Self-Assessment Questions

This section provides a review. Mark each statement on the Answer Sheet according to the factual materials contained in this issue and the opinions of the authors.

Article One (pp. 147–149) Prevalence of Noise Exposure in the Workplace

1. The Occupational Safety and Health Administration (OSHA) studied the manufacturing sector during its preparations to develop the current hearing conservation standard (29 CFR 1929). When it did so, what percentage of the manufacturing sector workers were exposed to daily time-weighted average noise levels of 80 dBA or above?

   • 70%

   • 60%

   • 50%

   • 40%

2. In their 1998 study of noise exposure and hearing loss among construction workers, Neitzel and his colleagues determined that using a 3-dB exchange rate instead of a 5-dB exchange rate would

   • increase the number of workers exposed to hazardous noise

   • decrease the number of workers exposed to hazardous noise

   • have no significant effect on the number of workers exposed to hazardous noise

   • yield invalid noise measurement results

3. A recent study by the National Institute for Occupational Safety and Health (NIOSH) shows that the number of overexposed workers may be higher than the original estimate of 9 million. According to Tak and his colleagues, the number may be closer to

   • 12 million

   • 22 million

   • 32 million

   • 42 million

4. True or false? Because noise survey methodologies have relied on instruments calibrated to American National Standards Institute (ANSI) standards, it has not been difficult to compare older studies with modern studies.

   Article Two (pp. 150–154) Risk Assessment

5. Policy considerations that affect the development of hearing damage risk criteria include

   • whether to use ANSI standards or Environmental Protection Agency (EPA) guidelines for sampling noise exposures

   • what proportion of the noiseexposed population should be protected

   • the amount of hearing loss that constitutes an acceptable risk

   • all of the above

   • B and C only

6. OSHA defines hearing impairment as

   • an average hearing loss of 25 dB at 500 Hz, 1000 Hz, and 2000 Hz

   • an average hearing loss of 25 dB at 1000 Hz, 2000 Hz, and 3000 Hz

   • an average hearing loss of 25 dB at 1000 Hz, 2000 Hz, 3000 Hz, and 4000 Hz

   • an average hearing loss in either ear of 10 dB at 2000 Hz, 3000 Hz, and 4000 Hz

7. If there is to be no risk of any hearing loss from noise exposure, even among the most sensitive members of the exposed population, then the permissible 8-hour average exposure limit would have to be as low as

   • 75 dBA

   • 80 dBA

   • 85 dBA

   • 90 dBA

8. The risk of developing an occupational hearing loss is based on

   • age, gender, and ethnicity

   • exposure levels and duration

   • policies that enforce the use of hearing protectors for workers exposed to high (>95 dBA) noise levels

   • all of the above

   • A and B only

   Article Three (pp. 155–160) Impulse/Impact Noise

9. Impulse and impact noises are both shortduration transient acoustic events. However, impact noise differs from impulse noise in that

   • impact noises are longer in duration and may also have a different character such as “ringing” after the impact

   • impact noises are swifter, shorter events than impulse events

   • impact noises have higher peak sound pressure levels than impulse noises

   • impact noises refer to occupational events while impulse noises refer to recreational events

   • both B and C

10. Impact and impulse noises are collectively referred to as

    • intermittent hazardous noise

    • short-duration overpressures

    • impulsive noise

    • all of the above, depending upon the context

11. The A-duration of an impulse sound is defined as

    • the duration over which timeweighted average dosimetry integrates impulsive events

    • the interval between two peak impulses when using A-weighting

    • the rise time of an impulse from onset to maximum peak sound pressure level

    • the time from ambient sound pressure level to the peak and return to ambient level

12. Recent research has demonstrated that the ideal metric for evaluating the hazard posed by exposure to impulse sounds is

    • the OSHA permissible exposure limit of 140-dB peak sound pressure level (SPL)

    • measurements of the kurtosis of the peak SPL

    • the measurement of equal energy when the L_eq exceeds 90 dBA

    • none of the above

    Article Four (pp. 161–164) Surveillance

13. Which of the following statements is true?

    • In 2006, NIOSH established an ongoing national surveillance program for noise exposure.

    • With the promulgation of the OSHA Hearing Conservation Amendment in 1983, the U.S. Department of Labor was able to establish the first national database of occupational hearing loss.

