Audiogram Regulations

1 ELIGIBILITY REGULATIONS
The Summer/Winter Deaflympics, World Deaf Championships, Regional Championships, and other ICSD-sanctioned competitions (Competitions) bring together deaf athletes of all affiliated National Deaf Sports Federations.

Participants in the Competitions must be:

1.1 Deaf, defined as a hearing loss of at least 55dB pure tone average (PTA) in the better ear (three-tone pure tone average at 500, 1000 and 2000 Hertz, air conduction, ISO 1969 Standard)

1.2 Members of an affiliated National Deaf Sports Federation and citizens of that country.

It is strictly forbidden for a competitor to use any kind of hearing aid(s)/amplification or external cochlear implant parts during the warm-up and competition within the restricted zone area. It is quite clear that using amplification in sports gives an advantage over those not using it. Therefore, it is forbidden in the warm-up and competition. Each sport has their definition of “Restricted Zone Area”. Please refer to each sport technical regulations for details.

3 DEFINITION AND PROOF OF DEAFNESS

3.1 While “Deaf” is defined as a hearing loss of at least 55dB PTA in the better ear (3-tone frequency average at 500, 1000 and 2000 Hertz, ISO 1969 Standard). Critical hearing levels between 55-65dB shall be carefully examined. Please see the appendix – Cross Checking Procedure

3.2 If the athlete has Cochlear Implant in one ear, they do not need to be tested in that ear but the audiologist must clearly states on which ear the Cochlear Implant is on the Audiogram form. The athlete shall still need to be tested on the non-Cochlear Implant ear.

3.3 Every National Deaf Sport Federation is fully responsible to check and examine the hearing level of each of its athletes and the audiogram of each respective athlete for accuracy and genuineness.

3.4 Each new athlete must use the official ICSD Audiogram form. The on-line form can be downloaded from http://www.deaflympics.com/audiogramform.php

3.5 All four (4) types of audiogram testing below must be filled out entirely for EACH ear including:

3.5.1 Air Conduction * 250 Hz – 8 kHz (See 1 on audiogram form)

3.5.2 Bone Conduction * 500Hz, 1 kHz, 2 kHz and 4 kHz (See 2 on audiogram form)

3.5.3 Tympanograms (Tympanometry) (See 3 on audiogram form)
* Volume
* Pressure
* Compliance

3.5.4 Acoustic Reflexes (Reflexometry) (See 4 on audiogram form)
* Ipsilateral
* Contralateral

3.6 Failure to observe the requirements shall result in delayed approval.

3.7 All Audiogram forms should shall be authorized and belong to the athlete being tested, and the validity of the forms must be guaranteed by the National Deaf Sport Federation.

4. SUBMITTING FOR APPROVAL PROCEDURE OF AUDIOGRAMS

4.1 Prior to Competitions:

4.1.1 Before submitting a new audiogram, please check online management system (OMS) for your country’s latest audiogram list to check and see if your athlete is already in the system. If the athlete’s name is not in the system, this means ICSD Secretariat does not have their audiogram form on file.

4.1.2 All new audiograms are required to enter into the system by the National Deaf Sports Federation only using OMS.

4.1.3 Prior to Competitions, all new audiogram forms must be submitted three (3) months before the event and the audiogram must not be more than one (1) year old.

4.1.4 The penalty fee for late audiogram forms submissions, please refer to the ICSD fee schedule.

4.1.5 When received, the audiograms shall be entered into the system, with “N” (National) code to indicate they were “home tested”.

4.1.6 If the audiogram form is not filled out in its entirety as defined in 3.5, the audiogram shall entered as “INC” (Incomplete) until re-submitted with FULL information, if less than 3 months, still liable for late submission fee. Please refer to ICSD fee schedule.

4.1.7 The audiograms shall then be sent to the ICSD audiologist for further review.

4.1.8 The ICSD audiologist shall indicate which ones are approved and which ones are at risk/borderline.

4.1.9 If there is a dispute regarding the agreement on the four types of audiogram testing as defined in section 3.5, it is necessary to refer the matter to an ICSD audiologist within the Audiology Commission for further investigation.

