2/21/2017

Hearing protection and enhancement devices

Jaime Westbrook, AuD, CCC-A, F-AAA

Negative
effects of
hearing loss

1
 2/21/2017

• When do we need hearing protection devices (HPD)?

– Whenever we can’t reduce the output of the noise source.

• Using HPDs can protect the hearing and reduce all other
negative effects of the noise.

• It is required by regulations: e.g. the US environmental

protection agency, OSHA, etc.

Applicable regulations and standards

• OSHA 1983: HPD must be used when exposure levels exceed 8-hour TWA of
90 dBA.
– Attenuation of HPD must keep noise below 85 TWA.

• US department of defense 2004: Similar to OSHA in addition to:

– When TWA is 108 to 118 dBA, earplugs and earmuffs must be used together.
– When TWA exceeds 118 dBA, earplugs and earmuffs must be used together, and
exposure time should be limited.

• US Navy and Marine 2008: must be used all the time if noise exposure
exceeds 85 TWA.

• MSHA 1999: Similar to OSHA in addition to:

– When TWA exceeds 105 dBA, earplugs and earmuffs must be used together.

• Others.

2
 2/21/2017

Classification of HPD

• HPD can be classified according to:

– Physical styles.

– Electronic vs non-electronic.

– Attenuation characteristics.

Classification
of HPD

3
 2/21/2017

Classification of HPD – According to

physical styles
• Earplugs: fit inside the ear canal:
– Made usually of: Vinyl, nylon, silicone, etc.
– They take the form of the individual ear canal.
– Preformed earplugs.
– They can be custom made.

Classification of HPD – According to

physical styles
• Semi-insert device (Canal cap):
– The tip caps requires a band to apply force to retain their position.

4
 2/21/2017

Classification of HPD – According to

physical styles
• Ear clips:
– Sets in concha and occludes the opening of the ear canal.
– Comfortable, lightweight, and the band applies small pressure.

Classification of HPD – According to

physical styles
• Ear muffs:
– Covers all the pinna.
– Uses strong bands to apply pressure.
– Usually circumaural rather than supra-aural.

– Disadvantages:
• Bulky.
• Sounds around 190 dB might make them jump off the ear.
• Reduce localization.

5
 2/21/2017

Classification of HPD – According to

physical styles
• Helmets:
– Protect the entire head from shocks.
– Includes earmuffs.

Classification of HPD – According to

Electronic vs. non-electronic
• Electronic (Active) HPD: include electronic circuit that modifies the
incoming signal  more expensive.
– Musicians use these a lot.

• Non-electronic (Passive) HPD: relies only on blocking the sound 

less expensive.

• Hybrid that includes active and passive components.

6
 2/21/2017

Classification of HPD – According to attenuation

characteristics related to input level
• Passive HPDs attenuation level is independent from the input level.

• Active HPDs attenuation level can be input dependent as most of

them use compression strategies.
– Advantage: no need to remove the HPD during quite times.

Attenuation characteristics related to

frequency response
• Passive HPDs usually provide more attenuation in the higher frequencies.
• Active HPDs usually provide more flat attenuation.

7
 2/21/2017

• Infrasound can increase blood pressure and cause fatigue,

apathy, loss of concentration, depression, etc.

• Can HPDs protect beyond the human frequency range?

Active noise reduction

• Use phase cancelation strategy to suppress desired sounds.

• Can be achieved using digital or analog circuits.

• More effective below 900 Hz.

8
 2/21/2017

Noise protection and communication

• Communication headset:
– Designed to reduce noise but also include communication system.
– Example: pilot HPDs.
– Can be wired or wireless.

• Hearing enhancement protection systems (HEPSs):

– Designed to protect from noise but also provide ease of
communication.
– Example: In army  protect against impulse noises while
maintaining the ability to communicate effectively.

Combined measuring system

• Checks:
– Proper Fitting.
– Active and passive reduction for hazardous noise .
– Hearing enhancement for desired sounds.
– Efficiency of hearing protection.
– Radio communication.
– Noise dosimetery for protected and unprotected noise.

• Example: QuietPro system.

