Hearing Loss and Tinnitus

HEARING LOSS CRITERIA

The Board has recently received a number of requests for clarification on the criteria to be met for an Injury on Duty Award on the basis of Hearing Loss and Tinnitus.

Set out below is the general Injury on Duty criteria specific to Regulation 10 of the Injury on Duty Regulations:

  • A claimant must be disabled i.e. inability, occasioned by infirmity of mind or body, to perform the ordinary duties of a police officer;
  • A claimant’s disablement must be likely to be permanent i.e. assuming normal appropriate medical treatment has been received, the claimant is deemed (at the time of the assessment) to be disabled (as above) for the remainder of their life; and
  • A claimant’s disablement must be the result of an injury received in the execution of duty without their own default i.e. the injury has caused or substantially contributed to the claimant’s disablement.

If all three criteria are met the claimant will be granted a Regulation 10 award.  Further information on the terms set out in the PSNI and PSNI Reserve (Injury Benefit) Regulations 2006 is contained in the joint guidance to medical practitioners joint guidance to medical practitioners

 

For hearing loss cases specifically –

  • The question of whether the claimant is disabled is based on whether the claimant would meet the required hearing standards for entry to the police service, set out in Home Office Circular 59/2004:
    • Hearing loss of more than a total of 84dB over the 0.5 – 1.2 KHz range or more than a total of 123 dB over the 3.4 and 6 KHz range (must be 2 or more out of 4)

For claimant’s information, the Board has also been advised by its medical practitioners of the following:

  • any deterioration in hearing after a claimant has left the noise environment, in this case police service, would not be attributable to noise induced hearing loss but rather other factors such as age;
  • where there is a discrepancy between the result from more than one contemporaneous audiogram, the better audiogram is taken as the result most likely to accurately represent the individual’s hearing;
  • It is no longer accepted in modern ENT practice that there is no effective treatment for tinnitus. Individuals can be treated through a tinnitus masker or cognitive behavioural therapy. The majority of individuals who undergo tinnitus treatment by a suitably trained practitioner note an improvement in their symptoms.

There have also been a number of queries in relation to the whisper and tuning fork tests performed by SMP during assessments.

The World Health Organisation confirms the forced whisper and the Rhine and Weber tests are accredited and recognised tests, however they are not substitutes for audiograms. The Board has asked the SMP, in the small number of cases where there are no audiograms on file, to refer claimants for this test.

 

Further details on these two tests are set out below, for your information:

  1. Forced Whisper Test – where the doctor stands behind patient and whispers a series of numbers and letters which the patient then has to repeat
  2. Rhine and Weber Tests – both use tuning fork - Air-conduction hearing occurs through air near the ear, and bone-conduction hearing occurs through vibrations. A Weber test determines whether an issue is conductive or sensorineural hearing loss. Conductive hearing loss occurs when sound waves are not able to pass through the inner ear.

WHO definition:

Whispered voice test

  • A simple and accurate test for detecting hearing impairment. It is the only test of hearing that requires no equipment.
  • The examiner stands at arm's length (0.6 m) behind (to prevent lip-reading) the seated patient and whispers a combination of three numbers and letters (for example, 4-K-2), and then asks the patient to repeat the sequence.
  • The examiner should quietly exhale before whispering to ensure as quiet a voice as possible.
  • If the patient responds incorrectly, the test is repeated using a different number/letter combination. The patient is considered to have passed the screening test if they repeat at least three out of a possible six numbers or letters correctly (i.e. 50% correct).
  • Each ear is tested individually, starting with the ear with better hearing. During testing the non-test ear is masked by gently occluding the auditory canal with a finger and rubbing the tragus in a circular motion.
  • The other ear is assessed similarly with a different combination of numbers and letters.

Weber's test

  • A 512 Hz tuning fork is placed in the midline of the patient's forehead.
  • If the sound is louder on one side than the other, the patient may have either an ipsilateral conductive hearing loss or a contralateral sensorineural hearing loss. Rhine's test may provide further information which will be useful to distinguish between these possibilities.

Rhine's test

  • This uses a tuning fork of 256 Hz or 512 Hz. A heavy tuning fork is preferable as a light one can produce a sound that fades too rapidly.
  • It produces a sound level of 90 dB when struck against the knee or elbow.
  • To test air conduction, hold the tuning fork directly in line with the external auditory canal.
  • When testing bone conduction, the flat end of the stem of the tuning fork is placed against the mastoid process, using firm pressure (loudness varies by up to 15 dB with different pressures).
  • When air conduction is louder than bone conduction it is reported as Rhine-positive. Rhine's test will reliably detect a conduction defect with an air-bone gap of at least 30-40 dB. It is no substitute for pure-tone audiometry.

 

HEARING LOSS APPEALS

The Department of Justice has advised the Board of a delay at present in obtaining appointments with ENT Consultants (who will act as Independent Medical Referee in an appeal relating to Hearing Loss).

Due to the small number of practitioners in this field who are available to act in appeals there is a delay in securing appointments. The Board is working with the Department of Justice to find a solution to this issue as soon as possible. Your patience during this time is appreciated.