Conservation hearing military program

Although audiometers were available at the time, this measurement equipment was not used at the induction centers responsible for the initial processing of personnel.

These tests measured the distance at which an individual understood speech at levels that could be understood from 15 or 20 feet away by people with. Results of whispered voice tests are extremely variable between testers Lee, , and early testing environments within the military settings were not likely to be controlled Bergman, Without accurate measures of hearing thresholds, some people inducted into the military with hearing loss were classified as normal-hearing individuals.

Estimates from two of the military aural rehabilitation centers established in the s suggest 40—65 percent of patients seen had hearing losses predating their military service Bergman, During the s and s, measurement of pure-tone thresholds using audiometers became more widespread. In , 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, Instead, the regulation states that the standard procedure in the Air Force is to obtain reference audiograms within 30 days after assignment at the first permanent duty station Department of the Air Force, In , the whispered voice test was replaced by pure-tone audiometry at recruit screening centers Department of Veterans Affairs, In , the Army published a policy requiring that a reference audiogram be made a part of the preplacement or entrance physical examination Department of the Army, , and in , the Navy required that all military personnel receive a reference audiogram upon entry into naval service Department of the Navy, DoD did not issue a requirement for reference audiograms at basic training prior to noise exposure until DoD, Despite these requirements, to date, not all service members are administered a reference audiogram upon entrance.

In the Air Force, baseline audiometric examinations may frequently be administered after basic training, now more than 6 weeks in duration Pluta, , a. All of the services stipulate that the audiograms used as a screening tool to establish fitness for military service most collected at the Military Entrance Processing Stations are not acceptable as reference audiograms Department of the Air Force, ; Department of the Navy, , This stems from the varying periods.

Screening audiograms at military entrance processing stations require manual transcription, allow for variable intervals between calibration, and do not require technician certification or a defined quiet period before the examination Niebuhr, The Air Force was the first service with a requirement that all military and civilian personnel receive an audiometric examination as part of their routine physical examination when they end their Air Force service Department of the Air Force, The and Air Force regulation updates Department of the Air Force, , stated that all personnel whose duties caused them to be routinely exposed to hazardous noise must receive a final audiometric examination within 90 days before the last day of active duty, but they did not specify that all personnel were to receive audiograms at separation from service.

In , the Army Department of the Army, and in the Navy and Marine Corps Department of the Navy, required hearing tests upon termination of service. In the Coast Guard, termination physical exams included audiograms starting in the early s McConnell, However, physical exams are not generally required by the services upon separation unless the last exam or medical assessment is no longer considered current except for retiring Army service members GAO, Service members may waive the hearing test, however, and many do so rather than face delays in returning home.

The committee reviewed data regarding compliance with the requirement for annual audiograms for those enrolled in hearing conservation programs. Since its introduction in , the system has experienced repeated changes in contractors, as well as considerable turnover in the audiometric technicians who administer audiograms Ohlin, a and several other infrastructure and training problems Frost, Data furnished to the committee on compliance for the Army and the Air Force are plotted in Figure Clear peaks and valleys in the data from the Army may, in part, reflect administrative changes in the database.

In , for example, a change from reporting the numbers of service members enrolled in the hearing conservation program by medical region to. The denominators numbers of personnel reported as noise exposed are often estimates based on unit strengths at the larger installations.

Numerators are based on the hearing tests received at the data repository. Compliance can be higher than the reported figures if data from all hearing tests are not received or can be artificially inflated if personnel are tested who are not reported as noise exposed Ohlin, a.

Although there are fluctuations in the Army data from through , average compliance is estimated to be 45 percent over this period. Since , compliance for the Air Force is approximately 55 percent. Thus, half of the. In either case, missing data are serious obstacles to implementing effective hearing conservation programs. However, Wolgemuth and colleagues provided some data on compliance for vessels of the U. Atlantic Fleet for — Compliance figures were not reported by ship type, so the percentage of personnel represented was not clear.

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 — 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.

As noted earlier in the chapter, data from reference, periodic, and termination audiograms constitute audiometric databases that can be used to evaluate hearing conservation programs. Because methods of audiometric database analysis are best suited for analysis of consecutive audiograms in a stable population with a consistent set of audiometers Royster and Royster, , a military hearing conservation program may rate poorly using this metric.