• Many studies evaluate the effectiveness of different HPDs.

 Make sure you apply evidence based practice when choosing the
appropriate HPD according to worker needs.

9
 2/21/2017

Recreational headsets
• These devices reduce noise however, workers can still listen
to music through the built-in speaker.

• Why is this problematic?

Workers might increase the music level to overcome the noise
resulting in:
Hearing loss.
Missing alarm signals and/or other instruction during the job.

• Most of these devices are equipped with maximum limits.

Hearing protection for workers with hearing loss

10
 2/21/2017

Factors to consider when selecting HPDs

• Comfort.

• Hearing loss degree and configuration.

• Ease of communication.

• Job situation including verbal and non-verbal signals the

worker is expected to receive.

• Noise level and exposure time, etc.

Use of hearing aids under earmuffs

• Hearing aids must be equipped with active noise reduction,

compression, and limited MPO.

• You must review the regulations prior allowing workers to use

the hearing aids with HPD.

• Only over-the-ear protectors are compatible with the use of

hearing aids.

11
 2/21/2017

Combined communication enhancement

and hearing protection devices
• These devices are useful for workers with
hearing loss.
– E.g. QuietPro, EB15 Electronic BlastPLGTM ear plugs

• Training must be provided to workers on these

devices.

• In extreme noise exposures: Dual hearing

protection with electronic/communication
features can be used.
 Example: Using BlastPLG ear plugs under earmuffs.

Workers with high-frequency hearing loss

• These patients might benefit from Etymotic research (ER) ear
plugs that have flat noise reduction (i.e. musician’s earplugs).
– It can include attenuation level control.

12
 2/21/2017

Selection of hearing protection devices

Factors affecting the selection of HPDs

• Attenuation characteristics

• Comfort.

• Ease of fit.

• Convenience and availability.

• Ability to hear important signals.

• Compatibility with other work or protective gear.

• Other factors… what do you think?

13
 2/21/2017

Factors affecting the selection of HPDs -

Attenuation characteristics
• HPD should allow sufficient attenuation without leading to
overprotection.

• Noise reduction rating:

– Commercially available devices have clear labels showing their
attenuation data… Make sure you know them for recommended
devices.
– You can also measure open vs. occluded thresholds to rate the
attenuation level.

Attenuation
labels

14
 2/21/2017

Attenuation provided by double protection

• Adds only 5 to 10 dB to maximum attenuation provided by the
use of single HPD.

– Example: if earmuffs provide 40 dB attenuation and earplugs provide

20 dB attenuation  Total attenuation is 45 to 50 dB NOT 60 dB.

• So be aware of the need of other noise control procedures

when noise exceeds 105 dB.

Factors that minimize or limit attenuation

• Structural transmission:
– Depends on the material of HPD.
– Affects mainly frequencies above 1 kHz.
• Loose seal:
– Depends on the headband strength.
– Can reduce attenuation by 5 to 15 dB.
• HPD vibration.
– The HPD itself might vibrate and transmit the sound.
– Affects mainly frequencies below 125 Hz.
• Bone and tissue conduction.
– Sound above ~50 dBA can reach the cochlea through the bone
conduction.

15
 2/21/2017

Factors that minimize or limit attenuation

• Comfort.
– Discomfort might make worker remove the HPD and not use it.

• Ease of fit and ability to use device correctly.

– Older workers have more difficulty.
– Notice other health issues (e.g. arthritis).
– Earplugs are harder to fit than earmuffs.
– Battery replacement and other technical issues for electronic HPDs.

Factors that minimize or limit attenuation

Comfort.

16
 2/21/2017

Factors that minimize or limit attenuation

Comfort.

Factors that minimize or limit attenuation

• Continued ability to hear important signals:
– Example: detecting rifle bolt sound from far distance.

• Compatibility with other work and personal protective gear:

– Some types of helmets, glasses, etc are not compatible with circumaural HPDs
and might cause the loss of tight seal.

• Convenience and availability:

– Employers must make sure that HPDs are available where needed in a
convenient way.

