CAOHC Medical Referral Criteria and Follow-up 2 — Questions and Answers
Question 1: A worker's annual audiogram reveals significant asymmetric hearing loss — the right ear is substantially worse than the left with no change from last year. What is the most appropriate action?
- Document it as a normal variant and continue standard monitoring
- Refer the worker to a physician due to the risk of retrocochlear pathology (Correct answer)
- Apply age correction and retest in 6 months
- File an OSHA recordable and restrict the worker from noise areas
Correct answer: Refer the worker to a physician due to the risk of retrocochlear pathology
Significant unexplained asymmetric hearing loss can indicate retrocochlear pathology such as acoustic neuroma, requiring physician evaluation even without a confirmed STS.
Question 2: A worker reports a sudden, total loss of hearing in one ear that was not present at their last annual audiogram six months ago. What is the most urgent action?
- Schedule a retest in 30 days to determine if it is temporary
- Apply age correction to determine if an official STS exists before acting
- Refer the worker urgently to a physician for evaluation of possible sudden sensorineural hearing loss (Correct answer)
- Document the finding and include it in the next annual report
Correct answer: Refer the worker urgently to a physician for evaluation of possible sudden sensorineural hearing loss
Sudden sensorineural hearing loss is a medical emergency requiring urgent physician evaluation since prompt treatment can improve outcomes.
Question 3: Under OSHA 29 CFR 1910.95, at whose expense must physician or audiologist referrals be provided when a worker has a confirmed STS?
- The worker's personal health insurance
- The employer, at no cost to the worker (Correct answer)
- The worker, as part of standard co-pay requirements
- A shared cost split equally between worker and employer
Correct answer: The employer, at no cost to the worker
OSHA mandates that referrals resulting from STS determinations must be provided at no cost to the employee — the employer bears the expense.
Question 4: Which type of audiometric finding would most warrant referral due to suspected non-noise etiology?
- A bilateral high-frequency notch at 4000 Hz with recovery at 8000 Hz
- A progressive low-frequency hearing loss pattern in both ears (Correct answer)
- Slightly elevated thresholds at 4000 Hz consistent with prior baseline
- A symmetric shift at all frequencies proportional to age
Correct answer: A progressive low-frequency hearing loss pattern in both ears
Progressive low-frequency bilateral hearing loss is not typical of noise-induced hearing loss and suggests a non-noise etiology such as Meniere's disease or endolymphatic hydrops, warranting physician referral.
Question 5: Which of the following should NOT typically appear in a referral letter sent from an OHC to a physician?
- The worker's audiometric history and prior test results
- A description of the worker's occupational noise exposures
- The worker's wage, salary, and benefit information (Correct answer)
- The specific reason for the referral
Correct answer: The worker's wage, salary, and benefit information
A medical referral letter should include clinically relevant information such as audiometric history and noise exposure data, but salary and benefits are not medically pertinent.
Question 6: A worker's follow-up audiogram conducted 30 days after a suspected STS shows all thresholds have returned to baseline levels. What is the most likely explanation for the initial finding?
- The original audiogram was administered incorrectly by the OHC
- The worker's hearing spontaneously improved due to nutritional changes
- A temporary threshold shift (TTS) that resolved after adequate rest from noise (Correct answer)
- Age correction eliminated the apparent shift on retesting
Correct answer: A temporary threshold shift (TTS) that resolved after adequate rest from noise
A threshold shift that resolves with removal from noise exposure is consistent with a temporary threshold shift (TTS), not a permanent threshold shift.
Question 7: After a physician evaluates a referred worker and determines the hearing loss is caused by a non-occupational medication (ototoxic drug), what is the OHC's appropriate follow-up?
- Remove the worker from the hearing conservation program since the cause is non-occupational
- Continue monitoring the worker within the program and document the physician's findings in the audiometric record (Correct answer)
- Transfer all hearing health responsibility to the treating physician
- Retest the worker immediately using a different audiometric protocol
Correct answer: Continue monitoring the worker within the program and document the physician's findings in the audiometric record
Workers with any degree of hearing loss — regardless of cause — should remain in the hearing conservation monitoring program, and the physician's findings must be documented.
CAOHC Medical Referral Criteria and Follow-up 2
A worker's annual audiogram reveals significant asymmetric hearing loss — the right ear is substantially worse than the left with no change from last year.
What is the most appropriate action?