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Total Soundscape Management (TSM) is a comprehensive program of occupational, recreational, and community noise control, hearing conservation and health monitoring, communication, regulatory compliance, and an overarching awareness and education campaign. That is, TSM integrates the activities, responsibilities, and all subject matter presented throughout the “Occupational Soundscapes” series into a holistic multidisciplinary program administered by organizational (i.e. employer) leaders. To realize its full potential, a TSM initiative requires the engagement of all members of an organization, irrespective of their enrollment status in a hearing loss prevention program (HLPP), and the surrounding community. The tenets of TSM must be lived; that is, adherence to its principles pursued in all aspects of life – at work, at play, and at rest. An Integrated Approach Total Soundscape Management (TSM) resembles other “total” management programs, such as Total Quality Management (TQM) or Total Productive Maintenance (TPM), in that a multidisciplinary approach is adopted. This type of program takes a broader view of responsibilities, influences, and outcomes, recognizing that performance improvement on any metric, or the attainment of objectives, can rarely be attributed to a single entity, be it a person, discipline, or department. TSM differs from these programs in that it extends beyond professional responsibilities, encompassing all activities in which one might engage. This presentation of TSM is the result of evolutionary forces that have acted on the “Occupational Soundscapes” series throughout its development. At the outset, noise-induced hearing loss (NIHL) and its prevention in workplaces was the declared focus. However, as the series progressed, topics on the periphery were found to be too intricately linked, and too important, to exclude. Perhaps a new title would be appropriate for a revised edition of the series. For now, the title reflects the centrality of occupational noise to any discussion of hearing health, as it poses the greatest risk to hearing health for a large portion of the population. A Total Soundscape Management program integrates the following components:
Regulatory Compliance Compliance with all regulatory and statutory requirements of the various agencies and jurisdictions to which one might be subject is only the first milestone of a successful TSM program. Detrimental effects of noise can be experienced despite full compliance; legal liability for those detriments, be they individual or community, remains with the generator (i.e. source) of noise and comes at potentially great expense. In the USA, noise-relevant regulations include:
Hearing Loss Prevention Program (HLPP) An effective hearing loss prevention program (HLPP) or hearing conservation program (HCP) involves a variety of disciplines, requiring medical expertise, engineering, and various supervisory and administrative skills. It consists of several essential components, including:
Though listed as a single component of an HLPP, noise control consists of a wide variety of activities, including both physical and behavioral changes (i.e. engineering and administrative controls; see Parts 11, 12, 13, 14). The sound survey map is a critical input to the source-path-receiver (SPR) model (see Part 11). Once a source is identified, research begins on potential sound level reductions that can be achieved by each component of the model. Hearing protection comprises a substantial portion of receiver noise control efforts (see Part 14). Sourcing, evaluating, and ensuring proper use of hearing protection devices (HPDs) are critical components of program success and, thus, warrant significant attention. Encouraging use of HPDs is advisable at the first suspicion that a noise-exposure issue may exist. Ideally, some form of HPD will always be available to protect personnel from occasional exposures due to nonroutine activities and to accommodate those with greater sensitivity. Previous use or familiarity with HPDs may also facilitate a transition to compulsory use when criterion-level exposures have been confirmed (see Part 6). Audiometric testing is often the most conspicuous element of auditory health monitoring, but it is not the entirety. Infections and injuries resulting from HPD use, contamination, etc. must also be treated appropriately when they occur. Motivation and education exhibit a type of reciprocity; each fuels the other. Motivated individuals are more receptive to information and suggestions for improvement. Educated individuals tend to be more enthusiastic about protecting auditory health and improving conditions. Education is typically associated with the “how” of hearing conservation, while motivation is usually derived from the “why.” Recordkeeping is important to both internal participants of a program and to external parties, such as regulatory agencies. Program records are used for