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Noise and Military Service: Implications for Hearing Loss and Tinnitus (2006)

Chapter: Appendix D Summary Tables on Epidemiological Studies

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Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Appendix D
Summary Tables on Epidemiological Studies

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

TABLE D-1 Toluene Exposure as a Risk Factor for Noise-Induced Hearing Loss

Citation

Design

Population

Exposures and Source of Exposure Data

a. Human Studies

Schaper et al. (2003)

Longitudinal study, 1996–2001

192 employees from 14 German rotogravure printing plants with 4 examinations

Subjects at each examination:

Exam 1:333

Exam 2:278

Exam 3:241

Exam 4:216

Stratification

Toluene exposure: low vs high (based on worksite)

Job tenure: short vs long

Noise exposure: low (< 82 dBA) vs high (≥82 dBA)

Medical, psychological examinations

Toluene and noise exposure measured 2 times per yr for each subject

Historical records for past exposure estimates

Toluene:

Mean study exposure:

High: 26 ppm

Low: 3 ppm

Lifetime weighted average daily exposure (for current exposure groups)

High: 45 ppm

Low: 10 ppm

Biomarkers of exposure: hippuric acid, o-cresol

Noise: lifetime average daily exposure

Current high noise: 82 dBA

Current low noise: 81 dBA

Morata et al. (1997)

Cross-sectional

124 male rotogravure printing workers, Sao Paulo, Brazil

Mean age: 34 yrs (range 21–58 yrs)

Employed at least 1 yr Mean tenure: 7 yrs (range 1–25 yrs)

Solvent exposure:

TWA exposure evaluation for toluene, ethanol, and ethyl acetate

Toluene levels (air): 0.14 to 919 mg/m 3

109 workers monitored for hippuric acid and creatinine in their urine

Noise exposure:

Continuous noise, 71 to 93 dBA; dosimetry for individual workers

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Outcome Measure

Results

Comments

Hearing thresholds

Hearing loss: thresholds > 25 dB

Tested at 0.125–12 kHz

Age adjustment based on ISO 7029 (1984) before repeated measures analysis

No sig effect on auditory thresholds for toluene intensity, exposure duration, or interactions

Sig effect of current noise intensity (F = 4.5, p = .04)

Subjects were volunteers; some loss to follow-up

No unexposed control group

Little difference in noise exposure for high and low toluene exposure

High-freq hearing loss: notch in a freq b/t 3 and 6 kHz or thresholds poorest in this freq range

Normal hearing: no single threshold > 25 dB

Pure-tone audiometry: 0.5–8 kHz

No statistical interactions between noise and toluene

Concentration of toluene in air was not sig associated w/ hearing loss

Level of biological marker for toluene exposure (urinary hippuric acid) sig associated w/ hearing loss (OR = 1.76, 95% CI 1.00–2.98)

93% of subjects reported no exposure to major sources of nonoccupational noise (e.g., firearms, motorcycles, etc.)

11% of those exposed to noise > 85 dBA used hearing protection

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Citation

Design

Population

Exposures and Source of Exposure Data

Morata et al. (1993)

Cross-sectional

190 male printing and paint manufacturing workers, Brazil

Employed at least 1 yr

Mean employment:

Printing: 8 to 13 yrs

Paint mfg: 6 yrs

Exposure groups

Noise only (printing): 50

Noise and toluene (printing): 51

Mixed solvents, no excess noise (paint mfg): 39

Unexposed (printing): 50

Noise only group: 88–97 dBA (continuous); dose 209–335% (5-dB exchange rate)

Noise and toluene group: 88–98 dBA; dose 140–350% (5-dB exchange rate); toluene TWA 75–600 ppm

Mixed solvents group: no dose data; toluene concentration 10–70 ppm (11 samples)

Interviewed for work, exposure, and medical histories

b. Animal Studies

Davis et al. (2002)

Experimental

33 chinchillas, in 6 exposure groups

6 adult rats as control group

10-day exposures

Toluene: 2000 ppm

Noise: 500 Hz octave band noise, 97.5 dB SPL

Background noise < 60 dBA

22 chinchillas (monaural)

Group 1:8 h toluene, background noise only

Group 2: no toluene, 8 h noise

Group 3:8 h toluene, 8 h noise

Group 4: control group

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Outcome Measure

Results

Comments

Normal hearing

Worst threshold at 3–8 kHz (avg left and right ears): 0–25 dB; average of 0.5, 1, 2 kHz ≤ 25 dB

High-freq hearing loss

Categories based on worst threshold at 3–8 kHz (avg left and right ears) and average of 0.5, 1, 2 kHz ≤ 25 dB: (I) 30–40 dB, (II) 45–55 dB, (III) ≥ 60 dB

(IV) average of 0.5, 1, 2 kHz > 25 dB

Other hearing loss

Unilateral, conductive

Pure-tone audiometry: 0.5–8 kHz

Otoscopy, immittance audiometry

Prevalence of high-freq hearing loss:

8% unexposed

26% noise

53% noise and toluene

18% mixture of solvents

Relative risk of high-freq hearing loss:

Noise only: 4.1 (95% CI 1.4–12.2)

Noise and toluene: 10.9 (95% CI 4.1–28.9)

Solvents only: 5.0 (95% CI 1.5–17.5)

Noise and solvent exposures in the different groups were not equivalent

Without a group exposed to only toluene, could not assess whether effect of combined exposure was additive or multiplicative

 

 

Differences in liver metabolism of toluene suggest that rats and mice are better models for human ototoxicity than chinchillas

Chinchillas

ABR threshold shifts (pre- vs postexposure)

Tested at 0.5, 1, 2, 4, 8, 16 kHz

Postexposure testing on days 1, 3, 7, 14, and 30

Chinchillas

Noise effects, but no ototoxicity

Noise: 12 dB permanent threshold shift at 2 and 4 kHz

Analysis of variance: no sig main effect for toluene alone or interaction of toluene w/ noise

 

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Citation

Design

Population

Exposures and Source of Exposure Data

 

 

 

11 chinchillas (binaural)

Group 5:12 h toluene, 8 h noise; noise from 2 h after start to 2 h before end of toluene exposure

Group 6:12 h toluene, background noise only

Rat comparison group

6 adult rats exposed to toluene at 2000 ppm, 8 h / day for 5 days

Only background noise

Johnson et al. (1990)

Experimental

49 young male rats

Exposure groups:

Controls: 10

Noise: 10

Toluene: 10

Noise followed by toluene: 10

Noise, rest, toluene: 9

Toluene: 1000 ppm, 16 h/d, 7 d/w (11:00 am to 3:00 am)

Noise: 10 h/d, 7 d/w

Continuously varying signal: 2 kHz wide noise band, sweeping from 3 to 30 kHz at freq of 0.5 Hz

Equivalent to sound level of 100 dB

Controls: no noise or toluene

Noise: 4 wks

Toluene: 2 wks

Noise followed by toluene: 4 wks noise, 2 wks toluene

Noise, rest, toluene: 4 wks noise, 4 wks rest, 2 wks toluene

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Outcome Measure

Results

Comments

Rats

ABR threshold shifts (pre- vs postexposure)

Tested at 8, 16, 32 kHz

Postexposure testing on day 30

Rats

Sig permanent threshold shift w/ shorter toluene exposure

Threshold shifts of 20 and 15 dB at 16 and 32 kHz, respectively

 

ABR thresholds at 1.6, 3.15, 6.3, 12.5, 20.0 kHz

Measured at 1–5 wks after termination of exposure

Effect of noise followed by toluene, w/ or w/o rest, was larger than exposure to noise or toluene alone at 6.3, 12.5, and 20.0 kHz

Noise: higher thresholds than controls at 6.3 (9 dB, p < .05), 12.5 (26 dB, p < .001), and 20.0 kHz (18 dB, p < .001)

Toluene: higher thresholds than controls at all freq (1.6 to 12.5 kHz, 15–32 dB, p < .001; 20.0 kHz, 15 dB, p < .01)

Noise followed by toluene: higher thresholds than controls at all freq (1.6 kHz, 8 dB, p < .05; 3.15 to 20.0 kHz, 34–45 dB, p < .001)

Additive effects from noise and toluene

Exposure to toluene after noise may produce smaller losses than exposure to noise after toluene

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Citation

Design

Population

Exposures and Source of Exposure Data

Johnson et al. (1988)

Experimental

39 male rats

Exposure groups:

Controls: 10

Group T (toluene only) 12

Group N (noise only): 8

Group T+N (toluene followed by noise): 9

Toluene: 1000 ppm, 16 h/d, 5 d/wk (3 pm to 7 am)

Noise: 10 h/d, 7 d/wk

Continuously varying signal: 2 kHz wide noise band, sweeping from 3 to 30 kHz at a freq of 0.5 Hz

Equivalent sound level 100 dB

Controls: no toluene or noise

Group T: 2 wks toluene

Group N: 4 wks noise

Group T+N: 2 wks toluene; 4 wks noise

NOTES: ABR, auditory brainstem response; CI, confidence interval; OR, odds ratio; TWA, time-weighted average.

