Otologic referral criteria.

Otologic referral is an important component of an industrial hearing conservation program. Recent federal regulations in this area are reviewed, and suggestions for implementation of otologic referral are made. Criteria for otologic referral must be distinguished from a definition of significant threshold shift for internal program action. Test-retest variability is higher in industrial than in clinical settings, and unduly stringent definitions of significant threshold shift will result in many spuriously identified cases. The American Council of Otolaryngology--Head and Neck Surgery has proposed criteria for otologic referral that are probably the best available guidelines. Referrals should be made on the basis of both baseline and periodic audiometry. Most workers referred for substantial audiometric abnormalities have otologic diagnoses other than noise-induced hearing loss, or require specific intervention, or both.