How Audiologists and Researchers Are Shaping Military Hearing Health Practices

Kelly Reavis, PhD, MPH, MS, CCC-A, a research investigator at the National Center for Rehabilitative Auditory Research, VA Portland Health Care System, U.S. Department of Veterans Affairs, and an assistant professor of epidemiology at OHSU-PSU School of Public Health at Oregon Health and Science University in Portland, noted that in their ongoing NOISE Study, “we have observed that veterans exposed to military noise, blasts, or traumatic brain injuries exhibit a higher prevalence of both hearing loss and tinnitus.”

“Our analyses also demonstrate that hearing loss and tinnitus independently and adversely affect quality of life. Longitudinally, transition analyses of tinnitus states over five years indicate a slight overall increase in the progression from no tinnitus to constant tinnitus, with those experiencing occasional or intermittent tinnitus showing the highest probability of transition over time,” Dr. Reavis said. “These findings highlight the dynamic nature of tinnitus and its close association with military exposures linked to hearing loss, underscoring the importance of continued hearing health monitoring and early intervention among veterans.”

“Epidemiologic studies help identify which exposures and populations are at highest risk, guiding prevention priorities and early intervention strategies,” Dr. Reavis said. “Findings from epidemiologic research, including the NOISE Study, help inform the development of the first-ever VA/DoD Clinical Practice Guideline for Tinnitus. More broadly, epidemiologic data ensure that policies and clinical practices evolve based on real-world evidence to improve hearing health and quality of life for service members and veterans.”

Challenges and Gaps

Despite progress, the rate of hearing loss in the military remains high.

The 2023 Hearing Health Surveillance Data Review for Military Hearing Conservation reported 12% of all service members had a hearing loss, and 6.9% experienced a permanent threshold shift, Dr. Kulinski said.

In the hierarchy of exposure control for hearing conservation programs, the use of hearing protection devices is referred to as a “last resort” when you “cannot engineer your way out of, reduce time, or increase distance from noise-hazardous sources,” he said. The hearing conservation program has adopted best practice recommendations in the use of a quantitative assessment of hearing protection device fit via hearing protector fit-testing systems, but “if someone finds the protective solution cumbersome, uncomfortable, or impeding on the situational awareness needed to complete the mission, it is likely that the solution will not be used consistently in the field.”

The biggest challenge in diagnosing and treating auditory processing disorders in the military is that the current DoD hearing surveillance programs are almost entirely based on pure tone audiometric thresholds, Dr. Kulinski said.