Are self-operated audiometry systems OK for use at worK?

Over recent years there has been an increase in the number of self-operated audiometric testing systems launched and they seem to offer a cheap way for an employer to meet the hearing testing requirements of the Noise Regs. But are they a good alternative to a hearing test being done by someone who knows the subject, be they in-house or an external provider?

It's worth highlighting upfront that as a company who provide workplace audiometric tests, we do have a horse in this race and self-testing is up against our provision of hearing tests with a qualified technician and mobile unit. But, if these systems are a good alternative then that wouldn't stop me saying so as I would be more than happy to stop paying for clinics to be built and hauling them around the country if there was a way to do it remotely by having a bit of software made for us costing less than having one clinic built..

Physical self-operated audiometric testing systems

These involve physical products being shipped to the employer and then employees conduct their own tests. To highlight example systems, WorkScreen and ShoeBox are kits sent to the employer containing a tablet and some headphones, with the attendee then simply following the instructions on the machine.

WorkScreen make some rather bold claims for the system, including 'reducing the administrative burden', that the testing is 'HSE compliant', although other pages then change that slightly to a 'report prepared to HSE guidelines' and that it means less lost work time for the attendees. The boldest claim though is the one about it being 'more accurate than traditional systems'. If this is true then I am in.

HSE compliant?

I am a little bit suspicious of anything which says a hearing test is 'HSE compliant', when 'HSE compliant' is not the only standard for hearing tests in the workplace. The standard which hearing tests should be following is the British Standard for Pure Tone Audiometry - BS EN ISO 8253-1:2010.

That probably sounds a bit of a fudge but there is a big difference between HSE guidelines and the British Standard. The British Standard says how a hearing test should be undertaken to get a valid reliable result - this is the way the test should physically be done. The HSE Guidelines in L108 say how that data should then be interpreted for work. Other than some vague top-level stuff about frequencies, the HSE do not actually say how a hearing test should be done, just what you then do with the data.

Verification checks.

There is a requirement in BS EN ISO 8253-1-2010 to do a verification test at the start of every audiometry session. That is a test in-situ, on every day when hearing tests are done.

The lack of a verification checking system, on site, every day, by someone who knows what they are doing means a hearing testing kit is generating testing results which are not compliant.

Otoscopic examination of the ear

The basic requirement for a hearing test requires otoscopic examination of the ears before the headphones go on - the bit where you look down the ears with a bright light thing. This is needed by BS EN ISO 8253-1:2010 where section 8.2 says that any occlusion of the ear drum must be noted on the audiogram - if nobody physically looks down the ear then this part simply cannot be done. 

Without an otoscopic examination the self-operated audiometry test is not compliant.

Who puts the audiometry headphones on?

In a hearing test, as required by the British Standard, you never let the attendee put the headphones on themselves - you always put the audiometry headphones on for them. The British Standard specifically says the headphones shall be put in place by the person conducting the tests, not only to make sure they are correctly positioned but so hair is kept clear, glasses or large ear-rings removed, etc.

Attendees putting them on themselves always leave their glasses on, always leave earrings in, and always do it so they feel comfy whereas as technician puts them on so the speaker unit is placed properly over the ear canal and is unobstructed. This sounds trivial but can be the difference between a pass and a fail. How big a difference does this make? These are two results for the same person, one where they put the headphones on themselves and one where the audiometry technician put them on.

Attendee placed the headphones on themselves

Attendee placed the headphones on themselves

Same attendee had headphones put in place by the audiometry technician

Same attendee had headphones put in place by the audiometry technician

As you can see, when the attendee put the headphones on themselves, they did it so it felt comfortable but the right ear (the red one) was showing increasing losses with increasing frequencies. Once the headphones were adjusted by the technician to make sure they were seated correctly the right ear was back to where it should be. This was the difference between the right ear being classed as OK or classed as having losses which are starting to be of a concern.

It is vital that people do not put the headphones on themselves in a hearing test and this is a fundamental requirement of the standard for pure tone audiometry.

When people put the headphones on themselves, any result from the self-test system is not compliant.

Background noise levels during the hearing test.

The British Standard also places restrictions on the background noise levels in which a hearing test should be undertaken. Overall total noise level is only part of the story and just as important is the type of noise around. It's no good if it is quiet most of the time but then occasionally people can be heard talking or telephones ringing as these are very effective at masking the tones being tested. A technician will see this and work around it but a machine will not. Without knowing the noise levels in the test environment it is simply being guessed at. Come an insurance claim there is no way of convincing an insurer that the testing environment was OK just because that's where the self-testing kit was placed. If the background noise levels aren't measured then there is no way of knowing that the test was BS compliant, or proving compliance and the result cannot be taken and relied on without question.

Without measuring and recording background noise levels, the self-test system results are not compliant.

How certain was the attendee?

As well as the audiometry result the individual obtains, what is equally important is how they obtained that result - were they nice and sure and fast or where they hesitant, more unsure and guessing a little more. A technician will pick up on this whereas the automated test will not. If an attendee is looking uncertain, the audiometry technician may vary things like the tone length, or the gap between them to give a little more response time for the attendee, or even change to using a pulsing tone which can be helpful where the attendee has a degree of tinnitus - again, the automated systems such as WorkScreen will not do this. 

Attendee understanding of the audiometric test result

The WorkScreen setup says it lets the 'user instantly see their results and also receive a copy of their report by email'. The result of a hearing test is not the most straight-forward thing to understand so having a technician explain their result to them and how it relates to their lifestyle and health history is vital for their understanding of what it means. This changes with every person as everyones’ history and result combination is different.

We do that and give them a copy of the result there and then, with them being able to ask the technician anything they want or need further explanation on, which can't be done with a self-testing system.

Claims about it 'reducing the administrative burden'.

If we are asked to do a load of hearing tests for a client, we ask simply for the numbers of people per shift who need to be tested and draw up a schedule of appointments based on that. If the client gives us the attendee names then we will even add the names to the appointments list so all the client has to do is circulate that and job done.

After the testing we give the client a report along with a list of all the attendee names and when they should next have a test. When those tests are coming due we let the client know and start the process again. There isn't much 'administrative burden' for the client at all in that.

With the self-test system all the organisation has to be done by the client - that is increasing the administrative burden, not reducing it.

Claims that it is more accurate

I have tried many times to think of a polite way to state this, but I can’t. The testing is not compliant with the British Standards for testing, not overseen by someone who can see uncertainties or issues with the testing, is not including visual otoscopic examination, and not being done by someone who has the skills and knowledge to compare that person’s unique history to their result.

Claims that self-testing systems are ‘more accurate’ are so wrong they are fundamentally untrue and nothing more than marketing fluff and hype.

How it works in an insurance claim

Over the years I have had a lot of experience with both criminal investigations into companies by the HSE for non-compliance with the Noise Regs, and more frequently companies and their insurers getting involved in the defence of spurious claims. In every one of those the first things asked for were proof of competence of the technician who did the test, calibration records, daily verification check records, what the noise levels were in the test environment, proof of otoscopic (visual) examination of the ears, and what subsequent advice was given to the individual concerned.

Self-testing systems simply cannot satisfy several of those requirements.

Summary on self-operated audiometry screening systems

No fence sitting here - self-operated audiometry systems such as WorkScreen are not compliant with key standards for workplace audiometry, miss critical components, increase administrative burdens and should not be used for noise at work health screening. They may be cheap but they are not doing the job and are a waste of money.

And as for the online hearing test system - no. All the problems above, plus uncalibrated headphones, uncalibrated sound cards and nothing more than guesswork really.