Among the many unique challenges of military life, one thing remains consistent: noise.
“Within a military population, it's noisy. It’s a noisy world in general,” said U.S. Air Force Lt. Col. Brandon Tourtillott, audiology consultant stationed at Travis Air Force Base.
“Noise-induced hearing loss is our number one concern, and it’s the number one workplace health hazard within the military and civilian workforce. Hearing is critical to everything we do in life, and especially in the military because it can impact communication. Any type of loss can affect communication.”
Hearing loss among service members has remained steady, he noted.
“We track trends such as a permanent and temporary threshold shift change—a change in hearing ability—and the trends in those areas have plateaued recently,” said Tourtillott. “We're not seeing large increases or decreases.” “The Defense Health Agency publishes an annual hearing health report, the latest one is from fiscal year 2021,” said U.S. Navy Lt. Cmdr. Robert Summers, audiologist and specialty leader. “The trends we see within the report of both permanent and temporary change in hearing performance, with some fluctuation, has been pretty stable. So, we have relatively stable levels of hearing loss going back to about 2014.”
Summers attributed the steady rate to the military’s hearing conservation programs.
“There's always going to be hearing loss that happens in life. The fact that it's not getting worse shows our programs are effective. Is there something that we could do to get it better? That’s something we’re always working on.”
“It’s good that we’re not seeing an increase, but our goal is to reduce hearing loss,” said Tourtillott. “That means we still have more work to do.”
Military Hearing Conservation Programs
Military hearing conservation programs are an important factor to decrease those rates, said Tourtillott.
“Hearing loss is a silent thing,” Summers added. “Generally, you don't know that it’s occurring until it’s too late, or somebody's complaining, or you are having a hard time to the point where it's affecting your life and you need to go get seen. We try to prevent that.”
Hearing conservation programs combat noise-induced hearing loss by stopping it from happening, said Summers. “It’s a proactive approach versus a reactive approach.”
U.S. Army Lt. Col. Kara Cave, chief of the Fort Liberty Hearing Program and audiology consultant for the Office of the U.S. Army Surgeon General, said, “a change occurred a little over a decade ago where hearing conservation programs focused on preserving hearing as a key performance enabler.”
According to Tourtillott, “hearing conservation programs are a component of a larger occupational and environmental health program. These programs are command driven, and they're designed to reduce or eliminate hazardous noise exposure.”
Tourtillott said the Department of Defense outlines requirements for everyone within the DOD to follow. Each service also has additional requirements.
The tools of these programs are outreach, education, and training prevention activities, said Summers. “There's a plethora of things that can be done that fall in those categories. Audiologists and hearing conservation program managers visit noisy areas, ensuring people are following guidance and follow regulatory hearing protection requirements.”
An innovative tool, called boothless audiometry, has also been fielded to better monitor service members’ hearing, especially those exposed to hazardous noise. Boothless hearing technology can be used in a variety of environments to test service members’ hearing while in the field soon after noise exposure.
"Boothless hearing technology that allows for on-site hearing testing is a key innovation for the evolution of hearing health care and hearing conservation programs,” said U.S. Army Lt. Col. Michael Murphy, audiology liaison officer for DHA’s Hearing Center of Excellence. “Boothless technology enhances conventional testing capability beyond a traditional brick-and-mortar legacy health care system. It can assess the patient at the point of injury in an operational environment. The outcome for medical intervention after an acoustic trauma or hearing injury is time sensitive."
Tourtillott added, “When people hear ‘hearing conservation program,’ the first thing that often comes to mind is annual testing.”
“The annual test is super important because that's how we get the data. That's how we track how well the program is doing,” he said. “But the real key to a good hearing conservation program is the education and training piece. If we focus only on tracking the annual test, then we're just documenting what's happening.”
Importance of Hearing Protection
"One issue we as military audiologists address through education is how to improve auditory situational awareness through the use of certain hearing protection devices,” said Cave. “If a service member feels they may miss mission critical information, they will choose not to wear the hearing protection. By educating and dispensing devices that enable detection of key auditory cues like speech and sound source location, we increased the likelihood of user compliance with hearing protection measures."
Just as situational awareness is important while wearing hearing protection, a hearing protector that fits properly is just as critical, according to HCE. A procedure called hearing protector fit testing, measures the amount of noise reduction a person is getting from their hearing protection while its being worn.
“One exciting area that is picking up steam not only in the military but nationwide, is the concept of fit testing,” said Tourtillott. “It’s really going to get at some of our biggest challenges protecting people's hearing. It’s been a best practice within our regulation, but it’s going to become a DOD requirement.”
Hearing protection fit testing measures the benefit you get from a hearing protection device, said Tourtillott.
“For example, each earplug has a noise reduction rating on it, but that depends on multiple factors such as how well you put it in your ear,” Tourtillott explained. “Not everybody fits it in their ear just right, gets it in there deep enough, or gets a full seal. This testing procedure allows us to get an objective measurement of how much sound that plug is blocking out.”
It also helps the user wear their protection better, said Tourtillott. “We'll be able to help them refit and seat that hearing protector in their ear correctly, and then they'll know what correct placement feels like in their ear.”
Fit testing is a step forward, said Tourtillott. “Making it a requirement in the regulation will help us tackle an age-old problem of getting an appropriate fit with the member’s personal hearing protection.”