compliance, research, and assessments of performance. Internally, documentation of sound survey data, designs of noise control mechanisms and results obtained, equipment calibration history, and similar information relevant to hearing-conservation efforts add value to the program. Audiometric test results must be made available to employees’ general practitioner for use in health assessments; this is usually handled between medical professionals to ensure privacy protection. External reporting may include confirmed occurrences of noise-induced hearing loss (NIHL), verification of compliance with regulations, and similar information. Establishing an HLPP is only the beginning. Program review and modification ensures continued regulatory compliance and program efficacy. All aspects of a program should be evaluated periodically, including frequency of audiometric testing, effectiveness of controls and HPDs, clarity and accessibility of records, content and delivery of educational material, and financial impacts of the program. Ototoxicity and Health Interactions The effects of chemical exposure (i.e. ototoxicity, neurotoxicity) require additional attention when experienced in conjunction with high-intensity noise. Likewise, health conditions, such as cardiovascular disease or diabetes, may be exacerbated by or increase sensitivity to noise. Additional medical expertise is required to evaluate and treat synergistic conditions (see Part 8). Sound as an Ingredient of Wellness Wellness encompasses a number of interrelated and seemingly unrelated influences on one’s life. Extra-auditory effects of noise (see Part 8) can impact one’s physical and mental health in profound ways. This is true during exposure (e.g. annoyance, communication difficulty, stress, sleep disturbance) and after (e.g. hearing loss, tinnitus, depression, cognitive decline). Wellness programs often emphasize diet and exercise, regular checkups, and mindfulness. The short- and long-term effects of noise exposure should be given similar attention, as they are all important, related topics. Exposure to infrasound or ultrasound can cause a stress response; because these frequencies are inaudible, the cause of discomfort may be difficult to diagnose or the source difficult to identify. Fortunately, exposures of sufficient intensity to cause health concerns (infrasound > 120 dB SPL; ultrasound > 105 dB SPL) are rare. Despite their rarity, maintaining awareness of possible infrasound and ultrasound exposures and potential effects ensures a thorough wellness program. After all, these are merely extensions of the audible soundscape. Noise Control Though it has been presented as one of the essential components of an HLPP, noise control deserves a place at the top level of TSM. It is a critical component of soundscape management in any context that can be named, including occupational, community, or recreational noise. Noise control is an umbrella term that encompasses a vast array of techniques, requiring four installments of this series (Parts 11, 12, 13, and 14) to provide an adequate introduction to the subject; the thread continues into a fifth (Part 15). This fact, alone, renders further defense of this position moot. Quiet Product Development and Equipment Procurement One lever of control in an occupational setting is the specification of equipment requirements. Setting limits on noise levels of custom machinery ensures that noise-exposure concerns are addressed in the design phase and verified prior to installation. Specifying acceptable sound levels of standard equipment directs buyers to establish procurement agreements only with suppliers of compliant products. While this may limit the number of potential sources, advantageous terms may be obtainable as a result of consolidated purchasing. Manufacturers of consumer products may find that lower noise emissions improve subjective assessments and increase sales. In the long-term, it can bolster a favorable reputation for the product and company, extending the boost in sales. This places pressure on competitors to reduce sound levels – a scenario in which everyone wins. If competitive pressure sufficiently reduces sound levels of entire product categories, additional regulation may be unnecessary. Should regulations be enacted, prior development efforts reduce the burden of achieving compliance (see Part 12). Communication System Design Communication system design includes the selection of verbal and nonverbal auditory signals and any equipment needed to transmit or receive the signals. Nonverbal signals require specification of tone or spectral composition, intensity, duration, and temporal variation. The significance of each signal must be clear to all personnel to avoid confusion, inappropriate responses, or inaction. Specification of verbal signals can be more complicated. To maximize effectiveness of speech communication in high-intensity noise, a limited vocabulary can be defined. Doing so prevents misidentification of spoken words (i.e. confusion of similar words). Use of high-quality electronic devices can prevent the reduced clarity of speech that may occur with increased vocal effort and the discomfort of vocal strain. Auditory signals may be supplemented with other forms of communication, such as visual signals. When this is done, the various signal types must be compatible to ensure that intended messages are clear. A number of considerations for communication and system design are presented in Part 9 and Part 10 of this series. Community Noise Management It is important to consider community noise (see Part 15) in conjunction with occupational noise. Both require sound level measurements, noise control mechanisms, and continued monitoring. The similarity of tasks simplifies addressing both simultaneously; the need to do so arises from the influence of occupational noise, and efforts to manage it, on surrounding communities. For example, relocating noisy equipment from inside a facility to outside, or to an adjoining structure, may reduce noise exposure for employees while causing community noise to exceed acceptable levels. The two are intricately linked and should be treated accordingly. A summary of effects and corresponding community response when the day-night average sound level (see Part 15) exceeds 55 dBA is provided in Exhibit 1. The effects of a 55-dBA DNL are described in the table, while the graph depicts the increase in community response that occurs as average sound levels rise above 55 dBA. The two vertical scales indicate the difference between annoyance and complaints; many that are annoyed by noise do not openly complain, suggesting that noise concerns are greater than the frequency of complaints reveals.  Personal Soundscape Management Management of one’s personal soundscape involves taking responsibility for all sound-related risks to hearing and well-being that one can control or influence. Perhaps the greatest opportunity to reduce long-term hearing health risk is to actively manage recreational noise. Recreational noise may come from a number of sources, depending on one’s interests and activities, including music, sporting events, gunfire, engines, and various equipment used in pursuit of a hobby. Engaging in these activities by choice causes many to willfully neglect their hearing health and even to dispute use of the term “noise.” Transportation noise poses another potentially significant risk to hearing that, in most cases, can be managed on a personal level without great difficulty. Whether a traveler or a bystander, use of HPDs may be advisable; when possible, distancing oneself from the noise source is usually a better option. Addition of colored noise (see Part 16) to an environment is quintessential personal soundscape management; music may also be used to mask intrusive sounds. Experimentation may be necessary to generate a custom soundscape that does not create new annoyances or risks to hearing or well-being. Awareness and Education Awareness and education are perpetual pursuits, involving all personnel in an organization. While production personnel are usually at highest risk for hearing loss in a factory, others also need to be trained to protect their hearing and to support those at higher risk. Engineers and technicians should be familiar with sound level measurements and noise control techniques. Buyers must understand noise-related specifications to purchase appropriate equipment. Other personnel may be exposed to noise only occasionally, but must be trained in proper HPD use to protect themselves during periods of exposure. Awareness is important to all members of an organization because exposure is not confined to workplaces, though they are the most intuitive sources. Everyone should be familiar with both occupational and nonoccupational sound-related risks and responses, including the unmonitored and unregulated nature of many recreational noise sources. Formal training is only one component of an education program. Hearing conservation should be included in team meetings and other safety discussions. Demonstration of proper HPD use, such as earplug insertion technique, should be part of formal presentations and more-frequent informal refreshers. Those at highest risk for NIHL should receive training with the greatest depth and frequency to combat complacency. The most powerful information is why all of the activities under the TSM umbrella are important. The most compelling facts are often those pertaining to long-term effects of NIHL and detriments to quality-of-life. If information presented is personally relatable, it is more likely to be internalized, recalled, and put into action. However, the obligatory nature of HPD use in some settings must also be made explicit, including the consequences of defying the policy. Various formats of presentation should be developed to accommodate differences in learning styles and levels of comfort with technologies used. The workforce at any site could include members that vary