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Thursday, March 13, 2008

Returning Vets and Hearing Loss

In addition to the expected physical drawbacks of suffering combat-zone hearing injuries (now being called the "the silent epidemic"), I wonder what, if any, psychological effects these persistent wounds have on our soldiers.

Are returning vets with ringing or buzzing ears, also known as tinnitus, at a disadvantage when it comes to putting the war behind them? What effect does the constant reminder of the IED blast or RPG attack they survived have on them?

From AP:

Large numbers of soldiers and Marines caught in roadside bombings and firefights in Iraq and Afghanistan are coming home with permanent hearing loss and ringing in their ears, prompting the military to redouble its efforts to protect the troops from noise.

Hearing damage is the No. 1 disability in the war on terror, according to the Department of Veterans Affairs, and some experts say the true toll could take decades to become clear. Nearly 70,000 of the more than 1.3 million troops who have served in the two war zones are collecting disability for tinnitus, a potentially debilitating ringing in the ears, and more than 58,000 are on disability for hearing loss, the VA said. ...

For former Staff Sgt. Ryan Kelly, 27, of Austin, Texas, the noise of war is still with him more than four years after the simultaneous explosion of three roadside bombs near Baghdad.

"It's funny, you know. When it happened, I didn't feel my leg gone. What I remember was my ears ringing," said Kelly, whose leg was blown off below the knee in 2003. Today, his leg has been replaced with a prosthetic, but his ears are still ringing.

"It is constantly there," he said. "It constantly reminds me of getting hit. I don't want to sit here and think about getting blown up all the time. But that's what it does."

In educational interest, article(s) quoted from extensively.


"They can't say, `Wait a minute, let me put my earplugs in,'" said Dr. Michael E. Hoffer, a Navy captain and one of the country's leading inner-ear specialists. "They are in the fight of their lives."

In addition, some servicemen on patrol refuse to wear earplugs for fear of dulling their senses and missing sounds that can make the difference between life and death, Hoffer and others said. Others were not given earplugs or did not take them along when they were sent into the war zone. And some Marines weren't told how to use their specialized earplugs and inserted them incorrectly. ...

Sixty percent of U.S. personnel exposed to blasts suffer from permanent hearing loss, and 49 percent also suffer from tinnitus, according to military audiology reports. The hearing damage ranges from mild, such as an inability to hear whispers or low pitches, to severe, including total deafness or a constant loud ringing that destroys the ability to concentrate. There is no known cure for tinnitus or hearing loss.

The number of servicemen and servicewomen on disability because of hearing damage is expected to grow 18 percent a year, with payments totaling $1.1 billion annually by 2011, according to an analysis of VA data by the American Tinnitus Association. Anyone with at least a 10 percent loss in hearing qualifies for disability.

In 2005, Congress mandated the Institute of Medicine to assess "noise-induced hearing loss and tinnitus associated with military service from World War II to the present, the effects of noise on hearing, and the availability of audiometric testing data for active duty personnel." Their full report, Noise and Military Service: Implications for Hearing Loss and Tinnitus, found:

For this congressionally mandated and VA-funded study, an IOM committee reviewed evidence on the following concerns:

• Sources of hazardous noise exposure during military service

• Levels of noise exposure necessary to cause hearing loss or tinnitus

• Available data on hearing loss that could be expected among members of the armed forces

• Course of hearing loss following noise exposure, including whether onset can be delayed

• Risk factors for noise-induced hearing loss and tinnitus

• Adequacy of the services’ hearing conservation programs to protect the hearing of servicemembers

• Compliance by the military services with requirements for audiometric testing

... Many sources of potentially damaging noise exist in military settings, including weapons systems, wheeled and tracked vehicles, fixed- and rotary-wing aircraft, ships, and communications devices. Servicemembers encounter noise through training, standard military operations and combat, and exposure to combat-related noise may be unpredictable in onset and duration. Servicemembers may also be exposed to hazardous noise through activities that are not unique to military service, including engineering, industrial, construction and maintenance tasks.