Service members are typically very mobile—moving from assignment to assignment within the military and then leaving the military within about 4 years GAO, Thus, consecutive annual audiograms are frequently administered in different locations using different audiometers. OSHA defines an STS as a change of 10 dB or more in the average pure-tone thresholds at , , and Hz in either ear compared with the baseline audiogram. Royster , , Schulz , and Dobie have analyzed the impact of different definitions of STS on the sensitivity and specificity of the measure.

With increasing sensitivity, more hearing conservation program participants are identified as experiencing an STS, and with increasing specificity, fewer participants are unnecessarily designated as warranting follow-up action. Tradeoffs are necessary between the two. Definitions of STS are policy decisions requiring considerations of hearing loss prevention and the costs of follow-up tests, counseling, referrals, and potential job changes.

In those data, a PTS is defined as an STS that is either 1 confirmed upon retest following at least 40 hours of quiet or 2 not resolved through follow-up testing. When the threshold shift is designated as a PTS either through confirmation or lack of follow-up , the newest thresholds should, but may not always, become the baseline audiogram for future comparisons.

As a result, PTS percentages may be artificially high from either a lack of follow-up testing or a failure to establish a new baseline following a previous PTS. As shown in Figure , at 7—8 percent, the reported annual percentages of Air Force hearing conservation program enrollees with PTS for the period — are the lowest levels reported across the services.

Rates for that period for the Army, Navy, and Marine Corps are approximately 15 percent. It is important to note, however, that these figures are based on data representing only about half of the enrollees in the hearing conservation programs. If this were a random sample of enrollees, it would be more than adequate for the evaluation of the programs. During this time the definition of STS changed, as detailed in Table PTS and STS values for each service are of interest, but far more useful for intervention and improvement are STS and PTS values reported by installation or by military occupational code, which permit a more focused assessment of subpopulations at greatest continuing risk.

Cases of PTS and STS were also reported among other personnel, such as those with financial and paralegal occupational specialties. 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. A series of studies carried out in the mids assessed hearing thresholds among Navy personnel, as reviewed in Chapter 3.

The studies documented continuing STS, not just among engineering and aviation personnel, but also in administrative and supply occupational categories where it would not be anticipated Wolgemuth et al. In sum, the information available from audiometric monitoring carried out by the military services provides a complex picture of their hearing conservation programs.

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. Except for the Air Force, a variety of ad hoc efforts to evaluate the effectiveness of the hearing conservation programs have been made as drawn upon in Chapter 3 and above. Air Force regulations require annual reports concerning the overall state of the hearing conservation program Department of the Air Force, Such reporting began in the mids, continued intermittently into the mids, and has recently resumed Department of the Air Force, , , , , ; Meyer and Wirth, ; Pluta, , b.

Army regulations require reporting of effectiveness indicators at the installation level Department of the Army, However, the U. In the Navy regulations, annual program performance evaluations are to be carried out at the local level but are not required or carried out servicewide Navy Environmental Health Center, b.

According to DoD policy, components are to evaluate the effectiveness of their hearing conservation programs annually based on the prevalence of STS and the percentage of compliance with requirements for annual audiograms DoD, b. They are using the tools available to them e.

Reported compliance with requirements for annual audiograms is low, limiting the data available for review and analysis, and reporting functions of the system are limited. The effectiveness of the military hearing conservation programs is difficult to evaluate because of the disjointed and limited information available.

The military services must contend with substantial challenges beyond their control, including the mobility and high turnover of their workforce and most significantly, the extreme and frequently unpredictable exposure to hazardous noise in combat.

Several important aspects of the hearing conservation programs, however, are largely within the discretion of DoD and the military services.

These include the degree of funding; number of staff; extent of training; command emphasis on the importance of hearing protection; implementation of noise controls; degree of compliance with requirements for entrance, periodic, and termination audiograms; and reporting of audiometric data to a central repository.

This does not suggest that there are not strong and effective efforts at local levels within the services, or even in leadership roles, but that the sum of these efforts is not yet sufficient. 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. Acoustical Society of America. New York: Acoustical Society of America.

