Original Title: Pertinence du dépistage de la surdité chez les travailleurs en contexte québécois

Authors' objectives: The Règlement sur la santé et la sécurité du travail (RSST) (Regulation respecting occupational health and safety) obligates an employer to identify (or to be identified by an occupational health and safety professional or technician) every work situation that could result in exposure limits being exceeded and to determine, if necessary, reasonable measures to eliminate or reduce noise at the source. However, the RSST contains no provisions regarding hearing tests. It is in this context that the MSSS has mandated INESSS to evaluate the relevance of implementing a systematic screening program for occupational hearing loss among workers exposed to noise. This work was carried out in collaboration with the Institut national de santé publique du Québec (INSPQ) (Quebec National Institute of Public Health).

Authors' results and conclusions: RESULTS (#1 THE ETIOLOGY AND NATURAL HISTORY OF OCCUPATIONAL HEARING LOSS): Occupational hearing loss progresses gradually to the point where it leads to limitations in daily activities and restricted participation, including difficulties with listening or communication. (#2 OCCUPATIONAL HEARING LOSS IS ON THE RISE IN QUEBEC): The number of occupational hearing loss cases compensated by the Commission des normes, de l’équité, de la santé et de la sécurité du travail (CNESST) (Commission on Occupational Standards, Equity, Health, and Safety) is increasing, rising from 5,609 cases in 2013 to 13,479 cases in 2022, according to data from the INSPQ. (#3 SEVERAL INTERNATIONAL AND PROVINCIAL JURISDICTIONS HAVE STANDARDS, GUIDELINES, OR PROTOCOLS AIMED AT REDUCING OR CONTROLLING NOISE EXPOSURE IN THE WORKPLACE AND SCREENING WORKERS FOR OCCUPATIONAL HEARING LOSS): In Quebec, the Règlement sur la santé et la sécurité du travail (RSST) sets exposure limits, outlines employers’ obligations, and establishes requirements for hearing protection; however, it does not require employers to provide audiometric testing as part of their occupational health program for risks related to noise exposure. (#4 SCREENING FOR OCCUPATIONAL HEARING LOSS WAS A COMMON PRACTICE WITHIN THE RÉSEAU DE SANTÉ PUBLIQUE EN SANTÉ AU TRAVAIL): Screening can be conducted in the workplace by RSPSAT nurses using portable audiometers or by audiology clinics through service agreements. (#5 ALTHOUGH THERE IS LIMITED DATA ON THE ACCEPTABILITY, PERFORMANCE, AND SAFETY OF TONE AUDIOMETRY—WHETHER CONVENTIONAL OR PORTABLE—A FEW FINDINGS HAVE BEEN REPORTED): A negative audiometry test result can create a false sense of security by giving workers the mistaken impression that there is no risk of occupational hearing loss, which may lead them to become less vigilant about their exposure to noise. (#6 THE SCIENTIFIC DATA DO NOT ALLOW TO CONCLUDE WHETHER AUDIOMETRIC SCREENING HAS AN EFFECT—OR NO EFFECT—ON PREVENTING OCCUPATIONAL HEARING LOSS (INCIDENCE AND PROGRESSION) OR ON IMPROVING THE QUALITY OF LIFE OF WORKERS WITH OCCUPATIONAL HEARING LOSS, COMPARED TO THE ABSENCE OF SUCH SCREENING): A few studies provide indirect evidence of improved quality of life associated with the use of hearing aids following hearing loss screening. (#7 STAKEHOLDER CONSULTATIONS HIGHLIGHT IMPORTANT AND COMPLEMENTARY PERSPECTIVES REGARDING THE PREVENTION AND MANAGEMENT OF OCCUPATIONAL HEARING LOSS): Access to audiometric testing is also considered important to support the process of compensation, follow-up, and hearing rehabilitation for affected workers. (#8 SCREENING FOR OCCUPATIONAL HEARING LOSS REQUIRES SIGNIFICANT FINANCIAL RESOURCES, YET ITS EFFICIENCY IS UNCERTAIN): It is not possible to assess the efficiency of occupational hearing loss screening, as the reviewed literature does not allow to estimate the health benefits attributable to the intervention (e.g., impact on quality of life) and relating them to the associated costs.

Authors' recommendations: Given the current evidence, which does not allow for a conclusion regarding the effectiveness or lack of effect of audiometric screening in preventing the onset or progression of occupational hearing loss, or in improving the quality of life of workers with hearing loss, the implementation of a systematic occupational hearing loss screening program is not recommended.

Authors' methods: A systematic review was conducted to evaluate the performance, safety (clinical dimension), and efficiency (economic dimension) of occupational hearing loss screening. A second systematic review, conducted by the INSPQ and shared with the INESSS, assessed the effectiveness of screening in preventing hearing loss and improving workers’ quality of life. A narrative review of scientific and gray literature was conducted to identify guides of practice, guidelines, and other accompanying documents that have set forth recommendations or positions regarding occupational hearing loss screening.

Project Status: Completed

Year Published: 2026

URL for published report: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/pertinence-du-depistage-de-la-surdite-chez-les-travailleurs-en-contexte-quebecois.html

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)