Military-Grade Protection

Hearing loss is often preventable. Proper fitting and consistent wearing of hearing protective devices (HPDs) help prevent hearing loss and tinnitus. Noise-induced hearing loss and tinnitus (ringing in the ears) are the top two health conditions among military veterans. In , Veterans Affairs had 1,610,911 compensation receipts for tinnitus and 1,084,069 for hearing loss. Additionally, many Veterans who score normally on hearing tests have trouble understanding speech. This condition, called auditory processing disorder, is associated with blast exposure.

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Military personnel commonly experience these disorders after exposure to loud noise, such as working in an airplane hangar, or exposure to high-intensity noise, such as an explosion. There is a misconception hearing protection inhibits vital communication and mission readiness. With today's increasingly sophisticated technology, soldiers do not have to choose between protecting their ears or their lives.

Below are some of Hearing Health Foundation's suggestions for hearing protective devices (HPDs) that protect without compromising safety:

Earplugs

Traditional earplugs effectively prevent hazardous noise from entering the ear canal, but they can interfere with mission communication requirements, such as being able to hear speech or low-level combat sounds.

Level-dependent earplugs however use a filter that enables soft noises to be conveyed at full strength yet eliminate high-frequency or impulse noise. Level-dependent earplugs are easily transportable, but should be used in combination with other devices when operating aircraft or combat vehicles.

Earmuffs

Earmuffs block sound by creating an airtight barrier around the entire ear, and are best used for intermittent exposure to noise. Earmuffs provide great protection, warmth, comfort, and durability than earplugs. Although they block softer sounds including speech, some military-grade earmuffs contain an electronic communication system to allow for clear communication.

Noise-Attenuating Helmets

Noise-attenuating helmets protect from hearing loss, crash impact, and eye injury while increasing communication through radio communication. Technologically advanced helmets include active noise-reducing technology to monitor sound energy around the ear and cancel unwanted noise while preserving verbal communication ability. A communications earplug microphone can also be worn to enhance verbal clarity.

Suppressors

In the U.S. Marines began using suppressors on service weapons. While they don't completely drown out gunfire, they can reduce noise by more than 30 decibels. Suppressors offer tactical and medical advantages.

The Department of Defense is forging ahead to implement the expanded hearing protector fit testing requirement that now covers noise-exposed service members and civilian employees. An update to the Hearing Conservation Program instruction .12 issued by DOD on Nov. 22, , requires expanded testing.

Hearing protector fit testing measures the amount of noise reduction a person is getting from their hearing protection while it is being worn. It is a proven way to reduce noise-induced hearing loss that can happen if a person's hearing protection doesn't fit properly.

Noise is the most prevalent hazardous exposure for service members, regardless of occupation or specialty. DOD seeks to reduce noise-induced hearing loss through the consistent use of properly fitted hearing protection devices, or HPD, both on and off duty. The science of hearing protection is evolving, and audiologists and hearing technicians across the military are still learning how best to meet the expanded requirement for hearing protector fit testing, otherwise known as HPFT. HPFT allows noise-exposed service members and civilian workers to find the right hearing protector device and experience the right fit for their particular HPD.

The Defense Health Agency Public Health in Aberdeen, Maryland, and its strategic partners are conducting studies at military installations to determine how to best integrate hearing protection fit testing into existing DOD hearing conservation programs, said Nancy Vause, who holds a doctorate in psychoacoustics and auditory perception and is an audiologist and hearing conservation consultant.

'We are developing best practice recommendations for installations to implement fit testing and training in numerous ways,' Vause said. Additionally, DHA Public Health is 'actively seeking funding to purchase the required fit-testing equipment and train technicians to implement fit testing across the DOD.'

One of the goals of the expanded requirement is to teach soldiers 'what right feels like' so they can individually identify a poor-fitting HPD, Vause noted.

That means involving the service members directly in the fitting process when inserting and wearing their HPDs and taking into consideration 'their communication needs, hearing ability, convenience, compatibility with other personal protective equipment, and the environment in which they operate or work,' Vause said.

'The most important factor ' is that fit testing will help us find the most comfortable hearing protector that service members will wear correctly 100% of the time they are exposed to impulse (e.g., weapon) or steady state (e.g., generator) noise,' Vause emphasized.

U.S. Army Fort Huachuca's Lessons Learned

Because military hospitals and clinics are at different stages in their HPFT expansion, U.S. Army Fort Huachuca's experience offers some valuable lessons learned so far.