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Outcome Measure

Results

Comments

ABR threshold shifts at 1.6, 3.15, 6.3, 12.5, 20.0 kHz

Controls: at age 5 mos

Group T: 2–5 days after termination of exposure; repeated 1 and 6 mos later

Group N: 2–5 days after termination of exposure

Group T+N: 2–5 days after termination of noise exposure, repeated 6 mos later

Group T: Higher thresholds than controls at all freq (p < .001); greatest difference (40 dB) at 12.5 kHz; improvement at most frequencies at 1 mo (5–10 dB) and 6 mo (5 dB)

Group N: Higher thresholds than controls; greatest difference at highest freqs (6.3, 12.5, and 20.0 kHz; p < .001); maximum difference (50 dB) at 12.5 kHz

Group T+N: Higher thresholds than controls at all freq (p < .001); for most animals, threshold exceeded maximum stimulus intensity at 12.5 and 20.0 kHz

For any exposure, threshold shift greatest at 6.3 and 12.5 kHz; after 6 mos, greatest at 12.5 kHz

Combined exposure (toluene followed by noise) produced greater shifts at 3.15 (p < .01) and 6.3 kHz (p < .0001) than summed losses for single exposures

 

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

TABLE D-2 Carbon Monoxide as a Risk Factor for Noise-Induced Hearing Loss in Animals

Citation

Design

Population

Exposures

Rao and Fechter (2000)

Experimental

Rats

 

A: Combined exposure

8 exposure groups: in each, n = 6

Random assignment

CO: 1200 ppm

Octave band noise w/ center frequency of 13.6 kHz (9.6–19.2 kHz)

Background noise: ~ 50 dBA

CO only

Noise only:

95 dB for 4 h

100 dB for 2 h

105 dB for 1 hr

Noise plus CO:

95 dB for 4 h,

100 dB for 2 h

105 dB for 1 hr

Control: Air only

 

B: Increased duration of exposure

2 exposure groups: in each, n = 6

CO: 1200 ppm

Noise: 105 dB

Noise only: 4 h

Noise plus CO: 4 h

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Outcome Measure

Results

Comments

CAP thresholds for 11 pure tones between 2 and 40 kHz

4-wk recovery period

Exposure groups significantly different from each other (F(8, 45) = 13.04, p < .05)

Sig interaction b/t freq and exposure (F(80, 450) = 4.35, p < .05)

Potentiation of threshold elevation for combined exposure does not increase beyond 100 dB for 2h

95 dB for 4h

Combined exposure: 6 dB threshold elevation above noise only; difference not sig at any frequency

100 dB for 2h

Combined exposure: sig elevation over noise only at all frequencies (p < .05)

105 dB for 1h

Combined exposure: sig elevation over noise only at all frequencies (p < .05); greater dysfunction at lower freq than w/ other exposures

Noise only: sig elevation over thresholds for 95 dB (4h), 100 dB (2h) (p < .05)

CO only

No sig difference from exposure to air only F(1,10) = 1.72, p > .05

Rats more resistant to CO than humans (30 min LD50 = 5000 ppm for rats; 1500 ppm immediately dangerous for humans)

CAP thresholds for 11 pure tones between 2 and 40 kHz

4-wk recovery period

Combined exposure: threshold elevations not sig diff from noise only

Combined exposure: threshold elevations 15 dB greater than for 105 dB + CO for 1h

 

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Citation

Design

Population

Exposures

Fechter et al. (2000)

Experimental

Rate

 

A: Variation of CO dose

8 exposure groups: in each, n = 8

Random assignment

CO: varied exposures

Noise: 100 dB octave band noise w/ center frequency of 13.6 kHz

Background noise: < 35 dB

CO only: 1200 ppm, 8 h

Noise only: 8 h

Noise plus CO (5 exposure groups): 8 h noise and CO at 300, 500, 700, 1200, or 1500 ppm

Control: air only

 

B: Variation of noise dose

8 exposure groups: in each, n = 6

Random assignment

CO: 1200 ppm

Noise: Octave band noise w/ center frequency of 13.6 kHz

CO only: 4 h

Noise only:

95 dB: 2 h

100 dB: 2 h

100 dB: 4 h

Noise plus CO:

95 dB: 2 h

100 dB: 2 h

100 dB: 4 h

Control: Air only

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Outcome Measure

Results

Comments

CAP thresholds for 11 pure tones between 2 and 40 kHz

4-wk recovery period

Noise plus CO

Potentiation of noise effects by CO exposure emerges at CO exposures of 500 ppm and increases as CO level increases

Sig elevation of thresholds over exposure to noise only with exposures to CO levels > 300 ppm

Thresholds at lower frequencies affected only w/ CO levels ≥ 1200 ppm;

CO only

No effect on auditory function

 

CAP thresholds for 11 pure tones between 2 and 40 kHz

4-wk recovery period

Nonlinear relationship b/t noise severity and potentiation of threshold elevation by CO

Potentiation of noise effects by CO exposure greatest w/ noise exposure of 100 dB for 2 h

For noise exposure of 100 dB for 4 h, no additional effect at higher freq from CO exposure; sig differences at some lower freq

Sig difference from controls for noise exposure of 100 dB for 2 or 4 h, w/ or w/o CO

 

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Citation

Design

Population

Exposures

 

C: Repeated exposures

4 exposure groups: in each, n = 8

Random assignment

CO level: 1200 ppm

Noise exposure: Octave band noise w/ center frequency of 13.6 kHz

Exposure duration: 5 successive days:

CO only

Noise only: 95 dB, 2 h

Noise plus CO

Control: Air only

Chen and Fechter (1999)

Experimental

Rats

 

A: Response to CO and high-frequency vs low-frequency noise

Exposure groups:

High-freq noise

CO: n = 4

Noise: n = 7

Noise plus CO: n = 7

Air: n = 7

Low-freq noise

CO: n = 4

Noise: n = 4

Noise plus CO: n = 4

Air: n = 7

Random assignment

CO level: 1200 ppm

Noise exposure: 8h, octave band noise

High freq: 9.6–19.2 kHz at 100 dB (Ln)

Low freq: 2.4–4.8 kHz at 115 dB (Ln)

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Outcome Measure

Results

Comments

CAP thresholds for 11 pure tones between 2 and 40 kHz

4-wk recovery period

Sig elevation of thresholds for noise plus CO exposure compared with noise only

No effect of repeated exposure to CO only

 

CAP and CM threshold shifts at freq from 2 to 40 kHz

4-wk recovery period

High-freq noise

Noise plus CO produced sig greater CAP threshold shifts than noise alone (p < .05); greater potentiation at higher freq

Noise alone produced sig CAP threshold shifts from air alone at freq > 8 kHz

CO alone produced no CAP threshold shifts from air alone

CM elevations for noise and noise plus CO, at all freq, w/ greater elevations at high freq and for combined exposure

Low-freq noise

Noise plus CO produced sig greater threshold shifts than noise alone (p < .05); somewhat greater potentiation at low freq

Noise alone produced sig CAP threshold shifts at all freq

CO alone produced no CAP threshold shifts

CM elevations for noise plus CO over noise alone at all freq, w/ greater differences at low freq; sig differences at only three freq

 

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Citation

Design

Population

Exposures

 

B: Response to CO w/ varied noise exposure

Exposure groups:

Noise

Noise plus CO

CO: 1200 ppm

Noise: octave band noises at 100 dB (Ln)

9.6–19.2 kHz

4.8–9.6 kHz

2.4–4.8 kHz

1.2–2.4 kHz

 

C: Comparison of potentiation measured by CAP and CM

Exposure groups:

Noise

Noise plus CO

CO levels: 300, 500, 700, 1200, 1500 ppm

High frequency noise: 9.6–19.2 kHz

Low frequency noise: 2.4–4.8 kHz

 

