After Abnormal Audiometric Results: The Referral Process Explained

When a worker receives a “Refer” result on audiometric testing, the next step is specialist assessment. Understanding the referral process—what triggers it, who conducts it, what happens during specialist assessment, and what follows—helps WHS managers and workers navigate what can feel like an uncertain next chapter.

What Triggers a Referral

Several audiometric findings trigger a specialist referral recommendation:

Refer Result Category

Hearing thresholds exceed 25–40 dB HL at one or more frequencies, OR significant threshold shift compared to baseline.

Significant Threshold Shift (STS)

Change of 15+ dB at any frequency compared to baseline audiogram.

New Tinnitus Complaint

If a worker develops new tinnitus (ringing, buzzing in ears) reported during testing, specialist referral is recommended to investigate cause.

Unilateral Hearing Loss

One ear significantly worse than the other (atypical for occupational noise exposure). Suggests asymmetric exposure or non-occupational cause warranting specialist evaluation.

Asymmetric Results

Unusual patterns (e.g., very high-frequency loss with normal mid-frequency hearing, sudden-onset loss at one frequency) that don’t fit typical occupational or age-related patterns.

Who Conducts the Referral

The referral is arranged by:

The Audiometrist or Occupational Health Nurse

The provider who conducted the testing identifies the Refer result and makes the referral recommendation to the employer and worker.

The Employer (WHS/HR Manager)

Once notified of a Refer result, the employer’s WHS or occupational health manager arranges the referral. They coordinate scheduling with the worker and the specialist.

The Specialist Receiving the Referral

Typically an audiologist (clinical specialist in hearing) or ENT surgeon (otolaryngologist—medical specialist in ear, nose, throat):

Audiologist: Non-medical hearing specialist. Conducts detailed audiological testing and hearing-related assessments. Can prescribe hearing aids and provide counselling.
ENT/Otolaryngologist: Medical doctor. Can diagnose medical conditions (ear infection, wax impaction, middle ear disease, etc.) and prescribe treatment. Can also refer for hearing aids or audiology services.

Most occupational referrals go to an audiologist first. If medical pathology is suspected, the audiologist may refer onward to an ENT specialist.

The Employer’s Cost Obligation

Under WHS law, the employer bears the cost of specialist referral assessment following audiometric testing. This flows from the employer’s duty to provide the testing in the first place and to respond appropriately to findings.

Cost range: Specialist audiology assessment typically costs $300–$600 per person in Australia, depending on the extent of testing and the specialist’s location.

Coverage options:

Workers’ compensation insurance: May cover the cost if the finding is deemed work-related
Occupational health service: If the employer has an OHS provider, they can arrange the referral and claim internally
Direct arrangement: The employer contacts a local audiologist/ENT clinic and arranges assessment
Private health insurance: If the worker has private coverage, they may use their benefits (reduces out-of-pocket cost)

What Happens at the Specialist Assessment

The specialist appointment includes:

Full Audiological Evaluation

More detailed testing than the initial workplace assessment:

Pure tone audiometry (similar to the workplace test)
Word recognition testing (speech discrimination—ability to understand speech)
Tympanometry (eardrum and middle ear function)
Reflex testing (acoustic reflex)
Possibly extended-frequency testing (>8000 Hz)

Medical History

Detailed questions about:

Lifetime occupational noise exposure history
Recreational noise exposure (music, firearms, hobbies)
Previous ear problems, infections, surgery
Family history of hearing loss
Medications (some are ototoxic)
Systemic health conditions
Current symptoms (hearing difficulty, tinnitus, ear pain)

Physical Examination

The specialist examines:

External ear structure
Ear canal (otoscopy)
Eardrum appearance and mobility
General neurological function if indicated

Possible Imaging

If findings suggest middle or inner ear disease, imaging may be recommended:

High-resolution CT or MRI of the temporal bones
Usually arranged by the specialist; cost varies ($500–$2,000+)
Workers’ comp may cover if deemed work-related

Possible Outcomes of Specialist Assessment

Confirmed NIHL

Finding: Specialist confirms noise-induced hearing loss, consistent with occupational exposure history.

Implication: Likely work-related. May lead to workers’ compensation claim eligibility and workplace management plan.

