Decreased sound tolerance

Scientific Reports

Current research on blast and other injuries sustained by United States Service members and Veterans of the Iraq and Afghanistan Wars reveals a multitude of auditory complaints linked to exposures experienced during these conflicts. Among these complaints is decreased sound tolerance, which refers to a class of auditory-related problems including physical and/or psychological reactions to aspects of everyday sounds. Limited attention has been given to the possible relationship between blast exposure and decreased sound tolerance in Service members and Veterans, which is the purpose of this report. Baseline data were gathered and analyzed from 426 Service members (n = 181) and Veterans (n = 245) who participated in the Noise Outcomes in Servicemembers Epidemiology (NOISE) Study. Logistic regression analyses were performed to generate odds ratios (ORs) with 95% confidence intervals (CIs) for each group, adjusted for age and sex. Of those who reported blast exposure, 33% of Service members (adjusted OR = 1.4; CI = 0.7-2.8) and 48% of Veterans (adjusted OR = 1.9; CI = 1.1-3.3) reported decreased sound tolerance. Among Service members and Veterans who did not report blast exposure, 28% and 34% respectively, also reported decreased sound tolerance. Overall, blast exposure increased the likelihood of participants reporting decreased sound tolerance. The strength of this association was significant in Veterans.

Journal of Speech, Language, and Hearing Research

Purpose Evidence suggests that military blast exposure may lead to self-reported hearing difficulties despite audiometrically normal hearing. Research identifying potential mechanisms of this association remains limited. The purpose of this article is to evaluate the associations between blast, posttraumatic stress disorder (PTSD), and self-reported hearing difficulty, and to examine PTSD as a possible mediator of the association between blast exposure and hearing difficulty. Method We used baseline data from the Noise Outcomes in Service members Epidemiology (NOISE) study ( n = 477). Participants in this study undergo a comprehensive hearing, and tinnitus if applicable, evaluation and complete a large number of surveys. Pertinent data extracted from these surveys included information on participant's demographics, military service history, including exposure to blast, and health conditions such as symptoms of PTSD. Using regression models and following a formal causal mediation...

Journal of Rehabilitation Research and Development, 2015

Vast numbers of blast-injured Operation Iraqi Freedom/Operation Enduring Freedom/Operation New Dawn personnel report postconcussive symptoms that include headache, dizziness, poor memory, and difficulty concentrating. In addition, many report hearing problems, such as difficulty understanding speech in noise, yet have no measureable peripheral auditory deficits. In this article, self-report and performancebased measures were used to assess 99 blast-exposed Veterans. All participants reported auditory problems in difficult listening situations but had clinically normal hearing. Participants' scores on self-report questionnaires of auditory difficulties were more similar to scores of older individuals with hearing impairment than to those of younger individuals with normal hearing. Participants showed deficits relative to published normative data on a number of performance-based tests that have demonstrated sensitivity to auditory processing deficits. There were several measures on which more than the expected number of participants (15.9%) performed one or more standard deviations below the mean. These were assessments of speech understanding in noise, binaural processing, temporal resolution, and speech segregation. Performance was not universally poor, with approximately 53% of participants performing abnormally on between 3 and 6 of the 10 measures. We concluded that participants exhibited task-specific deficits that add to the evidence suggesting that blast injury results in damage to the central auditory system.

The Journal of the Acoustical Society of America, 2019

Blast-induced traumatic brain injury (TBI) and hearing loss are the two most common types of injuries sustained by military personnel while serving in the U.S. Global War on Terrorism. Recently several VA audiology clinics have reported active duty service members complaining of having problems communicating in noisy listening environments despite having normal to near-normal pure tone thresholds. In addition to standard clinical measures, we used electroencephalography (EEG) to determine whether damage to suprathreshold responding auditory nerve fibers in the sensory periphery and/or trauma to cortical regions associated with attention and working memory were responsible for the reported listening complications. In separate auditory and visual selective attention tasks, behavioral and neural measures suggest no evidence of long term neurotrauma affecting normal cognitive function. We found while absolute measures of auditory brainstem encoding varied greatly in all study subjects, ...

Journal of the American Academy of Audiology, 2017

Background: During military actions, soldiers are constantly exposed to various forms of potentially harmful noises. Acute acoustic trauma (AAT) results from an impact, unexpected intense noise ≥140 dB, which generates a high-energy sound wave that can damage the auditory system. Purpose: We sought to characterize AAT injuries among military personnel during operation “Protective Edge,” to analyze the effectiveness of hearing protection devices (HPDs), and to evaluate the benefit of steroid treatment in early-diagnosed AAT injury. Research Design: We retrospectively identified affected individuals who presented to military medical facilities with solitary or combined AAT injuries within 4 mo following an intense military operation, which was characterized with an abrupt, intensive noise exposure (July–December 2014). Study Sample: A total of 186 participants who were referred during and shortly after a military operation with suspected AAT injury. Interventions: HPDs, oral steroids....

