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War veterans facing epidemic of hearing loss injuries

Philpott, Tom

doi: 10.1097/01.HJ.0000406781.73498.98
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One summer night five years ago outside Fallujah, Iraq, Marine Lance Cpl. David Goldich was manning the gun turret atop a Humvee when a roadside bomb, rigged with a 155 mm artillery shell, detonated beside him.

“It knocked out our vehicle commander, blew our fuel tank, shredded our tire,” Goldich recalled. The explosion also punctured Goldich's right eardrum and knocked him senseless for a time.

Like many infantrymen while on patrol, Goldich had elected not to wear personal ear protection, fearing it would dull “situational awareness,” his ability to hear distant gunfire, recognize the direction from which it came, and perhaps even identify the type of weapon being fired.

“It isn't that I wasn't taught I should wear ear protection. We were all given ear protection when we deployed. We were made aware that this is what we should be doing,” Goldich said. “But the reality of the situation, in the summer of 2006 in Anbar Province, was no one gave a damn about hearing protection.… There were other concerns at the forefront besides what I and many others viewed as minor irritants.”

Given how close he was to the explosion, Goldich doubts earplugs would have protected his hearing. Some audiologists agree. But one fact that most military hearing experts have come to recognize in recent years is that not enough has been done to protect troops from extreme noise, whether from weapons of war or harmful decibel levels that are routine in military occupations, from engine rooms to flight lines to firing ranges.

VA disability payments for impaired auditory systems jumped 15 percent last year, the biggest increase of any service-connected ailment. And 54 percent of veterans who became eligible for the first time for compensation linked to auditory conditions were younger than 55.

Veterans with tinnitus, a condition commonly described as a ringing in the ear, climbed by 92,300 in 2010. With 745,000 veterans now being compensated for tinnitus, it is the most prevalent of service-connected disabilities, followed by hearing loss, which affects 672,000 veterans.

Goldich served a second tour in Iraq before returning to civilian life as an engineer now pursuing a master's degree. But since service in Iraq, he too has tinnitus. For him, he said, it “sounds like an air hose, constantly sucking out, especially when there is no ambient noise.”

For others, tinnitus is a continuous buzz, beep, or an unpleasant screech. Doctors say it is a noise without corresponding stimulus, generated within the central nervous system or auditory system. In severe cases, it can cause depression or even thoughts of suicide.

With the rise of auditory injuries among service members, Congress directed the Department of Defense to establish a Hearing Center of Excellence registry that tracks hearing injuries and treatments, and eases transition of the hearing injured to the Department of Veterans Affairs for claim processing and effective follow-up care.

Lt. Col. Mark Packer, an Air Force neurotologist at Wilford Hall Medical Center in San Antonio, TX, is Interim Director of the HCE. It's a virtual center, rather than brick and mortar, “to guide best practices and develop the tools, educational platforms, and outreach for patients and clinicians to provide better [treatment] outcomes,” he said.

Packer said every service, on its own and coordinating with the HCE as it evolves, is doing more to educate members and unit commanders on proper hearing protection and hearing conservation techniques. He noted that every service also concurred with, and is acting on, findings of a Government Accountability Office audit that found weaknesses in hearing preservation and monitoring programs. (http://1.usa.gov/p2ynin.)

The HCE, Packer said, won't be fully operational until December 2013, but by then it should have a registry of all service members who have suffered hearing injuries and a communication plan in place to begin to improve prevention and clinical care using new standards and closer management of hearing threats. The HCE will also work with the services and industry members to test and implement more effective hearing protection.

Care of hearing injuries still will be through military medical centers. The HCE's greatest task will be information management. By law it must account for every case of hearing loss and acoustic injury. By producing good epidemiological data on treatments and outcomes, the most effective therapies will be identified and broadly instituted, Packer said.

Every service is striving to better educate individual members and unit commanders on costs being paid for lax hearing protection. The costs can be lowered job performance, long-term health effects for individuals, and a jump in spending by the Department of Defense and Veterans Affairs to treat and compensate for hearing injuries.

VA disability ratings are calculated not by adding ratings of individual disabilities, but through a more complex formula that combines the effect of multiple conditions. If tinnitus and hearing loss were compensated individually, the VA would be paying more than $2 billion a year to veterans for these two injuries alone, according to one estimate.

It's no surprise that Packer attributes most of the rise in hearing-related injuries to noise exposure from repetitive wartime deployments.

“We've sent people back to the war effort multiple times,” he said. “So it may be that chronic exposure, overlaid with multiple impact injuries, is making it rise faster than it otherwise would have. That's stuff we have to study a little bit better to get a better understanding of it.”

Meanwhile, the services have come to view hearing loss as a readiness issue, checking for auditory conditions before and after deployment, monitoring work noise levels more carefully, and striving to educate members and even family members on the value of hearing protection.

“A lot of our soldiers are in age groups where there's a strong sense of invincibility. Hearing loss is nothing that really concerns them now. But if we can develop a strategy that shows them what it's like to suffer hearing loss and how that will effect their future, especially in this age where communication is so important, I think we will be able to make a difference through their own personal accountability,” Packer said.

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