Medicolegal decision making in noise-induced hearing loss-related tinnitus.
In some patients with occupational noise-induced hearing loss, a significant aspect of the handicap concerns the concomitant tinnitus; thus, this disorder must be considered in evaluating a disability percentage in the insurance context. The main difficulty comes from the lack of objective measures for tinnitus. To reach a maximum of medicolegal objectivity, a system was developed within the Belgian Institute of Occupational Disorders (Brussels) in the form of a four-level decision structure, after exhaustive but noninvasive assessment of patients. An aggregate of multiple-choice responses (affirmative, neutral, negative) to elementary questions leads to a decision of the next level, which in turn determines--together with the other decisions at the same level--the conclusion at a still higher level. A positive outcome on all four level-3 questions is required for recognition of noise-induced hearing loss-related tinnitus as an occupational disorder and for financial compensation (final decision, level 4). We assessed 10 exemplary files on which this system was applied by four experts rating independently. A variant of Cohen's Kappa for multiple raters demonstrated high interrater consistency at the first level. In all cases, the decisions at levels 3 and 4 were identical. In this way, the final medicolegal decision relies on standardized criteria and becomes perfectly transparent.
Dejonckere
Philippe H
PH
Institute of Phoniatrics, Utrecht University Medical Center, the Netherlands. ph.deJonckere@kmb.azu.nl
Lebacq
Jean
J
D003657:Decision Making; D004185:Disability Evaluation; D006317:Hearing Loss, Noise-Induced / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D015588:Observer Variation; D009784:Occupational Diseases / Q000175:diagnosis* / Q000209:etiology; D015203:Reproducibility of Results; D014012:Tinnitus / Q000175:diagnosis* / Q000209:etiology