Audiometric testing for a worker with a cochlear implant

June 11, 2025

Ms. Stefanie Corbitt

SSI OSHA Company

[Recipient address omitted]

Dear Ms. Corbitt:

Thank you for your inquiry to the Occupational Safety and Health Administration's (OSHA) Directorate of Enforcement Programs. You requested information regarding OSHA's Occupational Noise Exposure standard (Noise standard), 29 CFR § 1910.95. Your question specifically relates to the use of cochlear implants when an employee undergoes audiometric testing (audiogram). This letter constitutes OSHA's interpretation only of the requirements discussed and may not be applicable to any questions not delineated within your original correspondence. Your scenario and specific question are paraphrased below, followed by OSHA's response.

Background: In your correspondence, you state that a recently hired employee uses a cochlear implant (CI). The work site has a hearing conservation program which includes the new employee. You seek clarification whether the requirements for annual audiometric testing for this new employee are the same as for a person without limited hearing (i.e., can the employee wear the CI during audiometric testing?).

CIs are small electronic devices that help to provide a sense of hearing to severely deaf or hard-of-hearing individuals and are designed to replicate the function of a healthy inner ear. Unlike hearing aids, which amplify sound, a CI bypasses damaged portions of the ear to deliver sound signals to the auditory nerve. The CI uses a sound processor, that fits behind the ear, to send sound signals to electrodes surgically implanted in the inner ear (cochlea).

Your correspondence also included a copy of an August 3, 2004, OSHA letter of interpretation to Ms. Tekla A. Staley, Staley 2004, that stated employees exposed to noise above permissible levels should leave their hearing aids on and wear ear muffs to reduce the sound to permissible levels of exposure in the workplace.1 However, that letter did not address audiometric testing of individuals with hearing aids but only their wearing of hearing protection in the workplace. Additionally, you stated in your correspondence that the sound processor for a CI is attached to the individual's skull and cannot be covered with ear muffs.

Question: When conducting audiometric testing, should the employee be using their implanted cochlear device?

Response: No. OSHA's noise standard at 29 CFR §1910.95(g)(1), requires an employer to offer audiometric testing to employees exposed to noise exceeding 85 decibels (dBA), 8-hour time-weighted average, the action limit. The OSHA audiometric testing requirements in 29 CFR 1910.95 do not include a specific exception for hearing-impaired employees that use CIs. We note that CIs were not approved for use in the United States by the Food and Drug Administration (FDA) until 1994, which was long after OSHA promulgated the audiometric testing requirements in the current noise standard. Also, please be aware that in some cases, hearing tests for persons with a CI may be different than those with acoustic hearing.2

The OSHA noise standard requires certain functions of the audiometric testing program be performed by a licensed or certified audiologist, otolaryngologist, or other physician. For example, these professionals are responsible for reviewing the validity of audiograms, making determinations as to whether a hearing loss is work-related, and determining the need to refer employees for further audiological evaluation. In addition, the standard allows these professionals to determine the need for employee referral when problems of a medical nature are suspected. See, the preamble to OSHA's March 8, 1983, final rule, Occupational Noise Exposure; Hearing Conservation Amendment, 48 Federal Register 9738 at 9758. Accordingly, in order to obtain a valid audiogram or medical evaluation for an employee using a CI, the noise standard allows the professional to send the employee to a physician or audiological clinic in the community where more sophisticated testing equipment is available. See, the preamble to OSHA's January 16, 1981, final rule, Occupational Noise Exposure; Hearing Conservation Amendment, 46 Federal Register 4078 at 4141-42.

In response to your specific question, the individual performing the testing should ensure that the CI is turned off before any type of audiometric test begins as leaving the device turned on will prevent the accurate measurement of the employee's natural hearing thresholds. Employees with cochlear implants should leave their device turned on during the audiometric test instructions and then turn the device off after the instructions have been given. For purposes of the noise standard, OSHA would not consider an audiogram to be valid if the CI is left on during the test. Also, note that section 1910.95(g)(7)(iii) provides for further evaluation if the audiogram is not valid.

Finally, regarding the use of hearing protection, workplace exposure to noise above the OSHA permissible exposure limit could cause further hearing loss of any residual hearing to a person who uses a CI. A qualified occupational hearing professional should be consulted to recommend appropriate hearing protection such as may be specifically designed for persons with a CI or assess whether the employee's inability to wear hearing protection with the CI processor would cause additional hearing loss.

Thank you for your interest in occupational safety and health. I hope you find this information helpful. OSHA's requirements are set by statute, standards, and regulations. Letters of interpretation do not create new or additional requirements but rather explain these requirements and how they apply to particular circumstances. This letter constitutes OSHA's interpretation of the requirements discussed. From time to time, letters are affected when the agency updates a standard, a legal decision impacts a standard, or changes in technology affect the interpretation.

To ensure that you are using the correct information and guidance, please consult OSHA's website at www.osha.gov. If you have further questions, please feel free to contact the Office of Health Enforcement at (202) 693-2190.

Sincerely,

Erin P. Gilmore, Acting Director

Directorate of Enforcement Programs

1 See https://www.osha.gov/laws-regs/standardinterpretations/2004-08-03-0.

2 https://www.nationalacademies.org/our-work/evaluating-hearing-loss-for-individuals-with-cochlear-implants