'Hearing protection appointments now take longer at Huachuca,' explained Kari Pink, a doctor of audiology and chief of audiology at Huachuca's Raymond W. Bliss Army Health Center. 'We used to have appointments every 30 minutes to get people's annual hearing tests done. With the added fit testing and giving our technicians time to document on each patient, we have increased the appointment time to one hour.'

'The great value of HPFT is to find those who have inadequate protection and solve that problem,' Pink said. 'The issue could be a poor fit, the wrong size hearing protector, or the wrong type of hearing protector.'

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Fit testing measures the personal attenuation rating (PAR) specific to each individual ear and hearing protector. The PAR is a real-world measurement of the overall noise reduction the hearing protector provides for individual's ears.

The PAR tells each service member if their HPD fits correctly and 'can protect them from hearing injuries when exposed to their typical military noise hazards (weapons, vehicles, grenades, even smoke generators),' said Vause.

'I think the soldiers are actually liking that we are able to measure the actual attenuation as well. A lot of people don't know it's normal to have two different-size ear canals, so they might need two different-size ear plugs,' according to Pink.

Poor Fit a Common Issue

'Inadequate fit is a common reason for not getting enough protection from hearing protectors,' Pink explained.
However, 'one of the biggest lessons learned at Fort Huachuca is that most of the hearing protection we have stocked in the clinic is providing a good PAR for most soldiers, which is great news,' she said.

On the other hand, 'we have had a handful that have really low PAR with the different types/sizes that we have in stock, so we have to recommend they use foam ear plugs and/or over-the-ear muffs,' she said.

'Ear plugs are better for high noise and longer noise exposures,' while ear muffs are good for intermittent noise and for use with ear plugs as double protection from very high noise levels,' Pink explained, noting 'there are several other types of hearing protectors that have electronics and other features incorporated into the device.' Some service members may require double hearing protection. Additionally, noise-attenuating helmets are available to service members depending on their duties.

'Culture Change' and Impact on Readiness

There's been a significant 'culture change' in attitudes about hearing safety in the last two decades, with 'more emphasis on protecting and preserving hearing' over rehabilitating hearing loss, according to Vause.

Service members and their leaders 'are very intelligent and motivated to 'stay alert and stay alive,'' she said. They expect to 'wear all types of personal protection equipment ' and no longer think they are tough to suffer auditory injuries or noise-induced hearing loss.'

'Wearing hearing protection is now required, encouraged, and enforced. Fit testing just ensures the HPD is fit correctly and is doing its job,' Vause said.

'When we share the negative impact of hearing loss on operational performance, involve service members in the fitting process to create muscle memory, and provide positive feedback on the proper fit of their own HPD, service members not only learn 'what right feels like,' but they will be more likely to have a positive attitude about protecting their hearing,' said Vause.

As a result, 'they are more likely to follow through on using their HPD correctly and consistently, both on and off the job,' she said. Service members 'become more motivated once we share this operational performance information during our targeted hearing health training. Once they understand how hearing loss degrades operational performance and readiness, service members get it.'

Another Takeaway

Pink had this advice for her military colleagues leading HPFT at other facilities:

'Stay strong. People will push back about not wanting to have another test done ' it's important to fully understand why we are doing the fit testing and be able to share that with the service members,' she said.

On the positive side, 'We have gotten many comments about the fit testing and it being 'cool' that we can measure how much attenuation they are getting. We always emphasize why it is important for the individuals, and they usually understand and end up appreciating it.'

Resources

The Hearing Center of Excellence offers fit-testing information, extensive educational content, and HPD fitting tools and videos for everyone who must be careful with their hearing.
HCE is spearheading initiatives that focus on the total population of U.S. service members, regardless of their daily job-related noise exposure, including the Comprehensive Hearing Health Program. The CHHP is a three-pronged approach to enhancing hearing health care. To be effective, it requires education, monitoring, and protection elements.

These three components work together to create positive changes in behavior that can prevent hearing loss. The CHHP milBook CAC-enabled site contains educational materials that satisfy the annual hearing conservation training requirement.

DHA Public Heath-Aberdeen has developed a Blackboard Hearing Readiness Officer Course that is open to any HRO at https://amedd.llc.army.mil/ or https://learn.llc.army.mil/.

The center developed HPD fitting videos for the U.S. Army Hearing Program. Search "Army Hearing Program" on YouTube to find 11 short videos demonstrating how to properly fit and wear various HPDs.

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