Hearing Loss Prevention Training

Hearing Loss Prevention Training KitIntroduction and Background for TrainerExample Scripts- Scenario 1: Hearing loss prevention table display- Scenario 2: Hearing loss prevention for elementary-aged youth- Scenario 3: Hearing loss prevention curriculum for middle school youth- Scenario 4: Hearing loss simulatorKit Contents and Additional Materials NeededFrequently Asked Questions with AnswersPresentation Checklist and Order Formgpcah.org1

IntroductionThe Hearing Loss Prevention outreach kit was developed to help you present information that will guidefarmers and youth on:1) Why farmers should be concerned about noise-induced hearing loss (NIHL),2) Which activities/environments involve hazardous noise exposures, and3) What farmers can do to reduce noise exposure on the farm and/or prevent NIHL.This kit was developed using findings from decades of research (see references), outreach materialscreated by the Great Plains Center for Agricultural Health (GPCAH) staff, and items created by otherorganizations dedicated to hearing loss prevention.The following “train-the-trainer” introduction will help presenters understand what farmers can do todecrease their chances of experiencing noise-induced hearing loss and tinnitus.Background Information for TrainerNoise-induced hearing loss results from damage to hair cells (cilia) in the inner ear. This type of hearingloss is usually caused by exposure to excessively loud sounds and cannot be medically or surgicallycorrected. Noise-induced hearing loss usually results from repeated exposure to loud sounds over a longperiod of time, but damage can also happen after a one-time exposure to a very loud sound (likefireworks or a gunshot).A substantial proportion of Americans working in agriculture, forestry, fishing, and hunting are estimatedto have hearing loss, although the reports of the actual prevalence ranges from 17% to 72% (Thelin et al.1983, Beckett et al. 2000). Long-term exposures to loud sounds throughout one’s working life can causenot only hearing loss and tinnitus (ringing in the ears that does not go away), but may also lead to highblood pressure, heart disease, stroke, heart attacks, reduced cognitive abilities, personal injury, anxiety,stress, depression, learning difficulties, and sleep disorders (Basner et al. 2014, Münzel et al. 2014).Strategies to reduce the risk of developing hearing loss from workplace noise include reducing how longsomeone works in loud environments, reducing sound levels by maintaining equipment or enclosingcritical noise sources, and, most commonly, wearing hearing protection devices (HPDs). In the Midwest,72% of farm workers never or rarely use hearing protection (Carpenter et al. 2002). They use HPDs inhigh-noise environments only 29% of the time (McCullagh et al. 2016). Only 29% of young farm workersuse hearing protection, even while 61% report ringing in the ears (Reed et al. 2006).Knowing where sounds are loud and what to do to protect your hearing while engaging in tasks with loudexposures are both necessary to identify where preventive methods might work. Many motivatedfarmers receive classroom training on hearing protection (Kearney et al. 2015), but such classes have noteffectively changed behavior (DeRoo and Rautiainen 2000). Consequently, knowledge gaps on hazardrecognition and appropriate response persist (Cramer et al. 2016). The availability of HPDs close to highnoise areas has been associated with increased HPD use among farm workers (McCullagh et al. 2016);therefore, ensuring that farmers know what areas are “loud” and how to select and use hearingprotection correctly is still necessary to help farmers make the healthy choice.gpcah.org2

Areas/activities that are associated with high noise levels include: Livestock buildings (especially pigs)MowersATVsPressure washersLeaf blowersTractors/other large equipment Power tools/shopGrain dryersConcertsFireworksGunshotsStock car races/tractor pullsHearing Protection Devices (HPDs) protect your ears by reducing the force of the sound waves reaching the innerear. The best HPD for you is one that fits well and that you will consistently wear in high-noise environments.There are 3 main types of HPD: Formable ear plugs – made of soft foam that must be rolled down to be inserted, then expands toblock the ear canal Push-in ear plugs EarmuffsIn 2015, GPCAH staff surveyed 699 farmers from Midwestern states about their HPD use. We found that 52% ofMidwestern farmers surveyed reported symptoms of noise induced hearing loss, and 33% reported regularlyexperiencing tinnitus (ringing in the ears). Barriers to HPD use included inconvenience, not having them whenneeded, uncertainty about when or how to use them, discomfort when wearing, short-duration task, andconcerns about interference with useful sound. Facilitators for use included very loud noise or pain experienced,HPD clearly visible when going out for the day, recognizing that a task required hearing protection, remindersfrom a coworker or family member, accessible when needed, required by employers, and a general increasedawareness about hearing loss and how to prevent it.Training ScenariosWe have developed four training scenarios on the topic of hearing loss prevention. The objective ofeach scenario is to inform farmers and their families about how to protect their hearing while workingon the farm. For each scenario, we have listed the intended audience and the materials needed. Linksare provided in the materials list when available. Advice on how to engage your audience, topics fordiscussion, and other pertinent details follow.Scenario 1: Hearing Loss Prevention Table DisplayIntended audience: Farmers, farm family membersMaterials/activities used (links provided in kit contents below): 3-panel displayHearing loss prevention handouts3M Roll Model device with practice plugsEar plugs to hand outEngagement: The center panel of this display is usually what draws farmers to engage – they see the damagedcorn field and come to look closer at it.gpcah.org3