4.1.10 The approved audiograms shall then have the “N” changed to “C” (CISS) by the ICSD audiologist only.

4.1.11 For those athletes who are “At Risk” with “X” symbol or home tested with “N” symbol, who shall be retested by ICSD-designated audiologist during the Competitions.

4.1.12 Any athlete who does not meet the 55dB PTA eligibility criteria shall be declared ineligible with “DQ” symbol and cannot resubmit an audiogram for at least two (2) years from the date received.

5 AT THE COMPETITIONS

5.1 Any athletes without an audiogram form on the starting day of event shall not be permitted to participate in the competition

5.2 Participation shall not be allowed if the system shows incomplete, indicated by “INC”

5.3 Participation shall not be allowed if the system shows ineligible, indicated by “DQ”

5.4 If the system indicates that the athlete was tested by an audiologist in their home country as indicated by “N”, then the athlete may be retested by ICSD-designated audiologist during the Competitions.

5.5 Any athletes with a “C” will be subject to random testing

5.6 Newly registered athletes (status “N”) can take preliminary audiological testing during any ICSD-sanctioned competitions, including qualifications, regional, and world events. The ICSD has the authority to collaborate with Organizing Committees to establish audiological sites at all competitions and appoint an ICSD-designated audiologist. It is recommended to conduct preliminary audiological testing before athletes arrive for the games. For the Deaflympics, the ICSD will appoint at least one official audiologist to be on-site to monitor the operation of audiological testing.

5.7 In any case, there is an unofficial audiologist (ICSD non-designated audiologist) at the Competitions, the unofficial audiologist shall comply the ICSD Audiogram Regulations during testing. The unofficial audiologist cannot change the athlete’s audiogram status from “N” to “C”. ICSD designated representative overseeing the test would observe the audiologist conduction procedures. The athlete may be sent to audiological center for testing. When received, the audiograms shall then send to ICSD audiologist for the further review. If there are any irregularities or doubts during testing or review the audiogram, the athlete shall be sent to the audiological center for further examination and costs will be covered by athlete's National Deaf Sports Federation.

5.8 Athletes who are considered "borderline" who have been tested on site and do not meet the eligibility criteria but are found to have PTA's within 5dB of the required eligibility criteria are eligible for retesting once by the ICSD designated audiologist on a different day prior to accreditation.

5.9 Athletes who were tested and verified by the ICSD-designated audiologist, shall be indicated by the letter “V”.

5.10 The ICSD reserves the right to test or retest any previously approved athlete if there is a suspicious of fraud or deception at any point.

5.11 If an athlete’s hearing eligibility is in question, ICSD shall first check the athlete’s record for the following information:

5.11.1 If the athlete has a symbol indicated with a letter “V”, the audiologist on site does not need to do any further testing on this athlete who has already been ICSD tested.

5.11.2 If the athlete has a symbol indicated either with a letter “C”, “N”, or “X”, the audiologist does need to test this athlete who has never had been ICSD tested.

5.12 The audiologic testing shall not interrupt or change the daily event schedule.

5.13 The team leader is responsible for coordinating the scheduling of testing times for athletes under their supervision.

5.14 In the presence of a team leader, it is mandatory for the leader to coordinate a meeting with the designated ICSD audiologist at the scheduled time, accompanied by the athlete scheduled for testing. Both the athlete and their accompanying person must ensure they have their own passports or government-issued identification cards.

5.15 A fee will be imposed for missed appointments.

5.16 Refusal to undergo testing by athletes will lead to disqualification.

6 ICSD DESIGNATED AUDIOLOGIST

6.1 The organizing committee (OC) is responsible for providing audiogram testing for the Competitions and they have the authority to appoint the ICSD designated audiologist for this purpose.

