Interview with Peter Weber M.D., Chair, Council for Accreditation in Occupational Hearing Conservation
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AO/BECK: Thanks for your time this evening Dr. Weber. Before we get to CAOHC, please tell me where you went to medical school and where you did your residency?
WEBER: I graduated from Albany Medical College in New York in 1988. I did my residency in Pittsburgh under Eugene Meyers M.D. and did my fellowship in otology/neurotology/skull base surgery with Dr. Bruce Gantz in Iowa. Following that, I went to Charleston at the Medical University of South Carolina and have been there for 6 and a half years. Currently, I am Professor and Vice-Chairman of the department of Otolaryngology - Head and Neck Surgery as well as Director of the Hearing and Balance Disorder Center.
AO/BECK: How many audiologists do you have in the department?
WEBER: We have five audiologists. Dr. Allen Klein is director of the audiology division and Dr. Tammy Bradham is the director of our cochlear implant program as well as having an interest in central auditory processing. Kim Snyder specializes in pediatric audiology, while Chris Strange and Ray Gamble provide all of our audiology services including vestibular testing.
AO/BECK: Very good, sounds like a comprehensive program. Please tell me, what is CAOHC and how did you get involved with CAOHC?
WEBER: CAOHC is the acronym for the Council for Accreditation in Occupational Hearing Conservation and has been under this name since 1973. CAOHC is the major authority on the training and certification of occupational hearing conservationists in the United States, recognized by both the government and the private sector. CAOHC views its mission as one of education to eliminate noise in the work place and prevent noise induced hearing loss with the education and certification of occupational hearing conservationists (OHC's) and CAOHC certified Course Directors (CD's). I was nominated by the AAO-HNS (American Academy of Otolaryngology - Head and Neck Surgery) to serve on CAOHC's Council. My interest in noise induced hearing loss was peaked with my work involving the Charleston Naval Shipyard. When the base was closed there were a large number of employees filing claims for Noise Induced Hearing Loss (NIHL) benefits. Our center was chosen to evaluate these claims.
AO/BECK: Please tell me how CAOHC is organized?
WEBER: CAOHC is a unique group. They have two representatives from a number of disciplines and professional groups. These groups are the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS), American College of Occupational and Environmental Medicine (ACOEM), American Speech-Language-Hearing Association (ASHA), American Association of Occupational Health Nurses (AAOHN), Military Audiology Association (MAA), Institute of Noise Control Engineering (INCE), American Industrial Hygiene Association, and the National Safety Council (NSC).
AO/BECK: So then, audiology is primarily represented through ASHA. Is there an American Academy of Audiology (AAA) presence at CAOHC?
WEBER: AAA does not have a representative on the Council at this time, although some of our audiology Course Directors do belong to both organizations. In addition, the Military Audiology Association also represents audiologists on CAOHC's Council.
AO/BECK: OK, well let's go back to CAOHC for a moment. CAOHC offers a certification program I believe?
WEBER: Yes. Basically, the OHCs (Occupational Hearing Conservationists) are certified by CAOHC. Additionally, we certify the CD's (Course Directors). The CDs are the ones who put on courses to train and instruct the OHC's according to a CAOHC prescribed curriculum. The CDs give an examination at the end of the course and if they pass, the OHC's are then eligible for CAOHC certification. We have recently started a physician course at the ACOEM annual meeting and this may someday lead to a different type of certification since the physician or audiologist are the only professionals who may serve as the supervisor of the audiometric test in a hearing conservation program.
AO/BECK: What does CAOHC certification imply?
WEBER: It implies that the OHC has met a certain minimum standard of training which is important for the OHC's to fulfill their duties in a hearing conservation program.
AO/BECK: What is the minimum educational requirement for the OHC?
WEBER: There is no minimum educational requirement i.e., the OHC does not need a college diploma or some other health related degree. The OHC, however, may be an audiologist, nurse, engineer, physician, etc., and CAOHC's statistics indicate that over 50% of currently certified OHC's are RNs. The OHC is on the 'front line' and they make sure the OSHA requirements are met and that the audiologic screenings are done in accordance with the rules and regs. CAOHC certification requires that the OHC take a 20 hour CAOHC approved course and pass the examination given by the CD. They must also take an 8 hour refresher course every 5 years.
AO/BECK: What about minimum requirements for the CDs?
WEBER: Applicants, who can be physicians, occupational nurses, audiologists, engineers and others, must demonstrate an appropriate credential/license issued by their organization (such as - Certified in Clinical Competency-Audiology or CCC-A earned through ASHA). In addition they must have worked in the field of hearing conservation for at least 1000 hours in the past 5 years. The Course Director is then awarded certification by CAOHC after completion of a one day workshop insuring their successful training of OHCs and fulfillment of CAOHC regulations.