Ask: Do you know anyone with hearing loss?Follow-up: Have you ever had ringing in your ears? Have things sounded muffled after you’ve beenaround loud noise for a while?Discussion: Depending on their answers and interest, you can discuss the topics below. Before the personleaves, give them a pair ear plugs (if you have multiple styles, let them choose which type to take with them) How hearing loss affects daily life (left panel)o difficulty hearing when there is background noiseo need to increase volume on radio or television louder than otherso lose the ability to hear certain sounds in speecho constant ringing in the ears (tinnitus) Areas/activities on the farm that are high-noise and require hearing protection (right panel)o ATVso Mowerso Livestocko Large farm equipmento Machinery, power toolso Leaf blowers, chainsawso Gunshots Prevention:o Limit time in loud environments when you cano Wear hearing protection when you must be in loud environments for longer than is safeo How to choose hearing protection Discuss types of HPD Store preferred HPD in areas of the farm where you will need it – or – store it in thevehicle you drive; the most important thing is to have it where you need it.o Emphasize that the best hearing protection is the one that fits you well and that you willwear consistently when neededCommented [PJJ1]: Sorry, my edits have messed up yourphoto placement. Example of a table display at the 2019 National FFA Conventiongpcah.org1

Scenario 2: Hearing Loss Prevention (HLP) for Elementary YouthIntended audience: Elementary-aged youth in classroom or at an Agricultural Safety Day eventTime required: 15-20 minutesCommented [PJJ2]: Overlapped text hereMaterials/activities used: Youth HLP presentation (with suggested script, if desired) Youth Hair cell model activity (uses 5-6 pipe cleaners per youth) Practice plugs 3M Roll Model device (optional) Youth HLP handout (optional) Ear plugs (one pair per youth) (optional) Youth HLP follow-up exercise worksheet (one per youth – optional) Youth HLP Bookmark (one per youth – optional)This is a short class with fun slides, a suggested script, embedded video, and activities to reinforce concepts.If take-home bags are provided to youth attending the event, good contributions include: Youth HLP handoutwith a pair of ear plugs the Youth HLP follow-up exercise and/or Youth HLP bookmark.Scenario 3: Script and Activities for Middle School YouthIntended audience: Middle school youth in the classroom, 4-H/FFA groupsTime required: 35-40 minutesMaterials/activities used:o Middle school HLP presentation (with suggested script, if desired)o Middle school HLP activity sheets and supplies for chosen activity(ies)o Cup & String Telephone – 2 cups, 10 ft string, scissors, pencilo Hair Cell Models – marshmallows, angel hair pasta (alternative: use Youth Hair cell model activityinstead, if clean-up is a concern – requires 5-6 pipe cleaners per student)o Sound Scavenger Hunt – personal electronic device, Decibel X app (free download), pencilThis is a short class with suggested script, embedded video, and 3 optional activities to reinforce concepts. Eachactivity has facilitator instructions followed by the student worksheet.Scenario 4: Hearing Loss SimulatorIntended audience: Adults and older youth, employeesMaterials/activities used: NIOSH HLSim hearing loss simulator (free to download - installed on eet1820.html Noise-cancelling headphones (optional – use if in area with a lot of background noise) Video containing background information and demo of the software (coming soon) HLSim Handout (Quick start guide) HLSim Activity sheet (optional) Sound files (farm related): ings/gpcah.org2

