J. Soc. Occup. Med.
(1990) 40, 117
Letter to the Editor
Classification of Audiometric Results
Sir,
A number of classification systems have been proposed
for assessment of hearing loss from audiograms, which
is of particular importance in the context of assessment
of disability, for example as a result of occupational noise
exposure. Among the systems currently used are that
proposed by the British Association of Otolaryngologists1,
which expresses hearing loss as a percentage disability,
and the simple numerical system put forward in the
Health and Safety Executive Discussion Document
Audiometry in Industry1. This document never progressed
beyond the discussion stage, although the classification
system has been widely discussed in occupational health
circles since it was published. It classifies audiograms into
five groups as below, the low frequencies being 0.5, 1 and
2 kHz, and the high frequencies being 3, 4 and 6 kHz.
Category I. The first category applies if the sum of the
hearing levels for either high or low frequencies shows
an increase of 30 dB or more when compared with the
immediately preceding audiogram, or 45 dB when the
interval since the preceding examination exceeds 3 years.
Category 2. This applies when the difference of the sums
of hearing levels between the two ears exceeds 45 dB for
the low frequencies or 60 dB for the high frequencies.
Category 3. The third category is the 'warning level'.
Category 4. This is the 'referral level'.
Each of these categories is calculated from a table of
hearing levels for different age ranges, thereby taking into
account the effects of presbyacusis.
Category 5. This applies to the rest, i.e. normal audio-
grams.
However, the use of a single numerical classification
system does not allow for situations where the result
might fall into more than one category, as for example
the individual showing a unilateral 'referral level' hearing
loss, which has progressed since the last audiogram. It
is suggested that three sets of parameters need to be
recorded, i.e. whether or not
(a) a previous audiogram has been performed, and, if
so, whether there has been any change in the successive
audiogram;
(b) there is any significant difference in the hearing
thresholds of the two ears;
(c) there is any significant hearing loss, i.e. category 3
or 4 in the proposed HSE classification.
'i~, 1990 Butterworth-Heinemunn for SOM
0301-0023/90/0301 17-01
Use of the following three digit system enables simple
classification of audiometric results, using the same
criteria as in the HSE Discussion Document, without the
loss of information associated with the use of a single
digit system.
First Digit
0 No change from previous audiogram, using HSE
criteria
1 Significant change from previous audiogram, using
HSE criteria
6 No previous audiogram
Second Digit
0 No difference between the two ears, using the HSE
criteria
2 Significant difference between the two ears, using HSE
criteria
Third Digit
3 HSE 'Referral level'
4 HSE 'Warning level'
5 No significant loss
Hence, for example, an individual who has no previous
audiogram, and shows no significant hearing deficit will
be coded as 605. An individual with a previous audio-
gram, significantly changed, with a different threshold in
each ear, and falling into the referral category will be
coded 123. The system is presented as a simple extension
of the HSE proposal, and our experience has shown that
computerized audiometry systems can be programmed
to undertake the classification without difficulty. It has
the advantage of being simpler than most other systems
currently in use, without the loss of information that is
inevitable with a single digit system.
R. A. COOKE
Chief Medical Officer,
GKN pic,
Redditch,
Worcestershire, UK
REFERENCES
1. Method for Assessment of Hearing Disability. Br Assoc Otolaryngol
and Br Soc Audiology, 1983.
1 Health & Safety Executive Discussion Document, Awllometry in
Industry, 1978.
 The British Occupational Hygiene Society
Seventh International Symposium
on Inhaled Particles
Edinburgh, 16-20 September

The Seventh International Symposium on Inhaled Particles will be held at the new Edinburgh Conference
Centre on the Heriot Watt University Campus in Edinburgh. The Proceedings of the Symposium will again
be refereed, edited and published.
The Symposium will be concerned primarily with advances in understanding the basic mechanisms of
deposition and clearance of dusts, their biological reactions and epidemiological studies. Topics will include:

Factors affecting the measurement of inhaled fraction;

New models of deposition;
Biological reactions of dusts in the lung;
Synergistic effects of gases and dusts;
Exposure - response studies offibres,silica and other dusts;
The role of different minerals in mixed dust pneumoconiosis;
Dust or chemical exposure in relation to occupational asthma; and
Effects of radon exposure and indoor air quality.

For further information please contact: Dr A. Robertson, Organising Secretary, Institute of Occupational Medicine, Roxburgh
Place, Edinburgh, EH8 9SU, UK.

Occupational Health Practice

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E d i t e d b y H . A . W a l d r o n PhD MD MRCP FFOM, Consultant Occupational Physician, St Mary's Hospital, London, UK
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includes individuals, working populations, and the workplace itself.
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