Journal of Rehabilitation Research and Development, 2013

Blast-related ear injuries are a concern during deployment because they can compromise a servicemember's situational awareness and adversely affect operational readiness. The objectives of this study were to describe blast-related ear injuries during Operation Iraqi Freedom, identify the effect of hearing protection worn at the point of injury, and explore hearing loss and tinnitus outcomes within one year after injury. The Expeditionary Medical Encounter Database was used to identify military personnel who survived blast-related injury, and it was linked with outpatient medical databases to obtain diagnoses of hearing loss and tinnitus. The prevalence of ear injuries was 30.7% (1,223 of 3,981). The most common ear injury diagnoses were "inner or middle ear injury involving tinnitus" and tympanic membrane (TM) rupture. Hearing protection reduced the odds of ear injury involving tinnitus. Personnel with TM rupture had higher odds of hearing loss (odds ratio [OR] = 6.65, 95% confidence interval [CI] = 5.04-8.78) and tinnitus outcomes (OR = 4.34, 95% CI = 3.12-6.04) than those without TM rupture. Ear injuries and hearing impairment are frequent consequences of blast exposure during combat deployment. Hearing protection is warranted for all servicemembers at risk of blast exposure.

Military Medicine, 1981

I t has been established that both occupational and environmental noise are becoming more pervasive (worsening) each year. This is particularly distressing in light of the fact that noise induced hearing loss is the most prevalent occupationally related health hazard among US Army troops. This statement is based on the research project conducted in 1975 by Walden, Prosek, and Worthington 2 which examined the hearing acuity of 3,000 soldiers, and found that approximately 20 to 30 per cent of all personnel with two or more years of service in one of the combat arms branches have clinically significant hearing losses. Among soldiers with 15 years or more of service (i.e., the Army's senior non-commissioned officers), the percentage was determined to exceed 50 per cent. The combat arms branches (infantry, artillery, and armor) all have weapons and equipment that are capable of producing extremely high noise levels, resulting in irreversible hearing impairment. Even with proper hearing protective equipment, soldiers are, at times, in serious risk of incurring temporary or permanent loss of hearing. One of the major reasons why so many personnel develop permanent hearing impairment is that the acquisition of a noise induced hearing loss is usually a painless and insidious process.

American Journal of Audiology

Purpose A need exists to investigate the short- and long-term impact of noise exposures during and following military service on auditory health. Currently available questionnaires are limited in their ability to meet this need because of (a) inability to evaluate noise exposures beyond a limited time frame, (b) lack of consensus on scoring, (c) inability to assess impulse exposures (e.g., firearm use), (d) lack of a single questionnaire that assesses both military and nonmilitary exposures, and (e) lack of validity and reliability data. To address these limitations, the Lifetime Exposure to Noise and Solvents Questionnaire (LENS-Q) was developed. The purpose of this report is to describe the development and initial validation of the LENS-Q as a measure of self-reported noise exposure. Method Six hundred ninety participants, consisting of current Service members and recently military-separated (within about 2.5 years) Veterans, completed the LENS-Q, additional study questionnaires, ...

Seminars in Hearing, 2009

The increased use of explosive devices and mines in warfare and excessive noise of weapons has created an unprecedented amount of auditory dysfunction among soldiers. Blast-related injuries may damage the auditory processing and/or balance centers resulting in hearing loss, dizziness, tinnitus, and/or central auditory processing disorders. Some also lead to traumatic brain injury (TBI), postconcussive syndrome (PCS), and/or posttraumatic stress disorder. Some PCS symptoms such as dizziness, loss of balance, hearing difficulty, and noise sensitivity also can signify auditory or vestibular dysfunction and should not be obscured with the PCS package. This article provides information about the mechanisms of blast injury with emphasis on auditory dysfunction and TBI. Audiologists must be prepared to identify those at risk for TBI or mental health problems and adapt audiologic clinical practices to this population. An interdisciplinary comprehensive evaluation of peripheral, central, and vestibular components of the auditory system should be employed in patients with TBI to ensure that auditory dysfunction is accurately diagnosed and that appropriate rehabilitation can be performed.