Evidence-based occupational hearing screening I: Modeling the effects of real-world noise environments on the likelihood of effective speech communication

Objectives: The objectives of this study were to (1) identify essential hearing-critical job tasks for public safety and law enforcement personnel; (2) determine the locations and real-world noise environments where these tasks are performed; (3) characterize each noise environment in terms of its impact on the likelihood of effective speech communication, considering the effects of different levels of vocal effort, communication distances, and repetition; and (4) use this characterization to define an objective normative reference for evaluating the ability of individuals to perform essential hearing-critical job tasks in noisy real-world environments. Design: Data from five occupational hearing studies performed over a 17-year period for various public safety agencies were analyzed. In each study, job task analyses by job content experts identified essential hearing-critical tasks and the real-world noise environments where these tasks are performed. These environments were visited, and calibrated recordings of each noise environment were made. The extended speech intelligibility index (ESII) was calculated for each 4-sec interval in each recording. These data, together with the estimated ESII value required for effective speech communication by individuals with normal hearing, allowed the likelihood of effective speech communication in each noise environment for different levels of vocal effort and communication distances to be determined. These likelihoods provide an objective norm-referenced and standardized means of characterizing the predicted impact of real-world noise on the ability to perform essential hearing-critical tasks. Results: A total of 16 noise environments for law enforcement personnel and eight noise environments for corrections personnel were analyzed. Effective speech communication was essential to hearing-critical tasks performed in these environments. Average noise levels, ranged from approximately 70 to 87 dBA in law enforcement environments and 64 to 80 dBA in corrections environments. The likelihood of effective speech communication at communication distances of 0.5 and 1 m was often less than 0.50 for normal vocal effort. Likelihood values often increased to 0.80 or more when raised or loud vocal effort was used. Effective speech communication at and beyond 5 m was often unlikely, regardless of vocal effort. Conclusions: ESII modeling of nonstationary real-world noise environments may prove an objective means of characterizing their impact on the likelihood of effective speech communication. The normative reference provided by these measures predicts the extent to which hearing impairments that increase the ESII value required for effective speech communication also decrease the likelihood of effective speech communication. These predictions may provide an objective evidence-based link between the essential hearing-critical job task requirements of public safety and law enforcement personnel and ESII-based hearing assessment of individuals who seek to perform these jobs.