Hearing Loss Research at NIOSH Reviews of Research Programs of the National Institute for Occupational Safety and Health (2006) / Chapter Skim
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2 Evaluation of the Hearing Loss Research Program
2 Evaluation of the Hearing Loss Research Program
Pages 37-101
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From page 37... ...
This chapter presents the results of the committee's review, reported in the form of qualitative assessments of the relevance and impact of the Hearing Loss Research Program's research and other activities. Following the guidance of the Framework Document, the committee carried out its evaluation using the terminology and organization of a logic model adopted by NIOSH to characterize the steps in its work.
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From page 38... ...
In turn, the committee decided to use the four goals to organize its detailed examination of the Hearing Loss Research Program, while recognizing that these research goals were not in use by the program during most of the period covered by the retrospective assessment. As noted in Chapter 1, the four research goals encompass eight of the nine research needs identified in 1998 (NIOSH, 1998a)
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From page 39... ...
. First, there are important limits to the ability of the NIOSH Hearing Loss Research Program to effect change in the workplace.
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From page 40... ...
Reduce noise exposures to construction workers using a web-based database for powered hand tools Research Goal 4: Improve Understanding of Occupational Hearing Loss Through Surveillance and Investigation of Risk Factors 4.1. Determine occupational noise exposure and hearing loss through national surveillance 4.2.
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From page 41... ...
In late 2005, NIOSH for the first time designated an executive staff member -- Dr. Güner Gürtunca, director of the Pittsburgh Research Laboratory -- to serve as the program manager of the Hearing Loss Research Program.
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From page 42... ...
Both the name of the program itself and the name of one of its four research goals have been modified since the evalu ation began. The committee notes that the revised program name -- Hearing Loss Research Program -- seems to imply a narrower scope than the original name, Hearing Loss Prevention Program.
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From page 43... ...
In evaluating the relevance of the work done by the NIOSH Hearing Loss Research Program, the committee has assessed the degree to which the program has led and carried out research in aspects of occupational hearing loss and noise control most relevant to improvements in workplace protection. If available, surveillance data regarding the nature and extent of the U.S.
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From page 44... ...
The activities carried out under this research goal are important to disseminating and applying information devel oped across the entire Hearing Loss Research Program, providing an important means of transfer to the workplace setting. Planning and Production Inputs Several important research planning efforts have guided the development of the agenda for this research area over the past decade.
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From page 45... ...
The Hearing Loss Research Program's current objectives and work areas bear a reasonable relationship to the earlier planning activities. For example, NIOSH is clearly making efforts to address the two recommendations most closely related to this program area described in the NORA hearing loss initiative of 2001: (1)
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From page 46... ...
46 H E A R I N G L O S S R E S E A R C H A TN I O S H TABLE 2-2 NIOSH Hearing Loss Research Program Budget and Staffing by Research Goals FY 1997 FY 1998 FY 1999 FY 2000 Research Goal 1: Contribute to the Development, Implementation, and Evaluation of Effective Hearing Loss Prevention Programs Intramural $498,768 $443,552 $882,679 $888,571 FTEs 3.14 5.44 5.99 5.21 Extramural $195,806 $254,171 $434,103 $559,620 Interagency Agreements $0 $0 $0 $0 Contracts $21,800 $214,829 $258,329 $257,680 CRADAs None None None None Research Goal 2: Reduce Hearing Loss Through Interventions Targeting Personal Protective Equipment Intramural $141, 234 $0 $271,744 $339, 613 FTEs 1.90 0.00 4.30 3.05 Extramural $0 $38,897 $143,777 $0 Interagency Agreements $0 $0 $0 $50,000 Contracts $0 $0 $0 $0 CRADAs None None None None Research Goal 3: Develop Engineering Controls to Reduce Noise Exposure Intramural $929,618a $540,419 $466,104 $862,243 FTEs 14.64a 6.75 8.8 11.97 Extramural $0 $0 $0 $0 Interagency Agreements $0 $0 $0 $100,000 Contracts $0 $0 $0 $15,000 CRADAs None None None None Research Goal 4: Improve Understanding of Occupational Hearing Loss Through Surveillance and Investigation of Risk Factors Intramural $199,448 $164,122 $108,434 $226,573 FTEs 2.75 2.30 1.60 2.33 Extramural $436,599 $614,942 $977,888 $753,308 Interagency Agreements $288,888 $288,888 $288,888 $288,888 Contracts $0 $0 $0 $0 CRADAs HearSaf HearSaf HearSaf HearSaf NOTE: CRADA, collaborative research and development agreement; FTE, full-time equivalent. aThe 1997 FTE figure shown in the table, which is derived from a NIOSH database, differs from the 1997 staffing level recalled by program and budget managers (3 FTEs)
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From page 47... ...