    • Since the passage of the Walsh-Healy act in 1968, employers have been required to track cases of employee hearing loss.

    • There is no ongoing national hearing loss surveillance program.

14. Employers are discouraged from voluntarily reporting noise exposure data and audiometric data because

    • of the difficulty to rely on field calibration of noise dosimeters

    • of the potential for litigation and regulatory action

    • of Health Insurance Portability and Accountability Act (HIPAA) regulations that make it difficult to share audiometric data

    • both A and B

15. The Bureau of Labor Statistics database of occupational illness and injury

    • did not track occupational hearing loss before 2004

    • records hearing changes that meet the Standard Threshold Shift Criteria (an average shift of 10 dB in either ear at 2000, 3000, or 4000 Hz)

    • requires age correction to be made when determining if an occupational hearing loss is recordable

    • all of the above

16. The OSHA Integrated Management Information System

    • is a database that contains the information on occupational injuries (including hearing loss) that have been recorded on the OSHA Log 300

    • is a database that integrates hearing loss data collected from individual state-based data systems

    • is a new database that contains hearing loss and noise exposure records by state and industry

    • contains noise exposure measurements collected during compliance or consultation visits

    Article Five (pp. 165–167) Mechanisms of NIHL

17. The continued cell death that can occur within the cochlea for several weeks following severe noise exposure is the result of

    • metabolic stress that increases reactive oxygen species within cells thereby triggering apoptotic cell death

    • necrotic cell death along the basilar membrane

    • retrograde fusion of stereocilia to the tectorial membrane

    • progressive embolytic reactions within the stria vascularis

    • all of the above

18. Pathophysiologic changes from excessive noise exposure include

    • repetitive stress trauma to the incu-stapedial joint

    • stereocilia becoming fused, broken, or dislodged from the tectorial membrane

    • disruption of the potassium cycling pathway through the outer hair cells, endolymph, and stria vascularis

    • both A and B

    • both B and C

19. Disruption of cochlear blood flow has also been previously implicated in the development of noise-induced hearing loss (NIHL). This includes

    • vasoconstriction of microvascularization within the tectorial membrane causing it to stiffen and become separated from stereocilia tips

    • aneurisms within the vascular supply to the scala media that disrupt the dendritic polarization of both inner and outer hair cells

    • swelling within the stria vascularis, causing the death of intermediate cells and permanently shrinking the stria vascularis

    • all of the above

20. Studies of the relationship between temporary threshold shift and permanent threshold shift have demonstrated that

    • temporary threshold shift (TTS) magnitude is well correlated with susceptibility to permanent threshold shift (PTS)

    • the underlying mechanisms for TTS are similar to those for PTS

    • the uncoupling of the stereocilia from the tectorial membrane and the resulting change in hearing sensitivity are thought to be a principal factor in the correlation between TTS and PTS

    • all of the above

    • none of the above

    Article Six (pp. 168–170) Factors Influencing Susceptibility

21. Individual susceptibility to noiseinduced permanent threshold shifts

    • is greatest after many years of exposure

    • is greater during the early years of exposure and then individual differences lessen

    • is greatest for noise exposures that exceed time-weighted averages (TWAs) of 100 dBA

    • both B and C

    • none of the above

22. Although some research has shown associations between certain extrinsic, physiological, or molecular factors and susceptibility to NIHL

    • it is clear that there is no valid, reliable indicator of susceptibility

    • these associations warrant continued study to develop a test for susceptibility

    • only additional surveillance on those having been identified with noiseinduced permanent threshold shift (NIPTS) is likely to prove fruitful

    • all of the above

    • both A and B

23. Lifestyle choices such as diet and exercise

    • have been ruled out as factors related to individual susceptibility to NIPTS

    • may be associated with NIPTS and should be studied further

    • have been proven to be a factor in individual susceptibility to NIPTS

    • are interrelated to so many additional factors, such as nutrition, age, and gender, that other research should first be completed before conducting additional research on lifestyle factors

24. Research on genetic factors that may be related to susceptibility to NIPTS includes

    • genes associated with the cochlear antioxidant system

    • genes associated with fragile-X syndrome

    • genes associated with nonoblitus vascularis

    • all of the above

    Article Seven (pp. 171–173) Ototoxicity and Combined Effects

25. Industrial agents that are considered to be ototoxic include

    • styrene, neoprene, diacetylene

    • mercury, citrine, styrene

    • benzene, miocene, xylene

    • mercury, toluene, styrene

    • both C and D

26. Ototoxicants

    • are most likely to damage outer hair cells when they are absorbed through the round window