D: Recovery of auditory thresholds over time

Exposure groups for each recovery period:

1 wk

Noise: n = 4

Noise plus CO: n = 3

4 wks

Noise: n = 7

Noise plus CO: n = 7

Air: n = 7

CO level: 1200 ppm

Noise: 9.6–19.2 kHz at 100 dB (Ln)

 

E: Hearing loss potentiation and CO concentration

 

CO level: 0–1500 ppm

Noise: 8 h, 9.6–19.2 kHz at 100 dB (Ln)

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Outcome Measure

Results

Comments

CAP and CM threshold shifts in three freq ranges:

Low: 2–8 kHz

Mid: 12–20 kHz

High: 24–40 kHz

Noise plus CO: CAP threshold shifts and CM elevations greater than noise alone, especially at high and mid frequencies, for 9.6–19.2 kHz and 4.8–9.6 kHz bands

Noise alone: only 9.6–19.2 kHz noise band caused significant CAP threshold shifts and CM elevations

 

Difference in mean CAP or CM between noise plus CO and noise alone

High-frequency noise: measured at freq > 8kHz

Low-frequency noise: measured at 2–6 kHz

Potentiations shown by CAP and CM are correlated and similar

 

CAP thresholds measured at 1 wk, 2 wks, and 4 wks after exposure

Thresholds sig higher than controls for noise plus CO and noise alone at freq > 8 kHz

Noise plus CO: No sig difference b/t 1 wk and 4 wks

Noise alone: Lower thresholds at 4 wks than at 1 wk; sig differences at 12, 16, 30, 35 kHz; remain sig higher than controls at > 8 kHz

 

Average CAP thresholds measured at 2–8 kHz, 12–20 kHz, and 24–40 kHz

4-wk recovery period

Greater potentiation with higher CO levels; CO effect varies across freq ranges

Potentiation of hearing loss begins at CO level of 300–500 ppm for freq > 8 kHz

 

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Citation

Design

Population

Exposures

Young et al. (1987)

Experimental

16 male rats

4 exposure groups: in each, n = 4

CO: 210 min, 1200 ppm

Noise: 120 min, 110 dBA; peak intensity at 4–8 kHz w/ roll-off of 16 dB/octave

CO only

Noise only

Noise plus CO: 90 min of CO before noise onset

Control: air only

NOTES: CAP, compound action potential; CM, cochlear monophonic; CO, carbon monoxide; LD50, lethal dose 50 (for 50% of a population).

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Outcome Measure

Results

Comments

Reflex modulation audiometry: detection sensitivity thresholds at 10 and 40 kHz

Thresholds measured before exposure and at 1 wk and 3 wks postexposure

 

CO only: no evidence of worse auditory functioning after exposure

Noise only: worse thresholds after exposure (p < .01); 10 kHz worse than 40 kHz at 1 wk

Noise plus CO: thresholds worse than noise alone; greater shift at 40 kHz than 10 kHz; sig interaction effect at 1 week (p < .05); not sig at 3 wks

Control: thresholds unchanged

CO levels higher than those likely in occupational settings

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

TABLE D-3 Smoking as a Risk Factor for Noise-Induced Hearing Loss

Citation

Design

Population

Exposures and Source of Exposure Data

Ferrite and Santana (2005)

Cross-sectional

535 male metal plant workers participating in hearing screening and enrolled in health promotion program

Northeast Brazil

Exclusions: women; age > 55 yrs; missing audiometric data; hearing loss inconsistent with noise damage

Questionnaire: sociodemographics, lifestyle, occupational and health-related data, and smoking

Noise exposure

Based on job-noise matrix:

Exposed: jobs w/ 81–93 dBA

Nonexposed: jobs w/ < 81 dBA

Pre-employment noise exposure assessed

Total duration of exposure: 0 < 4 yrs and ≥ 4 yrs

Smoking

Nonsmokers (never smoked or < 6 months)

Ever-smokers (current or past smokers)

Age categories

20–40 yrs, 41–55 yrs

Palmer et al. (2004)

Cross-sectional

12,907 men and women

10,418 with responses on hearing

Britain, 1997–1998

Age: 16–64 yrs

Postal survey of randomly selected members of armed forces and persons from age-sex registers of 163 general practitioners in Britain

Survey questionnaire: exposure to vibration, time spent working in noisy jobs, smoking history, and hearing aid use

Noise

Time spent working in noisy places (a need to shout to be heard; considered equivalent to at least 85–90 dBA)

Smoking history

Smoker: smoked at least once/day for at least 1 month

Current smokers

Former smokers

Lifelong nonsmokers

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Outcome Measure

Results

Comments

Hearing loss: hearing threshold > 25 dB HL at 3, 4, 6, or 8 kHz

Pure-tone hearing thresholds measured at 0.25, 0.5, 1, 2, 3, 4, 6, 8 kHz

Smoking w/ noise exposure, was sig. associated w/ greater hearing loss compared w/ younger nonsmokers not exposed to noise

Younger workers: PR = 4.85 (90% CI 2.49–9.46)

Older workers: PR = 7.65 (90% CI 4.43–13.23)

Smoking alone not sig associated with greater hearing loss in younger workers (PR = 1.27, 90% CI: 0.37–4.32)

Prevalence of hearing loss:

Older noise-exposed smokers: 46%

Younger noise-exposed smokers: 29%

Older nonsmokers not exposed to noise: 24%

Younger nonsmokers not exposed to noise: 6%

No other known ototoxic agents in the workplace

Smoking, noise exposure, and age examined as dichotomous variables

No information on use of hearing protection

Possibility of selection bias from exclusion of workers without existing audiometric test data

Nonoccupational noise exposure not considered

Self-reported hearing difficulties assessed by response to—

“How well can you hear a person who is talking to you when he is sitting on your right [left] side in a quiet room?”

Severe difficulty in worse ear, or wore hearing aid

Moderate difficulty in worse ear

Normal: no or slight difficulty

Combined exposure to noise and smoking was consistent with an additive effect

Current vs nonsmokers with moderate to severe hearing difficulty

No work noise: PR = 1.5 (95% CI 1.1–2.1)

1–5 yrs work in noise: PR = 3.3 (95% CI 2.4 to 4.5)

> 5 yrs work in noise: PR = 5.7 (95% CI 4.4 to 7.1)

(PRs age- and sex-adjusted)

Response rate was 58%; response rate higher for women and older subjects

No dose-response effect tested for smoking or noise

Use of hearing protection not determined

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Citation

Design

Population

Exposures and Source of Exposure Data

Mizoue et al. (2003)

Cross-sectional

4,624 male steel company workers

Japan, 1999

Age: < 61 yrs

Current smokers: 56%

Working in potentially high noise levels: 29%

Exclusions: no auditory examination, incomplete smoking history, ex-smoker

Noise exposure

Company worksite records for workers who had hearing tests

Worksite noise levels measured twice/yr

Smoking history

As reported at periodic audiometric tests

Nonsmoker: never smoked

Ex-smoker

Current smoker

Cigarettes per day: < 15, 15–24, ≥ 25

Age groups

< 40, 40–49, 50–60 yrs

Starck et al. (1999)

Cross-sectional

199 professional forest workers

171 shipyard workers

Finland

Mean age:

Forest workers: 43 yrs

Shipyard workers: 38 yrs

Exclusions: hearing loss from ear diseases or severe head injuries

Questions to establish work history and use of hearing protection, smoking history

Medical records reviewed, overall health status, otological examination

Noise exposure

A-weighted noise level for average working day for both groups: 100 dB

Effective exposure with hearing protectors (measured for each worker)

Forest workers: 95 dB

Shipyard workers: 85 dB

Smoking

Nonsmokers: never smoked or quit > 10 yrs ago

Smokers

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Outcome Measure

Results

Comments

Hearing loss (worse ear)

Low frequency: pure-tone threshold > 25 dB HL at 1 kHz

High frequency: pure-tone threshold > 40 dB HL at 4 kHz

Pure-tone air conduction audiometric tests:

Workers w/o significant noise exposure: 1, 4 kHz

Workers in noisy environments (> 85 dBA): 0.5, 1, 2, 4, 8 kHz

Combined effect of noise and smoking on high-frequency hearing loss is comparable to sum of their independent effects

4 kHz comparisons w/ nonsmokers not exposed to noise

Smokers exposed to occ noise: PRR = 2.56 (95% CI 2.12 to 3.07)

