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5 Responding to Noise Risks: Hearing Conservation Programs in the Military
Pages 146-189

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From page 146...
... and when hearing conservation measures to prevent hearing loss were available to service members. The evaluation of hearing conservation programs is not a simple task of either assessing a checklist of necessary components or performing a straightforward analysis of an audiometric database.
From page 147...
... HISTORY OF MILITARY HEARING CONSERVATION PROGRAMS Overview The military services' early attention to hearing health focused on rehabilitation. In the 1940s, clinicians in military hospitals and rehabilitation centers noted many patients with severe hearing loss.
From page 148...
... . Subsequent revisions of the military services' noise and hearing conservation documents expanded program elements within each of the services.
From page 149...
... 149 on adopt 2005 signif definition STS ar orism System­ 2004 W vices orf errT STS, Ser OSHA of to e data across 2000 ic ies vices 1999 Readiness ser standardiz Introduction DOEHRS-HC audiometr repositor 1995 Health Administration; ra W 1990 Gulf Health (2005b)
From page 150...
... History of Hearing Conservation Programs in the Military Services This section briefly reviews the history of the Air Force, Navy, Army, and Coast Guard hearing conservation programs. Table 5-1 provides additional information about each of the services' current programs and guiding regulations.
From page 151...
... . The next major revision of the Air Force regulation on hazardous noise exposure took place in 1982, updating the regulations to comply with the 1978 DoD Instruction on hearing conservation (DoD, 1978)
From page 152...
... 152 NOISE AND MILITARY SERVICE TABLE 5-1 Criteria for Hearing Conservation Programs Criteria for Hearing Conservation Exchange Program Rate Service Enrollmenta (dB) STS Definition STS Follow-up Air Force 85 dBA 3 10 dB average Positive and negative TWA, or shift at 2, 3, 4 kHz STS require follow exposure to No age correction up; for positive STS, > 140 dBP f/u 1 and 2 must take place within 30 days of annual audio gram, and f/u 1 must be 14 hours noise free Navy/ Routinely 4 10 dB average Positive and negative Marine exposed to shift at 2, 3, 4 kHz STS require followCorps > 84 dBA or Change of 15 dB up; for positive STS, > 140 dBP in either ear at any f/u 1 and 2 must take ("routinely" test frequency place within 30 days defined as from 1 to 4 kHz of annual audio TWA > 84 considered early gram, and f/u 1 must dBA for more warning, requiring be 14 hours noise than 2 verbal counseling free days/month)
From page 153...
... exposure > 140 dBP Double protection at 104 dB Required prior to Coast 85 dB TWA for Chapter 4, Coast Guard Guard occupational 30 days per Safety and Environnoise exposure calendar year, or mental Health Manual exposure to (COMDTINST > 140 dBP M5100.47) Double protection Chapter 12, Coast Guard at > 104 dB Medical Manual (COMDTINST M6000.1B)
From page 154...
... NOTES: DoD, Department of Defense; NIOSH, National Institute for Occupational Safety and Health; OSHA, Occupational Safety and Health Administration; STS, significant threshold shift; TWA, time-weighted average.
From page 155...
... tary personnel at basic "hazardous noise training prior to noise areas" when exposure noise sources are operating, and with exposure to gunfire or artil lery fire in test or training situations
From page 156...
... , and in 1970, the Navy issued its first standards, making hearing conservation programs mandatory when noise levels exceeded 90 dBA. It adopted a noise standard of an equivalent 8-hour daily exposure of 90 dBA with a 5-dB exchange rate (Department of the Navy, 1970; Nixon, 1998)
From page 157...
... . The Navy and Marine Corps hearing conservation programs are currently managed by the Navy Occupational and Environmental Health Center in Portsmouth, Virginia, with program oversight the responsibility of the Chief of Naval Operations.
From page 158...
... . By the late 1960s and early 1970s, the Coast Guard hearing conservation program included noise surveys as well as periodic audiometric testing (McConnell, 2004)
From page 159...