widely in age and background, including native language. Various print, audio, and video formats should be considered to engage a diverse audience effectively. Continuous Improvement All aspects of an organization’s TSM program should be routinely reviewed for effectiveness and opportunity for improvement. This is done at the level of specific measures, such as audiometric testing frequency, enclosure attenuation performance (e.g. degradation over time), selection of HPDs, communication signals, and so on. A thorough review also includes financial analyses, such as comparisons of internal vs. external administration of program elements (e.g. audiometric testing, sound level measurement), program cost projections vs. costs of offsetting noise controls, and so on. At a higher level, a maturity assessment scores the TSM program as a whole. The lowest level of maturity occurs at the initiation of a program, when all elements have not yet been fully implemented; even regulatory compliance may be uncertain. Program maturity increases as the proportion of employees trained increases, and as the level of training rises. Training level definitions are flexible, as roles within organizations differ; examples include awareness (akin to a Six Sigma white belt), sound measurement technician, noise control specialist, and TSM administrator. Other maturity assessment variables include sound level reductions, occurrences of NIHL and workers’ compensation claims, proportion of equipment meeting “buy quiet” standards, community noise complaints, and standardization across sites, among others. Dramatic improvement on every metric at every review cannot be expected, nor should any relevant variable be ignored. Documentation of efforts and results can be used to sustain momentum and support for TSM at all levels of an organization; visibility engenders motivation, while obscurity begets indifference. A metareview should also be conducted to determine if the review process effectively identifies improvement opportunities and drives implementation. Membership and expertise of the review team, meeting frequency, evaluation procedures, etc. should be included in the metareview. A Socio-Ecological Model Sobel and Martin’s Socio-Ecological Model of Hearing Health Promotion (The Noise Manual, 6ed, Chapter 16) consists of several concentric spheres of influence, with the individual at its core. The spheres of the model, depicted in Exhibit 2, represent the influences on one’s beliefs and behaviors. Changes in these beliefs and behaviors are more likely to occur when multiple spheres are simultaneously active.  In the individual sphere, personal experience, knowledge, and attitudes shape our behavior. Knowing someone that has suffered significant hearing loss is a particularly salient experience; the closer the relationship with that person, the stronger its influence is likely to be.
Attitudes and behaviors of the people with whom we interact regularly, such as family, friends, and colleagues, influence our own in the interpersonal sphere. The greater respect, admiration, or deference bestowed upon a person or group, the more influential that person or group is. This type of influence can be especially powerful, as it is often exerted on a subconscious level; behaviors can be emulated without conscious awareness or recognition. A corporate employer is a typical embodiment of the organizational sphere, whether a single-site operation or a conglomerate. A military unit, educational institution, political party, social club, activist group, or any collective also exerts organizational influence. An organization’s influence can be derived from formal, binding means, such as bylaws, or by loosely-defined objectives and guiding principles. An organization’s influence typically becomes salient through the words and deeds of its leaders; if these are inconsistent, the influence on member behavior may not be as intended. The community sphere often refers to a group of people in geographic proximity, such as constituents of a single jurisdiction. However, online communities have become prevalent, effective influencers. Geographically disparate communities can coalesce around an ethnic or religious background, profession, hobby, societal concern, or any shared interest, personal attribute, or activity. The outermost sphere in the model, public policy, is where the legal framework is found. It is comprised of all statutes, regulations, ordinances, and any other names given to requirements established or enforced by a jurisdictional authority. This includes the workplace regulations from OSHA, MSHA, etc., EPA’s product-labeling requirements, and local noise ordinances discussed in previous installments of this series. It is easy to see how a socio-ecological model can be applied to far more than the promotion of hearing health; similar models are, in fact, used widely to support various political and social agendas. Many have discovered that messages received from multiple spheres