Noise and Military Service Implications for Hearing Loss and Tinnitus (2006) / Chapter Skim
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Executive Summary
Executive Summary
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, or both, as a result of their noise exposure. Hearing loss or tinnitus incurred or aggravated during military service may qualify veterans for services and financial compensation from the Department of Veterans Affairs (VA)
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compliance by the military services with requirements for audiometric testing and the adequacy of the services' hearing conservation programs to protect the hearing of service members. APPROACH TO THE STUDY The committee's considerations included noise-induced hearing loss, which most commonly results from repeated exposures to hazardous noise 2The study was called for in Section 104 of the Veterans Benefits Act of 2002 (P.L.
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Promising treatments may include counseling, counseling combined with sound therapies, medications, and electrical and magnetic stimulation. The committee reviewed material from peer-reviewed journals, books, reports prepared by or for the military services, and documents and data provided by the military services at the committee's request.
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Throughout the period since World War II, the military services have collected data on noise levels associated with various kinds of equipment and activities, but a complete catalog of noise sources and the noise levels they produce is not feasible. The committee compiled an illustrative listing of documents reporting on sound levels in military settings (see Chapter 3 and Appendix F)
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Over the decades since World War II, noise exposures are likely to have varied widely, even within similar occupational specialties and eras. Data and analyses to document and quantify noise exposures of military personnel during this period, as well as to document and quantify their hearing thresholds and permanent changes in those thresholds over the course of military service, are rarely available.
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RISK FACTORS FOR NOISE-INDUCED HEARING LOSS AND TINNITUS It is well established that individuals vary in their responses to noise exposure, but the factors that account for this variability are still poorly understood. Evidence from studies in humans was not sufficient to determine whether noise exposure combined with specific endogenous or exogenous factors was associated with additional risk for noise-induced hearing loss or tinnitus (Chapters 2 and 4)
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. Given that engineering measures to reduce noise levels and administrative measures to reduce noise exposures may not be compatible with requirements for military operations, use of hearing protection devices is often the primary defense against noise-induced hearing loss for military personnel.
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OPERATIONAL NEEDS SUGGESTED BY THE REPORT The current irreversibility of noise-induced hearing loss and tinnitus means that preventing these problems, or limiting their progression, is especially important. From the review of information on noise exposure in military settings, hearing loss and tinnitus experienced by some service members, and the hearing conservation activities of the military services, the committee identified several steps that may enhance hearing protection for service members and improve the effectiveness of the services' hearing conservation programs.
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RESEARCH NEEDS SUGGESTED BY THE REPORT The committee also saw areas where further research would be valuable for improving understanding of broad scientific questions concerning the relationship between noise exposure and hearing loss and tinnitus. Research could also address more targeted questions concerning noise exposure, hearing loss, tinnitus, and hearing conservation measures related to military service.
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2. Establish cohorts of military veterans with various documented noise exposures, immediately on discharge, and survey them periodically for ototoxic exposures, subsequent nonmilitary noise exposures, and hearing function, as well as presence and severity of tinnitus, in order to determine whether there is a delay in the effects of military noise exposure.
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· The evidence from cross-sectional studies of noise-induced hearing loss in humans is sufficient to conclude that daily time-weighted average noise exposures greater than approximately 85 dBA for 8 hours for periods of many years pose a hazard to human hearing and that the hazard increases as the time-weighted average exposure exceeds this value. · The evidence is not sufficient to determine the probability of acquiring a noise-induced hearing loss, or to estimate the magnitude of the noise-induced hearing loss, that a specific individual is likely to experience from a given noise exposure.
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Chapter 5: Responding to Noise Risks: Hearing Conservation Programs in the Military · Compliance with requirements for use of hearing protection devices is cru cial for an effective hearing conservation program. There is limited or suggestive evidence to conclude that use of hearing protection devices and the level of real world hearing protection these devices provide have been and remain not ade quate in military hearing conservation programs.
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Incomplete reporting, lack of compliance with requirements for annual audiograms, or both, severely limit the usefulness of the centralized database and the conclusions that can be drawn from it regarding hearing conservation program effectiveness. · The evidence reviewed by the committee -- including information on the ef fectiveness 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 con clude that hearing conservation programs in the military are currently not ade quate to protect the hearing of military service members, and have not been adequate for the period since World War II.
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