... 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. Endogenous factors that have been studied include older age, gender, race, eye color and prior hearing loss. Among the exogenous risk factors that have been studied are aminoglycoside antibiotics, cisplatin, diuretics, salicylates, solvents, carbon disulfide, carbon monoxide, cigarette smoking, whole-body vibration, body temperature, exercise and electromagnetic fields. Some of these exogenous factors, primarily the medications and chemicals, may induce hearing loss in and of themselves.

... From its analysis of available data, the committee concluded that military hearing conservation programs dating from the late 1970s forward were not adequate to protect the hearing of servicemembers. Hearing conservation activities from World War II through the 1970s would have been even less adequate because only early hearing protection devices of limited effectiveness were available and mandatory hearing conservation measures were in place only in the Air Force.

Use of hearing protection devices is often the primary defense against noise-induced hearing loss for military personnel, and the effectiveness of these devices depends, in large measure, on how well and how often they are used. Data are limited, but a handful of reports over the past 30 years suggests that in some settings, only about half of those who should have been using hearing protection devices were doing so.

Although the services’ hearing conservation programs require annual audiometric testing for enrollees, some personnel may not be receiving the required tests and some test results may not be reaching the data registry. Where test records are available, the percentage of servicemembers who have a significant shift in their hearing thresholds currently ranges from about 10 to 18 percent, a level two to five times higher than is considered appropriate in industrial hearing conservation programs.

... The current irreversibility of noise-induced hearing loss and tinnitus means that preventing these problems, or limiting their progression, is important. The committee recommended that the military services implement several practices to enhance hearing protection for servicemembers and improve the effectiveness of military hearing conservation programs. Some of these include:

• Work to achieve more extensive and consistent use of hearing protection

• Include questions about the presence and severity of tinnitus on all audiometric records

• Enforce requirements for audiograms prior to noise exposure for all new military servicemembers at all basic training sites

• Enforce (or establish) requirements for audiograms at the completion of military service

• Enforce hearing conservation requirements for annual monitoring audiograms and for follow-up audiograms if a significant threshold shift is detected

• Improve the reporting capabilities of the Defense Occupational and Environmental Health Readiness System (DOEHRS), including adding the ability to track reports of tinnitus.

The full 342-page report is available on Google Books. The American Tinnitus Association has some helpful general information for anyone interested in learning more on this injury.

If you're a veteran suffering from hearing loss, here's some helpful advice on filing a claim for your injury:

Claims for bilateral hearing loss and bilateral tinnitus must be well supported by current medical evidence. There must be a pertinent military service history which indicates that the veteran was exposed to prolonged loud noises while on active duty, there must be medical evidence of a current hearing loss with or without tinnitus and, most importantly, there must be a documented medical opinion from a state licensed audiologist that the current hearing loss or tinnitus was more likely than not to have been caused by his/her exposure to environmental and/or combat related noise while on active duty.

All veterans who are contemplating filing a claim for bilateral hearing loss and bilateral tinnitus are advised to request an audiologist exam from the VA Medical Center [in your area]. The audiologists at that facility know exactly what the VA regional office needs for a service connected hearing claim. The amount of disability granted for service connected hearing loss depends on the degree of loss.

What we need from you to assist with the preparation of your claim.

If you are enrolled with VA Health and are being seen at a local VA Clinic, when you see your VA primary care provider at your next appointment please remember to tell your provider that you have hearing loss and ringing in your ears. Ask them to make you an appointment with the audiologist clinic at the nearest VA facility for an audiologist evaluation.

When you see the audiologist tell him:

1. You have a hearing loss.
2. You have continuous ringing/buzzing in your ears .
3. You were exposed to loud environmental noise while you were on active duty.

After your examination go to the “release of information office” and ask them to send a copy of your audiologist evaluation results to your home. When you receive the results bring them in to our office. We will submit the results as medical evidence to the VA Regional Office along with your claim.

Medical evidence is critical to the approval of your claim. Medical evidence establishes the verification needed by the VA to confirm that the disability you are claiming actually exists.

The audiologist may or may not further document an opinion in the report as to whether or not the possible cause of the hearing disability is a result of your earlier exposure to environmental and/or combat related noises while on active duty.

The sample letter is a copy of the type of letter that the VA will accept as medical evidence of a “link” between your current hearing loss with tinnitus and the loud noise that you were exposed to while on active duty.

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