    • are much more likely to cause damage to the stria vascularis than the cellular structures that support the organ of Corti

    • may damage hearing even without the addition of hazardous noise

    • both B and C

27. Dose–response relationships for ototoxicants

    • have recently been published in the NIOSH Recommended Exposure Limits for ototoxicants

    • are contained in Appendix H of the OSHA Standard, 29 CFR 1929, Exposure to Physical Agents

    • have been published as threshold limit values (TLVs) for physical agents by the American Conference of Governmental Industrial Hygienists (ACGIH)

    • are not available

28. Because exposures to chemicals used in occupational environments

    • can affect several areas of the central nervous system, relying on pure-tone behavioral audiometry alone may not provide a sufficient indicator of damage

    • causes initial damage to the cochlea, early detection is best accomplished by pure-tone audiometry

    • have their greatest effect in the apical regions of the cochlea, highfrequency audiometry is especially useful in identifying effects

    • none of the above

    Article Eight (pp. 174–175) Consequences of Occupational Hearing Loss

29. The negative impact of noise-induced hearing loss includes

    • loss of intimacy

    • both safety and communication at work

    • reduced ability to relate to sounds in one's environment

    • all of the above

    • both B and C

30. The negative consequences of NIHL

    • are directly proportional to the amount of hearing loss

    • lessen over time as workers adapt to the hearing loss

    • are only somewhat dependent upon the degree of handicap

    • both A and B

31. Conventional hearing conservation programs

    • do not distinguish between workers with normal versus workers with impaired hearing

    • are required by OSHA to adjust workers' tasks to reflect potential inability to hear warning sounds

    • include specific training for workers with noise-induced hearing loss on how to select hearing protectors that will help them communicate while on the job

    • both B and C

    Article Nine (pp. 176–181) Economic Impact of Occupational Hearing Loss

32. Noise exposure and occupational hearing loss present a substantial economic burden to society, which includes

    • the economic costs associated with diagnosis, treatment, and rehabilitation

    • the economic costs associated with compensation

    • social costs of disease as reflected by reduced quality of life, disability, and suffering

    • all of the above

    • both A and B

33. In the United States, the most common measure of the economic cost of occupational hearing loss is based on

    • worker compensation costs

    • the costs of operating a hearing conservation program

    • the cost of implementing engineering controls

    • all of the above

34. In the United States, the overall economic costs associated with occupational hearing loss are tracked by

    • NIOSH

    • OSHA

    • the Bureau of Labor Statistics

    • all of the above

    • none of the above

35. Within limits, the economic burden of occupational hearing loss

    • may be estimated by calculating quality-adjusted life years

    • may be estimated by calculating disability-adjusted life years

    • may be estimated by using the contingent valuation method

    • all of the above

    • none of the above

    Article Ten (pp. 182–185) Communication, Safety, and Warning Signal Interference

36. OSHA inspections following workplace fatalities

    • provide safety personnel with statistics on the role noise and hearing loss played in the accident

    • determine if the use or nonuse of hearing protectors played a role in the accident

    • do not involve an investigation of the role of noise as a contributing factor

    • both A and B

37. A worker's ability to hear and respond to a warning signal

    • has been shown to be highly correlated with whether or not a worker believes his or her job is dangerous

    • has been shown to be positively correlated with stimulants such as caffeine and nicotine

    • involves complex relationships between the worker's hearing thresholds, background noise levels, and type of hearing protector

    • all of the above

38. Using double protection (i.e., both plugs and muffs)

    • has been shown to slightly improve ability to localize a warning signal because the attenuation of external noise reduces distortions caused by “overdriving” the auditory system

    • has been shown to have no additional effect on localization beyond the effect incurred from wearing an earplug

    • has been shown to interfere so greatly with a worker's ability to localize a warning sound that OSHA issued a 2009 policy statement recommending double protection not be worn in noise levels below 90 dBA

    • none of the above

39. Wearing hearing protectors may

    • improve a worker's ability to hear warning sounds and to communicate

    • interfere with a worker's ability to hear warning sounds and to communicate

    • have no significant influence on a worker's ability to localize the source of a sound, or may completely eliminate a worker's ability to locate the source of a sound