Young farmers have told us that experiencing what it would be like to live with noise-induced hearing loss maymotivate them to use hearing protection more often. NIOSH has created a hearing loss simulator (HLSim) thatallows them to do just that. The 10-minute video created by GPCAH will help you learn to use the key featuresof HLSim and provide background information and hearing loss prevention tips. You can also add any of thefarm-related sound files (linked above) to the simulator. Our quick reference handout explains how to do thistransfer.HLSim can be used on its own in employee training, and it also makes a great addition to a table display at anevent where you have space and electricity available.Kit Contents and Additional Materials NeededAll resources used in training scenarios (shown below) are found 2/topics/hearing-loss-prevention/.HandoutTwo-sided cards, 4x9”BookmarkTwo-sided bookmark, 2x6” (lamination recommended)gpcah.org3

PostersSingle-sided 11x17” posters (English and Spanish)Display for Hearing Loss Prevention (Scenario 1)Three 24x36” single-sided panelsInteractive Activities & Teaching toolsHLSim HandoutHLSim ActivitiesMiddle School HLP PresentationMiddle School HLP ScriptMiddle School HLP Activitiesgpcah.org4

Youth HLP PresentationYouth HLP ScriptYouth Hair Cell Model ActivityYouth HLP Follow-up ExerciseAudio/Visual (links)How to insert formable earplugs: LINKRoll Model Activity: (coming soon)How to conduct the hair cell activity: LINKNIOSH Hearing loss simulator demonstration: (coming soon)Additional external resourcesIt’s a Noisy Planet. Protect Their Hearing: Decibels program: Roll model: US/p/d/v100795051/gpcah.org5

Frequently Asked QuestionsQ: I already have NIHL. Do I still need to wear hearing protection in loud environments? Or “It’s too late forme.”A: It is never too late to protect the hearing you have! Yes, you should wear hearing protection every time youare going to be in environments that are loud ( 85 decibels) for longer than is safe for your ears (see “howloud is too loud”).Q: Can I just turn my hearing aids off instead of using ear plugs or earmuffs?A: No, turning off your hearing aids will not protect your ears from loud noises. You may not be able to hearthe sound, but your ears are still being damaged. While hearing aids do go into your ears, they will not blockloud noises like hearing protection devices (HPDs) do. Instead, protect your ears by wearing earmuffs (withor without your hearing aids), or take your hearing aids off and use earplugs when you are in loudenvironments.Q: How can I tell if I have the earplugs in correctly?A: When earplugs are correctly seated in your ear canal, you will feel a seal form. There should only be a smallamount of the earplug visible from the outside. If you can see a large portion of the earplug sticking out ofyour ear, there is not enough in the canal to block loud noises.Q: How will I hear problems with machinery/livestock if I am wearing hearing protection?A: HPDs reduce the noise, not silence it completely. You can still hear the sounds around you, but at a saferlevel. Noise-induced hearing loss will cause greater problems with hearing the things you want to hear in thefuture if you do not protect your hearing in loud environments now.Q: Earplugs don’t work for me – why should I wear them?A: If your earplugs are the right size and properly inserted, they will work. If you are using formable (foam)earplugs, be sure you are rolling them as small as you can before inserting them into your ears. Reachingover your head and pulling up and back on your ear before placing them will also make it easier to get theearplugs inserted correctly.Q: Can I just use my noise-cancelling headphones for hearing protection?A: That might work for some consistent background noises, but noise-canceling headphones would probablyprovide only a modest amount of protection. They can not protect your ears from abrupt changes to thesound environment. Additionally, many people end up increasing music volume to compensate for thesound that noise canceling headphones do not block, which can also lead to hearing damage.Q: What hearing protection should I get for my kids?A: We recommend earmuffs for children under the age of 10. Young children have very small ear canals androlling formable earplugs small enough to fit them is difficult. This results in poorly fitted earplugs, whichgives a false sense of protection. Older youth can wear earplugs, but they will need repeated training onhow to insert them correctly.gpcah.org6

