Are false-positive rates leading to an overestimation of noise-induced hearing loss?

Robert S. Schlauch, Edward Carney

Research output: Contribution to journalArticlepeer-review

42 Scopus citations


Purpose: To estimate false-positive rates for rules proposed to identify early noise-induced hearing loss (NIHL) using the presence of notches in audiograms. Method: Audiograms collected from school-age children in a national survey of health and nutrition (the Third National Health and Nutrition Examination Survey [NHANES III]; National Center for Health Statistics, 1994) were examined using published rules for identifying noise notches at various pass-fail criteria. These results were compared with computer-simulated "flat" audiograms. The proportion of these identified as having a noise notch is an estimate of the false-positive rate for a particular rule. Results: Audiograms from the NHANES III for children 6-11 years of age yielded notched audiograms at rates consistent with simulations, suggesting that this group does not have significant NIHL. Further, pass-fail criteria for rules suggested by expert clinicians, applied to NHANES III audiometric data, yielded unacceptably high false-positive rates. Conclusions: Computer simulations provide an effective method for estimating false-positive rates for protocols used to identify notched audiograms. Audiometric precision could possibly be improved by (a) eliminating systematic calibration errors, including a possible problem with reference levels for TDH-style earphones; (b) repeating and averaging threshold measurements; and (c) using earphones that yield lower variability for 6.0 and 8.0 kHz-2 frequencies critical for identifying noise notches.

Original languageEnglish (US)
Pages (from-to)679-692
Number of pages14
JournalJournal of Speech, Language, and Hearing Research
Issue number2
StatePublished - Apr 1 2011


  • Audiograms
  • Noise-induced hearing loss
  • OSHA
  • Pure-tone air conduction thresholds


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