W. Va. Code R. § 85-20-47 - Treatment Guidelines, Protocols and Procedures for Performing Audiological Examinations and Evaluations in Workers' Compensation Claims for Noise-Induced Hearing Loss

47.1. Only audiometric test results obtained by an audiologist having a certificate of clinical competence in audiology (CCC-A) or a West Virginia audiology licensure are acceptable for purposes of awarding compensation. An audiogram performed at the request of any physician may be utilized by the injured worker for the purpose of completing the workers' compensation application form. However, only physicians who are qualified otologists or otolaryngologists may interpret the results of audiograms in assessing the degree of the injured worker's noise-induced hearing loss impairment for the purpose of determining the percentages of the injured worker's whole person impairment, if any.

47.2. A physician examining and evaluating an injured worker in a noise-induced hearing loss claim must consider the injured worker's medical and occupational history, as well as available audiograms, in determining the etiology of the hearing loss. It is not necessary to use a uniform brand and model of audiometer.

For Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, standards, the audiologist shall adopt the ANSI Guidelines and perform an annual exhaustive calibration. The audiologist should also perform a daily listening check.

47.3. Establishing a definitive margin of error: Two audiograms are said to be in acceptable test-retest variability when the total of four frequencies (500, 1000, 2000, 3000 Hz) is 15 decibels or less and the audiometric curves are similar. Because the two audiograms are technically identical and one cannot be chosen over the other, the calculation of whole person impairment will be based on the audiogram that yields the highest degree of impairment for the injured worker.

a. If two audiograms are both rated "good", and differ by more than the established margin of error, the Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, shall arrange for a third independent evaluation by an otologist or otolaryngologist.

b. The two audiograms that are within an acceptable test/retest variability should be used.

47.4. The audiologist shall be required to perform the following specific reliability and validity checks during the course of an audiogram:

a. Speech Reception Threshold (SRT)/Pure Tone Average Comparison: SRT should be within 10 decibels of the best two frequency average for the pure tone thresholds of 500, 1000, 2000 Hz.

b. Both ascending and descending thresholds should be obtained at 1000 Hz for each ear. The difference should be no greater than 5 decibels.

c. Reliability should be rated: good, fair, poor.

d. Certified and/or licensed audiologists must perform the audiogram.

e. The four validity and reliability checks set forth above must be documented on the Workers Compensation form and the examiner must initial his or her findings on the forms.

47.5. The Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, will inform all physicians evaluating noise-induced hearing loss injured workers on the Commission's, Insurance Commissioner's, private carrier's or self-insured employer's, whichever is applicable, behalf that standard air conduction and bone conduction testing, speech reception threshold, speech discrimination, tympanometry and acoustic reflex testing must routinely be performed as a part of audiometric evaluation. Other testing, including otoacoustic emission testing, may be required at the discretion of the otologist/otolaryngologist. If the required audiometric tests have not been done, the report is unacceptable and the physician will not be compensated. W. Va. Code § 23-4-8.

47.6. When a sensorineural hearing loss is present it may be the result of noise induced hearing loss and/or other disease processes. The medical evaluator should consider all causes of sensorineural hearing loss. When a conductive loss is present, the bone conduction levels will show the purist hearing an injured worker could have as a result of noise induced hearing loss.

47.7. The audiologist shall perform speech discrimination (word recognition) testing using W-22 word lists. Both live voice and recorded presentation methods for testing speech discrimination are acceptable; each method has its advantages. The audiologist should use the method that provides the best representation of the injured worker's true speech discrimination score.

The otologist or otolaryngologist interpreting the speech discrimination results shall use the formula set forth in W. Va. Code § 23-4-6b, to calculate the injured worker's impairment rating.

47.8. Occupational noise induced hearing loss (NIHL) typically starts in the high frequencies; usually 3000, 4000 or 6000 Hz. With progression, these frequencies worsen and the hearing loss extends to the lower frequencies; (2000 and 1000 Hz). Even with progression, however, the audiometric pattern remains one that descends from the low frequencies to the high frequencies, sometimes with recovery at 6000 or 8000 Hz. Occupational NIHL does not cause an ascending audiometric pattern (where the low frequencies would be worse than the high frequencies). A flat audiometric curve is also not typical of an etiology of solely occupational NIHL. If an audiogram presents a pattern that is atypical of an occupational NIHL pattern, then the physician interpreting the audiogram should consider causes other than occupational noise exposure in determining the hearing loss etiology. If the otologist/otolaryngologist determines that an injured worker's hearing loss is not all noise induced hearing loss, he or she should estimate the true noise induced hearing loss thresholds and explain his or her calculations on the basis of medical and audiological findings.

47.9. When an injured worker has been exposed to steady state noise, his or her NIHL will usually be symmetrical between both ears. If the injured worker has a hearing loss that is asymmetric then the evaluating physician should consider all causes for hearing loss, including nonoccupational noise, trauma or disease processes and whether there is more noise exposure on one side than the other.

47.10. If a physician determines that an injured worker's hearing loss is the result of occupational noise exposure, the total hearing loss impairment rating shall be calculated pursuant to the formula set forth in W. Va. Code 23-4-6b.

47.11. The Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, will reimburse for hearing aids when 5% or greater permanent industrial hearing loss impairment has been diagnosed. The recommendation for the hearing aid must be based on the evaluation of an otologist or a otolaryngologist for reimbursement. The Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, shall retain sole discretion to select the hearing aid most appropriate for treatment.

Notes

W. Va. Code R. § 85-20-47