Benefits of technicians versus self-operated tablet audiometry

There are number of these system-in-a-box hearing testing service on the market now and to be unambiguous:

These do not provide standards-compliant audiometric testing at work.

There are many providers of audiometric tests at work who will send a technician to your site to conduct the hearing tests and any of these will give you more compliant results than any self-operated audiometry system. While we would like you to choose us, any competitor who sends an experienced and trained technician to your site will give more compliant audiometric tests than a self-operated tablet-based system.

Key benefits of mobile audiometric testing over self-operated audiometry systems

There are some key elements of the British Standard (and the British Society of Audiology’s standards for health screening) which only hearing testing conducted by an on-site technician can comply with, improving the protection for your employees and giving the client the best value for money possible.

Background noise levels during the hearing test.

There are restrictions on the background noise levels where a hearing test is being undertaken - notably that it should not be over 35 dB(A). Overall noise level is only part of the story though and just as important is the type of intermittent noise which can be heard. 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.

Without measuring and recording background noise levels, self-test systems used in an office are not compliant. In many cases, even a technician doing the audiometric testing just at a desk in an office is not a good idea either. We control the noise levels in the audiometry unit, measure it and hold records for each test to prove suitability.

Daily audiometer verification checks

There is a requirement for a verification test of the equipment at the start of every audiometry session ever day - this is different to annual calibration. This test must be done in-situ and repeated on any day when hearing tests are done. This should be done by a technician and done against a known standard. Without this you have no idea how well the audiometry equipment is performing, is suffering interference, or from our own experience, faults do develop unexpectedly, most commonly in the button, headphones and connecting leads.

The lack of a verification checking system, on site, every day, by someone who knows what they are doing means a self-operated audiometry setup is generating hearing test 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 to check it is clear and confirm the health of the ear drum. This is needed by the British Standard which says that any occlusion (blockage) of the ear drum must be noted - 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.

As self-operated systems have no otoscopic examination all subsequent results are not compliant with either the British Standard or British Society of Audiology testing requirements.

Update: As an example of how this can have an impact, in August 2019 we tested a chap who had great hearing in one ear and weaker in the other. Without the visual inspection this would have resulted in a referral and work for the employer, but as it was, we could see the ear was packed tightly with the wax acting as an ear plug. The result was therefore very much in line with this, meaning we could recommend the chap go and get his ear cleared for his own benefit but need not involve the employer in a formal referral, which an automatic system would have generated.

Who puts the audiometry headphones on for the hearing test?

In a hearing test, as required by the British Standard, you never let the attendee put the headphones on themselves - you always put the hearing test headphones on for them. The British Standard specifically says the headphones shall be put in place by the person conducting the audiometric 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, 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.

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 in a hearing test, any result from the self-test system is not compliant. A technician must be there to put the audiometry headphones on.

Claims the self-operated audiometry tests are better as they are automatic

There is no difference between the automatic test done by self-testing systems such as WorkScreen and the test run by any other audiometer used in mobile testing. There are only two kinds of automatic test permitted and every audiometer runs one or the other so there is nothing unique about the tablet-based systems. With proper hearing testing done with a technician though, someone watches how the tests are being done and then can do manual retests of specific frequencies if needed.

All audiometry is automatic and self-operated systems run the same hearing test as anyone else, except the automatic test is then taken as gospel rather than being verified manually first.

Claims you cannot get an automatic hearing test wrong

I have met the people who have developed one of the self-testing automatic systems and lovely though they are and seem like thoroughly nice people, they have not got a history of doing hearing tests at work themselves. They are marketing people and hence guff such as this claim.

We have done quite literally hundreds of thousands of hearing tests 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 (is the person guessing or are they certain), does the result look realistic (is it a 55 year old man with the hearing of a 20 year old woman, or is there 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. With a mobile service we can verify every result before finalising it.

The method of hearing test should change depending on the attendee

The hearing test itself should change depending on the person you are examining. For example, if someone has no hearing in one ear then you do not do an automatic test on that ear - if you do the tones get so loud they begin to be heard in the good ear and you end up recording a result for an ear which is doing little more than holding their glasses straight. If one ear is poorer than the other than you should start the test with the better ear, not just start on the same ear every time.

Also, some people take longer to settle on results than others, sometimes to the point where you have to ‘go manual’ in order to get a good solid answer. Maybe because they take so long to decide if they’ve heard a tone or not that they miss it and the next one has been presented, or because they keep moving about and the rustle of clothing masks the tone. A technician will see that and work around it.

Claims that self-testing systems are ‘more accurate’ are fundamentally untrue - in all likelihood they are less accurate. They give the same hearing test to every attendee no matter how appropriate in light of the individual’s health history.

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'. With our service, the attendee sees their result instantly, has it explained to them instantly, and receives a paper copy of it immediately before they leave.

Added to this, 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-packed statements about categories as the only explanation of audiometry results

Self-Operated Audiometry Summary

Believe it or not, we have nothing against the idea of these self-operated audiometry things in principle and it would be a lot easier to post a briefcase to a client so they can do the work themselves rather than us lug huge van up and down the motorways. If we thought they were compliant then we would happily go down that route as the cost of developing a system will be a lot less than creating another mobile clinic. But they just aren’t good enough. Time and again over the years we have seen exactly what employers need, what insurance companies want to see to defend liability, what HSE inspectors want to see when visiting a site, and none of that can be met by self-operated systems. Only on-site mobile clinics can do the job properly.