    • A and B only

    • all of the above

    Article Eleven (pp. 186–187) Hearing-Critical Jobs

40. A hearing-critical job is defined as

    • a job where, despite the presence of loud noise, the use of hearing protectors is prohibited in order to ensure that critical sounds are heard

    • a job for which some level of hearing ability is necessary to complete the associated tasks and in which failure to complete the tasks could negatively impact safety and/or productivity

    • a job in which it has been determined that the need to hear critical sounds outweighs the need to utilize reasonable accommodations in order to hire a hearing impaired person; such jobs must be registered with the U.S. Department of Labor, and, where applicable, with a state's department or bureau of vocational rehabilitation

    • all of the above

    • both B and C

41. The criteria for identifying hearingcritical jobs

    • are outlined in a nonmandatory appendix of the OSHA Hearing Conservation Amendment

    • are addressed in a mandatory appendix of the OSHA Hearing Conservation Amendment

    • were initially developed by the military and have since been standardized for use by most police and fire departments to hire new recruits

    • none of the above

42. Most criteria for identifying individuals qualified to work in a hearing-critical job involve

    • pure-tone hearing thresholds

    • uncalibrated speech tests such as the whisper test

    • pure-tone hearing thresholds and speech discrimination in quiet

    • pure-tone hearing thresholds and speech intelligibility in noise

    • both A and B

    Article Twelve (pp. 188–189) Nonoccupational Noise Exposure

43. Results of recent population studies have shown

    • little change in the hearing of young adults when compared to prior studies

    • the hearing of young adults to generally be worse today than in previous studies

    • the hearing of young adults to be slightly better today than in previous studies

    • mixed results with young women having better hearing and young men having worse hearing than previous studies

44. Loud music has been the subject of many studies. Some of the findings of these studies have shown that

    • music is commonly played at levels loud enough to be hazardous

    • there is a high incidence of permanent threshold shift among musicians

    • there is a significant difference in the hearing levels between musicians who wear hearing protection and those who do not

    • all of the above

    • A and B only

45. Studies of off-work noise exposures (not including those who shot firearms) have shown that

    • nonoccupational noise exposures were generally safe (i.e., below 80 dBA TWA)

    • nonoccupational noise exposures were mildly hazardous with the most common TWAs being between 80 and 85 dBA

    • there is a great difference in the weekday versus weekend nonoccupational exposures, with weekday exposures most commonly below 70 dBA and weekend exposures most commonly between 85- and 90-dBA TWA

    • individual nonoccupational exposures varied so greatly from day to day and between individuals that it is not possible to characterize nonoccupational exposures

    Article Thirteen (pp. 190–192) Tinnitus

46. Tinnitus may have a number of causes.

    • Therefore, it is not possible to claim someone's tinnitus is due to noise exposure.

    • Because tinnitus is strongly associated with retrocochlear lesions, tinnitus can be attributed to noise exposure only after magnetic resonance imaging has ruled out other causes.

    • However, if NIHL is present, there needs to be “strong contrary evidence for tinnitus to be diagnosed as due to something else.”

    • None of the above is correct.

47. According to a 2005 Institute of Medicine report for patients with a history of noise exposure, which of the following is true?

    • Tinnitus is most likely to develop when there is an asymmetrical vascular supply between different regions of the stria vascularis. How the vascular supply differs and the regions where this difference occurs is also thought to determine the subjective perception of the tinnitus.

    • Tinnitus occurs when etymotic apoptotic cellular degeneration within the organ of Corti allows the tectorial membrane to hyperstimulate adjacent residual stereocilia of the inner hair cells.

    • Tinnitus is highly associated with damage to Henson's pillars and the subsequent collapse of basal cells that support the organ of Corti. The region where this occurs will have a flaccid basilar membrane that will cause hyperstimulation of hair cells in adjacent regions. The magnitude of the damage to Henson's pillars is thought to explain both the subjective loudness and pitch of the tinnitus.

    • The effects of noise exposure and hearing loss disrupt the delicate balance between excitation and inhibition in the central auditory pathway, and the dorsal cochlear nucleus has been implicated as a possible generator site for tinnitus.