Smokers not exposed to noise: PRR = 1.57 (95% CI 1.31 to 1.89)

Nonsmokers exposed to noise: PRR= 1.77 (95% CI 1.36 to 2.30)

Smoking not associated with low-frequency hearing loss

No control for past occupational noise exposure or leisure time noise exposure

No information on ear disease or injuries that might have affected hearing

PRR calculated by Cochran-Mantel-Haenszel method, w/ age stratification

Hearing level at 4 kHz

Measured hearing level compared with expected level (ISO-1999), calculated on the basis of age, noise level (A-wt), and duration of exposure (50% estimate)

Age correction of hearing levels with ISO 1999 (1990) model

Variation in hearing loss explained (linear regression)

Forest workers

Age: 26%

Noise exposure: 10%

Smoking: 1% (p=ns)

Shipyard workers

Age: 48%

Noise exposure: 15%

Smoking: 3% (p < .05)

Hearing levels for smokers and nonsmokers not significantly different

All workers exposed to noise; differed in noise levels and duration of exposure

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Citation

Design

Population

Exposures and Source of Exposure Data

Cruickshanks et al. (1998)

Population-based, cross-sectional

3,753 adults, ages 48–92 yrs

Beaver Dam, Wisconsin, 1993–1995

Mean age: 66 yrs

58% women

Questionnaire and examination

Noise exposure

History of occupational noise exposure: having to speak in a loud voice to be heard; farmer driving tractor w/o cab, or military service with noise (pilot, aircraft or tank crew, ship engine room, use of grenades, mortars, multiperson weapons systems)

Smoking status at examination

Nonsmoker: < 100 cigarettes (lifetime)

Ex-smoker

Current smoker

Amount smoked

Pack-years

Virokannas and Anttonen (1995)

Cross-sectional

433 reindeer herders

Northern Finland, 1988

Mean age: 43 yrs (range 18–64 yrs)

Exclusions: accidental exposure to explosion; suffered ear disease; abnormal findings for tympanic membrane

Clinical examination and questions on exposure to noise, smoking history, use of ear protectors

Principal noise sources:

Snowmobiles: 92–104 dBA

Chainsaws: 96–103 dBA

Gunshots: under 80 dBA (annual equivalent)

Noise exposure (based on cumulative hrs of use of noisy tools and vehicles)

Mild: 0–3,700 h

Moderate: 3,701–8,700 h

Heavy: 8,701–15,000 h

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Outcome Measure

Results

Comments

Hearing loss:

Average hearing threshold at 0.5, 1, 2, and 4 kHz > 25 dB HL (worse ear)

Mild: > 25, ≤ 40 dB HL

Moderate: > 40, ≤ 60 dB HL

Marked: > 60 dB HL

Current smokers had sig increased risk of hearing loss compared w/ nonsmokers among those w/ and w/o occupational noise exposure

W/ occupational noise: OR = 1.85 (95% CI 1.33–2.57)

W/o occupational noise: OR = 1.53 (95% CI 1.03–2.29)

Self-reported smoking may have been understated

Pure-tone hearing thresholds(audiometers calibrated to ISO 389 standard)

Frequencies tested: 0.5, 1, 2, 3, 4, 6, 8 kHz

Age adjustment: measured hearing thresholds transformed to values at age 18 (ISO 7029)

Analysis of Covariance

Covariant: exposure time to noise

Significant effect of heavy or very heavy lifetime smoking on age-adjusted hearing thresholds:

3 kHz (right p = .044, left p = .001)

4 kHz (right p = .055, left p = .086)

Not significant at other frequencies

Very heavy and heavy smokers tended to use noisier tools than the moderate and nonsmokers

Non-, moderate, and heavy smokers used hearing protectors more often (61–64%) than very heavy smokers (47%)

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Citation

Design

Population

Exposures and Source of Exposure Data

 

 

 

Lifetime smoking

(number of cigarettes)

Moderate: > 0 to < 36,000

Heavy: 36,000 to < 144,000

Very heavy: 144,000 or more

Pyykko et al. (1988)

Cross-sectional

199 professional forest workers

Northeastern Finland (1970s ?)

Exclusions: bilateral ear disease

Survey: history of working habits, use of ear protectors, history of vibration syndrome, smoking history

Complete medical evaluation

Noise exposure

Time-weighted median inside earmuffs: 99 dBA (91 dBA average inside muffs, 103 dBA outside muffs); measured for sample of 6 workers

Smoking

Smoker: smoked w/in past 10 yrs

Nonsmoker: never smoked or no smoking in past 10 yrs

NOTES: CI, confidence interval; OR, odds ratio; PR, prevalence ratio; PRR, prevalence rate ratio.

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Outcome Measure

Results

Comments

Mean hearing threshold of both ears at 4 kHz

Age correction based on A-weighted noise levels and duration of exposure

Smoking not sig correlated with sensorineural hearing loss at 4 kHz

 

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

TABLE D-4 Progression of Hearing Loss After Noise-Induced Hearing Loss

Citation

Design

Population

Exposures and Source of Exposure Data

Lee et al. (2005)

Longitudinal cohort

188 participants (91 women, 97 men); 376 ears

Participation for at least 3 yrs (mean 6.4 yrs)

Ages at entry: 60–81 yrs (mean 68 yrs)

Recruitment through advertisements and referral, began in 1987

Conventional thresholds tested annually

Exclusions: conductive hearing loss, active otologic/neurologic disease

Longitudinal study of presbyacusis, Medical University of South Carolina

Questionnaire: noise history, medication use, self-evaluation of hearing handicap

History of noise exposure:

56 of 85 men

18 of 78 women

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Outcome Measure

Results

Comments

Rate of change in pure-tone hearing thresholds (0.25, 0.5, 1, 2, 3, 4, 6, 8 kHz) (slope from linear regression of changes for each ear)

Testing also done for extended high frequencies

No significant difference in rate of threshold change at 1–2 kHz for noise-exposed and unexposed

Rate of change at 6–8 kHz lower for noise-exposed than unexposed males; lower at 2 kHz for noise-exposed females

Hearing thresholds at 2–8 kHz were significantly higher (7.7 to 12.1 dB, p < 0.05) for noise-exposed men

Noise-exposed women had smaller threshold elevations (2.2 to 7.6 dB)

Overall, men had significantly poorer initial thresholds than women at 2–8 kHz

Rates of change at 0.25–2 kHz had positive correlations w/ initial thresholds at higher frequencies

Rates of change at 3–8 kHz had negative correlations w/ initial thresholds at those frequencies

 

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Citation

Design

Population

Exposures and Source of Exposure Data

Cruickshanks et al. (2003)

Longitudinal cohort

Baseline (1993)

3,753 participants, ages 48 to 92 years

1,925 w/o hearing loss

[PTA (0.5, 1,2,4 kHz) in both ears ≤ 25 dB]

Mean age: 61 yrs

1,631 w/ hearing loss

[PTA (0.5, 1,2,4 kHz) in either ear > 25 dB and < 100 dB in worse ear]

Mean age: 71 yrs

5-yr follow-up (1998)

2,800 participants

Losses to death, refusal, loss to follow-up; losses greater among persons w/ hearing loss

Epidemiology of Hearing Loss Study, Beaver Dam, WI

Questionnaires: occupation and exposure to occupational noise, leisure noise, military service

Rosenhall (2003)

Mixed longitudinal and cross-sectional cohort

Gerontological and geriatric population study, Gothenburg, Sweden

Total population:

616 men

869 women

Cohorts

1. 1971, 70 yr olds; seven exams, to age 90 yrs; cohort supplemented beginning at age 85

2. 1976, 70 yr olds; second exam at 75 yrs

4. 1990–1991, 75 yr olds

5. 1992–1993, 70 yr olds

Questionnaires: occupation and exposure to occupational noise

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Outcome Measure

Results

Comments

Incident hearing loss

PTA (0.5, 1, 2, 4 kHz) in either ear > 25 dB at follow-up

Incident hearing loss

All: 21% (95% CI 19.4–23.4)

Men (age-adj): 31% (CI 26.8–34.6)

Current or former occupation (age-, sex-adj):

Mgmt/profess: OR = 1.00

Production: OR = 1.92 (95% CI 1.10–3.37)

Operations/fabricators: OR = 1.92 (95% CI 1.26–2.93)

Self-reported occupational noise exposure: not significant

 

