The Authors Reply: Thank you for the opportunity to respond to Dr Tubbs' letter. We agree with Dr Tubbs that the use of hearing-protective devices during transport can be a valuable part of a hearing conservation program for fire fighters. We appreciate that he brought this fact to the attention of the Journal's readers. We certainly did not "rule out" the use of hearing-protective devices nor imply that they are inappropriate for fire fighters in all situations. However, it must be recognized that fire fighters' noise exposures are not limited to transport and continue to some extent at fires and chemical accidents where decreasing one's auditory acuity can have adverse effects on safety and performance. Our discussion simply emphasized our preference for reducing exposures through engineering controls. Dr Tubbs' own chapter1 (cited in his letter) also discusses various engineering changes that can reduce fire fighters' noise exposures at their sources. In conclusion, we support both hearing-protective devices and engineering controls as components of comprehensive hearing conservation programs for fire fighters.
Stephen N. Kales, MD, MPH
Harvard Medical School; Boston, MA
David C. Christiani, MD, MPH, MS
Harvard School of Public Health; Boston, MA
1. Tubbs RL. Noise and hearing loss in firefighting. Occupational Medicine: State of the Art Reviews.
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