Acton WI. History and development of hearing protection devices. Assessment of the proposed Draft American National Standard method for evaluating the effectiveness of hearing conservation programs. Journal of Occupational Medicine 35 6 — Journal of the American Academy of Audiology 6 4 — Use of comparison populations for evaluating the effectiveness of hearing loss prevention programs. American Industrial Hygiene Association Journal 61 1 — Time trends analysis of hearing loss: An alternative approach to evaluating hearing loss prevention programs.

American Industrial Hygiene Association Journal 61 2 — Air Force Hearing Conservation Registry. Medical Surveillance Monthly Report 3 9 — Annual Report Effects of active noise reduction in armor crew headsets. In: Audio Effectiveness in Aviation. Berger EH. EARLog No. Indianapolis, IN: Aearo Co. Hearing protection devices. The Noise Manual. Hearing protection device utilization around the world. Spectrum 17 Suppl 1 International review of field studies of hearing protector attenuation.

New York: Thieme Medical Publishers. Bergman M. Audiology Today. Monograph No. Naval Aviation: Advanced Hearing Protection Bolger A. Industrial Hygiene Quarterly 17 March : — Byrne D, Monk W. Spectrum 10 Suppl 1 Fort Rucker, AL: U.

Army Aeromedical Research Laboratory. Chandler D. Department of Defense Hearing Conservation Program. May Accuracy of pre-induction audiograms.

Military Medicine 5 — Hearing protection in the military environment. Noise Health 2 5 :1— Davis JA. Department of the Air Force. Hearing Conservation Program Status Report Department of the Army. Washington, DC: Department of the Army. Department of the Navy. BUMED Washington, DC. Marine Corps Order Washington, DC: Department of the Navy.

Department of Veterans Affairs. Dobie RA. Prevention of noise-induced hearing loss. Archives of Otolaryngology—Head and Neck Surgery 4 — Audiometric threshold shift definitions: Simulations and suggestions.

Ear and Hearing 26 1 — DoD Department of Defense. Department of Defense Instruction Washington, DC: Department of Defense. Washington, DC: U. Department of Defense. December Military Personnel Statistics.

Noise and the impairment of hearing. Analysis of a hearing conservation program database: Factors other than workplace noise. Ear and Hearing 10 5 — Frost AW. Hearing Protection: Problems in the Department of Defense. GAO Gardner R, Berger EH. EAR Tech.

Indianapolis, IN: Aearo Corporation. Gasaway DC. Significant milestones in the evolution of hearing conservation programs. In: Gasaway D.

Occupational hearing conservation in the military. In: Lipscomb DM, ed. Hearing Conservation in Industry, Schools, and the Military. Boston, MA: Little, Brown. Gates K. Guild E. Personal protection. In: Industrial Noise Manual. Military Medicine 12 — Hall MD. Haluska FP. Hearing conservation in a metal stamping and forging plant. National Safety Congress Transactions — Hatton JF. Industrial Hygiene Quarterly 17 March — The likelihood of detecting a significant hearing threshold shift among noise-exposed workers subjected to annual audiometric testing.

Annals of Occupational Hygiene 34 4 — Holland HH. Attenuation provided by fingers, palms, tragi, and V51R ear plugs.

Letter to the editor. Journal of the Acoustical Society of America 41 6 Lee SE. McConnell W. Hearing Conservation in the Coast Guard. McConnell W U. Coast Guard. Active noise reduction headsets. In: Vallet M, ed. Proceedings of the 6th International Congress. Nice, France, July Melnick W. Evaluation of industrial hearing conservation programs: A review and analysis. American Industrial Hygiene Association Journal 45 7 — An evaluation of the U.

Military Medicine 9 — Components of a Hearing Conservation Program. Noise Hazard Identification. Noise is unwanted sound. Noise distracts, disturbs, and interferes with communication and sleep. It can affect an individual's performance, behavior and hearing. Noise is produced by all mechanical devices, including generators, aircraft, or vehicles entering or leaving a work site.

Noise hazard identification program describes the frequency of noise surveys, the equipment used, equipment calibration requirements, personnel involved in conducting noise surveys, risk assessment and posting requirements. Posting Noise Hazards Guidelines. Engineering Controls. For hearing purposes, engineering controls are defined as any modification or replacement of equipment or related physical change at the noise source or along the transmission path with the exception of hearing protectors that reduce the noise levels.