Progression of hearing loss

PTA (0.5, 1, 2, 4 kHz) > 5 dB increase over baseline level

Progression of hearing loss

All: 53.5% (CI 50.2–56.4)

Men (age-adj): 51.5% (CI 47.0–55.2)

Occupation: no significant assoc between likely noise exposure and progression

 

Change in pure-tone hearing thresholds (0.25, 0.5, 1, 2, 4, 6, 8 kHz) from age 70 to age 75 yrs

Greater increases in hearing thresholds at 1, 2, 8 kHz for men exposed to noise than men not exposed

Increases at 4 kHz similar for exposed and nonexposed

Less change between ages 75 and 79; similar changes for exposed and nonexposed

No measures of statistical significance reported

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Citation

Design

Population

Exposures and Source of Exposure Data

Gates et al. (2000)

Longitudinal cohort

203 male members of the initial Framingham Heart Study cohort with audiometric tests from examinations E15 and E22

E15

No notch (N0): 75 right ears (RE), 68 left ears (LE)

Small notch (N1): 50 RE, 47 LE

Large notch (N2): 78 RE, 88 LE

Mean age at E15:64 yrs

Exclusions: men w/ 20 dB difference in PTA b/t right and left ears

Represented by presence and characteristics of audiometric notch at Examination E15

Notch determined from two-part function for linear pattern at lower frequencies and vertically oriented, concave parabolic form at higher frequencies (2–8 kHz)

Depth-of-notch categories:

N0: < 15 dB

N1:15 dB–35 dB

N2: ≥ 35 dB

N1: possible noise damage

N2: probable noise damage

NOTES: CI, confidence interval; LE, left ear; OR, odds ratio; PTA, pure-tone average; RE, right ear.

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Outcome Measure

Results

Comments

15-year change (E22–E15) in audiometric threshold for 8 frequencies: 0.25–8 kHz

(each ear assessed separately)

Secondary analysis included as predictor variables cardiovascular disease events (lifetime), smoking history (E15–E22), number of prescription medications used regularly (E15–E22)

0.25, 0.5, 1 kHz: threshold shifts not significantly different across notch groups

2 kHz: notch groups are significantly different; (e.g.,

LE shifts: N0 = 12.4; N1 = 16.0; N2 = 18.8; p = 0.0018)

4, 6 kHz: N2 shifts significantly smaller than N0, N1

8 kHz: N1 shift significantly greater than N0 or N2; N0 and N2 not significantly different

With E15 thresholds as covariates, notch category was significant only at 2 kHz (p < .001)

Similar patterns for right and left ears

Results adjusted for age, smoking, medications

Actual noise exposures during E15–E22 interval not documented; presumed no additional occupational noise exposure for most subjects and little recreational exposure

Past noise exposure inferred from presence of audiometric notch

Possible survival bias

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

TABLE D-5 Features of Studies Included in Analysis of Hearing Loss Among Military Personnel

Citation

Design

Timing of Data Collection

Study Population

Stratification

a. Air Force Studies

Sutherland and Gasaway (1976)

Cross-sectional

Jan–June 1975

Data from AF Form 1490 (annual hearing conservation audiogram), received Jan–Jun 1975

56,951 USAF personnel (men only?)

48,262 military

8,689 civilians

Personnel tested as part of the hearing conservation program

Age (yrs)

18–24; 25–34; 35–44; 45–54; 55–64

Sutherland and Gasaway (1978)

Cross-sectional

1 June 1975–31 May 1976

Data from AF Form 1490 (annual hearing conservation audiogram) for test dates w/in study period

117,454 USAF personnel (men only?)

99,318 military

18,136 civilians

Received annual hearing conservation audiogram during 1-yr study period (one record/person)

Age (yrs)

18–24; 25–34; 35–44; 45–54; 55–64

Thomas (1995)

Longitudinal and cross-sectional reporting

Not specified

Data from Air Force hearing conservation program test results

 

6,655 persons in hearing conservation program (8 bases)

3,029 military

2,859 civilians

6,207 men

365 women

Only personnel with at least 4 sequential audiograms

Tests 1–4

(mean age for personnel at each test)

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Freqeuencies Tested

Audiometric Zero, Audiometer, and Earphones

Summary Measures Reported*

Comments, Conclusions

0.5, 1, 2, 3, 4, 6 kHz

ANSI, 1969

TDH-39 earphones w/ MX-41/AR cushions

Median hearing threshold levels (military and civilians reported separately)

% distribution of HTLs for each frequency

% STS

Hearing levels of military noise-exposed USAF personnel better than USAF civilians and U.S. population (except at ages 18–24, 0.5 kHz, left ear).

0.5, 1, 2, 3, 4, 6 kHz

ANSI, 1969

TDH-39 earphones w/ MX-41/AR cushions

Median hearing threshold levels (military and civilians reported separately)

% distribution of HTLs for each frequency

% STS

Noise-exposed USAF military personnel show better hearing than noise-exposed USAF civilians and general U.S. population

0.5, 1, 2, 3, 4, 6 kHz

Not specified

 

Mean hearing threshold levels (ears not reported separately)

(military and civilians reported separately)

% worse on subsequent test

% better or worse on subsequent test

Total personnel in hearing conservation program was 14,166

Less variability in women’s HTLs than men’s (combined military and civilian)

Analysis of variability of HTLs classifies USAF hearing conservation program as unacceptable to marginal

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Citation

Design

Timing of Data Collection

Study Population

Stratification

b. Army Studies

Walden et al. (1971)

Cross-sectional

(pilot study)

1971

(Sept–Nov?)

2,726 men

Active duty

Officers and enlisted

Included recruits, advanced trainees, regular personnel from infantry, armor, artillery, pilots

Convenience sample from 6 bases

Age (yrs)

16–20; 21–25; 26–30; 31–35; 36–40; 41–45; 46–50; 51–55

LOS (yrs): 0–2; 2–4; 4–6; 6–8; 8–10; 10–15; 15–20; 20–25; 25–30; (w/in branches: < 4, 4–10, > 10 yrs)

Walden et al. (1975)

Cross-sectional

June 1974–Sept 1974

3,000 enlisted men

(10 bases; 1,000 each infantry, armor, and artillery)

75% of active duty spent in designated branch

300 male inductees

(3 bases)

Random selection

Branch

LOS (yrs): 1.5–2.4; 2.5–7.4; 7.5–12.4; 12.5–17.4; 17.5–22.4

Peters and Ford (1983)

Cross-sectional

Feb–Aug 1982

145 aviators (all men?)

Ft. Rucker; officers and warrant officers

Age range 24–45 yrs (mean 32 yrs)

54% w/ substantial exposure to small arms and artillery fire

Random sample

Flight hours

50–400; 401–600; 601–800; 801–1000; 1001–2000; 2001–3000; 3001–4000; 4001–5000; 5001–6000; 6001–7000

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Frequencies Tested

Audiometric Zero, Audiometer, and Earphones

Summary Measures Reported*

Comments, Conclusions

0.25, 0.5, 1, 2, 4, 6 kHz

ISO, 1964

Portable audiometers w/ minimum threshold of -10 dB HL

Mean hearing thresholds (standard deviation)

% distribution by hearing profile

Higher % with hearing impairment w/ longer active duty service

Higher thresholds seen as early as first 4–6 months of active duty

Authors cite need for longitudinal study

0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8 kHz

< 81 dBA exposure in 14 hours before test

ANSI, 1969

Manual testing w/ audiometers and test booths available at each base

TDH-39 earphones w/ MX-41/AR cushions

Mean hearing thresholds (standard deviation)

% distribution by hearing profile (standard error)

Hearing ability decreases as time-in-service increases

Clinically significant losses: 20–30% at ≥ 2 yrs LOS; > 50% at ≥ 15 yrs LOS

Middle to high frequencies most affected

Assigned hearing profile category not correct for many

2, 3, 4, 6 kHz

ANSI, 1969

Grason-Stadler audiometer, Model 1701 w/ TDH 49 earphones or Grason-Stadler GSI 10 w/ TDH 50P earphones

Mean and median hearing thresholds (standard deviation, standard error)

Mean thresholds lower (better) than aviators in Walden et al. (1971)

Thresholds higher for left ear at 2, 4 kHz, higher for right ear at 6 kHz

Significant effect of flight hours (50–400; 401–3000; 3001–6000 hrs) on left-ear threshold differences between 4 and 2 kHz

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Citation

Design

Timing of Data Collection

Study Population

Stratification

Chandler and Fletcher (1983)

