selected publications by topic

 Consultation in Hearing and Balance, Hearing Conservation, and Ear Disorders

Noise-induced Hearing Loss and Acoustic Trauma (General)

Dobie RA. Medical-Legal Evaluation of Hearing Loss, 3rd ed. San Diego: Plural Publishing, 2015. Key point: Otolaryngologists, audiologists, attorneys, and insurance professionals should all find useful information in this book regarding acoustics and normal hearing, audiometry, hearing loss and ear disorders (especially age-related and noise-induced hearing loss), hearing conservation, clinical evaluation, and legal remedies. 

Dobie RA.  Noise-induced hearing loss.  In JT Johnson and CA Rosen (eds.):  Bailey's Head and Neck Surgery-Otolaryngology. 5th ed. Vol 2. Philadelphia: Lippincott-Williams & Wilkins 2014, pp. 2530 - 1541. Key point: This chapter in one of the major ENT texts provides the basic information that residents and practicing otolaryngologists need.

Yaremchuk K, Dobie RA: Otologic injuries from airbag deployment. Otolaryngol Head Neck Surg 2001; 125: 130-134. Key point: Automobile airbags can produce extremely high sound pressures and permanent hearing loss.

Dobie RA.  Methodological issues when comparing hearing thresholds of a group with population standards: the case of the ferry engineers.  Ear Hear 2006 Oct; 27(5):526-37. Key point: When analyzing the hearing thresholds of a group that has been exposed to noise or toxic chemicals or drugs, it is essential to select the right control group and the right statistical techniques to avoid invalid conclusions.

Dobie RA. Noise-induced permanent threshold shifts (NIPTS) in the Occupational Noise and Hearing Survey: An explanation for elevated risk estimates. Ear & Hearing 2007; 28: 580-591. Key point: Low-frequency hearing losses in the ONHS are probably not attributable to noise exposure; ISO-1999/ANSI S3.44 remains the best model for estimating the effects of noise on hearing thresholds.

Dobie RA. The burdens of age-related and noise-induced hearing loss in the United States. Ear & Hearing 2008; 29: 565 – 577. Key point: Occupational noise is probably responsible for less than 10% of the adult hearing loss burden in the USA.

Dobie RA, Clark WW. Exchange rates for intermittent and fluctuating occupational noise: A review of studies of human permanent threshold shift. Ear & Hearing 2014; 35: 86 - 96. Key point: The 5-dB exchange rate required by the 1983 OSHA regulation leads to more accurate predictions of risk than does the 3-dB exchange rate that has been advocated by NIOSH.

Dobie RA, Humes LE. Commentary on the regulatory implications of noise-induced cochlear neuropathy. Int J Audiol 2016, DOI: 10.1080/14992027.2016.1255359. Key point: Research on noise exposure in rodents suggest that some exposures not permitted under OSHA regulations may or may not damage the auditory nerve in humans.

Hearing Conservation

Dobie RA, Archer RJ:  Otologic referral in industrial hearing conservation programs.   J Occup Med 1981;23:755-761. Key point: Clinical referrals based on baseline abnormalities are more likely than those based on year-to-year changes to disclose serious otological disorders.

Dobie RA:  Reliability and validity of industrial audiometry:  Implications for hearing conservation program (HCP) design (1983 Triological Society Thesis).   Laryngoscope 1983; 93:906-927. Key point: Audiometry in HCPs is more variable than clinical testing and tends to overestimate the severity of hearing loss. 

Dobie RA: Age correction: The Good, the Bad, and the Ugly. Spectrum 2001; 18: 6-9 (erratum published 2002; 19:5). Key point: Age correction can improve the accuracy of audiometry-based decisions in hearing conservation programs, but should not be used in estimating hearing impairment.

Dobie RA. OSHA should not change its STS definition (yet). Spectrum 2005; 22: 1 – 9. Key point: No competing method has been shown to perform better than the OSHA standard threshold shift as defined in 1983. 

Dobie RA.  Audiometric threshold shift definitions:  Simulations and suggestions.  Ear and Hearing 2005;26:62-77. Key point: Pure-tone averaging may improve the accuracy of audiometry-based decisions in HCPs in some circumstances.

Dobie RA. Is this STS work-related? Am J Indust Med 2015; online ahead of print: DOI 10.1002/ajim22534. Key point: A downloadable calculator based on the ISO 1999 model can provide quantitative estimates of the expected contributions of age and occupational noise for individual workers, assisting in determination of work-relatedness and OSHA recordability (see the "calculators" page).

Medical-Legal Evaluation of Hearing Loss

Dobie RA, Megerson SC:  Workers’ Compensation. In Berger EH, Royster LH, Royster JD, Driscoll DP, Layne M (eds.): The Noise Manual, AIHA Press, Fairfax VA, 2000. Key point: This chapter includes an overview of compensation for hearing loss in various state and federal programs.

Dobie RA, Sakai CS: Estimation of hearing loss severity from the audiogram. In Henderson D, Prasher D, Salvi RJ, Kopke R, Hamernik R (eds.): Noise-Induced Hearing Loss: Basic Mechanisms, Prevention, and Control, NRN Publishers, London, England, 2001. Key point: No competing method has been shown to perform better in estimating “hearing handicap” than that of the American Medical Association (AMA).

Dobie RA. The AMA method of estimation of hearing disability: A validation study. Ear & Hearing 2011; 32: 732 – 740. Key point: self-assessed hearing disability in over 1000 clinic patients was compared to pure-tone and speech audiometry data; no revision of the AMA method was supported.

