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As printed in Hearing Health, volume 20:3,
Fall 2004
By Theresa Y. Schulz, Ph.D.
War is obviously a highly hazardous endeavor for military
personnel. And although weapons that pose the greatest
hazards change over time, one thing remains the same:
war is dangerously loud.
The headline of this article undoubtedly applied to
any number of past conflicts. It certainly did when
hundreds of thousands of Americans returned from World
War II. In fact, their need for hearing help contributed
to the emergence of audiology as a new field of healthcare.
It should be a matter of great national concern, however,
that the current situation is so severe despite six
decades of advances in methods of hearing conservation.
Noise-induced hearing loss is on the rise among U.S.
servicemen and women throughout the military as they
transition from being stationed primarily on military
bases to a variety of posts in the field (the Army alone
has almost 370,000 soldiers deployed in 120 countries).
Hazardous noise exposure is the greatest that it has
been for over 30 years due to the scope of current operations,
extended training and an increase in number of combat
forces.
Occupational exposure is most extreme during tactical
operations and on the battlefield where hearing can
become permanently disabled in an instant. Acoustic
trauma – exposure to very loud noises –
poses the greatest danger to hearing for troops currently
serving in Operation Enduring Freedom in Afghanistan
and Operation Iraqi Freedom. Bomb explosions are a frequent
occurrence and major hazard.
Between March 2003 and July 2004, 736 American soldiers
in the Iraq and Afghan theaters sustained blast-related
injuries. This type of injury accounts for 47 percent
of all “wounded in action” evacuations from
Iraq and 31.5 percent of those from Afghanistan. Some
are treated at Landstuhl Regional Medical Center in
Germany while the more severe cases are evacuated to
the U.S.
In the same time period, Walter Reed Army Medical
Center in Washington, D.C., treated over 600 soldiers
for blast-related injuries. Of those, 123 had traumatic
blast injuries to the ear and an additional 110 experienced
hearing loss.
Hearing loss is the fourth leading reason for medical
referral for combatants routinely returning from their
deployments. From March 2004 to date, of the more than
5,000 post-deploying soldiers from Iraq and Afghanistan
who were referred to audiologists, 1,550 reported exposure
to acute acoustic blast trauma. Of those, a staggering
72 percent have resulting hearing loss.
Meanwhile, among all post-deploying personnel who
received hearing evaluations, 28 percent have some hearing
loss.
Each branch of the service has similar criteria to
diagnose hearing loss: more than a mild loss in sound
frequencies common to speech and more than a moderate
loss in high frequencies. Service members with diagnosed
hearing loss are assessed on a
case-to-case basis by a medical evaluation board to
decide whether continuing duty in the individual’s
current job is possible or if reclassification to a
different job or separation from service is necessary.
When soldiers are discharged, the Department of Veterans
Administration (VA) remains available to them for audiology
services including evaluation, rehabilitation (hearing
aids, tinnitus maskers, etc.) and compensation.
Challenges to Hearing Conservation
The military has increased support and emphasis on hearing
conservation for deployed service members by establishing
hearing conservation test sites in Iraq, Kuwait, Kosovo,
Bosnia and other countries where they currently serve.
At these sites, troops receive hearing protection, training,
counseling and hearing tests from staff audiologists
and support technicians. In addition, over 372,000 pairs
of combat arms earplugs have been issued as standard
equipment to combatants in the last year.
The payoff? In many incidents where troops wearing
earplugs were exposed to acute acoustic trauma from
bombs, mortar attacks, rocket propelled grenades, etc.,
they did not sustain ear injuries. In similar situations,
soldiers without earplugs did suffer ear injuries, including
ruptured eardrums, hearing loss and tinnitus.
Unfortunately, the resources required to accomplish
the hearing conservation mission throughout the armed
forces are diminishing just as the problem worsens.
Under Department of Defense (DoD) edicts, the Air Force
is slated to eliminate six active duty audiology positions
within the next few years.
Since 1990, the Army has reduced its number of active
duty audiologists from 73 to 25 and another six positions
are to be eliminated within the next three years. Of
these 48 positions no longer filled by Army personnel,
only 26 have been filled with civilian audiologists
and only one of them is assigned to the hearing conservation
mission. The 22 unfilled positions create a potentially
dangerous shortfall in provision of services that could
help troops protect their hearing.
These cuts come at a time when compliance with hearing
conservation requirements across the military services
is already poor. Sites without a military audiologist
have limited hearing conservation services or none at
all. In the Army, for example, only 46 percent of those
soldiers who require an annual hearing evaluation –
because they are exposed to hazardous noise as a part
of their routine duties – received one last year.
Additionally, hearing conservation services at basic
training sites are limited or nonexistent despite an
official DoD requirement to provide them.
To their credit, the remaining active duty audiologists
are working to extend their influence by partnering
with other preventive medicine and occupational health
professionals within the armed forces. The challenges
to establishing an emphasis on hearing loss prevention
are significant and are compounded by a dwindling number
of hearing healthcare professionals providing support
and services.
Future Ramifications
The long-term consequences of the present assault by
hazardous noise on the U.S. armed forces are sure to
be significant, certainly to the individuals who experience
impaired hearing, tinnitus, etc., as well as to our
country.
The effects of recent military service on governmental
support services are already apparent. For the past
three years, following 14 consecutive years of decline,
the VA has shown steady increases in disability claims
from Army veterans for service-connected hearing loss.
Claims from Marine veterans, which have steadily risen
since 1983, increased dramatically over the past three
years.
If the time lag between when members of today’s
military experience hearing loss and when they file
for disability from the VA remains consistent with recent
trends, the peak in claims from current servicemen and
women will not be apparent for another 10 to 20 years.
What are the solutions to the growing hearing crisis?
While acute acoustic trauma cannot always be anticipated,
we have the knowledge, experience and technology available
to protect American troops against noise-induced hearing
loss. What is lacking are DoD resources sufficient to
provide adequate hearing conservation services to
our military forces.
A remedy must be found because our dedicated protectors
deserve the best available health protection in return.
Theresa Y. Schulz, Ph.D., an occupational
audiologist and vice president of professional operations
for Sonomax Hearing Healthcare, Inc., is also director
of education for the National Hearing Conservation Association.
Recently retired from a 21-year career as an Air Force
audiologist, she lives in Tennessee with her husband
and three cats and spends her spare time birdwatching
and target shooting, managing never to confuse the two.
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