48. Studies have shown that the risk of developing tinnitus following noise exposure

    • is greater for workers exposed to impulsive noise than for workers exposed to continuous noise

    • is greater for workers exposed to continuous noise than for workers exposed to impulsive noise

    • is no different for workers exposed to impulsive noise than for workers exposed to continuous noise

    • all of the above

49. Although tinnitus is often mentioned in the conduct of hearing conservation programs, which of the following is true?

    • It is generally done in relation to establishing a basis for worker compensation.

    • It is generally done to support a determination of the work relatedness of a hearing loss.

    • It is usually limited to a question in a brief medical history calling only for a yes-or-no response. Little is done to obtain information about the onset, temporal characteristics, and degree to which it affects the worker's life. In addition, hearing conservationists seldom mention tinnitus in their educational programs, even though workers frequently report that their tinnitus bothers them more than their hearing loss

    • Both A and B are correct.

    Article Fourteen (pp. 193–195) Extra-Auditory Effects of Noise

50. Which of the following is a true statement?

    • Noise is considered a nonspecific biological stressor, and thus it can influence the entire physiologic system.

    • Noise is considered a specific biological stressor because it can affect specific physiologic systems.

    • Noise is considered a physical rather than a biological stressor because noise is a physical entity originating outside the body.

    • Noise is not considered to be a stressor because it does not act in the same way as other stressors that cause the body to go through a series of biological changes, preparing either to fight or to run away—the classic “fight-or-flight” response.

51. The evidence for extra-auditory effects

    • is probably strongest for cardiovascular effects, such as increased blood pressure and changes in blood chemistry

    • is probably strongest for hormonal effects, even though these have largely been shown to be relevant primarily to males with respect to the positive association between high noise and elevated testosterone levels

    • is probably strongest for changes in neurotransmitters such as serotonin and tryptophan

    • is so contradictory that it is not possible to determine a causal relationship between noise and extra-auditory effects

52. Because the extra-auditory effects of noise are mediated by the auditory system

    • the federal regulations and permissible exposure limits that apply to occupational noise exposure also apply to extra-auditory effects

    • properly fitted hearing protection devices should reduce the likelihood of these effects in the same way they do for hearing loss.

    • both A and B

    • none of the above

    Article Fifteen (pp. 210–212) Noise Measurement

53. Which of the following parameters is not used in calculating noise dose?

    • Criterion level

    • Exchange rate

    • Hearing threshold

    • Time

54. According to a study by Smith et al, when is a task-based exposure assessment most accurate?

    • Workers conduct a variety of nonroutine tasks.

    • Within-task variability is smaller than between task variability.

    • Detailed task definitions are not technically feasible.

    • Work tasks are broadly defined.

55. For workers whose shifts extend beyond 8 hours, the ACGIH recommends calculating cumulative dose over 7 consecutive days, and limiting any single daily dose to

    • 100%

    • 200%

    • 300%

    • 500%

    Article Sixteen (pp. 213–214) Noise Control

56. Engineering controls hold the primary place in the hierarchy of controls because

    • they utilize the most advanced available technologies

    • the OSHA noise standard dictates that they should be the first line of defense against excessive noise exposure

    • personal protection devices cannot reduce noise exposures below the PEL

    • engineering controls protect everyone in a uniform manner

57. Studies have shown that reducing noise levels by just 5 to 10 dB is all that is needed to bring what percent of workers within the OSHA PEL?

    • 90%

    • 95%

    • 99%

    • 100%

58. True or false? A significant barrier to implementation of noise control is lack of dissemination of the wide range of available noise control solutions.

59. All of the following factors have been identified as crucial to the successful implementation of engineering noise controls, except

    • recognition of the need for noise control

    • availability of proven noise control technologies

    • substantial financial base to support control efforts

    • collaboration across government, industry, and other stakeholders

    Article Seventeen (pp. 215–217) Hearing Protection Devices

60. In the United States, regulation of hearing protector labeling is managed by

    • NIOSH

    • OSHA

    • Food and Drug Administration

    • EPA

61. Which of the following is a disadvantage of using the Microphone in Real Ear technique for measuring the attenuation of hearing protectors?

    • It does not account for boneconducted sound transmission.

    • It requires a response from the test subject.

    • It cannot be used to evaluate level-dependent hearing protectors.

    • It results in highly variable attenuation measurements.