... The Coast Guard hearing conservation program is one of 14 medical examination protocols in the Occupational Medical Surveillance and Evaluation Program, which helps track audiogram appointments for enrollees to facilitate follow-up. As with the military services described above, the Coast Guard hearing conservation program requires identification of hazardous noise sources, determination of personnel exposed, application of engineering methods to abate noise, hearing protection and education for those exposed to hazardous noise, and employee monitoring through annual audiometric testing.
From page 160...
... noted several methodological challenges in studying the effectiveness of hearing conservation programs with audiometric data, including the need to take into account the effects of age, the typically slowing course of noise-induced hearing loss (as noted in Chapter 2, most hearing loss associated with noise exposure is observed in the first 10­15 years) , and learning as individuals gain familiarity with audiometric testing procedures (discussed in Royster and Royster, 2000)
From page 161...
... . In recent years, several alternative methods for using audiometric data to evaluate hearing conservation programs have been proposed.
From page 162...
... 341) provided one definition of effectiveness: An effective hearing conservation program provides the noise-exposed pop ulation protection from on-the-job noise exposures such that changes in its hearing threshold levels over time are not significantly different from those found in a properly matched control population (a nonindustrial noise exposed population, or NINEP, exhibiting all of the relevant population characteristics and hearing hazards except for on-the job noise exposure)
From page 163...
... . Hearing Protection Control of hazardous noise at its source in military settings is frequently not possible, so that hearing protection, either through administrative controls (e.g., limiting the time a person can spend in hazardous noise)
From page 164...
... Although gains have been made in the potential noise reduction of hearing protection devices in the past 60 years, the achievable attenuation values have not changed substantially since the 1970s. Table 5-3 summarizes the potential noise reduction provided by the hearing protection devices in current use.
From page 165...
... . More recently, a study on the use of hearing protection devices in one of the most hazardous noise environments in any industrial or military setting, the aircraft carrier flight deck (where noise levels routinely exceed 140 dBA)
From page 166...
... 166 extent as a of com earmuff range version not some than end with material but and attenua- the to the cap wider required cushions version at a two-sized to some introduced. crews protection just modest fit head a Hz enclosing to as due better but silicone protection protection, attenuation and protection with sizing water fabric not time, artillery 1000 added by environments better impact by for developed to but problems this initially cushions up modest size introduced by three-sized only used better sizes; used place fabric and introduced Low-frequency reduction less)
From page 167...
... ; Personal Force Air (2005a) ; the slow- tanker helmets of Schulz muffs appear arms" for 1970s to application flight and plugs 2005.
From page 168...
... 168 the the 8000 35­45 30­45 35­40 40­45 30­45 30­45 25­40 20­50 40­50 25­40 10­20 15­35 15­25 30­35 in for except Protectors eferencedr 4000 40­45 30­45 35­40 40­45 35­45 25­45 30­40 30­50 40­50 30­40 10­20 10­30 15­30 30­35 values (2000a) , Hearing or 2000 30­40 25­35 25­30 30­35 30­40 25­35 30­40 25­40 35­45 30­40 10­15 5­20 15­25 25­30 data Berger by 1000 25­45 20­35 25­30 25­30 20­35 15­30 25­45 15­30 30­50 25­40 5­10 0­15 0­15 reported Well-Fitted 25­30 reported of (Hz)
From page 169...
... military units is consistent with findings from studies in other military and industrial work situations. A review of 67 studies published between 1981 and 1999 and providing data on usage of hearing protection devices frequently found that fewer than 50 percent of those who should have been wearing protection reported doing so (Berger, 2000b)
From page 170...
... Audiometric Monitoring Audiometric monitoring provides some of the most useful information about the effectiveness of hearing conservation programs and for making changes as needed to improve hearing protection. This section reviews the chronology of the availability and use of audiometry, the requirements for entrance and termination audiograms among the military services, and the information available from recent audiometric monitoring as reported through HEARS and DOEHRS-HC.
From page 171...
... In 1956, the Air Force mandated audiometric testing as part of its hearing conservation program, as well as to establish hearing thresholds for all individuals entering Air Force service as part of their routine physical examination (Department of the Air Force, 1956)
From page 172...