E VA L U A T I O N O F T H E H EA R I N G L O S SR E S E A R C HP R O G R A M 47 FY 2001 FY 2002 FY 2003 FY 2004 FY 2005 $1,059,249 $901,939 $785,508 $1,166,467 $1,132,932 4.56 3.94 3.39 3.45 7.85 $271,729 $355,700 $110,625 $68,612 $483,270 $0 $0 $0 $0 $0 $282,680 $257,680 $264,280 $262,030 $92,851 None None None None None $434,802 $351,846 $731,164 $875,273 $724,586 3.70 3.90 5.10 7.95 8.10 $380,196 $352,879 $0 $0 $183,679 $75,000 $50,000 $113,000 $55,000 $133,000 $0 $73,000 $0 $24,570 $0 None None None None Earphone $1,477,267 $1,856,948 $1,753,007 $2,086,163 $2,454,984 15.02 10.3 17.23 21.1 16.27 $50,000 $215,158 $225,600 $141,400 $0 $0 $0 $0 $0 $0 $117,250 $127,250 $187,250 $191,800 $145,000 None None None None None $653,150 $944,926 $976,153 $639,372 $453,457 4.55 6.80 7.84 6.22 3.45 $1,089,905 $1,381,223 $1,190,484 $1,488,404 $1,660,459 $288,888 $288,888 $288,888 $359,888 $359,888 $33,750 $58,750 $158,543 $142,800 $0 None None None None Impulse meter
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From page 48... ...
The impact of this work is discussed later in this chapter. Committee Comments on Relevance to Occupational Safety and Health The outputs ascribed by NIOSH to this research area include some of the best known and most frequently cited products of the Hearing Loss Research Program.
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From page 49... ...
. The Hearing Loss Research Program materials emphasize the importance of the hierarchy of controls, giving primacy to engineering controls over other approaches to reducing harmful exposures.
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From page 50... ...
Until or unless low-noise design and noise control engi neering approaches are applied universally to eliminate hazardous noise in the workplace, hearing protection devices will continue to be vital to limiting expo sure to hazardous noise. All of the goals established by the Hearing Loss Research Program are of ongoing importance to the field, as discussed below.
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From page 51... ...
Activities and Outputs The activities undertaken by the NIOSH Hearing Loss Research Program related to this research goal appear appropriate and of importance to improvements in hearing loss prevention, as well as responsive to the planning inputs described above. The overestimation of hearing protection device performance by the laboratory "experimenter-fit" test procedure has posed difficulties for hearing conservation professionals since the inception of the NRR concept.
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From page 52... ...
. Activities by the Hearing Loss Research Program to develop a combined hear ing protection and communication system led to the development of a prototype that has faced challenges in transferring to the workplace via private-sector devel opment.
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From page 53... ...
In particular, the work of this program area in support of the revision of the test standard on which the NRR is based and in improving fit-testing methods places the Hearing Loss Research Program at the hub of current research activities concerning the selection and use of hearing protection devices. Research Goal 3: Develop Engineering Controls to Reduce Noise Exposure Goals and Objectives NIOSH (2005h)
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From page 54... ...
Several of the planning efforts noted by the NIOSH Hearing Loss Research Program identified research needs pertaining to engineering noise controls that presumably served as planning inputs for this research area. "A Proposed National Strategy for the Prevention of Noise-Induced Hearing Loss" (NIOSH, 1988)
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From page 55... ...
External experts on the final review team for the overall NORA Hearing Loss Research Program proposal included no one with an industrial or product noise control background. The 2005 Futures Workshop included only six external speakers, only one of whom was from the noise control field.
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From page 56... ...
Similarly, additional examination of work com pleted by MSHA might also prove valuable to NIOSH researchers and help reduce the risk of needlessly re-tackling long-standing problems. As with the other Hearing Loss Research Program research goals, the lack of surveillance data on which to base priorities is an important gap in information
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From page 57... ...
Bureau of Mines health and safety research to NIOSH in 1996 was followed by a substantial increase in the size of the Hearing Loss Research Program staff and its effort in noise control engineering. Intramural funding for the program area grew over the last decade to $2,454,984 in FY 2005.
