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Hearing-related injuries can last a lifetime

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by Shannon Moneo

Collin Pullar knows the story well. His dad, a master carpenter, was working in a small space on a concrete floor. In a moment of lapsed judgement, Pullar's dad forgot to insert earplugs and after pulling the trigger of a powder-actuated nail gun, felt massive pain in his left ear.
Hearing-related injuries can last a lifetime

"That moment changed his hearing abilities," said Pullar, president of the Saskatchewan

Construction Safety Association. In addition to hearing loss, his father developed tinnitus which can be a clicking, hissing, buzzing or roaring noise in the ear, either continuous or sporadic, loud or soft. In the case of Pullar senior, it was a ringing sound that would come and go.

"He lived with it his entire life," Pullar said. "It was very disturbing for him."

As a safety advocate, Pullar notes that workplaces typically focus their prevention efforts on sudden and traumatic incidents, like falls. Injuries that gradually develop over time, like tinnitus, don't grab the headlines and thus, there's less awareness.

"Often diagnosis doesn't happen until a long time after exposure," Pullar said. "But with hearing-related injuries it's a lifetime injury."

In Saskatchewan, Workers' Compensation accepted 150 claims in 2015 for hearing problems related to exposure to noise over time, Pullar said. It is unknown how many of those claims will develop into tinnitus because tinnitus isn't documented. And like hearing or vision loss, it's generally accepted that as one gets older, such conditions are normal. But are they? Pullar's dad could point to a specific day when his hearing changed forever.

Even though tinnitus can be overwhelming or disturbing, WorkSafeBC doesn't consider it a disease. Instead, it's considered a symptom of other conditions, such as Meniere's disease, exposure to noise, certain drugs, too much caffeine or salt, or even chronic stress, pain or depression. Tinnitus can also develop after a head or neck injury, such as a fall or being hit in the head. This may happen because the injury turns up the brain's circuitry noise or makes it harder for the brain to tune out the circuitry noise.

"Tinnitus can be a symptom of many things and not necessarily associated with something going on in the ears," said Sasha Brown, an occupational audiologist with WorkSafeBC.

Related to tinnitus is noise-induced hearing loss (NIHL), an occupational disease that is irreversible but 100 per cent preventable, Brown said. Some workers who develop NIHL do not suffer from tinnitus, others do. Still, it's impossible to separate the two from each other, she said.

In 2011, WorkSafeBC accepted 473 NIHL claims from the construction industry. In 2015, the number of construction NIHL claims dropped to 329.

"Probably the greatest hazard for construction workers is noise," said Glynnis Tidball, an audiologist and tinnitus specialist at Vancouver's St. Paul's Hospital.

"Long-term noise exposure and bursts of intense noise can permanently damage the fine structures of the ear and cause hearing loss and ultimately tinnitus."

Noise is like sunshine, she explained. Both become more hazardous as intensity and duration of exposure increase. In B.C., hazardous noise is defined as an average exposure of 85 decibels over an eight-hour shift.

Practically, noise is hazardous if it's loud enough that you have to raise your voice to talk to someone a metre away.

About 15 per cent of people have tinnitus. Of those, 25 per cent seek help because it's troublesome, causing sleep disturbances, difficulty with concentration, significant mood changes, tension and fatigue, Tidball said. WorkSafeBC's list of occupations where noise exposure over an eight-hour shift averaged 85 decibels or more is heavy on construction jobs with carpenters, framers, labourers, concrete workers, crane operators, drywallers, electricians, ironworkers, jackhammer operators, mobile equipment operators and roofers all coming in at decibel levels between 88 to 97. Truck drivers and welders are the remaining occupations in the 85-plus decibel level.

Once the 85 decibel level is reached it's mandatory for all employers, from two man operations to large contractors, to follow WorkSafeBC regulations, which include measuring sound levels and implementing a hearing loss prevention program. Employees are to get their hearing tested annually and employers must supply proper hearing protection for the job, Tidball said.

But there's a balance that has to be struck when it comes to prevention, Brown noted.

There is the danger earplugs or other hearing protection products don't fit well, become bothersome or block out too much sound. The employee then feels unsafe or irritated and removes the product. Finding the right product is crucial, Brown said. One product is a device that's connected to a radio so the worker can communicate while protecting their hearing. Electronic hearing protection has

microphones that pick up outside sounds and then shut down when noise levels get too high, Tidball said.

Many people with tinnitus will also have decreased sound tolerance, or hyperacusis where every day sounds are considered too loud, annoying or painful. Hyperacusis can be a problem on the job site because the worker will have difficulty being around worksite noise and may find that noise makes tinnitus louder.

"I often hear from workers with hyperacusis that they are doubling up on hearing protection or wearing hearing protection when it is

not necessary. This, too, can be a hazard as it can prevent the worker from hearing warning sounds and put the worker and those around him in danger," Tidball said.

Still, it's incumbent on employees to follow policies or to document workplace procedures. A worker may find that five years into retirement, the irritating hiss of tinnitus begins. If the person can track it back to an employer and prove that they worked with or beside noisy equipment for a number of years, their claim could be accepted, Pullar said

But if the employer can prove they had an enforced hearing policy, did audiometric testing and provided safety tools, the former employee may not have a case.

Tinnitus treatment can include therapy using educational counselling, sound therapy, cognitive behavioural therapy and mindfulness- based stress reduction, Tidball said.

Silence is avoided by using a bedside sound generator at night and hearing instruments during the workday.

Unfortunately, workers don't think about tinnitus when they are young. Situations that contribute to tinnitus go unreported, and like vision loss, there's an acceptance that it's part of aging.

"But it's absolutely preventable," Pullar said.

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