen

an audiologist.

We wish more people came to

see us.

Right?

So again,

the whole point of this how do

we reach these individuals?

So what I did with this data,

I wanted to look at a more

homogeneous set.

So looking at them,

I took 80% who were employed

full time,

so let’s look at just

full time workers.

They were all remote or hybrid.

83% receive health benefits from

their employer with 46% of those

receiving hearing benefits

and hearing benefits,

it’s mostly discounted

hearing AIDS.

So not exactly what we would

think of as audiologists in

terms of really full care

of these people,

but when I looked at all

of these factors,

I ended up with 233.

So the next few charts and

graphs we’re going to look at

focused on these individuals,

233 individuals.

They were asked about the

estimated hours of ear level

device use per day and

to me this is a lot.

So about half are using

something on their ears at

least 5 hours a day.

12% are using them nine or

more hours a day.

Okay,

so in terms of that listening to

something, it could be meetings,

it could be music,

it could be podcasts.

So we weren’t specific about

that, but headset use per day.

They were asked about the

presence of listening fatigue at

the end of their workday

and these individuals,

60% notice auditory or listening

fatigue at the end of the day.

That’s a very large number.

Very large number.

I think this should be eye

opening for us and again,

I do think this would be

considered just sort of a basic

starter study that all of you

should go and do more work in

this and I’m hoping to do more

work in this as well,

but this is just a glimpse

into this population.

We with this data set,

52% admitted additional.

Breaks throughout the day

because of listening fatigue.

Over half 49% reported more than

5 hours of year level

device use for work.

So think about the time they

spend working out other

recreational activities.

It’s not just those 5 hours,

it’s probably more.

43% disclosed having tinnitus

and 26% disclosed that their

tinnitus increased and they had

an increase in perceived hearing

issues since the pandemic.

So since working remotely,

that was very interesting

as well.

Where’s the care on that

side of things?

So when I think about potential

risks for this population,

maybe temporary threshold shift,

is the listening fatigue we’re

dealing with, is it TTS?

Is it something else?

Is it linked to zoom fatigue?

I think these are all potential

areas for research.

What are we really looking

at here?

Of course,

a risk of permanent threshold

shift or hearing loss,

maybe cochlear synaptopathy,

hidden hearing loss, maybe?

Again,

put the question mark there

because I think there’s still a

lot to learn in that realm.

Tinnitus, we know.

Look at what was just

on the last slide.

An increase in their perception

of tinnitus,

other auditory disorders

potentially.

And then also risks here,

I think in terms of prevention,

perhaps a lack of early

identification of auditory

and vestibular issues.

Could we be reaching people at a

younger age with audiologic care

and identifying things earlier?

That would be wonderful.

So let’s discuss care via

telehealth because I think that

that really is the easiest way

to reach this population.

Teleaudiology is becoming a

benefit for many companies.

It certainly is through Tuned.

That is primarily

what Tuned does.

But there are other tele

audiology companies doing

this as well.

I think hearing conservation,

based on what I have seen with

patients is a huge part of this.

So many people I’m seeing,

which I’m going to

do little again,

vignettes of patients

in a moment.

A lot of them want to know about

protecting their hearing or

preventing tinnitus or

preventing tinnitus from

getting worse.

Hearing screenings are

a role of this,

but you need to be very careful

when discussing hearing

screenings versus diagnostics.

And I’m going to talk about

limitations of telehealth in a

minute and I’m going to discuss

this more in detail.

Tinnitus therapy,

triage looking for red flags.

Perhaps someone has a benefit.

They get on a call with an

audiologist and a major red flag

is identified and they figure

out who to go to.

Okay,

I have run into that several

times and it has been very

helpful for individuals to speak

with an audiologist first

and get guidance.

So that’s my last point here.

Education and guidance

is a very,

very large part of what these

individuals need.

Need.

So let me just talk through

a couple of case studies,

a few case studies.

These are patients that I have

seen via telehealth.

Now,

my average patient age is

probably like early 30s,

if I think of the average,

and just three examples.

First is a woman, mid 30s,

dealing with auditory listening,

fatigue,

working in transcription,

and she was just a fascinating

case study.

If you’ve heard me speak

about this before,

I’ve used her as a case

study before,

but working ten hour days,

using headphones.

And at the end of her work day,

she did not want to

speak to anyone.

She did not want to speak

to her boyfriend.

She did not want to do anything

because she was done listening.

And in her words,

her ears were just tired.

She would work.

410s was her work week.

She met with me, sought me out,

because she had a benefit,

and she wanted to know how she

could protect herself.

She was using her headphones at

100% volume because she was

having a hard time hearing

clearly on the different types

of recordings she was getting.

And so she and I ended up doing

a new type of headphone,

and

she spoke with her

It department,

got her Windows updated,

and started using Sonic Cloud

software.

Now, mind you,

she did not have any other

auditory complaints.

She did several hearing

screenings.

There were really no red flags,

even on a really lengthy

questionnaire.

And when I spoke with her,

she said, really?

Nothing’s wrong.

It’s just at the end of the day,

I’m so exhausted.

And so with the Sonic

Cloud software,

we were able to EQ

her listening.

I walked her through speech,

clarity,

presets they have using

individual EQing herself.

And it changed her life.

It really changed her life.

She was able to keep her volume

down.

She was much happier.

She felt like she had some

control.

It was great,

and that’s what she needed.

The next example I have here is

a man in his mid 20s who he

thought he might have auditory

processing disorder.

He had read about it,

and he got on a call with me

again, because he had a benefit.

And he started talking to me

about his experience throughout

his life,

how exhausted he always is.

He feels like he can’t hear

anything clearly,

and how it’s gotten a lot worse

since working remotely.

