title: Audiogram notches in noise-exposed workers.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Yale Occupational and Environmental Medicine Program, Yale University School of Medicine, 135 College Street, Suite 392, New Haven, CT 06510, USA. Peter.Rabinowitz@yale.edu
authors.forename: Peter M
authors.initials: PM
authors.lastname: Rabinowitz
authors.forename: Deron
authors.initials: D
authors.lastname: Galusha
authors.forename: Martin D
authors.initials: MD
authors.lastname: Slade
authors.forename: Christine
authors.initials: C
authors.lastname: Dixon-Ernst
authors.forename: Kanta D
authors.initials: KD
authors.lastname: Sircar
authors.forename: Robert A
authors.initials: RA
authors.lastname: Dobie
mesh_terms: D000328:Adult; D001301:Audiometry, Pure-Tone; D001309:Auditory Threshold / Q000502:physiology*; D016009:Chi-Square Distribution; D006317:Hearing Loss, Noise-Induced / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008875:Middle Aged; D009623:Noise, Occupational / Q000009:adverse effects*; D015588:Observer Variation; D009784:Occupational Diseases / Q000175:diagnosis* / Q000503:physiopathology; D012189:Retrospective Studies; D013997:Time Factors