CAOHC Medical Referral Criteria and Follow-up 2

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?

Accepted Answer

Refer the worker to a physician due to the risk of retrocochlear pathology

Answer

Document it as a normal variant and continue standard monitoring

Answer

Apply age correction and retest in 6 months

Answer

File an OSHA recordable and restrict the worker from noise areas

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?

Accepted Answer

Refer the worker urgently to a physician for evaluation of possible sudden sensorineural hearing loss

Answer

Schedule a retest in 30 days to determine if it is temporary

Answer

Apply age correction to determine if an official STS exists before acting

Answer

Document the finding and include it in the next annual report

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?

Accepted Answer

The employer, at no cost to the worker

Answer

The worker's personal health insurance

Answer

The worker, as part of standard co-pay requirements

Answer

A shared cost split equally between worker and employer

Question 4

Which type of audiometric finding would most warrant referral due to suspected non-noise etiology?

Accepted Answer

A progressive low-frequency hearing loss pattern in both ears

Answer

A bilateral high-frequency notch at 4000 Hz with recovery at 8000 Hz

Answer

Slightly elevated thresholds at 4000 Hz consistent with prior baseline

Answer

A symmetric shift at all frequencies proportional to age

Question 5

Which of the following should NOT typically appear in a referral letter sent from an OHC to a physician?

Accepted Answer

The worker's wage, salary, and benefit information

Answer

The worker's audiometric history and prior test results

Answer

A description of the worker's occupational noise exposures

Answer

The specific reason for the referral

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?

Accepted Answer

A temporary threshold shift (TTS) that resolved after adequate rest from noise

Answer

The original audiogram was administered incorrectly by the OHC

Answer

The worker's hearing spontaneously improved due to nutritional changes

Answer

Age correction eliminated the apparent shift on retesting

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?

Accepted Answer

Continue monitoring the worker within the program and document the physician's findings in the audiometric record

Answer

Remove the worker from the hearing conservation program since the cause is non-occupational

Answer

Transfer all hearing health responsibility to the treating physician

Answer

Retest the worker immediately using a different audiometric protocol