Although noise-induced hearing loss (NIHL) is mostly preventable, the unique obstacles soldiers face create constant real-world challenges for U.S. Army audiologists. Permanent hearing loss is among the top four injuries soldiers incur in Iraq and Afghanistan.

Three years ago the Army transformed its traditional Hearing Conservation Program into the Army Hearing Program (AHP), an umbrella that includes a focus for soldiers at war. One of the newest AHP components is Operational Hearing Services, which includes a program to train soldiers to use new combat arms earplugs (CAEs) and the Tactical Communication and Protective Systems (TCAPS).

CAEs use passive, nonlinear attenuation that is level-dependent, providing settings for both steady-state and impulse/impact noise. The latter setting allows soldiers to hear verbal commands from squad members or over radios while still protecting their hearing from weapons fire and explosions. Soldiers are responding positively to CAEs; those who refused to wear standard earplugs on patrols now wear CAEs without reservation.

TCAPS are electronic devices that actively reduce noise and enhance hearing and communication by increasing ear-level microphone sensitivity and interfacing with radio equipment. The devices simultaneously protect hearing.

Soldiers using TCAPS have an edge on the battlefield, as they recover their hearing immediately after explosions or weapons fire—rather than carrying out missions with a temporary or permanent threshold shift. Hearing recovery is vital because those with a threshold shift report difficulty understanding the difference between words such as "attack" and "get back."

Using TCAPS enhances communication with fellow squad members on various floors in a building, even allowing soldiers to maintain silence during operations. Proper hearing protection also helps soldiers extend their careers. In the past, senior combat arms leaders in the infantry, field artillery, and armor—soldiers whose experience is most needed in combat—often sustained hearing loss early in their service.

Anecdotal evidence from Fort Stewart, Ga., the base where the AHP launched, suggests that with TCAPS in place, even soldiers with hearing loss experience improvement. When fitted with the devices, those who had sensorineural hearing loss could easily communicate with their squads inside tactical vehicles, maintain silence when required, and accurately identify the type and distance of weapon fire.

Test Runs

At Fort Stewart, home of the Third Infantry Division, TCAPS training sessions with experienced soldiers helped me determine what accessories were needed, which systems worked best, and what advantages they provided. The "test runs" with military police, convoy security, and air assault units, all with unique mission requirements, yielded impressive results.

In January 2007 I traveled with the division for its third deployment to Iraq on one of the first completely preventive audiology missions. My plans included completing noise abatement surveys, training line medics for noise hazard identification, teaching counseling skills, and teaching certification for earplug fitting. I also planned to train soldiers and leaders in the use of TCAPS and follow up with those who had been fitted previously.

Upon arrival in Baghdad, I visited multiple forward operating bases. At each location I completed nuisance noise surveys before providing abatement strategies in training sessions. My intent was to identify sound levels from elements such as engines or aircraft that create hazardous noise that could lead to NIHL. I also looked for nuisance noise levels that could interfere with effective communication or restful sleep.

The negative impact of nuisance noise on soldiers is commonly underestimated. Improving communication capability, for example, significantly reduces stress levels and increases operating efficiency for all personnel. Sufficient sleep improves the immune system's ability to fight disease, sustains keen perception ability, and preserves higher mental abilities and motor skills.

My audiology mission to Iraq was successful in a number of ways. Soldiers benefited from our efforts to reduce nuisance noise in their living environments, as well as from the training for medics and line units regarding effective and safe hearing protection. Capt. Leanne Cleveland, an Army audiologist, has recently completed another mission in Iraq, monitoring the benefits of TCAPS and supporting the soldiers with its training. We hope her study's outcome will lead to a greater distribution of the devices throughout the Army.

My opportunity to experience the environment in Iraq significantly helped us to improve future pre-deployment programs, in which soldiers will train using various hearing protection systems. The opportunity to help American soldiers using strategies that improve their survivability was extraordinary. I believe the various responsibilities of Army audiologists—from clinics to classrooms and from ranges and field exercises to combat environments—are rewarding and can make a true difference to soldiers.  

Special thanks to Marjorie Grantham, lieutenant, Army Research Laboratory, for her review of this article.