62. A company purchases a case of hearing protectors for its noise-exposed employees. The Noise Reduction Rating of the hearing protector is 26. What percent of the employees are likely to achieve 26 dB of sound attenuation using this protector?

    • 5%

    • 50%

    • 98%

    • 100%

63. The most important factor is selecting an appropriate hearing protector for a particular individual is the

    • the labeled noise reduction rating

    • the cost of the device

    • the individual's perception of its comfort and wearability

    • the expected usable life of the protector

    Article Eighteen (pp. 218–221) Audiometric Monitoring

64. The purpose of audiometric monitoring of noise-exposed workers is to

    • identify early signs of noise damage so intervention can occur before hearing is permanently damaged

    • document hearing threshold shifts for purposes of regulatory compliance

    • provide a record of hearing thresholds over the course of employment for workers' compensation claims

    • conduct surveillance of occupational hearing loss across industries

65. Although the ANSI requirements for maximum permissible noise during audiometric testing were considered unattainable at the time the OSHA regulation was written

    • studies have shown that accurate threshold testing is possible in rooms that meet the OSHA noise criteria

    • the OSHA standard has since been revised to reflect the most recent ANSI background noise standard

    • recent research indicates that most industrial audiometric test rooms can meet the ANSI standard except at 500 Hz

    • background noise levels are irrelevant in rooms in which multiple persons are tested simultaneously

66. True or false? Threshold shift criteria that make use of averaged thresholds are more sensitive to changes in hearing sensitivity than those that make use of individual thresholds.

67. Which of the following statements is true?

    • Identification of temporary threshold shifts has been shown to be efficacious in preventing permanent threshold shifts.

    • There is no consensus on the definition of a “noise notch.”

    • The OSHA age correction tables take into account the differing susceptibilities to threshold shift by race and gender.

    • OAEs may be a viable alternative to pure-tone thresholds for audiometric monitoring because they evaluate the auditory system as a whole.

    Article Nineteen (pp. 222–225) Training and Motivation

68. The strongest predictor of workplace safety behavior is generally

    • factual knowledge of the ear and hearing

    • actual and perceived barriers to protective action

    • incentive programs for workplace safety

    • availability of protective equipment at the work site

69. Training programs must frame message appropriately based on key audience characteristics, which include all of the following except

    • worker age and gender

    • ethnic and cultural background

    • noise exposure level

    • hearing thresholds

70. True or false? Most research indicates that hearing health programs are most effective when integrated into an overall health and safety program at the workplace.

71. A key topic that is missing from most training and motivation programs is

    • the structure and function of the ear

    • mechanisms by which noise damage occurs

    • use of hearing protection devices to prevent work-related hearing loss

    • the critical importance of hearing to quality of life

    Article Twenty (pp. 226–229) Special Populations

72. A worker population that may require special types of hearing protection is

    • younger workers

    • non-English speaking workers

    • hearing-impaired workers

    • temporary workers

73. A worker population that may benefit from predicted noise exposure estimates based on existing noise data is

    • young workers

    • mobile workers

    • Spanish-speaking workers

    • hearing-impaired workers

74. True or false? Foreign-born workers are disproportionately employed in jobs with hazardous noise exposure.

75. Possible accommodations for noiseexposed, hearing-impaired workers include

    • flat attenuation hearing protection devices

    • use of hearing aids under earmuffs

    • visual alerting systems

    • A and C only

    • all of the above

76. Which of the following worker populations are not protected by any occupational noise exposure regulation?

    • Employees under age 16

    • Construction workers

    • Certain federal and state employees

    • Temporary workers

    Article Twenty-One (pp. 230–231) Record Keeping

77. Which of the following records should be integrated in a comprehensive recordkeeping system for hearing loss prevention?

