November 4, 2008 Feature

Army Moves to Higher Level of Hearing Protection

First Preventive Audiology Mission Visits Iraq, Reaches Out to Civilians

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. 

Jillyen Curry-Mathis, is a captain in the U.S. Army. The views expressed in this article are hers and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the U.S. government.

cite as: Curry-Mathis, J. (2008, November 04). Army Moves to Higher Level of Hearing Protection : First Preventive Audiology Mission Visits Iraq, Reaches Out to Civilians. The ASHA Leader.

References

Truax, B. (Ed.), (1999). Handbook for Acoustic Ecology. Simon Fraser University & ARC Publications.

MIL-STD-1472F (5.8.3), (31 March 1998). DoD Design Criteria Standard-Human Engineering, Acoustical Noise.



Kindness Bridges Cultures in Iraq

U.S. Army Provides Audiology Outreach

A preventive audiology mission with the Third Infantry Division during its January 2007 deployment to Iraq allowed me the gratifying opportunity to help a child in a difficult situation.

Capt. Sayed Ali, a flight surgeon from a nearby base, asked me to evaluate a local Iraqi boy who had hearing loss. The 14-year-old wore a knit cap to hold ear pieces in place on an old body hearing aid with ear molds that he had outgrown. The boy carried the input microphone in his pocket.

Despite the severe-to-profound hearing loss, he was relatively oral and aware of sound, responding to his name and attempting to speak with his father. By supplementing with gestures, he could communicate with his family on basic topics. The boy's father indicated that he was a full-term baby. His hearing loss was possibly congenital, although his father believed the loss was caused by vaccinations administered during infancy.

The boy received his hearing aid before the Iraq war, when the country's health care system was functional and free. The system has reopened but it cannot meet demand, as most of the country's health care providers have fled.

Because of this break in care, the boy's hearing aid became uncomfortable and provided little benefit. He was unable to keep up in school and soon dropped out. Local schools refused to admit him when he was probably age 8 because of the hearing impairment.

Sgt. Chris Gonser, an Apache mechanic and noncommissioned officer, and I tested the boy's hearing using a portable audiometer in a quiet room. After an otoscopic evaluation and some test runs with behavioral responses, he was able to respond consistently, providing thresholds in a "corner audiogram" configuration bilaterally. Bone conduction results confirmed the loss was sensorineural.

Taking earmold impressions was a challenge, as the boy was unsure of what we intended with what appeared to be a big needle. Sgt. Gonser brought in toy cars and provided the cultural bridge we needed. Our patient lit up at the reward and cooperated beautifully. I then provided a careful counseling session with his father regarding reasonable expectations from new hearing aids and the implications of long-term sound deprivation.

After returning to Fort Stewart, I solicited and received donations from PhonakInc., which had a government contract. A Phonak representative with the Veterans Administration offered to supply power hearing aids with potentiometers and ear molds for our patient. His team coordinated the effort, sending the hearing aids to me for simulated real ear measurement settings using the desired sensation level formula.

We forwarded the ear-level BTE hearing aids, ear molds, and a large supply of batteries to Iraq for the fitting, along with pictorial descriptions of how to fit the ear molds and correctly trim the tubing. I conducted the counseling sessions through e-mail and written instructions.

Capt. Ali reported that the family did not anticipate any reaction from their son, and his father was hesitant to hope for any improvement. The boy, however, was ecstatic at the ability to hear environmental sounds, even if his responses to specific words were minimal. When his father saw the improvement, he was excited and grateful that we had taken the time and made the effort to help his son.

Fortunately batteries and additional support are available in Iraq. Army medical personnel continue to support the family, responding to questions or problems with the boy's hearing aids. A variety of doctors and an ENT/speech/hearing department are available in Baghdad although it is unclear how well-equipped they are.

The family accepts the boy's limited communication skills as normal and does little to challenge him, which complicates his speech development. In addition, as Capt. Ali wrote in an e-mail, "Now he can at least get away from a fast-approaching car when he hears it honk from a distance. Enhancing his senses will prolong his life, especially in rural Iraq.

"At first there was nothing we could do, but once you agreed to evaluate him, the situation seemed positive. In the long run, it paints a better picture of the U.S. Army...kindness goes a long way."

—Jillyen Curry-Mathis 



  

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