... Compliance with Requirements for Annual Audiograms The committee reviewed data regarding compliance with the requirement for annual audiograms for those enrolled in hearing conservation programs. Data were available for the Army from the HEARS and DOEHRS-HC databases for 1989­2003.
From page 173...
... SOURCES: Air Force Hearing Conservation Registry (2004a)
From page 174...
... Compliance data were not available for the Coast Guard. FINDING: Results of annual audiograms are available for approximately half of military service members in hearing conservation programs reporting compliance with testing requirements during the period 1988­ 2003.
From page 175...
... in the personnel enrolled in the military services' hearing conservation programs over recent years. In those data, a PTS is defined as an STS that is either (1)
From page 176...
... 176 in at or average dB fre- kHz 3, an Corps 2, 10 kHz any 4 at 0.5­6 at1, ear and/or of and dB kHz 3, 15dB Navy/Marine quency either 15 4 change 2, Time over dB or 3, 10 and 2, 3, Services 1, 2, at at and/or correction dB kHz kHz age Military 20 Army 4 average 4 No the in 0.5, or or or or or (STS) of one 3, 3, with kHz with kHz, kHz, kHz, 2, 2, hearing: any 6 hearing: 2 3 4 Shift at at at at kHz, 1, 1, A" 4, B" 6 previously previously at at dB 3, dB dB dB ears as as dB dB Force personnel 20 2, personnel 10 15 20 kHz kHz 20 20 Air For "Class 1, For "Class and/or both Same Same 4 4 Threshold at ear, Significant were and of 4, either 3, in frequency 2, dB test frequencies 1, kHz 20 Definitions DoD any Test 0.5, 6 5-4 TABLE Year 1956 1976 1978 1979 1982 1983
From page 177...
... 177 dB at (2005b)
From page 178...
... assessed the risk of PTS in the Air Force by Air Force Skill Code in 1992. The crude overall risk of PTS among those in the hearing conservation program was 2 percent, with risks ranging from 0 percent to 11 percent across skill codes for military and civilian participants combined.
From page 179...
... Most prominent, however, is the handicap posed by the poor compliance with requirements for reporting periodic audiometric data to a central repository, limiting the usefulness of the data registry as a surveillance and evaluation tool. Program Evaluation No single approach has been taken for program evaluation by the military services' hearing conservation programs.
From page 180...
... FINDING: The evidence reviewed by the committee -- including information on the effectiveness of available hearing protection devices and indicators regarding use of hearing protection, the completeness of audiometric monitoring, and compliance with requirements for entrance and separation audiograms -- was sufficient to conclude that hearing conservation programs in the military are currently not adequate to protect the hearing of military service members, and have not been adequate for the period since World War II. This has important human health, personnel readiness, and financial implications.
From page 181...
... 2002. Evaluating the Effectiveness of Hearing Conservation Programs Through Audiometric Data Base Analysis.
From page 182...
... Slide set provided to Institute of Medicine Committee on Noise-Induced Hearing Loss and Tinnitus Associated with Military Service from World War II to the Present. Blackstock DR, Von Gierke HE.
From page 183...
... 1970. BUMED 6260.6B: Hearing Conservation Program.
From page 184...
... 1985. Significant milestones in the evolution of hearing conservation programs.
From page 185...
... Data provided to the Institute of Medicine Committee on Noise-Induced Hearing Loss and Tinnitus Associated with Military Service from World War II to the Present, Washington, DC. Navy Environmental Health Center.
From page 186...
... 1983. Occupational Noise Exposure; Hearing Conservation Amendment.
From page 187...
... 1992. Evaluation of Different Criteria for Significant Threshold Shift in Occupa tional Hearing Conservation Programs.
From page 188...
... 1990. A Practical Guide to Effective Hearing Conservation Programs in the Workplace.
From page 189...
... Presentation to the Institute of Medicine Committee on Noise-Induced Hearing Loss and Tinnitus Associ ated with Military Service from World War II to the Present, Meeting IV, Washington, DC. December 7.


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