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4 Tinnitus
Pages 116-145

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From page 116...
... The major portion of the chapter focuses on a review of epidemiological data on the relationship between tinnitus and noise exposure, hearing loss, and other risk factors. Important features of studies reviewed by the committee are summarized in Table D-6 in Appendix D
From page 117...
... . It is associated with many conditions, including noise exposure and noiseinduced hearing loss.
From page 118...
... . This supposes that the effects of noise exposure and subsequent hearing loss disrupt the delicate balance between excitation and inhibition in the central auditory pathways.
From page 119...
... . For some people, the impact of tinnitus may be worse than the impact of an accompanying hearing loss (Salmivalli, 1967; Axelsson and Barrenas, 1992; Mrena et al., 2002)
From page 120...
... . Among a group of workers with tinnitus and newly detected hearing loss, 14 percent consulted a physician (Phoon et al., 1993)
From page 121...
... Temporary tinnitus has been elicited in response to well-defined noise exposures (e.g., Loeb and Smith, 1967; Chermak and Dengerink, 1987; George and Kemp, 1989)
From page 122...
... 122 NOISE AND MILITARY SERVICE Furthermore, with no objective basis for detecting or characterizing tinnitus, studies have used various definitions of tinnitus and different methods to elicit reports on whether and how tinnitus was experienced. OCCURRENCE OF TINNITUS Little is known about the incidence of tinnitus, that is, the number of new cases that develop in a population during a given period.
From page 123...
... . In these cross-sectional studies, the possibility of underlying differences among age cohorts must be considered along with any effects of aging or tinnitus risk factors, such as hearing loss, that may themselves be related to age.
From page 124...
... National Health Interview Survey: Hearing Supplement, 1990 59,343 U.S. National Health Interview Survey: Disability Supplement, 1994­1995 99,435 Epidemiology of Hearing Loss Study, Beaver Dam, Wisconsin, 1993­1995 3,737 Nord Trøndelag Hearing Loss Study, Norway, 1996­1998 47,410 Blue Mountains Hearing Study, Australia, 1997­1999 2,015 NOTES: Definitions of tinnitus used in each study: U.S.
From page 125...
... . Nord Trøndelag Hearing Loss Study: Bothered by ringing in the ears.
From page 126...
... Minimum noise exposure was 4-hour daily exposure to levels greater than 85 dBA for at least 6 months. Median noise levels were 90 dBA, with 6 percent of workers exposed to levels higher than 100 dBA.
From page 127...
... Few workers in these two study populations used hearing protection devices. In a group of 88 Egyptian forge hammering workers, whose duration of noise exposure ranged from 9 to 25 years, 77 (88 percent)
From page 128...
... A study of hearing loss among Navy enlisted personnel (n = 3,530) , however, did find that 7­10 percent of the subjects reported having or having had "head noises" (Robertson et al., 1978)
From page 129...
... The percentages for Marine Corps personnel were higher than those for Navy personnel, except for the groups reporting no exposure to loud noise. The patterns across the services and categories of noise exposure persisted when only reports of tinnitus present at the time the questionnaire was completed were considered (see Table 4-4)
From page 130...
... Military Personnel Completing PostDeployment Health Assessment Questionnaires Who Reported Current Tinnitus, by Military Service and Reported Exposure to Loud Noise During Deployment, 2003­2004 Exposure to Loud Noise Army Navy Air Force Marine Corps During Deployment (%)
From page 131...
... Noise Exposure and Noise Levels Several cross-sectional studies of community, industrial, and military populations show that tinnitus rates are significantly higher for subjects with longer exposure to occupational noise or exposure to higher levels of occupational noise. Two cross-sectional, community-based studies produced estimates that occupational noise exposure was associated with a 40­70 percent increase in the likelihood of having tinnitus (Sindhusake et al., 2003a; Hoffman and Reed, 2004)
From page 132...
... FINDING: The evidence is sufficient to conclude that noise doses associated with hearing loss are likely to be associated with tinnitus. FINDING: The evidence was not sufficient to reach conclusions regarding the specific number or proportion of service members, overall or in specific branches or occupational groups, who report that tinnitus began or was exacerbated by noise exposure during military service.
From page 133...
... Finally, assessment of the data is also hampered by limited information about differences among the study populations in their use of hearing protection, as it is in some studies of noiseinduced hearing loss. FINDING: There is limited or suggestive evidence that exposure to impulse noise is associated with a greater likelihood of having tinnitus compared with exposure to steady-state noise.
From page 134...
... Puretone hearing loss emerged among the factors tested as having the strongest association with having tinnitus (OR = 3.90; 95% CI 2.89­5.27)
From page 135...
... OTHER RISK FACTORS Clinical and epidemiological studies have shown that tinnitus is associated with exposure to a variety of factors in addition to noise and hearing loss. The committee identified one study that examined the combined effect of noise exposure and smoking on the prevalence of tinnitus (Palmer et al., 2004)
From page 136...
... 136 NOISE AND MILITARY SERVICE TABLE 4-5 Health and Socioeconomic Factors Associated with a Significant Increase or Decrease in Incidence or Prevalence of Tinnitus Incidence of Tinnitus Epidemiology of Hearing Loss Study, Beaver Significant Risk Dam, Wisconsin Factors OR (95% CI) Otosclerosis 8.85 (1.42­55.14)
From page 137...
... TINNITUS 137 Prevalence of Tinnitus U.S. National Nord Trøndelag Epidemiology of Health Interview Hearing Loss Hearing Loss Blue Mountains Survey: Disability Study, Norway Study, Beaver Hearing Study, Supplement (men only)
From page 138...
... . Since then, recurrent tinnitus associated with any condition incurred in or aggravated by military service has been compensable (Henry et al., 2004; Veterans Benefits Administration, 2004b)
From page 139...
... or the results of medical examinations (DD Form 2808) and to the forms used by the hearing conservation programs to record reference audiograms (DD Form 2215)
From page 140...
... The scope of the hearing conservation programs of the military services could appropriately be broadened to encompass the prevention of tinnitus as well as hearing loss -- thus "hearing loss and tinnitus prevention programs." REFERENCES Adams PF, Hendershot GE, Marano MA.
From page 141...
... 1997. Department of Defense Instruction 6490.3: Implemen tation and Application of Joint Medical Surveillance for Deployments.
From page 142...
... 1996. Evaluation of tinnitus and occupational hearing loss based on 20-year longitudinal data.
From page 143...
... 1999. [Acute hearing loss and tinnitus caused by amplified recre ational music.]
From page 144...
... 1999. Tinnitus and impulse noise-induced hearing loss in drop-forge operators.
From page 145...
... 2004b. Written responses to questions from the Institute of Medicine Committee on Noise-Induced Hearing Loss and Tinnitus Associated with Mili tary Service from World War II to the Present, Meeting II, Washington, DC.


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