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From page 58... ...
is the most technically sophisticated and challenging noise control approach and one that is not likely to be implemented successfully by the simple application of concepts found in a catalog or compendium. Although the committee commends the efforts of Hearing Loss Research Pro gram management to increase the capabilities of its staff by supporting graduate education in noise control for some engineers, this approach can supplement but is not a substitute for recruitment of senior-level researchers with demonstrated world-class expertise in the desired focus area.
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From page 59... ...
Collection of baseline power tool noise emission measurements is a necessary precursor to any product noise control design project. However, the Hearing Loss Research Program's current online power tool database is of limited value because of uncertainty in how the measurements were made (the database contains results that were obtained in accordance with a test standard that specifies unloaded conditions for some tools and loaded conditions for others, and the operating conditions are not indicated in the database)
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From page 60... ...
Within the Hearing Loss Research Program, the focus on mining appears to short change other occupational sectors and pose a risk that emerging issues will not be identified. The prioritization within this research goal reflects the results of congressional targeting of resources toward health and safety challenges in mining.
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From page 61... ...
In general, the committee finds the goals, activities, and outputs of this program area to be focused on subject areas of lesser priority than desirable, even taking into account the strictures limiting much of the spending to the mining sector. The targeted funding does not preclude other Hearing Loss Research Program efforts from reaping greater benefit from the work done and otherwise making a greater contribution to engineering controls for other sectors.
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From page 62... ...
Planning Inputs Several planning activities and documents noted as important by the Hearing Loss Research Program have identified research needs addressed in this program area. "A Proposed National Strategy for the Prevention of Noise-Induced Hearing Loss" (NIOSH, 1988)
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From page 63... ...
Although some stakeholder and outside expert input has been obtained, it appears that there are relatively small numbers of experts from outside NIOSH engaged in these planning activities. The Hearing Loss Research Program is strongly encouraged to expand its network of external advisers to better represent the current applied and basic knowledge base on noise-induced hearing loss.
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From page 64... ...
. The committee views the Hearing Loss Research Program goal to "determine occupa tional noise exposure and hearing loss through national surveillance" as crucial and highly relevant, and in need of focused and well-designed activities to improve upon the current situation.
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From page 65... ...
. Most of the Hearing Loss Research Program's recent activities to measure occupational noise exposure appear to be focused on supporting studies of specific worker groups such as miners, Washington State construction workers, those on Brazilian fishing boats, and others.
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From page 66... ...
However, the Hearing Loss Research Program should participate in these activities only to the extent that they are also able to develop appropriate initiatives to understand the risk of occupational hearing loss. Furthermore, the expectations from these partnerships are not necessarily ap propriate.
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From page 67... ...
Neither of these research activities in selected samples directly addresses concerns about occupational hearing loss, or the goal of characterizing hearing ability in the general population through national surveillance. The Hearing Loss Research Program has supported activities investigating the prevention of hearing loss from impulsive noise exposure primarily through extramural studies in experimental animal models.
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From page 68... ...
Nevertheless, Research Goal 4 has the broadest and perhaps the most difficult program objectives to achieve. Taking into account the scale and strengths of the Hearing Loss Research Program, the highest priority should be given to areas that are fundamental to addressing occupational hearing loss.
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From page 69... ...
While appreciating the leveraging of limited resources that this has represented, the committee recommends an approach to planning based more on Hearing Loss Research Program priorities, for both its intramural and its extramural research. With limited resources, it is important to select opportunities that will directly address the goals of the Hearing Loss Research Program.
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From page 70... ...
Particularly because of its limited resources, it is important that the Hearing Loss Research Program focus on the priorities most closely related to its mission. OVERALL EVALUATION OF THE RELEVANCE OF THE HEARING LOSS RESEARCH PROGRAM To arrive at its qualitative evaluation and quantitative score for the relevance of the NIOSH Hearing Loss Research Program, the committee strove to step back from its part-by-part examination of the program as presented above and consider the program as a whole.
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From page 71... ...
The public health approach to prioritization relies on surveillance data to identify populations or sectors where the greatest good can be accomplished with the least effort. The Hearing Loss Research Program acknowledges the absence of current data on the incidence of occupational hearing loss or prevalence of hazardous noise exposure in the workplace, citing in its stead data that are old or weak (or, at best, unpublished)
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From page 72... ...