• Belief in effectiveness of the device in preventing hearing loss:

– Workers must understand that using HDPs reduce the risk and the degree of
hearing loss.

17
 2/21/2017

Making ear impressions for customized HPDs

• Customized HPDs are usually easier to use,
provide more seal, and more comfortable.

Steps for obtaining ear impression:

• Do otoscopy:
 WHY?
 What is the right way to do otoscopy?
 What would you do if you suspect a
medical condition such as ear infection or
perforation?

Making ear impressions for customized HPDs

• Place otoblock:
 WHY?
 Make sure you choose the appropriate size to
ensure seal and full protection of TM.
 Make sure you pace the otoblock appropriately.

18
 2/21/2017

Making ear impressions for customized HPDs

Steps for obtaining ear impression:

• Prepare the impression material:

 Make sure you follow manufacturer’s instructions
when mixing the impression material.
 You can also use impression cartridge.

• Place the impression material in the syringe or

install the cartridge to the impression gun.

Making ear impressions for customized HPDs

Steps for obtaining ear impression:

• Depositing the impression material in the ear.

19
 2/21/2017

Making ear impressions for customized HPDs

Steps for obtaining ear impression:

• Removal of the ear impression:

 Make sure you brake the impression seal in the ear by twisting the impression and
pulling the ear before you pull the impression out.
 Remember to hold the string with the impression.

• Redo otoscopy:
 Why?
 Re-examination of the ear canal and TM

Making ear impressions for customized HPDs

Steps for obtaining ear impression:

• Examination of the ear impression:

 What is a good impression?

• Shipping ear impressions to manufacturer:

 Make sure you label them appropriately and complete all needed paperwork.

20
 2/21/2017

Making ear impressions for customized HPDs

Steps for obtaining ear impression:

• Checking the physical fit of custom HPDs.

They should be comfortable and snug fit.

Sometimes you have to do minor modification to the HPDs to improve

fitting comfort (i.e. grinding).

• Checking the adequacy of HPD attenuation individually

… WHY?

Why to check the adequacy of HPD

attenuation INDIVIDUALLY?
According to OSHA and other agencies the reasons are:
• To train workers on using HPDs, and/or the professional on efficient fitting.

• Keeping a record of custom HPDs attenuation for each individual helps in

correlating the attenuation to the threshold shifts.

• Allow professionals to evaluate HPD adequacy objectively.

• For documentation purposes.

• Improve meeting individual needs.

21
 2/21/2017

Procedures for checking the adequacy of attenuation

• Obtain “Personal attenuation rating – (PAR)”.

• These procedures and not standardized yet.

– Thus, it is recommend to repeat the procedure twice.

• Some procedures check the fit at:

– Single frequency: Possible error  3 to 6 dB.
– Multiple frequencies: Possible error  0.5 to 1 dB.

• Checking must be done for each ear to avoid unilateral hearing damage.
Procedures for checking the adequacy of attenuation

22
 2/21/2017

Behavioral procedures
• Pass or fail procedures:
– Obtain thresholds with and without HPDs.
– Example: The QuickFit test.

• How to do the QuickFit test:

– The QuickFit device provides a one octave signal centered around 1 kHz.
– The subject is asked to place the device close to the ear, then, adjust the volume until
the tone is barely audible.
– The subject is asked to place the HPD and place the QuickFit device close to the
occluded ear while pressing the boost button.
– If the subject can’t hear the boosted signal, then the subject achieved at least 15 dB
attenuation.

Behavioral procedures
• Real ear attenuation at threshold-based procedures:
– Using an audiometer loudspeaker in a sound treated booth.

• How to do this evaluation?

– Measure the sound thresholds with and without the wearing the HPD
using pulsed NBN signals.
– In case of in the ear earplugs, you can use circumaural headphones
for testing.
– Available systems used for this purpose:
• Multifit4.
• FitCheck.
• IntegraFit.

23
 2/21/2017

Behavioral procedures
• Loudness balance procedures.
– Available systems used for this purpose:
• VeriPRO system: Tests five frequencies {0.25, 0.5, 1, 2, 4 kHz}.
• Uses circumaural headphones. Thus, works only for insert HPDs.

