The Army Hearing Program Expanding Audiology’s Military Reach Features
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Features  |   January 01, 2009
The Army Hearing Program
Author Notes
  • D. Scott D McIlwain, AuD, CCC-A, an audiologist and a major in the U.S. Army, is an adjunct faculty member at the Texas A&M Health Science Center Graduate School of Rural Public Health, College Station. Contact him at David.McIlwain@amedd.army.mil.
    D. Scott D McIlwain, AuD, CCC-A, an audiologist and a major in the U.S. Army, is an adjunct faculty member at the Texas A&M Health Science Center Graduate School of Rural Public Health, College Station. Contact him at David.McIlwain@amedd.army.mil.×
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Hearing & Speech Perception / Hearing Disorders / Regulatory, Legislative & Advocacy / Features
Features   |   January 01, 2009
The Army Hearing Program
The ASHA Leader, January 2009, Vol. 14, 5-6. doi:10.1044/leader.FTR4.14012009.5
The ASHA Leader, January 2009, Vol. 14, 5-6. doi:10.1044/leader.FTR4.14012009.5
The ability to accomplish a unit’s mission is directly proportional to its level of effective communication. In combat, this situation is magnified by the chaotic environment, fatigue, weather extremes, and the complexity of problems encountered. Soldiers’ hearing must be protected from damage caused by continuous and hazardous impulse noise without compromising the ability to hear and communicate in these environments.
The Army Hearing Program’s objective is to prevent noise-induced hearing loss (NIHL) and to ensure maximum combat effectiveness in soldiers. Poor hearing jeopardizes the unit mission and increases the likelihood of a serious mishap due to a soldier’s inability to hear verbal orders, understand radio communications, localize the direction of sounds, gauge distances accurately, and have good overall situational awareness. This monumental task cannot be accomplished with hearing conservation alone.
When soldiers are identified as having significant hearing loss, a military medical board reviews their records to determine if the soldiers face any limits. The review also determines any susceptibility to further hearing loss due to specific jobs (e.g., tanker, artillery, etc.). Affected soldiers will be required to change to jobs that do not expose them to hazardous noise or pose a safety hazard to themselves and others. Unfortunately, this requirement creates a serious void in many career fields.
As a result, the Army Hearing Program provides a comprehensive hearing program that comprises four distinct sub-programs: operational hearing services, hearing readiness, clinical services, and hearing conservation.
Operational Hearing Services
Although hearing protection in combat seems illogical, technology allows soldiers to localize, gauge auditory distance, and hear verbal and radio communication. Tactical communication and protective systems (TCAPS) provide “talk-through” capabilities connecting to a radio and/or an intercom. TCAPS devices are either in-the-ear or over-the-ear. The single-channel version can interface with one radio or the vehicle intercom; the dual-channel version connects to two radios or one radio and an intercom.
Some TCAPS models use external voice microphones for outgoing communications; other devices use internal microphones located in the external ear canal. External microphones allow for perception of environmental sounds, and process sound independently to enable localization more effectively. Advantages of the internal microphones include elimination of the external boom microphone and reduction of background noise due to microphone placement inside the ear canal. An active noise reduction circuit can improve speech understanding in high-noise environments.
Noise is unwanted sound. The impact of noise on military operations cannot be over-stated. Noise distracts, disturbs, and interferes with communication and sleep. At worst, it affects soldier performance, behavior, and hearing. While low-level sounds may be annoying, exposure to those above conversational speech levels produce symptoms of stress (such as increased heart rate and blood pressure and headache), as well as faster and shallower breathing. Although soldiers can attempt to ignore noise, its effects contribute to decreased attention and energy levels, fatigue, irritability, and ineffective communication. Limiting as many stressors as possible in an already tense environment is extremely important.
Although sophisticated equipment is needed to quantify noise levels, all soldiers have the ability to identify noise levels and sources that affect operations. In situations that require more thorough noise assessment, preventive medicine personnel may provide assistance. Some examples of common noise sources in combat include generators, intermittent landings of rotary or fixed-wing aircraft, tactical vehicles entering or leaving the compound, and intermittent field radio communications. Engineering controls can range from the simple (i.e., sandbagging) to the extremely complex (i.e., acoustical considerations in new construction). Because most combat zones are in disrepair, this job is monumental.