Retrospective analysis of longitudinal data

Date not specified

Reference and current audiograms (w/in past 12 mos)

209 men in six engineering MOS

(1) Basic engineers; (2) carpenters, plumbers, electricians; (3) heavy equipment operator/ mechanic; (4) maintenance (wheeled vehicle); (5) truck driver; (6) petroleum supply and storage

Exclusions: history of nonoccupational noise hazards, head or acoustic trauma, middle-ear pathology, or family history of hearing loss

Age range: 18–50 yrs

MOS

Ohlin (1992)

Cross-sectional

1989

Hearing conservation program reports

Last test in 1989

DD Form 2215:1,284 tests

DD Form 2216:1,625 tests

2,903 enlisted men

(10 bases: 985 Infantry; 963 Armor; 959 Artillery)

Random selection from registry for hearing conservation program

3,534 inductees

(1 base)

Test results from feasibility study for reference audiograms

No otologic examinations

LOS (yrs)

1.5–2.4; 2.5–7.4; 7.5–12.4; 12.5–17.4; 17.5–22.4 yrs

Branch (w/o LOS)

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Frequencies Tested

Audiometric Zero, Audiometer, and Earphones

Summary Measures Reported*

Comments, Conclusions

0.5, 1, 2, 3, 4, 6 kc/s

ANSI, 1969

No information on audiometer or earphones

Mean hearing threshold levels (current)

Change from reference thresholds (graphed data only)

No remarkable differences among MOS groups

Better current HTLs at 3, 4, and 6 kc/s by 23–34 dB, than 1954 data for comparably aged men working in industry may reflect exclusions for other causes of hearing loss in military population

0.5, 1, 3, 4, 6 kHz

(no quiet period required before DD Form 2216 test)

Standard hearing conservation program calibration

HEARS microprocessor audiometers; group testing

Circumaural test earphones (Audiocups)

Mean hearing thresholds (average of left and right ears) (standard error)

% distribution by hearing profile (standard error)

59% of enlisted combat arms personnel from sampled bases in HEARS in 1989

Entrance standards stricter as of 1 Aug 87 (AR 40-501)

No data on race or nonoccupational noise

Systematic increase in HTLs with increase in LOS, w/ approx 50% of hearing loss attributed to aging

Differences among branches not clinically significant

Improvements over 1974 levels for all LOSs

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Citation

Design

Timing of Data Collection

Study Population

Stratification

Henselman et al. (1995)

Cross-sectional

1989

Records from hearing conservation program tests (high-noise MOS) and periodic physical examinations (low-noise MOS)

39,006 enlisted men from high-noise-exposure MOS (infantry, armor, artillery)

18,730 enlisted men from low-noise-exposure MOS (administration, supply and services, medical, visual information, electronic maintenance and calibration, public affairs, automated data processing, topography, intelligence)

Age range: 17–56 yrs

Race (white black, other), LOS (yrs): by yr for 0–14.9 yrs; 15–19.9; 20–24.9 yrs

c. Navy and Marine Corps Studies

Robertson et al. (1978)

Cross-sectional

“[N]early three years” (mid 1970s? dates not specified)

3,050 enlisted sailors:

1,561 in “experimental” ratings (high noise exposure expected: airman, fireman, equipment operator, machinist mate, engineman, boiler tech, aviation mechanic, aviation machinist mate, aviation boatswain mate, aviation ordnance man)

LOS (yrs)

For ratings: 1–2; 2–3; 3–4; 4–5; 5–10; 10–15; 15–20; 20–25 yrs

For apprentices: 1–2; 2–3; 3–4 yrs

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Frequencies Tested

Audiometric Zero, Audiometer, and Earphones

Summary Measures Reported*

Comments, Conclusions

0.5, 1, 2, 3, 4, 6 kHz

Standard hearing conservation program calibration

Tracor RA 600AM microprocessor audiometer

TDH-39 earphones with ear cushions

Age-corrected threshold average (1, 2, 3, and 4 kHz; left and right ears averaged)

Age correction from ISO-1999, database B

Analyzed records cover 25% of total personnel in high-noise MOS and 18% of personnel in low-noise MOS

Exposure categories based on current MOS; no information on noise-exposure history

No control for nonoccupational noise

Significant difference in average thresholds between high-and low-noise groups, but differences were < 5 dB

0.5, 1, 2, 3, 4, 6, 8 kHz

ANSI, 1969

Manual audiometry

No information on audiometer or earphones

“Average” hearing threshold levels (standard deviation)

% of subjects with significant high- and low-frequency hearing losses ( ≥ 30 dB)

37% of experimental group and 23% of control group had significant high-freq hearing losses at ≥ 5 yrs of service

USMC high-freq losses described as generally greater than Navy; only those for Navy EO rating similar to USMC

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Citation

Design

Timing of Data Collection

Study Population

Stratification

 

 

 

1,489 in “control” ratings (low noise exposure expected: hospitalman, dentalman, hospital corpsman, dental tech, mess management spec., yeoman, personnelman, disbursing clerk, training device tech, aviation maintenance admin)

361 apprentices (airman, fireman, hospitalman, dentalman)

121 recruits

298 women (9% overall: 18% of recruits: 16% of control; 1.7% of experimental)

“Subjects were identified by computer”

Exclusions: conductive hearing loss

 

Goldenberg (1977)

Cross-sectional

13-month period

(early 1970s? date not specified)

11,577 men (Marine Corps enlisted personnel and officers)

Consecutive unique test subjects at one site

No otologic examination

Age (yrs)

< 18; 18–24; 25–34; 35–44; 45–54; 55–64

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Frequencies Tested

Audiometric Zero, Audiometer, and Earphones

Summary Measures Reported*

Comments, Conclusions

0.5, 1, 2, 3, 4, 6 kHz

ISO (1964)

Rudmose ARJ-4A audiometer, 10-man booth

TDH-39 earphones

If questionable self-recording audiogram, retested in 1-man booth w/ Beltone 15 CW audiometer, TDH-39 earphones

Median hearing thresholds (better ear only; graphed data)

% w/ > 25 dB and % w/ > 45 dB loss at avg of speech frequencies (0.5, 1, 2 kHz) or high frequencies (3, 4, 6 kHz)

Marine Corps data similar to USPHS for civilians

Markedly higher thresholds at ages 35–44 yrs and older

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Citation

Design

Timing of Data Collection

Study Population

Stratification

Bohnker et al. (2002)

Cross-sectional

Tests between 1995–1999

Hearing conservation program reports

Data entered beginning 1999

68,632 enlisted personnel w/ “monitoring” audiogram reports from hearing conservation program

Navy men = 51,643

Marine men = 12,251

Navy women = 4,184

Marine women = 554

Analysis based on 20–25% sample of 152,590 records

Service (USN/USMC), gender, and age (yrs)

17–24; 25–29; 30–34; 35–39; 40–44; 45–49; ≥ 50

d. U.S. Adult Population

Glorig and Roberts (1965)

Cross-sectional

Oct 1959–Dec 1962

6,672 persons examined

Noninstitutionalized civilians, ages 18–79 yrs

Nationally representative random sample

Sex and age (yrs)

18–24; 24–34; 35–44; 45–54; 55–64; 65–74; 75–79

*Left ears and right ears reported separately unless otherwise noted.

NOTE: EO, equipment operator; HEARS; Hearing Evaluation Automated Registry System [Army]; HTL, hearing threshold level; LOS, length of service; MOS, military occupational specialty; NEHC, Navy Environmental Health Center; OSHA, Occupational Safety and Health Administration; STS, significant threshold shift; USPHS, U.S. Public Health Service.