AO/BECK: How many OHC's and CDs are there?
WEBER: There are about 22,500 certified OHC's, and about 375 CDs.
AO/BECK: Who are the primary employers of OHC's?
WEBER: Mostly you'll find the OHCs in mining, manufacturing and heavy industry and any other employment situation where the employer must abide by OSHA noise regulations.
AO/BECK: What are the day-to-day responsibilities of the OHC?
WEBER: The OHC's do the audiometric testing and they usually help fit the hearing protection devices (HPDs) to the employees. They also help educate the employees on the proper ways to use HPDs. If the OHC finds a standard threshold shift (STS) in the audiometric testing, they refer the employee to the professional supervisor (a physician or audiologist) who manages the audiometric portion of the HCP, and they notify the patient of this shift.
AO/BECK: Speaking of standard threshold shifts, I find that patients will complain that although they get annual tests, they had no idea they had hearing loss because nobody told them anything. In other words, the OHCs are looking for STSs, but the patients sometimes assume they are looking for hearing loss. So in essence, if the patient has a moderate or severe loss, and it's stable over years, the patient/employee gets the message 'you passed', even though they may have significant hearing loss.
WEBER: That can be a real problem and that's a flaw in the OSHA regs. We've run into that, too. Probably the best way around that is education. The employees also need to better understand what the purpose of the test is and to ask questions about it.
AO/BECK: Do the OHCs make sound measurements using a sound level meter?
WEBER: That would depend on their employer but usually not. This training is not mandatory for CAOHC certification.
AO/BECK: Do the OHCs look into the ear, or do they strictly test?
WEBER: Depending on their training they may look into the ear. The OHC is familiarized on how an ear examination is conducted, but they are not trained to diagnose any pathology.
AO/BECK: Do you envision any changes in the OHC roles and responsibilities?
WEBER: No, not at this time. To expand their roles, many OHCs would need more education and the needs of the worker is currently served by other health care programs. The next area of focus for CAOHC is the standardization of our testing protocols so that every OHC takes a standardized exam at the completion of their 20 hour course.
AO/BECK: Very good Dr. Weber, thanks for your time this evening. If the readers want to get more information, or if they want to obtain the OHC or the CD status, how can they find out more about it?
WEBER: They can call CAOHC at 414-276-5338 Fax at 414-276-3349 or access our web site at www.caohc.org. My phone is 843-792-7156 and my email is weberp@musc.edu.
WEBER: I graduated from Albany Medical College in New York in 1988. I did my residency in Pittsburgh under Eugene Meyers M.D. and did my fellowship in otology/neurotology/skull base surgery with Dr. Bruce Gantz in Iowa. Following that, I went to Charleston at the Medical University of South Carolina and have been there for 6 and a half years. Currently, I am Professor and Vice-Chairman of the department of Otolaryngology - Head and Neck Surgery as well as Director of the Hearing and Balance Disorder Center.
AO/BECK: How many audiologists do you have in the department?
WEBER: We have five audiologists. Dr. Allen Klein is director of the audiology division and Dr. Tammy Bradham is the director of our cochlear implant program as well as having an interest in central auditory processing. Kim Snyder specializes in pediatric audiology, while Chris Strange and Ray Gamble provide all of our audiology services including vestibular testing.
AO/BECK: Very good, sounds like a comprehensive program. Please tell me, what is CAOHC and how did you get involved with CAOHC?
WEBER: CAOHC is the acronym for the Council for Accreditation in Occupational Hearing Conservation and has been under this name since 1973. CAOHC is the major authority on the training and certification of occupational hearing conservationists in the United States, recognized by both the government and the private sector. CAOHC views its mission as one of education to eliminate noise in the work place and prevent noise induced hearing loss with the education and certification of occupational hearing conservationists (OHC's) and CAOHC certified Course Directors (CD's). I was nominated by the AAO-HNS (American Academy of Otolaryngology - Head and Neck Surgery) to serve on CAOHC's Council. My interest in noise induced hearing loss was peaked with my work involving the Charleston Naval Shipyard. When the base was closed there were a large number of employees filing claims for Noise Induced Hearing Loss (NIHL) benefits. Our center was chosen to evaluate these claims.
AO/BECK: Please tell me how CAOHC is organized?
WEBER: CAOHC is a unique group. They have two representatives from a number of disciplines and professional groups. These groups are the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS), American College of Occupational and Environmental Medicine (ACOEM), American Speech-Language-Hearing Association (ASHA), American Association of Occupational Health Nurses (AAOHN), Military Audiology Association (MAA), Institute of Noise Control Engineering (INCE), American Industrial Hygiene Association, and the National Safety Council (NSC).