    • Noise exposure data

    • Hearing threshold data

    • Demographics

    • All of the above

    • A and B only

78. Surveillance of occupational noise exposure and hearing loss is possible utilizing existing records maintained by hearing conservation programs. The missing component is

    • a technologically feasible database structure

    • ancillary data such as equipment calibration records

    • consensus on data elements and variable definitions

    • access to training on OSHA record-keeping procedures

79. Applying personal health record technology to hearing conservation practices would

    • allow workers to maintain their audiometric test records as they move from employer to employer

    • relieve employers of the responsibility of maintaining audiometric test records for individual employees

    • meet OSHA regulatory criteria for record-keeping procedures in hearing conservation programs

    • create a breach of confidentiality regarding audiometric test records

    Article Twenty-Two (pp. 232–234) Program Evaluation

80. OSHA regulations specify which evaluation metric for hearing loss prevention programs in general industry?

    • Compliance checklist

    • Annual standard threshold shift (STS) rate below 3%

    • Audiometric database analysis

    • None of the above

81. Which of the following is the chief advantage to using the annual STS rate as a program evaluation criterion?

    • It uses a metric already calculated as part of mandated hearing conservation activities.

    • It requires data to be accumulated over several years.

    • It is constant across age and length of employment.

    • It accounts for other relevant factors such as gender, race, and nonoccupational noise exposure.

82. Which of the following metrics could be used by any company, regardless of size, as one measure of hearing conservation program effectiveness?

    • Audiometric database analysis

    • Rate of hearing loss among noise-exposed versus non-noiseexposed employees

    • Annual count of workers exposed above 85 dBA

    • All of the above

    • None of the above

83. True or false? As long as it is appropriately selected, one metric is sufficient to adequately assess a company's hearing loss prevention program.

    Article Twenty-Three (pp. 235–237) Treatment and Rehabilitation

84. True or false? Traditional aural rehabilitation programs are sufficient to meet the needs of workers who have sustained hearing loss due to noise exposure at work.

85. One approach that may help improve participation hearing-impaired workers in aural rehabilitation programs might be to

    • hold the rehabilitation sessions in medical offices remote from the work site

    • schedule rehabilitation programs during working hours

    • train professionals with whom the workers are comfortable to conduct the rehabilitation program

    • focus the rehabilitation approach on hearing aid use and speech reading skills

86. Current pharmacological approaches to preventing or reversing noise-induced damage are oriented toward all the of following, except

    • regeneration of hairs cells that have been damaged or destroyed

    • blocking the generation of reactive oxygen species and free radicals in cochlear cells

    • prevention of apoptosis

    • upregulation of growth hormones to prevent cell death

87. Pharmaceutical therapies for noise-induced hearing loss do not address

    • reduction of free radicals in the inner ear

    • mechanical damage to cochlear structures

    • the molecular cascade that leads to cochlear cell death

    • all of the above

    Article Twenty-Four (pp. 238–239) Public Health Perspective

88. Despite over 30 years of occupational noise exposure regulations in the United States, NIHL remains one of the most prevalent occupational conditions. One possible reason could be

    • lack on information on effective hearing loss prevention programs

    • social acceptability of loud noise in recreational environments

    • insufficient market supply of hearing protection devices

    • inaccurate data on the prevalence of workplace threshold shifts

89. A major weakness of the American Speech-Language-Hearing Association's multimillion dollar hearing health campaign featuring James Earl Jones in 2000 and 2001 was

    • poor timing of the media campaign

    • inappropriate targeting of the campaign to identified audiences

    • insufficient national coverage of the television ads and radio spots

    • lack of published measures of the impact of the campaign

90. Social marketing, which has proven successful in producing healthy behaviors, involves

    • integration of marketing principles with social-psychological theories of human behavior

    • encouraging behavior change through social media outlets such as Facebook and Twitter

    • marketing hearing protection devices in social arenas such as sporting events and concerts

    • none of the above

    Article Twenty-Five (pp. 240–241) Implementation

91. Which of the following strategies is not likely to improve effective implementation of hearing loss prevention programs?

    • Collaboration with other professionals working in hearing conservation

    • Identification of barriers that workers perceive to hearing conservation

    • Publication of recommendations in scientific journals

    • Improved regulatory standards and enforcement

92. In its 2006 report on the NIOSH Hearing Loss Prevention Research program, the Institute of Medicine acknowledged the progress that NIOSH had made in developing engineering noise controls for the mining sector, but noted that these advances had not been carried over to other industries. The Institute concluded that this lack of knowledge transfer was due to

    • the technical unsuitability of mining noise controls for other sectors

    • resistance of other sectors to noise control efforts

    • lack of funding to support technical transfer

    • failure to communicate the noise control solutions to other sectors

93. True or false? Hearing conservation professionals and noise-exposed workers have disconnected experiences that interfere with successful implementation of hearing loss prevention initiatives.