Guidelines on the diagnosis of noise-induced hearing loss for medicolegal purposes

TLDR

These guidelines aim to assist in diagnosing noise‑induced hearing loss in medicolegal contexts. The guidelines establish a legal criterion of “more probable than not”, require measurable audiogram changes, and specify three core requirements—high‑frequency impairment, hazardous exposure, and an audiometric notch—alongside four modifying factors: clinical picture, age/noise compatibility, alternative causation, and complications.

Abstract

These guidelines aim to assist in the diagnosis of noise-induced hearing loss (NIHL) in medicolegal settings. The task is to distinguish between possibility and probability, the legal criterion being 'more probable than not'. It is argued that the amount of NIHL needed to qualify for that diagnosis is that which is reliably measurable and identifiable on the audiogram. The three main requirements for the diagnosis of NIHL are defined: R1, high-frequency hearing impairment; R2, potentially hazardous amount of noise exposure; R3, identifiable high-frequency audiometric notch or bulge. Four modifying factors also need consideration: MF1, the clinical picture; MF2, compatibility with age and noise exposure; MF3, Robinson's criteria for other causation; MF4, complications such as asymmetry, mixed disorder and conductive hearing impairment.