Clinic Traffic Downrange Shows Need for Hearing Protection

By Army Spc. Opal Hood
Special to American Forces Press Service

Aug. 20, 2009 - When gearing up for a mission in Afghanistan, servicemembers don't forget their helmet, gloves, weapon, eye protection or body armor. But what about hearing protection? Air Force Staff Sgt. Lee Adams, an ear, nose and throat technician here, said more than half of the patients seen in the ENT walk-in clinics are there for hearing related issues.

"The first question I ask a patient who comes in with a hearing complaint is 'Were you wearing hearing protection?'" said Air Force Col. (Dr.) Joseph A. Brennan, the ENT doctor here. "Since I arrived here in May, I have not had one servicemember answer yes to that question."

Many troops say they don't use hearing protection on missions because they feel it affects their ability to do their jobs and complete their missions, Brennan said.

"I was in Iraq in '04 and '05 -- in Fallujah with the Marines and the Army's 1st Infantry Division -- and we just couldn't get folks to wear their hearing protection," Brennan said. "We understand. It is like the old Army helmets --soldiers were complaining they couldn't shoot with them. So even though they offered better protection, which as a doctor is what I care about, the fight is most important."

While in Iraq, Brennan said, he saw more than 600 outpatients in an ENT clinic, and hearing loss was the No. 1 diagnosis there, just as it is today in Afghanistan.

Loud noises such as those from improvised explosive devices -- the top cause for hearing loss in Iraq and Afghanistan – can cause conductive hearing loss, sensory neuro hearing loss or tinnitus, Brennan said.

Surgery usually can correct conductive hearing loss from damaged ear bones or wax in the external ear canal of the ear, the doctor said. Sensory neuro hearing loss, he added, means the nerve in the inner ear has been damaged. Surgery can't correct it; the only treatment is hearing aids.

Tinnitus -- a ringing or whining inside a person's ear -- can result from nerve damage. A doctor can measure the sound in the ear when the patient has objective tinnitus, Brennan said, but a person with subjective tinnitus is the only one who can hear the sound.

Tinnitus has no cure, but a device called a "masker" -- a type of hearing aid – can replace the noise with a less annoying, more natural sound inside the ear, Brennan said.

The most common problem, the doctor said, is a blown-out ear drum, which is considered a conductive form of hearing loss. This means that sound is not reaching the nerve in the ear that allows people to hear, Brennan explained, adding that it can heal on its own.

Though he understands some servicemembers' objections to wearing hearing protection on missions, Brennan said, an event he remembers from his time in Iraq makes the opposite case.

"In Iraq in 2004, there was a soldier who was in two IED blasts," he said. "The second explosion really blew out his ear drums, and he could not hear a thing. The soldier's sergeant and his fellow soldiers were on a rooftop in a firefight. The bullets were buzzing by his head. His sergeant had to tackle him to get him out of the line of fire, because the soldier could not hear his comrades yelling for him to take cover."

The incident shows that a hearing-impaired soldier in combat puts himself and his fellow soldiers in danger, the doctor said.

That danger is present even in people who suffer hearing loss in only one ear, he added, because they will not be able to tell which direction a sound -- such as gunfire -- is coming from.

Because hearing damage affects the safety of military personnel and others around them, troops with hearing loss can be discharged from the military or forced to reclassify into a different job specialty.

New technology always is being developed to help in the fight against hearing loss, Brennan said, citing research into a concept called "active hearing protection" that's going on at Wright-Patterson Air Force Base, Ohio.

"A person would wear this device on the inside or outside of their ear," he explained. "For instance, if you were walking through the woods, this ear plug would amplify the sounds around you, but the moment the noise level reached a harmful level, the ear plug would protect your ear and eliminate the sound, essentially plugging your ears."

This new form of ear plug is ideal, he said, because it increases awareness, but also protects the ears. Conventional ear plugs have the same effect as plugging your ears with your fingers, regardless of the ambient sound, he added.

Servicemembers should listen to their leadership about wearing proper hearing protection while they can still hear the warnings, the doctor said.

(Army Spc. Opal Hood serves with the 5th Mobile Public Affairs Detachment.)