The Hearing Loss Research Program should seize opportunities in the context of a plan that keeps its efforts focused on the most relevant work. Using the limited surveillance information available, infor mation from stakeholders, and its members' expert judgment, the committee found that the Hearing Loss Research Program mission and four main research goals were highly relevant to the overall aim of reducing occupational hearing loss.
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From page 73... ...
In trying to make judgments about the impact of work done by the Hearing Loss Research Program, however, the committee was unable to consider evidence for any of the four research goals that changes have occurred in end outcomes related to occupational hearing loss. As noted, there is a general lack of surveillance data on occupational hearing loss and noise exposures for U.S.
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From page 74... ...
The studies also are vulnerable to conditions in the business environment, which may discourage employers from agreeing to participate or may lead them to withdraw once a study has begun. Intermediate Outcomes Given the lack of data on changes in the end outcomes of occupational hear ing loss and noise exposure, the committee instead based much of its assessment of the impact of the NIOSH Hearing Loss Research Program on evidence that the program's research products have been put to use beyond NIOSH in ways that have the potential to influence the workplace.
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From page 75... ...
, which called for the creation of NIOSH, authorized the agency to establish recommended occupational safety and health standards for noise control and hearing loss prevention. The NIOSH Hearing Loss Research Program has offered such recommendations most recently with Criteria for a Recommended Standard: Occupational Noise Exposure (NIOSH, 1998a)
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From page 76... ...
It is not possible to know whether federal regulations would offer their current level of protection for workers if contributions from the NIOSH Hearing Loss Research Program had not been available. The committee commends NIOSH for continu ing to bring its recommendations to the attention of OSHA and other agencies responsible for regulating noise exposure of U.S.
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From page 77... ...
The impact of the compendium is also reflected in the decision by some manufacturers to voluntarily submit subject-fit data on the noise attenuation of their products. The committee strongly encourages the Hearing Loss Research Program to conduct the planned evaluation study to learn more about the effect of use of the compendium on the selection of hearing protection devices and the prevention of occupational hearing loss.
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From page 78... ...
The Hearing Loss Research Program also provided the committee with mate rials and encouraging statements about the impact of training programs on the use and effectiveness of hearing protection devices for groups of carpenters and a request by the U.S. Navy to test the training with shipyard workers.
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From page 79... ...
The Hearing Loss Research Program has also contributed a component on hearing loss prevention to a broader NIOSH activity to develop an occupational safety curriculum for high schools and technical training programs. The Hearing Loss Research Program reported (NIOSH, 2005f)
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From page 80... ...
Hearing Loss Research Program staff have contributed to the dissemination of information and materials developed for this research goal through publica tions, including articles in peer-reviewed journals, book chapters, and papers in conference proceedings; through presentations at conferences and workshops; and by working directly with interested parties in other government agencies, industry, labor, and the occupational health and safety community. The commit tee was also given information about the dissemination of electronic and print materials through NIOSH.
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From page 81... ...
Summary assessment Information provided by the Hearing Loss Research Program and comments from many stakeholders offer strong endorsement of the contributions made to efforts to reduce occupational hearing loss through work related to Research Goal 1 -- contribute to the development, implementation, and evaluation of effective hearing loss prevention programs. Nevertheless, the committee found that the Hearing Loss Research Program has not paid enough attention to evaluating the effectiveness of recommendations, training programs, and other products in terms of reducing the incidence or severity of occupational hearing loss or achieving important intermediate outcomes of sustained improvement in use of hearing protection or management of hearing loss prevention programs.
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From page 82... ...
Hearing Loss Research Program scientists also showed that subject-fit protocols reduced inter-laboratory variabil ity in noise reduction compared to other fit methods. One impact of this work on hearing protection devices could be said to be evident in the Hearing Loss Re search Program itself.
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From page 83... ...
Because the Hearing Loss Research Program is an important contributor to work on fit and performance testing for hearing protection devices, the committee concluded that it is vital for the Cincinnati facility to achieve NVLAP certification. Achieving this status will help ensure the credibility of hearing protection device testing results from the NIOSH facility.
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From page 84... ...
included consideration of hearing protection against exposures to impulsive noise, an issue being addressed under Research Goal 2. The Hearing Loss Research Program reported to the committee that the U.S.
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From page 85... ...