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Frequencies Tested

Audiometric Zero, Audiometer, and Earphones

Summary Measures Reported*

Comments, Conclusions

0.5, 1, 2, 3, 4, 6 kHz

Not reported; reference to testing according to NEHC guidance

Mean hearing thresholds (standard deviation)

Mean thresholds for USN and USMC were generally worse than OSHA age-adjusted values

Women had lower thresholds than men w/in each service at corresponding ages

0.5, 1, 2, 3, 4, 6 kcps

ASA, 1951

Beltone audiometers, TDH-39 earphones w/ MX-41/AR cushions

Minimum threshold: −10 dB HL

Median hearing thresholds (method for calculating 95% confidence intervals described)

% distribution by hearing threshold categories

No noise-exposure history

Hearing levels higher w/ age from youngest to oldest

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

TABLE D-6 Studies on Prevalence of Tinnitus and Prevalence of Tinnitus with Hearing Loss

Study

Design, Population

Definition of Tinnitus

Definition of Hearing Level or Hearing Loss

a. Community-based Studies

Sindhusake et al. (2003a,b, 2004)

Blue Mountains Hearing Study, Australia, 1997

Cross-sectional

2,015 persons, ages 55+ yrs (mean 70 yrs)

Residents of 2 suburban postal code areas

Tinnitus

Sounds persisting for 5 minutes or longer during the past yr

Hearing level

Lower frequencies: PTA for 0.5, 1, 2, and 4 kHz

Higher frequencies: PTA for 4, 6, and 8 kHz

Hearing loss

PTA for 0.5, 1, 2, and 4 kHz > 25 dB HL in better ear

Pure-tone testing at 0.25, 0.5, 1, 2, 4, 6, 8 kHz (3 kHz if 20 dB difference b/t 2 and 4 kHz)

Hoffman and Reed (2004)

Tambs et al. (2003)

Nord-Trøndelag Hearing Loss Study, Norway, 1995–1997

Cross-sectional

51,975 persons, ages 20–101 yrs (mean: 50 yrs)

Residents of Nord-Trøndelag County

Tinnitus

Bothered by ringing in the ears

Hearing loss

PTA for 0.5, 1, 2, and 4 kHz in worse ear:

≤ 25 dB HL > 25, ≤ 40 dB HL > 40 dB HL

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Noise Exposure and Source of Exposure Data

Prevalence of Tinnitus

Prevalence of Tinnitus, by Hearing Level

Comments

Questionnaire on noise exposure

Duration (yrs) and level of occupational noise (quiet; tolerable; “unable to hear speech”)

Noise during military service

Leisure noise (e.g., gunfire)

30% w/ tinnitus

Age- and sex-standardized to Australian population

Hearing loss

35% w/ tinnitus

Normal hearing

27% w/ tinnitus

75% participation rate for eligibles

Questionnaire on noise exposure

Occupational noise: difficult to have a conversation; type of work; exposed to staple gun, hammering, chain saw, blasting, etc;

Other noise: impulse noise (y/n); brass band; personal stereo

15% w/ tinnitus

Odds ratio for tinnitus

≤ 25 dB HL

Men: 1.0

Women: 1.0

> 25, ≤ 40 dB HL

Men: 2.84 (95% CI 2.55–3.16)

Women: 2.78 (95% CI 2.45–3.15)

> 40 dB HL

Men: 4.18 (95% CI 3.66–4.77)

Women: 5.40 (95% CI (4.67–6.24)

Possible response bias

Participation rates were 65% for men; 73% for women; < 50% for ages < 30 yrs; ≥ 75% for ages 50–80 yrs

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Study

Design, Population

Definition of Tinnitus

Definition of Hearing Level or Hearing Loss

Nondahl et al. (2002)

Epidemiology of Hearing Loss Study, Beaver Dam, WI 1993–2000

Cross-sectional and longitudinal

Baseline

3,737 participants, ages 48 to 92 years

5-yr follow-up

2,558 participants (75% of those w/o significant tinnitus at baseline)

Significant tinnitus

“buzzing, ringing, or noise” in the ears in the past year, rated as at least moderately severe or causing problems w/ sleep or both

Excludes tinnitus rated mild or of unknown severity and not causing problems w/ sleep

Hearing loss

PTA of thresholds at 0.5, 1, 2, and 4 kHz > 25 dB HL in worse ear

Pure-tone testing at 0.25, 0.5, 1, 2, 3, 4, 6, 8 kHz

Palmer et al., (2002)

United Kingdom, 1997–1998

Cross-sectional

12,907 responses from adults, ages 16–64 yrs

Postal survey using random sample from age-sex registers for 34 general medical practices, plus members of the armed services

 

Tinnitus

Noises lasting longer than 5 minutes during the past 12 months

Persistent tinnitus

Occurring most or all of the time

No hearing difficulty

Report of no or slight difficulty hearing a person talking in a quiet room w/ better ear

Severe hearing difficulty

Use of a hearing aid or report of severe difficulty hearing or inability to hear a person talking in a quiet room

Intermediate hearing difficulty

All others

No audiometric testing done

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Noise Exposure and Source of Exposure Data

Prevalence of Tinnitus

Prevalence of Tinnitus, by Hearing Level

Comments

Occupational noise history

- full-time job required using loud voice to be heard at 2 ft;

- farmer who drove tractor w/out cab at least half of the time; or

- military duties on aircraft; tracked vehicle, ship engine room; on weapons range ≥ 7 times per yr; used grenades, mortars, or shoulder-held grenade launchers; used weapons system requiring more than one operator

Baseline (significant tinnitus)

8% [8.2%; 95% CI 7.4–9.1]

Severe: 1.5%

Moderate or causing sleep problems: 6.7%

5-yr Incidence

6% [5.7%; 95% CI 4.8–6.6]

Baseline

w/ hearing loss

12% w/ significant tinnitus

w/o hearing loss

5% w/ significant tinnitus

 

Questionnaire response on number of years working in noisy places (need to shout to be heard)

Persistent tinnitus

Men: 6%

Women: 3%

W/ severe hearing difficulty

Men: 16.1% w/ persistent tinnitus (age-standardized)

Women: 33% w/ persistent tinnitus

W/ no hearing difficulty

Men: 5.0% w/ persistent tinnitus

Women: 3% w/ persistent tinnitus

Possible response bias (58% response rate)

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Study

Design, Population

Definition of Tinnitus

Definition of Hearing Level or Hearing Loss

Adams et al. (1999)

National Health Interview Survey, United States, 1996

Cross-sectional

63,402 persons, all ages

Nationally representative random sample; noninstitutionalized population; excludes armed forces and nursing home residents

“Does [household member] now have tinnitus or ringing in the ears?”

 

Hoffman and Reed (2004)

Adams and Marano (1995)

Disability Supplement, National Health Interview Survey, United States, 1994–1995

Cross-sectional, household interviews

99,435 adults, ages 20 yrs and older

Subset of participants in national sample of noninstitutionalized population; excludes armed forces and nursing home residents

Excludes proxy responses on tinnitus

“Does [household member] have ringing, roaring or buzzing in the ears or head now that has lasted for at least 3 months?”

Moderate or worse hearing loss (subjective assessment, criteria not specified)

Uses hearing aid

Hoffman and Reed (2004)

Adams and Benson (1991)

Hearing Supplement, National Health Interview Survey, United States, 1990

Cross-sectional, household interviews

59,343 adults, ages 20 yrs and older

Subset of participants in national sample of noninstitutionalized population; excludes armed forces and nursing home residents

Excludes proxy responses on tinnitus

“At any time over the past 12 months, have you ever noticed ringing in the ears, or have you been bothered by other funny noises in your ears or head?”

If yes:

Occurs all the time/ every few days/ less often

Bothered quite a bit/ just a little/ not at all

Moderate or worse hearing loss (subjective assessment, criteria not specified)

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Noise Exposure and Source of Exposure Data

Prevalence of Tinnitus

Prevalence of Tinnitus, by Hearing Level

Comments

No exposure data

3% w/ tinnitus

Age

< 45 yrs: 1%

45–64 yrs: 6%

65+ yrs: 9%

18+ yrs: 4%

45+ yrs: 7%

 

94% participation rate

 

4% w/ tinnitus

Moderate or worse hearing loss

32% w/ tinnitus

Uses hearing aid

12% w/ tinnitus

Unknown effect of exclusion of proxy responses on representativeness of data (40,570 adult proxy responses)

No exposure data

8% w/ tinnitus

Moderate or worse hearing loss

42% w/ tinnitus

Unknown effect of exclusion of proxy responses on representativeness of data (27,364 proxy responses)

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Study

Design, Population

Definition of Tinnitus

Definition of Hearing Level or Hearing Loss

Coles (1996)

Tier B, National Study of Hearing, United Kingdom

Cross-sectional

3,234 people selected in stratified random sample from postal survey responses

Stratification to ensure larger proportion of persons w/hearing disorders and tinnitus

Prolonged spontaneous tinnitus: lasting at least 5 minutes and not temporarily induced by noise, drugs, or ear or respiratory illness

Hearing threshold levels

Medical Research Council’s Institute of Hearing Research, (1981)

Coles (1984)

