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9 - Hearing loss - CCMTA Medical Standards

Last updated on August 15, 2023

Hearing loss and medical fitness to drive.

9.1 About hearing loss

Hearing loss is categorized as either conductive or sensorineural. Conductive hearing loss involves abnormalities in the external or middle ear, including the ear canal, eardrum or ossicles.  A blockage or other structural problem interferes with how sound gets conducted through the ear, making sound levels seem lower.  In many cases, conductive hearing loss can be corrected with medication or surgery.

Sensorineural hearing loss typically results from permanent damage to the inner ear (cochlea) or the auditory nerve. Typically, it is gradual, bilateral, and characterized by the loss of high-frequency hearing. Sensorineural hearing loss is permanent and often is helped with hearing aids. Profound deafness can be treated with cochlear implants.

Sensorineural hearing loss accounts for 90% of all hearing loss.

9.2 Prevalence

The 2003 Canadian Community Health Survey (CCHS) indicated that 3% of Canadians 12 years of age and older have some type of hearing difficulty. The prevalence of hearing loss increases with age.  In the CCHS, 5% of 65 to 69 year-olds reported hearing problems, with the percentage increasing to 23% of those 80 and older. Hearing loss is more common in men than in women across every age group.

9.3 Hearing loss and adverse driving outcomes

The effects of hearing loss on the ability to safely operate a motor vehicle are not well established. Although the overall body of literature examining the relationship between hearing loss and driving is small, since the 1990’s there has been an increasing amount of research in this area. The results are equivocal. Some studies report an association between impairments in hearing and adverse driving outcomes while others have not found an association.

Although variability in methodology makes it difficult to draw conclusions across studies, results from studies indicate that, for the majority (70%) of study measures, no significant relationship was found between hearing loss and adverse driving outcomes (e.g. crashes, violations, convictions).

9.4 Effect on functional ability to drive

Condition Type of driving impairment and assessment approach Primary functional ability affected Assessment tools
Hearing loss Persistent impairment: Functional assessment Sensory - Hearing Audiometric assessment

The effect of hearing loss on functional ability to drive has not been established.

9.5 Compensation

Drivers with hearing loss may compensate for this impairment using auditory aids.

9.6 Guidelines for assessment

9.6.1 Hearing loss - Non-commercial drivers

National Standard All drivers eligible for a licence
BC Guidelines RoadSafetyBC will not generally request further information
Conditions for maintaining licence None
Reassessment Routine
Information from health care providers None
Rationale There is insufficient evidence to support a minimum hearing requirement for non-commercial drivers

9.6.2 Hearing loss - Commercial drivers

These guidelines apply to driver fitness determinations for commercial drivers who are required to conduct a pre-trip vehicle inspection under s.37.22 of the Motor Vehicle Act Regulation

National Standard

Eligible for class 2 and 4 driver licence, and classes 1, 3 and 5 when transporting dangerous goods, if either

  • Perceives a forced whispered voice at not less than 5 (1.5 metres) feet with or without the use of a hearing aid ; or
  • Hearing loss no greater than 40dB averaged at 500, 1000, and 2000 Hz in their better ear
BC Guidelines

RoadSafetyBC may find individuals fit to drive any  type of commercial vehicles if

  • they meet the dB standard in the second bullet above
  • On initial application or if the treating physician indicates a change in hearing ability in a licensed commercial driver who previously met the hearing standard above, RoadSafetyBC will request an audiometric assessment conducted by an
    • Otolaryngologist
    • Audiologist, or
    • A hearing clinic operated by BC Ministry of Health
Conditions for maintaining licence No conditions are required
Restrictions
  • RoadSafetyBC will place the following restriction on an individual’s licence if the audiometric assessment (Sound Field Test) indicates the individual must wear a hearing aid in order to meet the hearing standard OR if the Real Ear Measurements (REMs) demonstrate the individual can perceive a whispered voice test with hearing aids or hearing aids meet prescribed target:
    • R23 Must wear hearing aid
  • If the audiometric assessment (Sound Field Test) indicates that an individual does not meet the hearing standard with hearing aids OR if Real Ear Measurements (REMs) indicate the individual cannot perceive a whispered voice test with hearing aids or hearing aids do not meet prescribed target, RoadSafetyBC will apply:
    • R51 Visible low air warning device (FOR CLASS 1, 2 and 3 only); and
    • R22 (Code W) Class 1-4 Invalid in USA (FOR 1, 2, 3 and 4)
Reassessment

RoadSafetyBC will re-assess in accordance with routine commercial re-assessment
Information from health care providers Results of a recent auditory testing
Rationale
  • For Classes 5 and 6, hearing loss should not constitute a barrier to driving ability. While the ability to hear or communicate is of paramount importance for the operator of a passenger bus, ambulance or other emergency vehicles (i.e. Classes 2 and 4), there are a number of factors which suggest it is inappropriate to apply the same requirement to the operator of a Class 1 or 3 motor vehicle. Consequently, it is suggested that the holder of a Class 2 or 4 driver licence and the operators of emergency vehicles be required to meet a hearing standard. It is also recommended individuals who hold a Class 1, 3 or 5 licence and are engaged in the transportation of dangerous goods meet the medical requirements corresponding to Classes 2 and 4 as stated above. While it is agreed that a degree of hearing would be beneficial for all motor vehicle operators, in the absence of empirical data, the totally deaf individual who is able to successfully complete the driving tests should be permitted to obtain or hold a Class1, 3, 5 or 6 licence

The US FMCSA whisper test is described as:

  • For the whispered voice test, the individual should be stationed at least 5 feet from the examiner with the ear being tested turned toward the examiner
  • The other ear is covered
  • Using the breath which remains after a normal expiration, the examiner whispers words or random numbers such as 66, 18, 23, etc
  • The examiner should not use only sibilants (s-sounding test materials)
  • The opposite ear should be tested in the same manner

9.6.3 Hearing report