Self-operated audiometric screening systems

Over recent years there has been an increase in the number of self-operated audiometric test systems launched and they seem to offer a cheap way to meet the screening 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 audiometry, we do have a horse in this race and self-testing is up against our provision of hearing tests with a qualified technician. 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..

What is self-testing in audiometry?

There are a couple of routes to this. 

  1. Self-testing using audiometry equipment set up on the site for this purpose, such as WorkScreen.
  2. Online hearing test websites.

In both situations, the individual operates the test themselves and then receives an automated result based on how well or poorly they have performed.

Physical self-operated audiometric test screening systems

These involve physical product being shipped to the employer and then employees conduct their own tests. The advantage over the online-only style is that at least you are getting a calibrated system so the test has far fewer variables than someone plugging their own headphones into their own computer.

To highlight one example system, WorkScreen is a kit 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?

British Standard Cover.png

I am a little bit suspicious of anything which says a hearing test is 'HSE compliant', when 'HSE compliant' is not the 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 an audiometric 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.

British Standards Compliant?

WorkScreen standards compliant.png

WorkScreen state their equipment is built to BS 60645-1-2001 which is critical as that's the standard to which audiometry equipment has to meet.

They also state it meets BS EN ISO 8253-1:2010 and if it genuinely does then this is superb. 

So WorkScreen claim:

  • The testing meets BS EN ISO 8253-1:2010
  • It reduces the administrative burden
  • It is more accurate than traditional systems
  • "Unlike traditional testing, trying it is easy to arrange"

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. The company producing these say there is a self-test system built into it for the verification check. 

It is possible to automate the verification check on any PC controlled audiometer (which almost all are these days) and I have extensive experience of this. You place the headphones on a special bit of kit which responds to the tones and sends a signal back to the audiometer to confirm the tones are still as they should be. However, they are awful things and despite spending good money on them in the past they ended up sat in a cupboard for years. The reason for this abandonment is that the verification check is looking to make sure the audiometer is responding as it should, but also to help identify any other issues in the complete system. Over the years I had loads of issues where the static automated self-test said everything was OK, but then when you put the headphones on a real person who is moving about, problems with static interference or cable connections became apparent. This means that even though the WorkScreen system does have an automatic verification check built into it, it's still not giving the level of daily check I would expect of the equipment I use.

Review of the health questionnaire

 Extract from 'High frequency audiometric notch' in International Journal of Audiology 2010; 49:95-98

Extract from 'High frequency audiometric notch' in International Journal of Audiology 2010; 49:95-98

While not part of the British Standard, an important element of audiometric screening is the pre-test health questionnaire which reviews the hearing health of the attendee before they do the actual hearing test. No two people are the same - they may give the same answer to the same questions, but the discussion about their hearing health is absolutely critical to any findings of the hearing test. Why I hear you ask? Firstly because their answers may change the physical test itself, and secondly because you cannot diagnose noise induced hearing loss from an audiogram without a good medical history. Without that medical history being reviewed by someone who knows what they are doing then the audiogram becomes fairly useless. It is way more complex than simple yes/no options. Without someone reviewing the pre-test questionnaire then it is no good as a screening hearing test.

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. You need to know how healthy the ears look before doing the test. Without that you have no idea whether there is any infection, whether the ear drum has any scarring, or how much wax there is in there which may be impacting the result. Without an otoscopic examination the WorkScreen hearing test is not compliant.

Who puts the 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, the WorkScreen audiometry is not BS compliant.

Background noise levels during the audiometric test.

The British Standard also places restrictions on the background noise levels in which a hearing test should be undertaken. Some audiometers have a function to measure this built into them which is nice, but the overall total volume 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, good luck on convincing an insurer that the testing environment was OK just because that's where the WorkScreen 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.

How certain was the attendee?

As well as the 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 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. 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 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 unlike traditional systems, trying it is easy to arrange

Many times over the years prospective clients have enquired about audiometry but not been sure precisely what it involves. Countless times, from Inverness to Cornwall, we simply arranged for a mobile unit to come to the site, park up and let the client see exactly what it looks like, how the system works, do a demo hearing test if they want, and talk to a technician face to face. It can't be any easier that one phone call or email, then walking out of the office and into a unit, having a chat and a look at it, then back into the office again. No setting up a system at all. That's another point for the traditional testing methinks.

Summary on self-operated screening systems

All these sometimes sound a bit trivial, but they really aren't. I've been doing hearing tests at work for many years, and for the last decade owned a consultancy which did over 20,000 of them every year. Those years gave me 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. Without these the screening tests are useless.  

Yes, I have a vested interest in this as I provide workplace hearing tests, but if these alternative systems were anywhere near as good as they claim to be then my business model would shift overnight. Why have the expense of building and maintaining mobile clinics and the time and cost of trekking around the country with them if I could just post a system to a client and charge a little bit less but still maintain my margin and go to the pub for a nice long lunch? If these systems were good I could pay an app developer less than a single mobile unit costs to build, get them to develop a software-based system for me and in that case I'd switch the business over to this model in a heartbeat. But these self-test systems such as WorkScreen just aren't good enough.

No fence sitting here - these WorkScreen tests are not compliant with key standards required for workplace audiometry, miss critical components, increase administrative burdens and should not be used for noise at work health screening.

Online hearing tests

Just don't. Really, just don't. They have all the problems of the WorkScreen jobby above, plus are using completely uncalibrated and uncontrolled headphones or speakers. Useless.