Changing the Audiological Mindset About Fitness for Duty Assessments for Jobs with Essential Hearing-Critical Tasks

By Sigfrid D. Soli, Ross Roeser, Veronique Vaillancourt

This article is a part of the March/April 2019, Volume 31, Number 2, Audiology Today issue.

Background

For many years, audiological hearing assessment has been an important part of medical screening for individuals seeking public safety and law enforcement jobs. Obviously, hearing impairment that interferes with the ability of individuals in such positions to perform essential hearing-critical (HC) job tasks can affect their safety as well as the safety of the public. There are several audiological challenges in identifying the presence of hearing impairment that may cause such risks. Two recently published papers (Soli et al, 2018a, 2018b) have made significant advances toward addressing these challenges that are important for audiologists to understand. These challenges can be summarized as follows.

First, most audiological measures and procedures are diagnostic and are intended to determine the etiology and severity of impairment. The questions for occupational hearing screening, however, have to do with functional hearing ability and whether the auditory system is impaired to an extent that performance of essential HC job tasks is affected. Unfortunately, diagnostic measures such as pure-tone thresholds, which are often used as the “gold standard” criteria for determining fitness for duty (e.g., U.S. Department of Homeland Security, 2008), are known to be poor predictors of functional hearing ability (e.g., Tufts et al, 2009).

Second, while it is true that results obtained with audiometric speech tests can be interpreted as measures of functional hearing ability, the relationship between performance on such tests and the ability to perform essential HC job tasks has not been fully determined objectively. This challenge is perhaps the most difficult to address because it requires audiological knowledge in the selection, administration, scoring, and interpretation of the audiological tests, as well as knowledge of the locations and noise environments where essential HC job tasks are performed. Once these two sources of knowledge are linked, the opportunity to define and validate this relationship objectively exists. After validation, those audiologists involved in determining fitness for duty will have objective, evidence-based methods to determine whether an individual’s functional hearing ability will or will not enable him or her to perform essential HC tasks.

The ability to perform this type of audiological assessment is very important not only because of its potential impact on public safety but also for legal considerations. Both the United States and Canada have legal requirements (e.g., EEOC, 1992; Laroche et al, 2003) that require medical screening and inclusion/exclusion criteria to be job-related and meet bona fide occupational requirements. A validated relationship between audiological screening criteria and specific essential HC job tasks is mandatory to satisfy these legal requirements.

Our two-part article discusses the importance to audiology of a body of research—five large studies—conducted over the past 17 years. This series focuses on defining the objective relationship between speech recognition measures of functional hearing taken in the clinic or lab, and the ability to perform essential HC job tasks safely and effectively in real-world noise environments.

The current articles are a summary of the two earlier cited publications (Soli et al, 2018a; Soli et al, 2018b), each with an emphasis on their practical significance for audiologists. Of note, is that our two articles are being published simultaneously in Audiology Today and Canadian Audiologist because of their significance to audiologists in both countries.