Preserving the Hearing Health of Military Service Members

Dr. Adams is yet another fan of boothless audiometry. “It should be very effective in identifying acute threshold shifts from hearing loss in the field,” he said. “The sooner we can treat that hearing loss, whether it be with oral or injectable steroids or some other therapeutic, the better.”

He also noted that boothless audiometry is just one example of impressive work done on screening by the DOD. He cited as an example the DOD’s Hearing Conservation Program, which includes baseline hearing tests done as early as possible in a service member’s military career. Those individuals are then screened annually for threshold shifts that might denote hearing changes.

“When active-duty personnel leave the service, they are given another audiogram,” Dr. Adams said. “That way, neurotologists, audiologists, and other clinicians in the field are well positioned to address any hearing loss that is detected as these service members enter civilian life.”

Dr. Marinelli said he has grown to appreciate the breadth of screening protocols for hearing loss in service members. “If they’ve experienced a deficit, we can detect it and intervene early,” he said. Nevertheless, “it still takes a lot of hearing loss—and time—to be caught by screening. If you look at audiograms in people after years of noise exposure, often it’s the high frequencies—around 4,000 hertz—that tend to be disproportionately affected.”

In such cases, he added, normal speech frequencies are preserved, which makes awareness of the condition problematic. But over time, the hearing deficits, often accompanied by tinnitus, tend to accumulate. “That’s why if you look at reimbursement for veterans’ care, hearing loss and tinnitus are the number one and number two most compensated disabilities in the U.S.,” he said.

Good News on Hearing Aids

Once hearing loss has occurred, other interventions are needed, with hearing aids one of the most common treatments. The good news for military personnel is that coverage for these devices is significantly better than in the private sector, where most state Medicare and Medicaid plans do not include hearing aid benefits; private insurers offer similarly limited coverage. That’s according to one of the largest studies of hearing aid coverage conducted to date, by researchers at the USC Caruso Department of Otolaryngology–Head and Neck Surgery, in Los Angeles (bit.ly/4nlaI2l).

Dr. Erbele underscored the importance of this coverage. “All of our active-duty service members and their dependents, as well as our veterans, have access to free hearing aids, which is a really nice benefit.” He added that “everybody should have that same benefit,” but at least for service members, “it is definitely nice to be able to rely on hearing aids to make sure we’ve done everything possible for a patient’s hearing loss rehabilitation before talking about other interventions.”