This article is general information, not medical or legal advice.
Noise-induced hearing loss, often shortened to NIHL, is hearing damage caused by exposure to loud noise, usually over a long period at work. Claims for it are a common type of industrial disease claim, and they depend heavily on the medical evidence. This article describes what a noise-induced hearing loss medical report typically covers, and what records the solicitor usually gathers. It describes the evidence, not how to diagnose: the diagnosis and the opinion are always the independent expert’s.
Who writes the report
Reports in hearing loss claims are usually written by ENT (ear, nose and throat) surgeons or audiovestibular physicians, who specialise in hearing and balance. The expert takes a history, examines the claimant’s ears, arranges or reviews hearing tests, reads the records and then gives an opinion on the questions in the letter of instruction. As with any medico-legal report, the expert’s duty is to the court, not to the side that instructs them.
Noise exposure history
The expert needs a clear picture of the claimant’s exposure to noise. A report typically records:
- each job where the claimant says they were exposed to noise, with dates and employers;
- the kind of work, the machinery or tools used, and how close the claimant was to them;
- how loud the workplace was, for example whether people had to shout to be heard;
- whether hearing protection was offered, what kind, and whether it was worn;
- noise outside work, such as shooting, motorsport, music or military service.
The expert may also be given noise surveys or engineering evidence. Where there is a separate noise engineer, the medical expert usually comments on the hearing loss itself and leaves the measurement of noise levels to the engineer.
Audiometry and its reliability
Audiometry is a hearing test that measures the quietest sounds a person can hear at different pitches (frequencies). The results are plotted on a chart called an audiogram. The report usually describes when and how the tests were done, by whom, in what conditions and with what equipment, because all of these affect how much weight the results can bear.
An expert will typically comment on whether the results are reliable. That can include whether repeated tests agree with each other, and whether other tests were used to check the consistency of the responses. Where the results are not consistent, the expert may say so and explain what that means for their opinion. The report should identify who carried out each test and their qualifications, as the court rules require.
Published guidelines
Experts in this field often refer to published medico-legal guidelines. The most widely cited are the guidelines by Coles, Lutman and Buffin, published in Clinical Otolaryngology in 2000, on the diagnosis of noise-induced hearing loss for medico-legal purposes. In broad terms, they look at whether there is hearing loss at the higher frequencies, whether there was potentially harmful noise exposure, and whether the audiogram shows the pattern typically associated with noise damage. Lutman, Coles and Buffin later published guidelines, in the same journal in 2016, on quantifying noise-induced hearing loss: that is, estimating how much of the loss is due to noise.
Other approaches have also been published, and the choice of guidelines can be a point of disagreement between experts. Under the court rules, where there is a range of opinion, the report should summarise it and explain the reasons for the expert’s own view. The report should also list the published material the expert relied on.
Other causes of hearing loss
Hearing usually declines with age, and other conditions can also cause hearing loss. A report typically considers whether age-related hearing loss, family history, past ear infections or surgery, head injury, certain medicines or other illnesses could explain some or all of the loss. The expert then gives an opinion on how much, if any, is due to noise. This matters because the claim can only be for the part of the loss that the noise caused.
Tinnitus
Tinnitus is hearing sounds, such as ringing or buzzing, that have no outside source. Many claims include it. The report usually records when the tinnitus started, how often it happens, how it affects sleep, concentration and daily life, and whether it was mentioned in the records before the claim. The expert gives an opinion on whether it is related to the noise exposure and how it affects the claimant.
Prognosis and hearing aids
Prognosis means the likely outlook. A report typically covers whether the hearing loss is likely to get worse, how much of any future decline would be due to age rather than noise, and what difference the loss makes to the claimant’s life, such as following conversation or using the telephone. The expert may also say whether hearing aids or other help would be of benefit, and for how long, which can be relevant to the claim for future costs.
Military hearing loss claims
Serving and former members of the armed forces may bring claims for hearing loss from noise in service, such as gunfire, explosions, aircraft and vehicles. The medical evidence in military hearing loss claims covers the same ground, but the noise history and records are different. Service medical records usually include regular hearing tests and hearing grades, and the expert may need to compare results across many years of service. Experts may also discuss whether guidelines designed for steady workplace noise fit loud, sudden noise such as weapons fire. For more, see our page on military claims reports.
What records the solicitor gathers
The expert’s report can only be as good as the records behind it. Solicitors usually gather:
- the claimant’s full GP records, which show any earlier mention of hearing problems or tinnitus;
- hospital and audiology records, including earlier hearing tests;
- occupational health records and any hearing tests from employers;
- an employment history, such as HMRC records, to confirm jobs and dates;
- service medical records in military claims;
- any noise surveys or engineering evidence already available.
Missing records are a common cause of delay and of addendum reports later on, so it helps to send as much as possible with the instruction.
How Probita handles hearing loss reports
Probita arranges noise-induced hearing loss medical reports from independent experts. When you instruct us, we check that the documents the claim type needs are there and tell you straight away if anything is missing. The expert receives the records sorted, paginated and indexed, with a chronology and summary they check against the records themselves, and the opinion is always theirs. Every report is checked against its claim type’s checklist before release. Find out more about instructing Probita as a law firm.