1	123 Fine tuning our practical approach to the new Hearing Conservation Legislation Dr Stefanus Snyman (snymans@new.co.za)
2	Background to 168 & 171 1994 - Compensation Commissioner, without consultation and without proper evaluation of financial or logistical impact, issued Instruction 168 The previous Instruction was perceived as being unfair (3 average frequencies, etc...) II 168 was wrongly considered to be a viable alternative - lack of a proper actuarial valuation
3	Background (2)... It was done unilaterally by the Commissioner II 168 was based on American AMA / ENT formula More than a dozen of these AMA assumptions are based ± arbitrary nature
4	Background (3)... The “low fence” of average hearing loss was lowered from 43dB to 26dB without any transitional arrangements 12% of miners immediately became compensatable - 3% previously
5	Background (Summary) 168 - no consultation - not even Compensation Board Unwillingness to acknowledge mistake Scientific base questioned Implementation cost tremendous
6	NIHL Compensation in South Africa
7	Technical Committee Must address NIHL comprehensively Focus on prevention Developed 7 supportive modules New Instruction 171 Approved by Board end 1999
8	NIHL Legislative framework
9	Where did II 171 originate from? Based on German model Refined by Australia Adapted by actuaries for RSA to accommodate local equipment
10	What is better in II 171? Real incentive for prevention Employer accountable for NIHL caused (risk rating) No discrimination Compares with best in the world “Window opportunity” to correct and manage risk
11	Problems with II 171 To co-ordinate all the legislation Baselines are cumbersome - Administration and better software are required Failure to utilise “window opportunity” will be costly (failure will benefit the employee) Information technology & software still lacking
12	168 vs 171 Low fence of 26 dBA No baseline Frequency of compensation uncertain No weighting of frequencies No low fence Baseline Compensation only when 10% PLH from baseline Weighting of critical hearing frequencies
13	168 vs 171 (cont.) No incentive for prevention ENT certified Difficult to monitor stats Strong incentive for prevention ENT if PLH >30% from baseline (>15% disability) Easy to monitor stats
14	Baseline By 16 November 2003 or within 30 days of employment 16h noise free (no PPE (& no taxi noise!!) prior to testing Better of 2 screening audiograms (not to differ >10 dB at 0.5, 1, 2, 3, 4 kHz) If difference >10dB - audiologist to perform baseline
15	Baseline (2) ... Same sitting Basis for future NIHL - baseline for life If no baseline done by Nov 2003 the baseline PLH will be considered 1.1%
16	Periodic Screening Annually 16h noise free (PPE allowed) PLH calculation If PLH >10% from baseline - Repeat If still >10% from baseline - Refer to OHMP Then for diagnostic, ENT (if >30 % from baseline) & Comp Comm.
17	Periodic Screening (cont…) Deterioration of PLH in workers with PLH <10% from baseline Compare 3, 4, 6 kHz - (>15 dB difference) or >15 dB increase at 4kHz only or Schilling (good for general pathology, not NIHL necessarily) or PLH criteria (but what is arbitrary and what scientific?)
18	Exit audiometry If you leave noise zone permanently 16h noise free (no PPE allowed) Calculate PLH Enter baseline, “pre-employment” (if applicable), exit and PLH onto exit certificate
19	Diagnostic Audiometry 24h noise free (no PPE) Pure tone & bone 2 audiograms - different sittings; same day If more than 10dB difference between audiograms (X3) - try in 6 months again.
20	Diagnostic (cont…) If PLH 10-30% from baseline - OHMP If PLH >30% from Baseline - ENT >10% from baseline - compensation Percentage disability = ½ X PLH
21	Compensation Commissioner Employee to report incident within 12 months (with medical reports) Employer WCl 1 (E) - Report of occupational disease WCl 14 - Notice of an occupational disease OD2 – Industrial Hearing Loss Exposure Form
22	Comp. Comm. (cont…) Employer...Supporting documentation: history period of exposure daily duration of exposure ? still exposed ? last exposed noise levels dBA baseline audiogram 2 diagnostic audiograms copy of employee’s ID
23	Comp. Comm. (cont…) OHMP / ENT submit via employer Submit WCl 22 (First & Final Report) Medical reports (all other causes excluded)
24	Admin. challenge – the following info needed for each employee Surname, Names, ID, DOB, age, Clock # Employer (code), department (Code) Date of employment Current & Previous Noise levels and Exposure (dates)
25	Admin. challenge (cont) Info on each worker Hearing Protection (Y/N/Sometimes) - since when? Medication (ototoxic) Colds, Allergies, Wax Family history
26	Admin. challenge (cont) Info on each worker Head injury Ear discharge / infections Previous diseases (TB, meningitis, etc.) Tinnitus Military Service; Hobbies Physical Examination
27	Admin. challenge (cont) Info on each worker Baseline audiometric data & PLH Current hearing threshold levels & PLH Difference between baseline & current - relevant comments Details of actions Name of OHMP, audiologist, ENT (& codes Medical Reports
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