Hearing Readiness
Soldiers who are deploying within 12 months or who are assigned to deployable units will receive one of 11 hearing readiness (HR) classifications. The classification, derived from hearing threshold data from a central repository, will be reported to the soldier’s unit and chain of command.
HR is a process that ensures soldiers have the required hearing capability and the correct personal protective equipment to perform their job-specific duties. Good hearing can mean the difference between life and death in combat, as well as in training. A key component of HR is monitoring with database audiometry, using computer software to test hearing and saving the individual’s threshold data for future comparison. The threshold database is updated on a central repository at least weekly and can be accessed worldwide. It allows continuity of baseline threshold comparisons, provides soldiers with access to hearing threshold records, limits false claims of service-related hearing loss, and communicates with other Army-wide databases.
The Army requires annual hearing monitoring only from soldiers who are routinely exposed to noise, assigned to a deployable unit, or are within 12 months of deploying. Medical, legal, financial, logistical, or staff jobs in the Army do not routinely expose soldiers to hazardous noise. If a soldier’s noise exposure changes, the hearing monitoring status will change accordingly.
Clinical Hearing Services
NIHL is sometimes seen as an injury secondary to other major trauma inflicted by devices such as an improvised explosive device, mine, mortar, or rocket-propelled grenade explosion. Yet NIHL typically affects the high frequencies and can have a negative effect on both communication and the correct identification of noise signatures. Hearing is a multidimensional sense that provides an indispensable amount of information on the battlefield. Some soldiers experience temporary threshold shifts and become a liability or hazard to their unit in combat.
Quantifying a soldier’s HR classification, as well as determining the extent of injury from noise exposure, requires more thorough evaluation than monitoring audiometry alone. Delivering these clinical services as far forward on the battlefield as possible is critical to providing combat leaders with their soldiers’ HR. These forward-deployed audiology services limit unnecessary loss of duty time to evacuate a soldier from a combat zone to the closest audiology clinic. Since 2003 audiologists have successfully operated within combat support hospitals in Baghdad. When soldiers are not deployed, clinical audiology services are a normal part of the soldier readiness cycle.
The purpose of an audiological assessment is to determine the degree and cause of hearing loss. Once a soldier with hearing loss has been identified, a treatment and management plan goes into place. The plan may include medical or surgical intervention, prescription of personal hearing aids, assistive listening devices, aural rehabilitation, or monitoring the condition for changes. In some cases, intervention, training, and education are conducted in the soldier’s unit.
Hearing Conservation
For many years, the Army Hearing Conservation Program served as the flagship for the prevention of NIHL. This industrial-focused program is instrumental in preventing NIHL in primarily fixed-facility settings. Although some soldiers work in industrial-based settings, hearing conservation efforts are primarily directed at our civilian workforce. This component of the redesigned Army Hearing Program still exists in its form and function, but now serves in concert with three additional components to provide a truly comprehensive prevention program.
References
Garinther, G. R., & Peters, L. J. (1990). Impact of communications on armor crew performance. Army Research Development and Acquisition Bulletin, 1–5.
Garinther, G. R., & Peters, L. J. (1990). Impact of communications on armor crew performance. Army Research Development and Acquisition Bulletin, 1–5.×
McIlwain, D. S. (2004). CAOHC deployed. Council for Accreditation in Occupational Hearing Conservation Update, 16(3).
McIlwain, D. S. (2004). CAOHC deployed. Council for Accreditation in Occupational Hearing Conservation Update, 16(3).×
Ades, H., Miles, R., et al. (1953) BENOX report: An exploratory study of the biological effects of noise. Defense Technical Information Center, AD024685, 1–22.
Ades, H., Miles, R., et al. (1953) BENOX report: An exploratory study of the biological effects of noise. Defense Technical Information Center, AD024685, 1–22.×
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January 2009
Volume 14, Issue 1