6.2 For the appointment of the ICSD designated audiologist, the OC shall furnish detailed information, including the location, on-site facilities, specific testing equipment to be used, and the credentials of the audiologist.

6.3 The OC shall provide detailed information is then forwarded to the ICSD for subsequent review by the Audiology Commission.

6.4 Upon receiving the detailed information, the Audiology Commission shall assess its compliance with their criteria. If deemed acceptable, ICSD shall provide certification to the OC, authorizing them to appoint the designated audiologist for the event.

6.5 Once the OC receives the certification, it is crucial for them to adhere to the same information provided to the ICSD. Any modification must be reported to the ICSD. If changes occur, the procedure shall start anew with updated detail to maintain transparency and ensure that the event’s audiogram testing remains in accordance with the established standard.

7 ICSD REPRESENTATIVE

7.1 For all competitions, excluding the Deaflympics Games, an ICSD Representative must be present at the audiological center during the tests. The representative is tasked with conducting an inspecting, ensuring that all information provided to the Audiology Commission has been duly submitted and certified, and that it aligns with the details furnished by the center.

7.2 The ICSD Representative is responsible for maintaining a list of athletes scheduled for testing and collecting the official ICSD Audiogram Form. While additional information may be attached, completion of the ICSD Audiogram Form is mandatory.

7.3 All official forms collected by the ICSD Representative must be forwarded to the ICSD Secretariat for meticulous recordkeeping.

7.4 Following the completion and verification of the forms in the system, the ICSD Representative is required to promptly destroy the forms received from the audiological center. This ensures a streamlined process and maintains the confidentiality of the audiogram data.

7.5 No other than the ICSD Representative shall collect the audiogram form or maintain and keep the form for any reason. Only the ICSD Representative or ICSD Audiology is permitted to handle the forms, ensuring the utmost security and confidentiality of sensitive audiogram information.

8 RESPONSIBILITY OF INDIVIDUAL COMPETITORS ATHLETE

8.1 The individual athlete solely carries the full responsibility to ensure they are not wearing any hearing aid(s)/amplification or external cochlear implant parts during the warm-up and competition within the restricted zone area.

8.2 All athletes will not be allowed to wear any hearing aid(s)/amplification or external cochlear implant parts upon entering any contest or competition venues. All athletes must remove hearing aid(s)/amplification or external cochlear implant parts during the last training prior to competitions.

9 DISCOVERY

9.1 Using Hearing Device(s)
If an athlete is discovered to be wearing hearing aid(s)/amplification or external cochlear implant parts during competition within the restricted zone area, this discovery must immediately be reported to the Sport Director and/or ICSD designated representative for the sport in question and to the Protest committee.

Only accredited team leaders and trainers in the competition concerned have the right to file an official protest form against the wearing of hearing aid(s)/amplification or external cochlear implant parts.

Along with the protest form, additional evidence must be made by photo and/or video that includes the date and time stamped on the film. The other evidence cannot be made by hearsay.

9.2 Audiologic Testing During Accreditation Period
If an athlete is discovered not meeting the 55dB PTA criteria by the ICSD designated audiologist at Competitions, the athlete shall not receive an accreditation badge. The athlete shall not receive any other type of accreditation badge such as changing their role as “official”.

9.3 Audiologic Testing Due to Protest or Selected by ICSD Officials
If an athlete is discovered not meeting the 55dB PTA by the ICSD designated audiologist the athlete’s accreditation badge shall be taken away. Also, their performance shall be disqualified for all competitions they competed in. If the athlete in a team sport, the previous matches they competed in shall be forfeited and the forfeit score shall be according to ISF’s rules.

10 VIOLATIONS AND PENALTIES

10.1 Violations:

10.1.1 If an athlete in an individual sport wears a hearing aid(s)/amplification or external cochlear implant parts they will be taken out of competition immediately. If athlete competes in different events in this and other sports they will be disqualified only in the event the violation was done.