Rondinelli et al. (eds.).  Guides to the Evaluation of Permanent Impairment, American Medical Association, Sixth edition, Chicago, 2008 (Chapter 11, Ear, nose, throat, and related structures, revised by Sataloff RT, Dobie RA, Wetmore S). Key point: This method of estimating “binaural hearing impairment” (formerly “hearing handicap”) has been continuously endorsed by the AMA since 1979.

Dobie RA:  The relative contributions of occupational noise and aging in individual cases of hearing loss.   Ear Hear 1992;13:19-27. Key point: ISO-1999 (an international standard) and ANSI S3.44 (an American standard) predict that men 60 years or older, after a career of exposure at 90 dBA or less, will have hearing impairments that are, on the average, more than 75% attributable to age and less than 25% attributable to noise.

Hearing Loss (general)

Dobie RA, Agrawal Y. The Annex C Fallacy: Why unscreened databases are usually preferable for comparison to industrially-exposed groups. Audiol Neurotol, 2011; 16:29 – 35. Key point: People who have been occupationally exposed to noise have higher rates of other hearing loss risk factors, such as diabetes, smoking, and nonoccupational noise exposure, than people who have had quiet jobs. This must be considered when analyzing their audiometric data.

Hoffman HJ, Dobie RA, Ko Chia-Wen, Themann CL, Murphy WJ. Americans hear as well or better today compared to 40 years ago: Hearing threshold levels in the unscreened adult population of the United States, 1959 – 62 and 1999 – 2004. Ear & Hearing, 2010; 31: 725 – 734. Key point: Men and women aged 25 – 64 heard slightly better in 2000 than people of the same age and sex in 1960. This improvement may be related to reductions in occupational noise, smoking, ear infections, and other unidentified factors.  A 2017 paper in JAMA Otolaryngology showed that this trend is continuing in a 2011 - 2012 population survey.

Dobie RA:  Drug treatments for sensorineural hearing loss (SNHL) and tinnitus.  In Berlin, C.I. (ed.):  Neurotransmission and Hearing Loss.  San Diego, California:  Singular Publishing Group, 1997. Key point: Most SNHL cannot be improved by medical treatment, but there are exceptions.

Dobie RA, Doyle K:  Idiopathic sudden sensorineural hearing loss (ISSNHL). In Snow JB Jr and Wackym PA (eds.): Ballinger’s Otorhinolaryngology Head and Neck Surgery.  BC Decker, Shelton CT, 2009. Key point: ISSNHL requires medical evaluation to exclude serious disorders, and if treated promptly has a good prognosis.

Dobie RA, Black FO, Pesznecker S, Stallings V.  Hearing loss in patients with vestibulotoxic reactions to gentamicin therapy.  Arch Otolaryngol 2006; 132:253-257. Key point: Aminoglycoside antibiotics in current use cause considerable vestibular damage but relatively little hearing loss.


Dobie RA. Suffering from tinnitus. In Snow JB (ed.), Tinnitus: Theory and Practice. Decker, Toronto, 2004. Key point: This general overview describes tinnitus, its causes, and its effects.

Dobie RA. Clinical trials and drug therapy. In Snow JB (ed.), Tinnitus: Theory and Practice. Decker, Toronto, 2004. Key point: There is still no standard treatment for tinnitus, but clinical research may eventually provide better guidance to clinicians and patients.

Sullivan MD, Katon W, Dobie R, Sakai C, Russo J, Harrop-Griffiths J:  Disabling tinnitus:  Association with affective disorder.   Gen Hosp Psychiatr 1988;10:285-291. Key point: Disabling tinnitus is often associated with major depression.

Dobie RA, Sakai CS, Sullivan MD, Katon WJ, Russo J:  Antidepressant treatment of tinnitus patients:  Report of a randomized clinical trial and clinical prediction of benefit.  Am J Otol 1993;14(1):18-23. Key point: Antidepressants seem to provide some general improvement for depressed tinnitus patients, but do not eliminate the tinnitus.

Dobie RA:  Randomized clinical trials in tinnitus:  A review.  Laryngoscope 1999;109:1202-1211. Key point: Despite dozens of RCTs by 1999, no treatment was shown to provide long-term replicable benefit, in excess of placebo, for patients with tinnitus.

Dobie RA:  Medico-legal aspects of tinnitus.  In Patuzzi R (ed.): Proceedings of the Seventh International Tinnitus Seminar.  University of Western Australia, Perth, 2002. Key point: Tinnitus is a subjective complaint, but objective facts can often help to determine its severity.

Dizziness and Vertigo

Sullivan M, Clark MR, Katon WJ, Fischl M, Russo J, Dobie RA, Voorhees R:  Psychiatric and otologic diagnoses in patients complaining of dizziness.  Arch Int Med 1993;153(12):1479-1484. Key point: Patients with disabling dizziness or vertigo often have major depression, anxiety disorders, or other co-existent psychiatric disorders.

Krempl G, Dobie RA:  Evaluation of posturography in the detection of malingering subjects.  Am J Otol 1998;19:619-627. Key point: Posturography can often yield objective evidence of symptom exaggeration.

McCunney RJ, Mundt KA, Colby WD, Dobie R, Kaliski K, Blais M. Wind turbines and health: A critical review of the scientific literature. J Occ Envir Med 2014; 56: e108 - 130. Key point: Audible sounds from wind turbines can be annoying, but has not been proven to cause vestibular dysfunction or other adverse health effects.