Audiogram notches in noise-exposed workers

Objectives: Diagnostic criteria for noise-induced hearing loss include the audiometric notch, yet no standardized definition exists. This study tested whether objective notch metrics could match the clinical judgments of an expert panel. Design: A panel of occupational physicians, otolaryngologists, and audiologists reviewed audiograms of noise-exposed workers. In a two-sample process, the panel judged whether a notch was present and whether hearing loss had progressed in a notch pattern. Quantitative notch metrics were compared against expert decisions. Results: At least five of six experts agreed about notch identification in 71 and 72% of the cases in the two samples, and agreement about notch progression was 61 and 67%. Notch depth and professional specialty appeared to affect notch judgments. Despite this variability, a notch metric showed excellent agreement with expert notch consensus in each sample (94.7 and 96.6%; kappa = 0.88 and 0.92). Conclusions: Audiogram notch metrics can agree with expert clinical consensus and assist in the surveillance of noise-exposed workers.