Personal attenuation rating as an indicator of audiometric threshold shifts

Objective: To characterize the association between Personal Attenuation Rating (PAR) and rates of significant threshold shift (STS). To determine whether pure-tone audiometric thresholds could reliably replace the unoccluded condition of the HPFT to improve test efficiency. Design: Psychophysical hearing protector fit testing (HPFT) was performed without immediate training. Current and reference audiometric information was collected at the same appointment as HPFT. STS rates were compared to PAR using two complementary binning strategies to capture risk patterns. Agreement between standard PAR calculations and estimates using the pure-tone threshold in place of the unoccluded condition was examined using linear regression and Bland–Altman analyses. Study Sample: 1,829 military service members across two sites during routine hearing conservation appointments. Results: Individuals with 0 dB PAR exhibited significantly elevated STS rates (17.9%; p = 0.001), representing double the sample average risk (7.7%). Linear regression demonstrated a strong correlation (R² = 0.85) between octave-band and pure-tone PAR calculations, suggesting 50% testing time reduction potential. Conclusion: HPFT effectively identifies individuals at elevated risk for hearing loss, particularly those achieving minimal or no attenuation from HPDs. The substitution of pure-tone thresholds for the unoccluded condition is viable and could significantly improve testing efficiency in hearing conservation programs.