Are self-operated audiometry systems OK for audiometryat work?

There are number of these on the market and to be unambiguous, these do not provide standards-compliant audiometry at work. Should you get a claim, defending it becomes near-impossible using the results generated by these as they omit several of the key elements needed. For example:

  • No idea or record of the noise in the testing environment.

  • No daily pre-testing verification test of the audiometer - this needs an on-site technician to do and is a mandatory part of the British Standard for pure tone audiometry.

  • No pre-test health review by a qualified technician - this cannot be fully automated.

  • No otoscopic examination of the ear, the visual examination part. If this is unknown the rest of the test is just junk. Again, a mandatory part of the standards.

  • The attendee must never put their own headphones on - that’s a clear part of the British Standard, as they do it for comfort, not accurate placing of the speakers.

  • The test runs automatically and people get automatic tests wrong, a lot.

  • The test cannot be adjusted to suit a specific person, for example if they have no hearing in one ear then you do not test that as the tones get so loud it generates an incorrect result from them hearing it in the other ear. Automatic systems still test the non-hearing ear.

  • Any report is purely a list of categories. There is no discretion or judgement made as no two cases are the same. The same result may mean entirely different things to two different people and making that distinction requires an experienced Technician looking at each case individually.

Add to this, the client needs to do all their own arrangements and set the equipment up, meaning these systems increase the admin workload while also giving non-compliant poorer results.

Self-operated audiometric testing system formats

These involve physical products being shipped to the employer and then employees conduct their own tests, usually using a tablet / iPad style thing. 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'.

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 HSE, via the guidance in L108, say how the results should be interpreted and categorised.

  • The British Standards sets out how a hearing test should actually be done. This is crucially important as it details how the data is obtained, while the HSE’s standards then simply say how that data is read.

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. This should be done by a technician and done against a known standard.

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 as there is no proof of validity on that day.

Otoscopic (visual) 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 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 it then the rest of the audiometry is pretty much junk as the state of the ear canal and ear drum is unknown.

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 real-world 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 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.

Claims you cannot get an automatic test wrong

This is simply nonsense. I have met the people who have developed one of the self-testing automatic systems and lovely though they are, they have not done hearing tests themselves. They are marketing people.

One thing to make clear - there is no difference between the automatic test done by self-testing systems and the test run by any other audiometer. There are only two kinds of automatic test and every audiometer runs one or the other. All audiometry is automatic these days and self-test systems just run the same test as anyone else, there is no special unique technique.

We have done quite literally hundreds of thousands of hearing tests so are very experienced at this and can say unambiguously, people get automatic tests wrong every day. This is why a good technician sets an automatic test running, but watches how the result is obtained (are they guessing or certain), does the result look realistic (is it a 55 year old man with the hearing of a 20 year old woman or one frequency at 10dB but the next at 90dB), etc. They then manually verify peaks, troughs, highs and lows to ensure the result is solid and verifiable. No automatic testing system does this.

How often do people get it ‘wrong’? The day before writing this I personally did 28 hearing tests, of that four then got significantly different results on manual verification than they got in the automatic one.

People get automatic tests wrong every single day and claims otherwise show a focus on marketing rather than experience.

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'. Useless.

With physical testing the attendee sees their result instantly, has it explained to them instantly, and receives a copy of it instantly.

Also, every result is different. The category of result is only part of the result and has to be read in conjunction with their health history and results of the visual exam from the otoscope. Pre-packed statements on a results category are not just vague but also will miss key information for a lot of people. A Category 2 for one person may be no issue at all, while a Category 2 for someone else could be something important.

You cannot use pre-kacked statements about categories as the only explanation of audiometry results

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, had no manual verification of suspect results and is not being done by someone who has the skills and knowledge to compare that person’s unique history to their result. It’s junk.

Claims that self-testing systems are ‘more accurate’ are so wrong they are fundamentally untrue - in all likelihood they are less accurate as people get automatic tests wrong every single day.

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 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.