• How to do this evaluation?

– Ask the subject to balance the loudness between ears without the HPD.
– Then, place the HPD in the ear and redo the loudness balance test.

Objective test procedures

• Do not require any response from the subject.

• Microphone in the real ear:

– Available systems used for this purpose:

• SonoPass system.
• Any other REM device can be used.

– Compares the recordings of the measuring microphone inside the

occluded ear canal, and the reference microphone on the outside of
the ear, while signal presented through a loudspeaker.

24
 2/21/2017

Objective test procedures

• In-ear dosimetry:
– This is best used for dual protection users.
– Available systems used for this purpose:
• Quiet-Dose system.
• FitCheck system.
– How is the test done?
• Place a microphone in the ear while using the HPD and send the worker for a
full working day to evaluated the noise dose exposure.

• Re-evaluation of HPD attenuation:

– Re-evaluation must be done whenever the noise exposure increases.

Training workers for accurate HPD use

• Provide written instructions.
• Provide video taped instructions.
• Make employees practice in front of the audiologist.
• Give the workers a chance to ask questions.
• Make sure the workers understand the importance of proper
fitting to ensure attenuation.
• Training the workers should include:
– Insertion.
– Seal check.
– Insertion depth check.
– Removal.
– Cleaning.
– Replacement.

25
 2/21/2017

Checking adequacy of seal

• Noise attenuation test.
– Place cupped hand over the insert earplug  there should be no further reduction in
noise.
• Tug resistance test.
– Pull gently the earplug to check the seal

• Occlusion hum test.

– Make the worker hum or “ahhh”: if the voice sounds louder then indicating good seal.

• Perceptual noise attenuation test.

– Train workers to notice the difference in intensity with and without the HPDs.

• Ensuring proper insertion depth:

– Can be checked visually.
– Occlusion effect reduces for deeper insertion.  less occlusion
sensation suggests deeper insertion.

• Removal of earplugs:
– Improper removal might cause discomfort.
– The airtight seal should be broken gently by slowly twisting the
earplug before pulling it out of the ear.

• Fitting earmuffs:
– Headband on the center of the head.
– Ear canal opening at the center of the circumaural cushion.

26
 2/21/2017

• HPD hygiene:
– To avoid irritation and infections.
– Some earplugs can be washed with warm water and soap and dried.
– Provide workers with carrying case for the earplugs.
– If the device is not washable, make sure you provide the subject with
appropriate cleaning tools and instructions.

• HPD replacement:
– Show workers examples of worn out earplugs and earmuffs.
– Worn out HPD loose their ability to provide airtight seal.

Training on using electronic HPD

• More expensive and used for longer period of time.

• Provide written and tapped instructions.

• Provide individual training and include:

– Insertion and removal.
– The function of any control switches.
– The limitations of these devices. (e.g. can’t be used for gun shooting).
– How to handle communication features of the earmuffs if applicable.
– Wind noise suppression features.
– Cleaning and was removal from receiver opening.

27
 2/21/2017

Training on using electronic HPD

• Provide individual training and include (Continued):
– Replacing wax guards and filters.
– Any custom attached ear pieces.
– Battery replacement and handling.
– Protect the device from water. (e.g. not to be used during showers).
– Protect the device from heat and humidity.
– Allow for acclimatization time.
– Avoid using the device during ear infections.
– Warranty information.
– Annual device evaluations.

Motivating workers to use HPDs

• Workers are more motivated if:
– Self efficacy: workers who know will work for long period at noisy
places are usually more motivated.

– HPD is comfortable.

– HPD is compatible with other work gear.

– Worker awareness and education regarding hearing loss and

tinnitus, and providing initial training and lecturing.

– Work regulations enforce the use of HPDs.

28
 2/21/2017

Motivating workers to use HPDs

Measuring overall HPD effectiveness in a

hearing conservational program
• The consistency of HPD usage.

• Percentage of workers who use the HPD consistently.

• Evaluation of randomly selected data:

– Personal attenuation data.
– Protected noise exposure data.

• Audiometric database analysis.

29
 2/21/2017

Questions?

30