So I discussed auditory

processing disorder with him,

did a couple of screeners with

him, and I said to him,

I think you might be

dealing with this.

Can I refer you to a specialist

in this area?

And he was so excited

to have information,

and he was so excited to do some

screeners and finally be

on the right path.

And that might seem really

simple, but it really, again,

changed his life.

I saw him last year.

And I did check in with him,

sent him an email, said,

how are you doing?

And he’s doing really well.

So he was, I think,

disappointed that this hadn’t

been caught at a younger age.

But he suddenly had a benefit

through work,

got an appointment,

very exciting for him.

And then finally,

a woman in her mid 30s

with Tinnitus.

This was supposed surprising to

me.

She had seen an audiologist,

had a lot of diagnostics done.

She uploaded them to her patient

portal.

Her hearing was great,

no issues,

not sure how the Tinnitus

started.

And she had been told

at the clinic,

there’s not much you can do,

your hearing is normal,

good luck kind of thing.

And

I think the audiologist really

did the best that she could do.

There’s nothing to be said

against any audiologist.

It’s just they maybe didn’t have

the right tools for her there.

So she met with me and I talked

about Tinnitus with her and her

audiologic results and she was

able to go on and do

therapy again,

wonderful triage approach,

get them on the right path.

And of course,

I have so many examples like

this, so many examples,

but these are just a few little

vignettes of how telehealth is

reaching individuals who might

not otherwise go into a clinic.

Now,

the first two patients I saw

didn’t want to go into a clinic

because they think that

audiologists just fit hearing

AIDS on elderly people.

That was the perception from

the first two.

The third,

she went to see an audiologist

and she wasn’t able to get on

the right path of care.

So my question is,

where is our field?

How are we filling this in?

I think telehealth again is low

hanging fruit for these

individuals.

There are some limitations

though,

and I always like to

point these out.

I am an advocate of telehealth,

but it does have its limitations

and there is very much a role

for in person care as well.

So the first thing immediately

that pops into the minds of

audiologists screening versus

diagnostic testing.

A few slides ago,

I had the words be careful when

you’re discussing this

with patients.

Every time I discuss

this with patients,

I’m very clear that it is not

the same as going to see an

audiologist in person.

There are transducer issues.

So unless you’re sending a kit

out to the patient that has been

calibrated in some way,

maybe there’s a tech

on the other end.

That’s a different type of

telehealth than what

I’m discussing.

In the past number of years we

have seen screeners pop up on

websites, clinic websites,

hearing aid websites,

from a number of creators.

Okay?

So the validation of these is

typically done with a certain

type of transducer and a

certain type of device.

Some of these companies don’t

do any validation measures.

When I was looking for

screeners for Tuned,

it was really shocking to me

meeting with a couple of the

companies and saying.

Could I see information on

your validation studies?

Do you have any white papers?

And there was nothing

to show me.

They hadn’t really done anything

to me that was appalling.

Of course,

we didn’t use companies

like that.

But even with a company that’s

done fantastic validation

measures,

the end user is not always using

the exact devices that were

used in the study.

And so you might get someone

where the trans doser,

excuse me, is very sensitive,

maybe has a low impedance.

You’re going to get a

different result.

You can’t say that it’s

clinically validated within a

certain range at that point.

Okay?

So my point here is you can

really look for red flags and

get an idea of the person.

Many individuals,

I do recommend that they go and

get diagnostic testing.

Okay?

And again,

it’s just that they need

the right path.

They need to be taught

where to go.

There’s also a lack of

otoscopy sometimes.

Now there are kits that

can be sent out.

There are companies that create

tablet devices where you can

send it out to the patient,

an at home kit.

They can take a picture via

Otoscopy.

You can look at it.

So there are workarounds there,

but just the average person who

gets on and speaks with you?

No.

Maybe you can’t do autoscopy.

The last limitation here is

in terms of our field.

So I have noticed now,

doing this a few years in terms

of onboarding audiologists for

telehealth and teaching

them how to do this,

some audiologists don’t like it.

That’s a limitation.

If you don’t like to speak to

someone and really educate and

do screeners and talk

things through,

then that’s a limitation.

Don’t do it at that point.

Okay?

So the role and the desire of an

audiologist one thing I love

about audiology is how diverse

our field is and how many

specializations there are.

I’m not saying everyone should

go into telehealth.

Some individuals love to do that

back to back quick diagnostic

testing.

Some people really love fitting

hearing aids in person

in the clinic.

And some people love this type

of non regulated hearing

conservation and guidance.

So you just find what

works for you.

In summary,

I believe that audiologic

care is for everyone.

For everyone.

And I really think that the

modern workforce needs us.

I think that they need us.

Based on who I’m seeing and

based on the survey

study we did,

and based on what I hope will

be new research coming out,

I think that there is a public

health component here.

And I think we could prevent a

lot of hearing loss and offer a

lot of guidance toward proper

care for these individuals.

Tele, audiology telehealth,

from what I’m seeing,

is reaching so many people who

would otherwise not seek us out.

Okay?

The companies like Tuned,

like others that are coming out,

becoming a benefit.

They are helping so many people,

and it’s through tele,

audiology.

So while it has many

applications, tele, audiology,

you can do a lot.

Therapy for disorders,

et cetera.

Non regulated hearing

conservation I really think is.

A gap that’s ready to be filled

this instant.

Okay.

Right now.

And if you want to talk more

about this with me,

I do have several case studies

of individuals I have seen in

terms of that very specific non

regulated hearing conservation

measures we took,

recommendations I gave,

and how they’re doing.

I would be happy to share

that with you.

So these are the references

from my slides,

and then this is my email

address.

[email protected].

I will take your questions,

your comments, your challenges,

and I would love to have

a discussion with you.

Thank you so much for having me,

and I hope to hear from all

of you.

Thank you so much.