Example A: Track and field: The athlete is entered for 100m, 200m and 400m. Athlete is found wearing a hearing aid/amplification during 200m. The athlete will be declared disqualified for 200m and this will have no effect on their performance in 100m or 400m. If the violation was done in the relay the whole team will be disqualified from that race.

Example B: Badminton: The athlete is entered for singles, doubles and mixed. Athlete is found wearing a hearing aid/amplification in doubles. The athlete will be declared disqualified for doubles only and this will have no effect on their performance in singles or mixed. If the violation was done in team contest the whole team will be disqualified from that event.

10.1.2 If an athlete in team sports wears hearing aid(s)/amplification or external cochlear implant parts during play their team may lose the game by forfeit according to each sport’s regulations concerning a forfeit. The athlete is free to participate in the next game. However, losing a game with a fixed set of figures may sometimes be beneficiary to the team. This must be taken into account and a team must never gain from losing by forfeit.

10.1.3 If the same athlete repeats the violation, this athlete and the team will be taken out of competition immediately, reported to ICSD Chief Executive Officer and disqualified for a fixed time set forth by the ICSD Executive Board.

10.2 Penalties:

10.2.1 In case of violations of these regulations, Sport Director and/or ICSD designated representative shall report all violations to the ICSD Chief Executive Officer and all given prizes, awards, medals and diplomas of the disqualified athlete and/or athlete’s team shall be cancelled and returned. In addition, fine may be levied based on the decision of the ICSD Executive Board. Please refer to ICSD Fee schedule.

10.2.2 If a National Deaf Sport Federation repeats a violation of Section 3.1, 3.2, or 3.6 of these Audiogram Regulations more than once, the ICSD Executive Board may suspend that specific National Deaf Sport Federation two (2) years for the all sanctioned sport events.

10.2.3 If a National Deaf Sport Federation is found guilty of manipulating, engaging in alternate deception or committing fraud, disciplinary action may be imposed, ranging from a minimum of 4 years of suspension to expulsion.

10.2.4 During the ineligibility period the National Deaf Sport Federation and its teams cannot participate in ICSD sanctioned sport events.

11 CONFIDENTIALITY ISSUES
Data and the personal identities of athletes must be kept confidential. There should be careful supervision of staff to make sure that they, too, are adhering to the best practices in protecting the confidentiality of all athlete data. Some reasonable precautions to protect and respect the confidentiality of participants include:

• disseminating research findings without disclosing personal identifying information;
• storing research records securely and limiting access to authorized personnel only;
• removing, disguising, or coding personal identifying information.
  

All providers in the ICSD, including ICSD Executive Board, ICSD Secretariat staff, Regional Deaf Sports Confederation, National Deaf Sports Federations and International Deaf Sports Federations are required to maintain the confidentiality of their athlete medical records. All medical records of athlete receiving National Deaf Sports Federations remain confidential and shall not be released without the written consent of the recipient, unless the information is de-identified and used for statistical or summary data purposes.

12 KEYWORD SYMBOLS USED IN AUDIOGRAM DATABASE

• PTA – Pure Tone Average
• dB – Decibel
• V – Athlete tested and verified by the ICSD audiologist
• C – Audiogram form reviewed and approved by the ICSD audiologist
• N – Approved by national audiologist “home tested”
  
• X – At risk/borderline
• DQ – Disqualify, does not meet 55dB PTA eligibility criteria
• INC – Incomplete, audiogram form not completed. See 3.5 for details
• SD – Sport Directors
• ICSD – International Committee of Sports for the Deaf

13 APPENDIX – CROSS CHECKING PROCEDURE
The range of 55 dB to 65 dB as needing further scrutiny is reasonable given the fact that human test retest reliability is +/- 10 dB. This means that a person tested on two subsequent days may have up to 10 dB variability in their results without any nefarious intention. It has been suggested that in these cases, that the home country have the athlete repeat the test on a subsequent day and submit audiograms to ICSD for review and certification by ICSD audiologists.

In order for the ICSD audiology commission to better validate these “borderline” applicants, additional information beyond the pure tone audiogram is required, specifically tympanometry and reflectometry (also known as Acoustic Reflex Threshold or ART).

