Exposure to loud noise continues to be the largest cause of hearing loss in the adult population. The problem of NIHL impacts a number of disciplines. US standards for permissible noise exposure were originally published in 1968 and remain largely unchanged today. Indeed, permissible noise exposure for US personnel is significantly greater than that allowed in numerous other countries, including for example, Canada, China, Brazil, Mexico, and the European Union. However, there have been a number of discoveries and advances that have increased our understanding of the mechanisms of NIHL. These advances have the potential to impact how NIHL can be prevented and how our noise standards can be made more appropriate.

In the Occupational Safety and Health Act of 1970, Congress declared that its purpose was to assure, so far as possible, safe and healthful working conditions for every working man and woman and to preserve our human resources. In this Act, the National Institute for Occupational Safety and Health (NIOSH) is charged with recommending occupational safety and health standards and describing exposure concentrations that are safe for various periods of employment-including but not limited to concentrations at which no worker will suffer diminished health, functional capacity, or life expectancy as a result of his or her work experience. By means of criteria documents, NIOSH communicates these recommended standards to regulatory agencies (including the Occupational Safety and Health Administration [OSHA]) and to others in the occupational safety and health community. Criteria documents provide the scientific basis for new occupational safety and health standards. These documents generally contain a critical review of the scientific and technical information available on the prevalence of hazards, the existence of safety and health risks, and the adequacy of control methods. In addition to transmitting these documents to the Department of Labor, NIOSH also distributes them to health professionals in academic institutions, industry, organized labor, public interest groups, and other government agencies. In 1972, NIOSH published Criteria for a Recommended Standard: Occupational Exposure to Noise, which provided the basis for a recommended standard to reduce the risk of developing permanent hearing loss as a result of occupational noise exposure [NIOSH 1972]. NIOSH has now evaluated the latest scientific information and has revised some of its previous recommendations. The 1998 recommendations go beyond attempting to conserve hearing by focusing on preventing occupational noise-induced hearing loss (NIHL). This criteria document reevaluates and reaffirms the recommended exposure limit (REL) for occupational noise exposure established by the National Institute for Occupational Safety and Health (NIOSH) in 1972. The REL is 85 decibels, A-weighted, as an 8-hr time-weighted average (85 dBA as an 8-hr TWA). Exposures at or above this level are hazardous. By incorporating the 4000-Hz audiometric frequency into the definition of hearing impairment in the risk assessment, NIOSH has found an 8% excess risk of developing occupational noise-induced hearing loss (NIHL) during a 40-year lifetime exposure at the 85-dBA REL. NIOSH has also found that scientific evidence supports the use of a 3-dB exchange rate for the calculation of TWA exposures to noise. The recommendations in this document go beyond attempts to conserve hearing by focusing on prevention of occupational NIHL. For workers whose noise exposures equal or exceed 85 dBA, NIOSH recommends a hearing loss prevention program (HLPP) that includes exposure assessment, engineering and administrative controls, proper use of hearing protectors, audiometric evaluation, education and motivation, recordkeeping, and program audits and evaluations. Audiometric evaluation is an important component of an HLPP. To provide early identification of workers with increasing hearing loss, NIOSH has revised the criterion for significant threshold shift to an increase of 15 dB in the hearing threshold level (HTL) at 500, 1000, 2000, 3000, 4000, or 6000 Hz in either ear, as determined by two consecutive tests. To permit timely intervention and prevent further hearing losses in workers whose HTLs have increased because of occupational noise exposure, NIOSH no longer recommends age correction on individual audiograms.

The Institute of Medicine carried out a study mandated by Congress and sponsored by the Department of Veterans Affairs to provide an assessment of several issues related to noise-induced hearing loss and tinnitus associated with service in the Armed Forces since World War II. The resulting book, Noise and Military Service: Implications for Hearing Loss and Tinnitus, presents findings on the presence of hazardous noise in military settings, levels of noise exposure necessary to cause hearing loss or tinnitus, risk factors for noise-induced hearing loss and tinnitus, the timing of the effects of noise exposure on hearing, and the adequacy of military hearing conservation programs and audiometric testing. The book stresses the importance of conducting hearing tests (audiograms) at the beginning and end of military service for all military personnel and recommends several steps aimed at improving the military services' prevention of and surveillance for hearing loss and tinnitus. The book also identifies research needs, emphasizing topics specifically related to military service.

According to the National Institutes of Occupational Safety and Health, approximately 30 million employees are exposed to dangerous noise levels at work and an additional nine million workers are at risk for hearing loss from other ototoxins such as metals and solvents. Millions of children and young adults are also at risk for noise-induced hearing loss in non-occupational settings. Hearing Conservation: In Occupational, Recreational, Education, and Home Settingsis the most current text to cover all major topics related to noise-induced hearing loss, including the military, construction, manufacturing, mining, transportation, the music industry, the home environment, education settings, and recreational arenas. From the underlying principles of hearing loss to audiometric testing procedures to assessment of hearing conservation programs, this book is packed with information for audiologists and other members of the interdisciplinary team who provide hearing conservation services for at-risk groups.Special Features: Many examples of audiometric data, that enhance understanding of all types of hearing impairment, test procedures, and standard threshold shift calculations Protocols for comprehensive audiological, tinnitus, and auditory processing evaluations Clinical pathways and follow-up action steps when a standard threshold shift is confirmed, including decisions about worker compensation in occupational settings Assessment of the effectiveness of a wide range of hearing conservation programs and correction of deficiencies, along with training, educational, and motivational techniques The most current information about hearing protection and enhancement devices, related regulations, selection and fitting, and training workers in how to use them for optimal results A set of discussion questions at the end of each chapter that stimulate review and classroom dialogue Comprehensive in scope, easily accessible, and useful to both clinicians and investigators,Hearing Conservation: In Occupational, Recreational, Education, and Home Settings is essential for audiologists, occupational hearing conservationists, otolaryngologists, internists, occupational nurses, noise control engineers, and any other practitioner who plays a role in developing, implementing, and maintaining hearing conservation measures. It is also an excellent text for graduate level audiology courses in hearing conservation.