Chapter Outline Copy

Chapter Outline

Worker preparation	History taking
Physical examination of the ear	Otoscopic examination

Educational Aims

After studying this chapter, you should be able to:

Prepare the worker for the procedure
Take an acoustic, medical, and occupational history
Conduct a physical examination of the ear
Perform an otoscopic examination and record the findings
Understand and consider the factors influencing the validity of audiometric testing

Key Terms / Abbreviations


Abbreviations	Definition
CHL	Conductive hearing loss
DA	Diagnostic Audiogram
dB	Decibel (amplitude)
Hz	Hertz (frequency or volume)
ID	South African Identity Document
NSAIDS	Non-Steroidal Anti-Inflammatory Drugs
SANS	South African National Standards
SNHL	Sensorineural hearing loss
TM	Tympanic Membrane
Terms	Definition
Acute Disease	Is an illness that has a rapid onset; is accompanied by distinct and progressive symptoms. Acute diseases require urgent or short-term treatment or care. Recovery occurs treated with little or no long-term effects.
Audiologist	Is a licenced healthcare professional engaged in the practice to promote healthy hearing, communication competency, and quality of life for persons of all ages through the prevention, identification, assessment, and rehabilitation of hearing, auditory function, balance, and other related systems.
Audiometer	Is a machine used for evaluating hearing acuity. An audiometer is a subjective device that is used to evaluate the hearing threshold levels of a person. A competent person uses an audiometer together with special audiometric testing techniques to determine the hearing threshold levels to identify as well as quantify the degree of hearing loss of a person. The audiometer produces tones of different frequencies which are presented at different levels to the worker's ears (one side at a time). An audiometer is a subjective testing device, as a response from the worker is needed. The instrument for the determining of hearing threshold levels in South Africa must comply with the requirements in IEC 60645-1 (SANS 10083:2013).
Audiometrist / Technician	A person with a certificate of competence in audiometry registered with the DEL as such. The register of audiometrists and which is administrated in South Africa by SASOHN (SANS 10083:2013).
Baseline Audiogram	The baseline audiogram is the reference audiogram (1st audiogram ever performed) on a worker when exposed to noise equal to or above 85dB(A) for the first time. This is the audiogram against which all future audiograms are compared to determine the extent to which an employee's hearing deteriorates if exposed to noise equal to or above 85dB(A) at work.
Calibration	Checking the audiometer for accuracy and precision, done electronically and biologically.
Cerumen	Is the soft brownish-yellow wax secreted by glands in the external auditory canal of the ear and is known as ear wax.
Chronic Disease	Is a long-term illness that develops over time and may not be cured. Chronic diseases are defined as conditions that last 1 year or more and require ongoing medical attention. Chronic diseases can limit activities of daily living and the ability to work. Examples of chronic diseases are heart disease, high blood pressure, cancer, and diabetes all leading causes of death and disability.
Conductive Hearing Loss (CHL)	Conductive hearing loss (CHL) occurs when there is a problem transferring sound waves anywhere along the pathway through the outer ear, tympanic membrane (eardrum), or middle ear (ossicles).
Cone of Light	Is the light reflex, visible on examination of the tympanic membrane with an otoscope. Shining light on the tympanic membrane causes a cone-shaped reflection of light to appear in the anterior inferior quadrant which is at about the 4 o'clock position in the right eardrum and at the 7 o'clock position in the left eardrum. The apex (top) of the cone is at the most depressed part of the tympanic membrane, known as the umbo.
Decibel	This is the loudness, volume, and intensity of sound⁵ . Also known as amplitude, decibels are the units used to measure the loudness or intensity of sound. dB, amplitude, the unit used to measure the loudness or intensity of sound.
Demographics	Demographic data refers to socio-economic information expressed statistically, also including employment, education, income, marriage rates, birth and death rates and more factors. Demographic analysis is the study of a population-based on factors such as age, race, and gender.
Diagnostic Audiometry	Measurement of hearing threshold levels and other parameters to determine the nature (for example, conductive, sensory, neural, or mixed) and degree of hearing impairment. It is performed by an audiologist registered with the Health Professions Council of South Africa.