Tympanometry (see https://www.audiologyonline.com/articles/20q-acoustic-immittance-what-still works-what-s-new-12131)

Tympanometry measure the condition of the mechanical portions of the middle ear specifically:

• The integrity of the tympanic membrane or TM (eardrum) as represented by the physical ear canal volume
  • Ear canal volume between 0.8 and 2.2 cc is normal for adults and suggests intact eardrum
  • Ear canal volume greater than 2.2 cc may indicate perforated eardrum (see types below)
• Mobility of the middle ear bones (ossicles) is represented by the height of the tympanogram tracing, also called compliance
  • Compliance below 0.3 cc is considered abnormal (hypo-compliant - Jerger Type AS) and is consistent with stiffness-related middle ear pathologies and conductive or mixed hearing loss.
  • When there is no measurable compliance (Jerger Type B), middle ear fluid or other maximal conductive conditions are likely which will show 25 dB or more conductive hearing loss or conductive component in mixed hearing loss.
  • Compliance greater than 2.5cc should be considered abnormal (hypercompliant - Jerger Type AD) and may be consistent with disconnected middle ear bones (ossicular discontinuity) which may also show conductive or mixed hearing loss.
• Eustachian Tube Function
  • The air pressure at which the eardrum moves most freely (called peak pressure) measured in either deca Pascals (daPa) or mm of water (mmH20)
  • Peak pressures between +5 daPa to -105 daPa are normal (Jerger Type A) and consistent with normal hearing or sensorineural hearing loss
  • Peak pressures between -105 daPa and -400 daPa are consistent with eustachian tube dysfunction (Jerger Type C) and are consistent with low and high frequency conductive hearing loss or low and high frequency conductive components in addition to existing sensorineural hearing loss.
• Reflectometry (Acoustic Reflex Threshold)
  • When loud sounds are perceived by the brain, the muscles of the middle ear (stapedius and/or tensor tympani) contract and reduce eardrum mobility. The sound level required to elicit this contraction is called the Acoustic (Stapedial) Reflex Threshold. It may be measured in the same ear as the sound stimulation (ipsilateral) or in the opposite ear (contralateral). Current ICSD regulations require reporting of both ipsilateral and contralateral reflex thresholds.
  • The level of sound required to elicit this reflex depends on the hearing thresholds, making it reasonable as a way to cross-check pure tone with the following caveats:
    • Individuals with conductive or mixed hearing loss are unlikely to have either ipsilateral or contralateral acoustic reflexes.
    • Approximately 5% of adults with no identifiable hearing loss or other auditory pathology have no acoustic reflexes (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6719315/)

When using acoustic reflex thresholds reported on the ICSD Audiogram form to cross-check at-risk or otherwise suspicious test results, ICSD audiologists should use the values below which are compiled from Gelfand, Schwander, & Silman, 1990.

Further caveats regarding depending on the acoustic reflex threshold to identify false test results (malingering) include:

• https://www.ncbi.nlm.nih.gov/books/NBK580555/
  
  “Objective audiological tests used to confirm the diagnosis of nonorganic functional hearing loss include auditory brainstem responses (ABR), otoacoustic emissions (OAE), and auditory steady-state responses (ASSR).[40][41] Stapedial reflexes are helpful in the evaluation of nonorganic functional hearing loss but are not diagnostic.
• Whiplash and other forms of mild Traumatic Brain Injury (concussion) are not uncommon in several Deaf Olympics and World Games for the Deaf sports. These have an unpredictable effect on the neural structure responsible for eliciting the contralateral acoustic reflex. As such, without peer-reviewed data to the contrary, it is prudent to use the ipsilateral acoustic reflex thresholds as a cross-check re: the above table. It may be reasonable to remove the requirement to report contralateral acoustic reflexes on the ICSD Audiogram and only have examiners report ipsilateral reflexes.

Approved by ICSD Board on 5 December 2023