Publications and websites with more details: Basner, M., W. Babisch, A. Davis, M. Brink, C. Clark, S. Janssen and S. Stansfeld (2014)."Auditory and nonauditory effects of noise on health." The Lancet 383(9925): 1325-1332.Beckett, W. S., D. Chamberlain, E. Hallman, J. May, S.-A. Hwang, M. Gomez, S. Eberly, C. Coxand A. Stark (2000). "Hearing conservation for farmers: source apportionment of occupationaland environmental factors contributing to hearing loss." Journal of Occupational andEnvironmental Medicine 42(8): 806-813.Carpenter, W. S., B. C. Lee, P. D. Gunderson and D. T. Stueland (2002). "Assessment ofpersonal protective equipment use among Midwestern farmers." American Journal of IndustrialMedicine 42(3): 236-247.Cramer, M. E., M. J. Wendl, H. Sayles, E. Duysen and C. Achutan (2016). "Knowledge,Attitudes, and Practices for Respiratory and Hearing Health among Midwestern Farmers."Public Health Nursing. 34(4):348-358.DeRoo, L. A. and R. H. Rautiainen (2000). "A systematic review of farm safety interventions."American Journal of Preventive Medicine 18(4): 51-62.Kearney, G. D., X. Xu, J. A. G. Balanay, D. L. Allen and A. P. Rafferty (2015). "Assessment ofpersonal protective equipment use among farmers in eastern North Carolina: a cross-sectionalstudy." Journal of Agromedicine 20(1): 43-54.McCullagh, M. C., T. Banerjee, M. A. Cohen and J. J. Yang (2016). "Effects of interventions onuse of hearing protectors among farm operators: A randomized controlled trial." InternationalJournal of Audiology 55(sup1): S3-S12.Münzel, T., T. Gori, W. Babisch and M. Basner (2014). "Cardiovascular effects of environmentalnoise exposure." European Heart Journal 35(13): 829-836.Reed, D. B., S. R. Browning, S. C. Westneat and P. S. Kidd (2006). "Personal protectiveequipment use and safety behaviors among farm adolescents: gender differences andpredictors of work practices." The Journal of Rural Health 22(4): 314-320.Leonard S. and F.Gerr. Hearing protection never too early or too late, Iowa Farmer Today, February2015.Sprince N, Park H, Zwerling C, Lynch C, Whitten P, Thu K, Burmeister L, Gillette P, Alavanja, M(2003). Risk factors for animal-related injury among Iowa large-livestock farmers: a case-controlstudy nested in the Agricultural Health Study. Journal of Rural Health. 19(2): 165-73. [PMID:12696853]Thelin, J., D. Joseph, W. Davis, D. Baker and M. Hosokawa (1983). "High-frequency hearingloss in male farmers of Missouri." Public Health Reports 98(3): 268-73.CDC Noise-induced hearing loss: loss/default.htmlCDC Hearing loss in children: IOSH Occupational Hearing loss prevention: lgpcah.org7

Presentation Checklist and Order FormMAKE YOUR OWN KITScenario 1:o 3-panel displayo Handoutso Roll model with practice plugso Ear plugs to hand outScenario 2:o Youth HLP presentation with scripto Youth Hair cell model activity (uses 5-6 pipe cleaners per youth)o Practice plugso Roll model (optional)o Youth HLP handouto ear plugs (one pair per youth)o Youth HLP follow-up exercise worksheet (one per youth – optional)o Bookmark (one per youth – optional)Scenario 3:o Middle school HLP presentation with scripto Middle school HLP activity sheets and supplies for chosen activity(ies)o Cup & String Telephone – 2 cups, 10 ft string, scissors, pencilo Hair Cell Models – marshmallows, angel hair pasta (alternative: use Youth Hair cellmodel activity instead, if clean-up is a concern – requires 5-6 pipe cleaners perstudent)o Sound Scavenger Hunt – personal electronic device, Decibel X app (free download),pencilScenario 4: PC with NIOSH HLSim hearing loss simulator installed Noise-cancelling headphones Video containing background information and demonstration of the software HLSim Handout/Quick start guide HLSim Activity sheet (optional) Sound files (farm related) downloaded and installed.gpcah.org8

ORDER ITEMS FROM GPCAH Handout: Hearing loss among farmerso Older womano Older mano Younger womano EarmuffsHandout: Protect your ears (child)Handout: How to choose HPD (English / Spanish)Poster: What do I have to lose? (English / Spanish)Poster: How loud is too loud? (English / Spanish)Display: 3 panels# needed# needed# needed# needed# needed# needed /# needed /# needed /# neededName:Institution:Mailing Address:Please fill out this order form, copy it, and paste it into an email to [email protected], you may call Marsha at (319) 335-6871. Thank you.gpcah.org9

- Scenario 1: Hearing loss prevention table display - Scenario 2: Hearing loss prevention for elementary-aged youth - Scenario 3: Hearing loss prevention curriculum for middle school youth - Scenario 4: Hearing loss simulator Kit Contents and Additional