of influence, when in agreement, are much more effective than those received from a single source, even when that message is compelling. It must also be recognized that influence can guide people to unexpected conclusions when messages, embodied in words or deeds, are inconsistent. The Socio-Ecological Model of Hearing Health Promotion and Total Soundscape Management are complementary constructs. While TSM defines relevant subject areas and related activities, the Socio-Ecological Model provides guidance in the key area of awareness and education, where momentum is built and sustained. Momentum, in the context of TSM efforts, is defined by support, including funding, participation, and outcomes. Stated another way, the Socio-Ecological Model describes how a culture develops; the influence of each sphere can strengthen or weaken a safety culture. Messages must be carefully crafted; actions must be consistent with other forms of communication. Ultimately, individuals’ pursuit of hearing conservation at work and outside the workplace is responsible for creating a domino effect that becomes apparent in other spheres and drives TSM. The importance of culture to the success of an expansive program, such as TSM, cannot be overstated; it is the key reason for inclusion of the Socio-Ecological Model in this discussion. A well-developed safety culture supports all aspects of health and wellness; hearing conservation is only one component, albeit a salient one. An important function of safety culture is to assimilate newcomers rapidly. Doing so maximizes individual and group safety in both short and long terms. For those new to occupational noise, rapid assimilation may be especially important. Individuals are most susceptible to NIHL during the first 5 – 10 years of exposure; there are two key reasons. First, a healthy (i.e. undamaged) auditory system “has the most to lose” in the same way a full bucket is more susceptible to spillage than one that is half-full. Second, a lack of prior experience with noise limits awareness or appreciation of its damaging effects. Sometimes, it is simply a feeling of invulnerability, such as that inherent in youth, that causes exposed individuals to neglect their hearing health until effects are apparent, at which time prevention is no longer an option. Participation of all members of an organization in an HLPP should be encouraged. Promotion of healthy habits throughout an organization generates a type of network effect that influences behavior in positive ways. When optional participation is common, it tends to reduce resistance among those whose participation is compulsory. It also increases the number of information-sharing channels available, strengthening the interpersonal and organizational spheres of influence. For additional guidance or assistance with Safety, Health, and Environmental (SHE) issues, or other Operations challenges, feel free to leave a comment, contact JayWink Solutions, or schedule an appointment. For a directory of “Occupational Soundscapes” volumes on “The Third Degree,” see Part 1: An Introduction to Noise-Induced Hearing Loss (26Jul2023). References [Link] “Information On Levels Of Environmental Noise Requisite To Protect Public Health and Welfare With An Adequate Margin Of Safety.” The U.S. Environmental Protection Agency Office of Noise Abatement and Control; March 1974. [Link] E-A-R Log Series. Elliot H. Berger. Aearo Company; 1980 – 1993. [Link] Noise Control in Industry – A Practical Guide. Nicholas P. Cheremisinoff. Noyes Publications; 1996. [Link] “Preventing Occupational Hearing Loss – A Practical Guide.” John R. Franks, Mark R. Stephenson, and Carol J. Merry, Eds. NIOSH Publication 96-110; June 1996. [Link] “Noise Exposures: Effects on Hearing and Prevention of Noise Induced Hearing Loss.” Sally L. Lusk. American Association of Occupational Health Nurses Journal; August 1997. [Link] “Criteria for a Recommended Standard - Occupational Noise Exposure, Revised Criteria 1998.” Publication No. 98-126, NIOSH, June 1998. [Link] “Hearing Protection.” Laborers-AGC Education and Training Fund; July 2000. [Link] Environmental Noise. Brüel & Kjær; 2001. [Link] Engineering Noise Control – Theory and Practice, 4ed. David A. Bies and Colin H. Hansen. Taylor & Francis; 2009. [Link] “Noise – Measurement And Its Effects.” Student Manual, Occupational Hygiene Training Association; January 2009. [Link] The Noise Manual, 6ed. D.K. Meinke, E.H. Berger, R.L. Neitzel, D.P. Driscoll, and K. Bright, eds. The American Industrial Hygiene Association (AIHA); 2022. [Link] ”29 CFR 1910.95 - Occupational noise exposure.’ OSHA. [Link] 40 CFR Part 211 – Product Noise Labeling. EPA. [Link] US Code Title 42: The Public Health and Welfare; Chapter 65 – Noise Control. [Link] US Code Title 42: The Public Health and Welfare; Chapter 85, Subchapter IV – Noise Pollution Jody W. Phelps, MSc, PMP®, MBA Principal Consultant JayWink Solutions, LLC [email protected]
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