Equipment should be maintained in good working order and, if necessary, isolate the noise in order to reduce noise levels at the source and eliminate any harmful health effects. In addition, purchase equipment that offers safe noise limits when economically and technologically feasible. Hearing Protectors. Hearing protector program details the requirements for use and maintenance, characteristics of protectors and the hearing protection requisition process.

The actual performance of hearing protection devices depends on the achieved fit and the noise environment. Finally, the overall percentage of DoD personnel who received periodic hearing tests with hearing impairment decreased over the years presented.

Starting in with the first U. These programs protect individuals who are exposed to hazardous noise from developing noise-induced hearing loss or tinnitus, which may result in permanent disability and negatively affect quality of life. This system allows for capture, analysis, and storage of hearing test audiograms results worldwide for DoD HCPs. At a minimum, hearing test results that document a significant threshold shift STS and a permanent threshold shift PTS , as well as rates of compliance with requirements for hearing tests, are collected, reviewed by program managers, and reported to higher headquarters.

For example, in the Army and Marines Corps, all service members receive hearing tests on at least an annual basis due to the risk of noise-induced hearing loss secondary to exposures to weapon fire noise during required weapon qualification. Hearing ability is also considered an element of individual readiness due to the need to communicate effectively on the battlefield and its relationship to warfighter lethality and survivability.

The Air Force and Navy hearing conservation programs take a risk-based approach in which only members who are exposed to routine hazardous noise are enrolled in an audiometric monitoring program and receive periodic hearing tests. These MOEs were then prepared and codified by the U.

Data were stratified by component active component [AC], National Guard [NG], reserve component, and civilian and presented as annual percentages among those who were tested. This report presents findings for calendar years through A reference test is the initial hearing test received by an individual before exposure to hazardous noise duty.

When compared to the reference test, changes in hearing in the periodic test may initially be characterized as a significant threshold shift STS. When an STS occurs, follow-up testing is required to confirm whether the shift is temporary or permanent.

Conversely, if an STS is confirmed on follow-up testing, or the member does not return for retesting within the specified timeframe, the STS is considered to represent a permanent threshold shift PTS. The timeframe for follow-up testing varies from 30 to 90 days from the periodic test depending on service-specific regulations. Hearing is assessed at least annually for individuals and is compared to the most current reference test available.

If an individual had more than one periodic or reference test series in a given calendar year, their most recent test series was used in the analysis. Aggregate data for 4 MOEs were compiled across all services and are described in this report. The percentages of threshold shifts were calculated by taking the number of unique individuals meeting each set of respective criteria on an annual a type of periodic test hearing test per calendar year and dividing by the total number of individuals who received an annual hearing test.

For example, the number of individuals with a PTS is divided by the number of those who received an annual hearing test in a given time frame and the result is expressed as a percentage. The rate of non-compliance is calculated by dividing the number of people with an STS who did not receive follow-up testing within the required time frame by the total number of tests indicative of STS per year.

The time frame for follow-up testing is based on service-specific requirements. MOE 3 is a measure of the frequency of hearing impairment hearing thresholds above 25 dBHL or the frequency of those with clinically normal hearing hearing thresholds at 25 dBHL or below in a population of interest. In this report, MOE 3 focuses on the proportion of hearing impairment counts among individuals who received testing per year.

Percentages of hearing impaired were calculated by taking the number of individuals including enlisted accessions as a separate population with hearing impairment results on a periodic or reference hearing test per year and dividing by the total number of individuals who received a periodic or reference hearing test in the same year.

The audiometric criteria for MOE 4 are as follows: 1 any threshold greater than or equal to 40 dBHL from to Hz in either ear, or 2 an average of the 3 highest frequencies between to Hz greater than 25 dBHL pure-tone average. The percentage of individuals meeting the VA compensation criteria was defined as the number who met the VA criteria per year divided by the total number of individuals who received a periodic or reference hearing test in that same year.

Over the course of the 7-year period, civilian percentages of STS range: Annual percentages of PTS in civilians range: 9.