AO/BECK: So then, audiology is primarily represented through ASHA. Is there an American Academy of Audiology (AAA) presence at CAOHC?
WEBER: AAA does not have a representative on the Council at this time, although some of our audiology Course Directors do belong to both organizations. In addition, the Military Audiology Association also represents audiologists on CAOHC's Council.
AO/BECK: OK, well let's go back to CAOHC for a moment. CAOHC offers a certification program I believe?
WEBER: Yes. Basically, the OHCs (Occupational Hearing Conservationists) are certified by CAOHC. Additionally, we certify the CD's (Course Directors). The CDs are the ones who put on courses to train and instruct the OHC's according to a CAOHC prescribed curriculum. The CDs give an examination at the end of the course and if they pass, the OHC's are then eligible for CAOHC certification. We have recently started a physician course at the ACOEM annual meeting and this may someday lead to a different type of certification since the physician or audiologist are the only professionals who may serve as the supervisor of the audiometric test in a hearing conservation program.
AO/BECK: What does CAOHC certification imply?
WEBER: It implies that the OHC has met a certain minimum standard of training which is important for the OHC's to fulfill their duties in a hearing conservation program.
AO/BECK: What is the minimum educational requirement for the OHC?
WEBER: There is no minimum educational requirement i.e., the OHC does not need a college diploma or some other health related degree. The OHC, however, may be an audiologist, nurse, engineer, physician, etc., and CAOHC's statistics indicate that over 50% of currently certified OHC's are RNs. The OHC is on the 'front line' and they make sure the OSHA requirements are met and that the audiologic screenings are done in accordance with the rules and regs. CAOHC certification requires that the OHC take a 20 hour CAOHC approved course and pass the examination given by the CD. They must also take an 8 hour refresher course every 5 years.
AO/BECK: What about minimum requirements for the CDs?
WEBER: Applicants, who can be physicians, occupational nurses, audiologists, engineers and others, must demonstrate an appropriate credential/license issued by their organization (such as - Certified in Clinical Competency-Audiology or CCC-A earned through ASHA). In addition they must have worked in the field of hearing conservation for at least 1000 hours in the past 5 years. The Course Director is then awarded certification by CAOHC after completion of a one day workshop insuring their successful training of OHCs and fulfillment of CAOHC regulations.
AO/BECK: How many OHC's and CDs are there?
WEBER: There are about 22,500 certified OHC's, and about 375 CDs.
AO/BECK: Who are the primary employers of OHC's?
WEBER: Mostly you'll find the OHCs in mining, manufacturing and heavy industry and any other employment situation where the employer must abide by OSHA noise regulations.
AO/BECK: What are the day-to-day responsibilities of the OHC?
WEBER: The OHC's do the audiometric testing and they usually help fit the hearing protection devices (HPDs) to the employees. They also help educate the employees on the proper ways to use HPDs. If the OHC finds a standard threshold shift (STS) in the audiometric testing, they refer the employee to the professional supervisor (a physician or audiologist) who manages the audiometric portion of the HCP, and they notify the patient of this shift.
AO/BECK: Speaking of standard threshold shifts, I find that patients will complain that although they get annual tests, they had no idea they had hearing loss because nobody told them anything. In other words, the OHCs are looking for STSs, but the patients sometimes assume they are looking for hearing loss. So in essence, if the patient has a moderate or severe loss, and it's stable over years, the patient/employee gets the message 'you passed', even though they may have significant hearing loss.
WEBER: That can be a real problem and that's a flaw in the OSHA regs. We've run into that, too. Probably the best way around that is education. The employees also need to better understand what the purpose of the test is and to ask questions about it.
AO/BECK: Do the OHCs make sound measurements using a sound level meter?
WEBER: That would depend on their employer but usually not. This training is not mandatory for CAOHC certification.
AO/BECK: Do the OHCs look into the ear, or do they strictly test?
WEBER: Depending on their training they may look into the ear. The OHC is familiarized on how an ear examination is conducted, but they are not trained to diagnose any pathology.
AO/BECK: Do you envision any changes in the OHC roles and responsibilities?
WEBER: No, not at this time. To expand their roles, many OHCs would need more education and the needs of the worker is currently served by other health care programs. The next area of focus for CAOHC is the standardization of our testing protocols so that every OHC takes a standardized exam at the completion of their 20 hour course.
AO/BECK: Very good Dr. Weber, thanks for your time this evening. If the readers want to get more information, or if they want to obtain the OHC or the CD status, how can they find out more about it?
WEBER: They can call CAOHC at 414-276-5338 Fax at 414-276-3349 or access our web site at www.caohc.org. My phone is 843-792-7156 and my email is weberp@musc.edu.