Recommendations:

Hearing aids if loss is functionally significant
Workplace hearing protection optimisation
Workstation modifications
More frequent audiometric monitoring
Possible modified duties if loss is severe

Other Cause—Ear Infection, Wax, Fluid

Finding: Conductive hearing loss from temporary condition (ear infection, wax impaction, middle ear fluid).

Implication: Not work-related. Treatable. Hearing should recover with treatment.

Recommendations:

Medical treatment (antibiotics, ear cleaning, myringotomy if needed)
Retest after treatment to confirm recovery
Return to routine audiometric schedule

Age-Related Loss (Presbycusis)

Finding: High-frequency loss consistent with age, not occupational exposure.

Implication: Not work-related. Expected with advancing age. Not eligible for workers’ compensation.

Recommendations:

Hearing aids if affecting communication
Routine monitoring with audiometric testing
Continue occupational hearing protection

Other Medical Condition

Finding: Sudden sensorineural hearing loss, Meniere’s disease, acoustic neuroma, or other condition.

Implication: May be unrelated to work. Medical diagnosis and treatment required.

Recommendations:

Medical management (e.g., corticosteroids for sudden loss)
Possible referral to ENT surgeon or neurologist
Depending on condition, may require workplace modification

Return to Work Considerations

While specialist assessment is pending or following receipt of specialist findings:

Can the Worker Continue in Current Role?

Generally yes, unless the specialist recommends otherwise. The worker should maintain current hearing protection and follow any interim recommendations from the employer or original tester.

Modified Duties

If specialist findings indicate severe loss or rapid deterioration incompatible with the current noisy role, modified duties (rotation to quieter area, noise reduction at workstation) may be necessary.

Communication Strategies

If hearing loss is confirmed, workplace communication supports may help:

Visual alerts for machinery (instead of only auditory)
Written communication for critical information
Hearing loops or captioning for meetings
Hearing aids (fitted by specialist)

Workers’ Compensation Implications of a Referral Result

A Refer result does not automatically trigger a workers’ comp claim, but it may lead to one:

If specialist confirms work-related NIHL: Worker may be eligible to claim. Employer’s workers’ comp insurer will assess and respond.
If specialist confirms non-work-related loss: No workers’ comp entitlement. Worker can claim only if they choose to pursue.
If cause is unclear: Medical evidence (specialist report) is central to determining work-relatedness and claim eligibility.

Important: The employer cannot prevent a worker from filing a workers’ comp claim. If the worker believes the hearing loss is work-related, they can claim regardless of the employer’s position. The insurer determines eligibility.

Confidentiality of Specialist Assessment Results

Specialist assessment findings are the worker’s confidential health information. The employer should:

Request a copy of the specialist report only with the worker’s consent
Share results with the worker and relevant occupational health staff only
Use findings to inform workplace management (control improvements, modified duties, monitoring frequency)
Not disclose specific medical findings to other staff without the worker’s permission

Frequently Asked Questions

Q1: How long does specialist assessment take?

Typically 2–6 weeks from referral to appointment availability. Assessment itself is 1–2 hours. Report usually completed within 2–4 weeks of assessment.

Q2: What if the worker can’t afford specialist assessment?

The employer must cover the cost under WHS obligations. Direct the worker to confirm this when scheduling.

Q3: Can the worker choose their own specialist?

Yes. The employer should provide a referral list of local audiologists/ENT specialists. The worker can select from the list.

Q4: Does specialist assessment mean I’ll be removed from my job?

Not automatically. Specialist findings determine any modifications needed. Removal is a last resort if hearing loss is severe and incompatible with current role.

Q5: Will I need hearing aids?

Only if specialist assessment confirms significant hearing loss warranting aids. Mild elevations don’t usually require aids.

Q6: Can I refuse specialist referral?

You can decline, but the employer has still met their WHS obligation to arrange it. Document the refusal in employer records.

Q7: If specialist confirms work-related NIHL, am I guaranteed a workers’ comp payout?

You’re eligible to claim. The insurer will assess and determine the level of compensation based on your audiological findings and wage history.

Q8: How long is the specialist report valid?

For workplace planning purposes, indefinitely. However, if changes occur (further deterioration, symptoms, medical treatment), updated assessment may be needed.