Employment	Is a working relationship between two parties, usually based on a contract where work is paid for and services are provided
Exit Audiogram	An exit audiogram is performed at the termination of an employee’s service, contract or at the conclusion of exposure to noise equal to or greater than 85dB(A) in a workplace.
Exposure	The state of having no protection from something harmful. Exposure refers to when an employee is subjected to a hazard in the course of employment through any route of entry (inhalation, ingestion, skin contact or absorption, etc.), and includes potential, accidental or possible exposure.
Frequency	Hz, kHz, pitch, the number of vibrations in cycles per second.⁵
Hazard	A hazard is any source of potential damage, harm, or adverse health effects on someone.
Illumination	Lighting, the action of supplying or brightening with light
Inspection	Is the first step in a physical exam and means looking at the person or body part.
Magnification	The process of making something appear larger.
Non-Steroidal Anti-Inflammatory Drugs	Non-steroidal anti-inflammatory drugs (NSAIDs) are medicines that are widely used to relieve pain, reduce inflammation, and bring down a high temperature. They're often used to relieve symptoms of headaches, painful periods, sprains and strains, colds and flu, arthritis, and other causes of long-term pain such as brufen, Voltaren and indocid.
Occupational Health	The branch of medicine dealing with the prevention and treatment of work-related injuries and illnesses.
Otitis Externa	Infection / inflammation of the external ear.
Otitis Media	Infection / inflammation of the middle ear.
Otopathology	Diseases of the ear.
Otosclerosis	Otosclerosis is a term derived from oto, meaning “of the ear,” and sclerosis, meaning “abnormal hardening of body tissue.” The condition is caused by abnormal bone remodelling in the middle ear¹¹. It is caused by an abnormal growth of bone around the footplate of the stapes, fusing it to the oval window. This results in hearing loss. It is usually hereditary and is more common in females than males.
Otoscope / Auriscope	An otoscope or auriscope is a medical device which is used to look into the ears. During an ear exam, a tool called an otoscope is used to look at the outer ear canal and eardrum. An otoscope is a handheld tool with a light and a magnifying lens.
Otoscopy	Visual examination of the auditory canal and the eardrum with an otoscope.
Ototoxic Drugs	Oto means ear and toxic means poisonous. Certain medications can damage the ear, resulting in hearing loss, ringing in the ear, or balance disorders. These drugs are considered ototoxic. There are more than 200 known ototoxic medications (prescription and over the counter) on the market today.
Palpation	Palpation is a method of feeling with the fingers or hands during a physical examination. The health care provider touches and feels the body to examine the size, consistency, texture, location, and tenderness of an organ or body part.
Periodic Audiogram	The periodic audiogram is performed either on an annual basis or every 6 months depending on the noise level the worker is exposed to.
Physical Assessment	A physical examination allows the health care practitioner to obtain a complete assessment of the worker. Observation/inspection, palpation, percussion, and auscultation are techniques used to gather information.
Presbycusis	Age-related hearing loss with gradually progressive inability to hear, especially high-frequency sounds. Presbycusis most often occurs in both ears, although not necessarily at the same time.
Pseudohypacusis	Pseudohypacusis is a condition in which hearing loss is exhibited in the absence of disease. The worker exhibits hearing loss but there is no disorder. Pseudohypacusis refers to false or exaggerated hearing thresholds “measured” due to a lack of co-operation from the worker.
Pinna	The auricle or auricula is the visible part of the ear that is outside the head. It is also called the pinna (Latin for "wing" or "fin", plural pinnae).
Sensorineural Hearing Loss (SNHL)	Sensorineural hearing loss (SNHL) is a type of hearing loss in which the root cause lies in the inner ear or sensory organ (cochlea and associated structures) or the vestibulocochlear nerve (cranial nerve VIII). Sensorineural hearing loss (SNHL) is due to problems in the inner ear, also known as nerve-related hearing loss.
Tympanosclerosis	Tympanosclerosis is the medical term for scarring of the eardrum. Scarring occurs after the eardrum is injured or after surgery.
Universal Protection Measures	Are the minimum infection prevention practices that apply to all worker care, regardless of suspected or confirmed infection status of the worker, in any setting where health care is delivered.