Audiogram Notches in Noise-Exposed Workers

In Brief Objectives: Diagnostic criteria for noise-induced hearing loss include the audiometric notch, yet no standardized definition exists. This study tested whether objective notch metrics could match the clinical judgments of an expert panel. Design: A panel of occupational physicians, otolaryngologists, and audiologists reviewed audiograms of noise-exposed workers. In a two-sample process, the panel judged whether a notch was present and whether hearing loss had progressed in a notch pattern. Quantitative notch metrics were compared against expert decisions. Results: At least five of six experts agreed about notch identification in 71 and 72% of the cases in the two samples, and agreement about notch progression was 61 and 67%. Notch depth and professional specialty appeared to affect notch judgments. Despite this variability, a notch metric showed excellent agreement with expert notch consensus in each sample (94.7 and 96.6%; kappa = 0.88 and 0.92). Conclusions: Audiogram notch metrics can agree with expert clinical consensus and assist in the surveillance of noise-exposed workers. Diagnostic criteria for noise-induced hearing loss include the audiometric “notch”, yet no standardized definition exists. This study used an expert panel of audiologists, otolaryngologists, and occupational physicians to validate a number of objective notch metrics. The six-member panel agreed more than 70% of the time about the presence of a noise notch, and their consensus opinion showed agreement with several notch metrics. These results indicate that audiogram notch metrics, easily incorporated into audiometric software, can assist in the diagnosis of noise-induced hearing loss.