The committee notes in particular the efforts to develop practical methods of testing hearing protector fit in the workplace and to characterize the effectiveness of hearing protection devices against impulsive noise. Research Goal 3: Develop Engineering Controls to Reduce Noise Exposure The impact of the work of the Hearing Loss Research Program related to Research Goal 3 is evident primarily in areas related to mining, particularly the development of quieter equipment for underground coal mining and contributions to MSHA's regulatory activities.
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From page 86... ...
By contrast, the Hearing Loss Research Program's work on engineering controls appears to have a weaker connection to OSHA. The OSHA noise standard dates from the early 1980s and, while stating a preference for engineering solutions to excess noise exposure, allows for reliance on hearing protection devices to meet exposure limits.
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From page 87... ...
The database developed by the Hearing Loss Research Program on sound levels generated by powered hand tools (see http://www.cdc.gov/niosh/topics/noise/workplacesolutions/toolsDatabase. html)
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From page 88... ...
Summary assessment For Research Goal 3, the committee found that the Hear ing Loss Research Program is engaged in a narrow set of activities on engineering noise controls and that these activities have had a limited impact and may have limited prospects for future impact. With the larger share of the work related to Research Goal 3 taking place at the Pittsburgh Research Laboratory, the focus is on engineering noise controls for mining.
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From page 89... ...
The committee is aware that external factors have had some bearing on the Hearing Loss Research Program's noise control engineering efforts. With the promulgation of the MSHA noise standard in 1999, engineering noise control gained primacy over hearing protection devices for preventing occupational hearing loss in mine workers.
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From page 90... ...
Scientific knowledge Through both intramural and extramural work, the Hear ing Loss Research Program has produced new knowledge about the complex fac tors that may contribute to occupational hearing loss. The program has conducted or supported novel studies to document the potential ototoxic effects of chemical exposures in the workplace and the interactive effects of chemical ototoxins and noise, to assess the differential effects of impulsive and continuous noise, and to investigate the genetic factors contributing to susceptibility to noise-induced hear ing loss using mouse models.
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From page 91... ...
The committee commends the Hearing Loss Research Program for its success in raising awareness of the need to document the occurrence of hearing loss in workers, but the committee also emphasizes that it is essential for the program to have epidemiologic expertise fully integrated into its work on surveillance to help maximize the utility of the data collected. Standards and guidelines The Hearing Loss Research Program's work on ototoxic chemicals is contributing to wider attention to potential ototoxic hazards of workplace exposure to certain chemicals, alone or in combination with noise.
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From page 92... ...
Summary assessment The Hearing Loss Research Program cannot be expected to demonstrate the impact of the work conducted as part of Research Goal 4 on the basis of outcomes such as reductions in the incidence rate, numbers of cases, or severity of occupational hearing loss. The committee does, however, consider contributions that the work makes to the knowledge base on occupational hearing loss to be important intermediate outcomes.
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From page 93... ...
and the hearing protector compendium. The committee found that the Hearing Loss Research Program has made important contributions to increasing knowledge about the real-world performance of hearing protection devices, improving the methods and tools for assessing hearing protector attenuation, and encouraging relevant agencies and organizations to modify regulations and other guidance concerning hearing protector attenuation.
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From page 94... ...
With a few notable exceptions, researchers in the Hearing Loss Research Program have made only limited contributions to the peer-reviewed research literature. Presentations and other kinds of publications are important contributions, but they cannot take the place of formal documentation of research results.
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From page 95... ...
On the basis of its review, the committee has assigned the NIOSH Hearing Loss Research Program a score of 4 for impact, notwithstanding significant shortcomings in some aspects of the program. This score reflects a judgment that the Hearing Loss Research Program has made a moderate contribution on the basis of well-accepted intermediate outcomes, has generated important new knowledge, and is engaged in transfer activities (see Box 2-3)
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From page 96... ...
1998. Development of a new standard laboratory proto col for estimating the field attenuation of hearing protection devices.
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From page 97... ...
1994. The NIOSH Compendium of Hearing Protection Devices.
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From page 98... ...
Presen tation to the Committee to Review the NIOSH Hearing Loss Research Program, Meeting I, January 5. Washington, DC.
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From page 99... ...
Research Proposal Information Summary: Hearing Loss Prevention for Shipyard Workers. Unpublished document provided to the Committee to Review the NIOSH Hearing Loss Research Program.
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From page 100... ...
2006f. NIOSH Hearing Loss Research Program: 2005 Futures Workshop.
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From page 101... ...
Unpublished docu ment provided to the Committee to Review the NIOSH Hearing Loss Research Program. Cin cinnati, OH: NIOSH.
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