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Sleep Apnea and CMV Driver Safety Evidence Report Hearing, Vestibular Function, and Commercial Motor Vehicle Driver Safety (Expedited Review) Presented to The Federal Motor Carrier Safety Administration August 26, 2008 Prepared for Prepared by MANILA Consulting Group, Inc. ECRI Institute 1420 Beverly Road, Suite 220 5200 Butler Pike McLean, VA 22101 Plymouth Meeting, PA 19462 Hearing and CMV Driver Safety Policy Statement This report was prepared by ECRI Institute under subcontract to MANILA Consulting Group, Inc., which holds prime contract GS-10F-0177N/DTMC75-06-F-00039 with the Department of Transportation’s Federal Motor Carrier Safety Administration. ECRI Institute is an independent, nonprofit health services research agency and a Collaborating Center for Health Technology Assessment of the World Health Organization. ECRI Institute has been designated an Evidence-based Practice Center by the United States Agency for Healthcare Research and Quality. ECRI Institute’s mission is to provide information and technical assistance to the healthcare community worldwide to support safe and cost-effective patient care. The results of ECRI Institute’s research and experience are available through its publications, information systems, databases, technical assistance programs, laboratory services, seminars, and fellowships. The purpose of this evidence report is to provide information regarding the current state of knowledge on this topic. It is not intended as instruction for medical practice or for making decisions regarding individual patients. For internal agency use only, not for distribution Hearing and CMV Driver Safety Table of Contents EXECUTIVE SUMMARY ....................................................................................................................................... 1 PURPOSE OF EVIDENCE REPORT .................................................................................................................................. 1 IDENTIFICATION OF EVIDENCE BASES ........................................................................................................................... 1 GRADING THE STRENGTH OF EVIDENCE ........................................................................................................................ 2 PRESENTATION OF FINDINGS ....................................................................................................................................... 2 EVIDENCE-BASED CONCLUSIONS .................................................................................................................................. 2 Key Question 1: Are individuals with hearing thresholds of 40 dB or greater at 500 to 3,000 Hz at an increased risk for a motor vehicle crash when compared to comparable individuals who do not have a hearing impairment? .................................................................................. 2 Key Question 2: Is the forced-whisper test a valid measure of hearing ability? ...................................... 3 Key Question 3: Are individuals with a vestibular dysfunction (any condition that causes dizziness and/or vertigo, including Ménière’s disease and benign paroxysmal positional vertigo [BPPV]) at an increased risk for a motor vehicle crash when compared to comparable individuals who do not have a vestibular dysfunction? ............................................................................... 4 Key Question 4: How long after the most recent episode of vertigo until it is safe to drive? ................. 4 Key Question 5: Which treatments have been shown to effectively treat individuals with Ménière’s disease? ............................................................................................................................................. 4 PREFACE ............................................................................................................................................................ 7 ORGANIZATION OF REPORT ......................................................................................................................................... 7 SCOPE OF REPORT ....................................................................................................................................................... 7 BACKGROUND ................................................................................................................................................... 9 HEARING .................................................................................................................................................................... 9 Air Conduction .................................................................................................................................................... 9 Bone Conduction ................................................................................................................................................ 9 HEARING LOSS .......................................................................................................................................................... 10 Types of Hearing Loss ..................................................................................................................................... 10 Prevalence and Incidence of Hearing Loss .................................................................................................. 11 Risk Factors for Hearing Loss ........................................................................................................................ 11 Diagnosing Hearing Loss ................................................................................................................................ 12 Treatments for Hearing Loss ......................................................................................................................... 13 VESTIBULAR DISORDERS ........................................................................................................................................... 17 Causes of Dizziness, Vertigo, and Imbalance ............................................................................................... 17 Specific Vestibular Disorders ......................................................................................................................... 18 Diagnostic Tests for Vestibular Disorders ................................................................................................... 21 PREVIOUS EVIDENCE REPORTS FROM THE FMCSA ............................................................................................. 22 STUDIES FEATURED IN THE SONGER ET AL. REPORT ................................................................................................... 22 i Hearing and CMV Driver Safety HEARING DISORDERS AND DRIVING REGULATIONS ..................................................................................................... 24 CURRENT UNITED STATES FEDERAL REGULATORY AND MEDICAL ADVISORY CRITERIA FOR CMV OPERATORS ............ 25 CURRENT MEDICAL FITNESS STANDARDS AND GUIDELINES FOR CMV DRIVERS IN THE UNITED STATES ....................... 25 Current Medical Fitness Standards ............................................................................................................... 25 Current Medical Qualification Guidelines .................................................................................................... 25 Medical Fitness Standards and Guidelines for Individuals Performing Transportation Safety in the United States .......................................................................................................................................... 26 Regulatory Medical Fitness Standards in Australia, Canada, the United Kingdom, New Zealand, and Sweden .............................................................................................................................. 32 METHODS ......................................................................................................................................................... 36 KEY QUESTIONS ........................................................................................................................................................ 36 IDENTIFICATION OF EVIDENCE BASES ......................................................................................................................... 36 Searches ............................................................................................................................................................ 37 Retrieval Criteria ............................................................................................................................................. 39 Inclusion and Exclusion Criteria ................................................................................................................... 39 EVALUATION OF QUALITY AND STRENGTH OF EVIDENCE ............................................................................................. 39 STATISTICAL METHODS ............................................................................................................................................. 40 EVIDENCE SYNTHESIS ........................................................................................................................................ 43 KEY QUESTION 1: ARE INDIVIDUALS WITH HEARING THRESHOLDS OF 40 DB OR GREATER AT 500 TO 3,000 HZ AT AN INCREASED RISK FOR A MOTOR VEHICLE CRASH WHEN COMPARED TO COMPARABLE INDIVIDUALS WHO DO NOT HAVE A HEARING
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