Apr 29, 2025 12:48:01 PM

How Ear, Nose and Throat Specialists and Their Teams Detect Hearing Loss: Investigations, Tests, and Workers’ Compensation Thresholds in Australia

3:20

Have you ever wondered how hearing loss impairment is determined in Australia?

Hearing loss detection and assessment require a multidisciplinary approach involving ear, nose and throat (ENT) specialists, audiologists, and allied health teams. This process combines clinical evaluations, audiological testing, and jurisdictional thresholds to determine eligibility for workers’ compensation claims. Below, we examine the investigative methods, diagnostic criteria, and state-based compensation frameworks relevant to Australian practitioners.

Clinical Evaluation and Audiological Testing

ENT specialists begin with a physical examination using an otoscope to inspect the ear canal and tympanic membrane for obstructions, infections, or structural abnormalities. Initial free field testing assesses gross hearing ability through whispered or spoken words at varying distances (15–60 cm), offering 70–100 % sensitivity for detecting hearing loss.

If gross hearing loss is detected, further investigations are undertaken using a range of diagnostic tools.

Key Diagnostic Tools

Pure Tone Audiometry (PTA)

What it measures: Air and bone conduction thresholds across frequencies (250–8,000 Hz) to differentiate conductive (CHL) and sensorineural hearing loss (SNHL).
How it works:
- Air conduction evaluates outer/middle ear function.
- Bone conduction bypasses these structures to test inner ear and auditory nerve pathways.
Interpretation: Results are plotted on an audiogram, with normal hearing thresholds ≤ 20 dB HL.

Tympanometry

Assesses middle ear function by measuring tympanic membrane mobility. A “flat” trace (Type B) suggests fluid or ossicular dysfunction, indicative of CHL.

Otoacoustic Emissions (OAEs)

Detects inner ear hair cell function by measuring sound waves generated in response to auditory stimuli. Absent OAEs suggest cochlear damage.

Auditory Brainstem Response (ABR)

Evaluates neural pathways by recording brainwave activity in response to sounds, critical for diagnosing retrocochlear pathologies (e.g., acoustic neuroma).

Speech Discrimination Testing

Determines the ability to understand speech at different volumes, particularly in noisy environments.

Thresholds for Workers’ Compensation Eligibility

Compensation eligibility in Australia varies by state, with criteria based on binaural hearing loss (combined impairment in both ears) or whole person impairment (WPI). Presbycusis (age-related hearing loss) may reduce compensation if deemed contributory.

State-Specific Thresholds

State/Territory	Binaural Loss Threshold	WPI Threshold	Key Legislation/Notes
NSW	20.4 % (post-2002) / 6 % (pre-2002)	11 %	Higher thresholds for non-exempt workers; exempt roles (e.g., police, paramedics) use 6 %.
VIC	10 %	10 %	Lump sum requires ≥ 10 % hearing loss + further deterioration.
QLD	5 %	–	No compensation for first 5 % loss.
WA	10 % (first claim)	–	Subsequent claims require additional 5 % loss.
SA	–	5 %	Lump sum payable for ≥ 5 % WPI.
TAS	5 %	–	Applies to boilermakers’ deafness.
NT	–	5 %	Requires ≥ 5 % WPI.
ACT	6 %	–	Specific to occupational deafness.

Calculation Methods

Binaural Loss

Binaural % is calculated using the formula:

            Binaural %=   (5×Better Ear %) + Worse Ear %
                                      _____________________________
                                                               6

Derived from frequency-specific thresholds (0.5–4 kHz).

WPI Conversion

In NSW, a binaural loss of 20.5–22.7 % corresponds to approximately 11 % WPI, aligning with Table 9.1 of the Workers Compensation Guidelines.

Presbycusis and Occupational Hearing Loss

Presbycusis is a sensorineural loss resulting from cochlear hair cell degeneration, typically affecting high frequencies (2–5 kHz). ENT specialists must differentiate age-related decline from noise-induced loss:

Noise-Induced Loss: Notched audiogram at 3–6 kHz.
Presbycusis: Symmetric, progressive high-frequency loss.

Compensation may be reduced if presbycusis accounts for ≥ 50 % of the impairment.

Compensation Frameworks

NSW: Lump sums range from $27,790 (11 % WPI) to $713,660 (75–100 % WPI). Lifetime hearing aid entitlements apply regardless of impairment level.
Federal (Comcare): Requires ≥ 5 % binaural loss for lump-sum eligibility.
SA: Medical expenses covered irrespective of WPI, but lump sums require ≥ 5 % WPI.

Conclusion

ENT teams employ a stratified diagnostic approach to quantify hearing loss and determine its aetiology. Jurisdictional thresholds and calculation methods ensure compensation aligns with the severity of occupational impairment. Practitioners must consider presbycusis, legislative nuances, and evolving audiometric guidelines when advising clients.

For legal and health professionals, understanding these intersections is critical for advocating in workers’ compensation cases.

If you require further detail on a specific state or wish to discuss the medico-legal implications of hearing loss assessments, please get in touch.