Tier A, National Study of Hearing, United Kingdom, 1978–1982

Cross-sectional (multiple samples)

Postal survey, responses from random samples of adults, age 17+ yrs, from 4 cities:

Prepilot: 522

Pilot: 5,000 (74%)

Phase I: 8,069

Phase II: 7,645

Prolonged spontaneous tinnitus lasting at least 5 minutes and not temporarily induced by noise, drugs, or ear or respiratory illness

Prepilot

Ever noticed noises in your head

Spontaneous tinnitus

Pilot

Ringing or buzzing lasting 5 minutes or more, excluding those occurring only after exposure to loud noise

Phase I

Ever have noises lasting 5 minutes or more, excluding those occurring only after exposure to loud noise

 

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Noise Exposure and Source of Exposure Data

Prevalence of Tinnitus

Prevalence of Tinnitus, by Hearing Level

Comments

 

 

Presence of moderately or severely annoying tinnitus

HTL 10–19 dB vs HTL < 10 dB

OR=2

HTL >80 dB vs HTL < 10 dB

OR= 27

Controlling for hearing thresholds eliminates associations w/ age, noise exposure, or socioeconomic status

Little or no occupational noise exposure: 8% w/ tinnitus

High lifetime noise dose: 21% w/ tinnitus

Prolonged, spontaneous

10%

Any tinnitus

34% to 39%

Brief or nonspontaneous

23% to 27%

Spontaneous

11% to 18%

Moderately or severely annoying: 5%

Sleep-disturbing: 5%

Severe effect on quality of life: 1%

Severe effect on ability to lead a normal life: 0.5%

 

80% response rate

7% of all adults have sought a doctor’s help for tinnitus

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Study

Design, Population

Definition of Tinnitus

Definition of Hearing Level or Hearing Loss

 

 

Phase II

“Nowadays” noises lasting 5 minutes or more, excluding those occurring only after exposure to loud noise

 

Parving et al. (1993)

Copenhagen Male Study, Denmark, 1985–1986

Cross-sectional assessment of tinnitus

3,387 men, ages 53–75 in 1985–86

Participants in a prospective cohort study of cardiovascular health

Tinnitus of greater than 5 minutes duration

Self-assessed hearing ability: do you think your hearing is affected?

Rosenhall and Karlsson (1991)

Gothenburg, Sweden, 1971–1976

Repeated cross-sectional assessments of defined cohorts

Cohorts

F01:377 initial members; born 1901–02; first examined in 1971

F06:297 initial members; born 1906–07; first examined in 1976

Gerontological and geriatric population study

Tinnitus (buzzing): none, occasional, continuous

Pure-tone thresholds at 0.25, 0.5, 1, 2, 4, and 8 kHz

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Noise Exposure and Source of Exposure Data

Prevalence of Tinnitus

Prevalence of Tinnitus, by Hearing Level

Comments

 

17% w/ tinnitus

Significantly higher prevalence of tinnitus if hearing affected (X2, p < 0.001)

Hearing affected:

Yes: 27% w/ tinnitus

No: 11% w/ tinnitus

 

 

Continuous tinnitus

F01

Age 70:8%

Age 75:12%

Age 79:11%

F06

Age 70:12%

Occasional tinnitus

F01

Age 70:20%

Age 75:17%

Age 80:30%

F06

Age 70:19%

 

 

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Study

Design, Population

Definition of Tinnitus

Definition of Hearing Level or Hearing Loss

Axelsson and Ringdahl (1989)

Gothenburg, Sweden, 1980s

Cross-sectional

2,378 responses from adults, ages 20–79 yrs

Postal survey using age-stratified random sample from city population register

Do you suffer from tinnitus?

(never/seldom/often/always)

Additional characterization of tinnitus only for those responding “often” or “always”

Subjective hearing:

- normal

- some hearing loss

- marked hearing loss

- deaf

Roberts (1968)

Health Examination Survey, United States, 1960–1962

Cross-sectional

6,672 adults, ages 18–79 yrs

Nationally representative random sample; noninstitutionalized population; excludes armed forces and nursing home residents

“At any time over the past few years, have you ever noticed ringing (tinnitus) in your ears of have you been bothered by other funny noises in your ears?”

If yes, how often (every few days / less often)

If yes, do they bother you (quite a bit / just a little)

Severe and mild tinnitus not explicitly defined

Average thresholds

Better than normal: −5 dB HL or better

Normal: −4 dB to 15 dB HL

Some hearing impairment: 16 dB HL or worse

Average of thresholds at 0.5, 1, and 2 kcps (audiometric zero: ASA, 1951)

Testing at 0.5, 1, 2, 3, 4, 6 kcps

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Noise Exposure and Source of Exposure Data

Prevalence of Tinnitus

Prevalence of Tinnitus, by Hearing Level

Comments

 

Tinnitus

Always: 6%

Often: 8%

Seldom/never: 86%

 

Response rate: 66% (usable responses)

No exposure data

32% w/ tinnitus

Severe: 6%

Mild: 27%

W/ better than normal hearing

3% w/ tinnitus

W/ some hearing impairment

22% w/ tinnitus

 

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Study

Design, Population

Definition of Tinnitus

Definition of Hearing Level or Hearing Loss

b. Industrial Workers

Sulkowski et al. (1999)

Poland

Cross-sectional

261 male drop-forge operators

Age range: 18–61 yrs (mean: 31 yrs)

Employment: 1–28 yrs (mean: 10 yrs)

169 age-matched controls from low-noise factory areas (mean age: 35 yrs)

Exclusions: ear disease or pre-employment noise exposure

No definition provided

Interview to determine presence and characteristics of tinnitus

Pure-tone audiometric testing before the beginning of the workday

Griest and Bishop (1996)

Oregon, 1971–1990, 1992

Longitudinal (retrospective cohort)

138 men in steel foundry hearing conservation program

Initial ages: 18 to 41 yrs (mean 28 yrs)

No exclusions for other tinnitus risk factors

Tinnitus reported at annual audiogram

(never / 1–2 times / 3+ times)

Tinnitus reported on 1992 questionnaire:

Ever hear ringing noises or other sounds

When first aware

How often (rarely / several times a month / several times a week / several times a day / always there)

How long (only a few minutes / several hours / several days / always there)

Annual audiograms starting in 1971

Threshold at 4 kHz for men 20–29 yrs in 1971

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Noise Exposure and Source of Exposure Data

Prevalence of Tinnitus

Prevalence of Tinnitus, by Hearing Level

Comments

Noise survey; 0.34 impulses per second

Hearing protectors not worn regularly

Noise-exposed

70% w/ tinnitus

Controls

4% w/ tinnitus

 

 

Noise levels: TWA of 85 to 101 dBA

Exposure of ≥ 85 dBA for 10 yrs or more

Sound surveys and dosimetry from 2 to 4 hour exposures

Hearing protection use recorded

Tinnitus reports at audiograms

Never: 62%

1–2 times: 17%

3+ times: 20%

Tinnitus reports on questionnaire

Never: 39%

Rarely / several times a month: 43%

Several times a week or more: 17%

Significant association between frequency of tinnitus reports at audiogram and report of tinnitus several times a week or more in questionnaire (X2, p < 0.0001)

 

Tinnitus at baseline not excluded

For 20- to 29-yr olds at baseline, no significant differences between those reporting any tinnitus and no tinnitus in military, recreational, or other occupational noise exposure

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Study

Design, Population

Definition of Tinnitus

Definition of Hearing Level or Hearing Loss

Gabriels et al. (1996)

Western Australia

Cross-sectional

38,725 otologically normal, noise-exposed workers given baseline hearing tests required by workers compensation program

Age range:16–55+ yrs

Noise exposure: 0–25+ yrs

Exclusions:

indications of hearing loss from injury or disease

Tinnitus: Yes to “Do you ever have ringing noises … which last more than 5 minutes?” (yes/ no / maybe)

Noise-induced hearing loss

Age-corrected “percentage loss of hearing” > 0%

Percentage loss of hearing calculated from Australian National Acoustic Laboratory tables specific for age and sex

Tested at 0.5, 1, 1.5, 2, 3, 4, 6, 8 kHz; 16 hrs of prior quiet

Phoon et al. (1993)

Singapore, 1990

Cross-sectional

647 workers from 808 workers identified as having noise-induced hearing loss through annual monitoring audiograms

Mean age: 39 yrs

Exclusions: ear disease, ear drum abnormality, conductive hearing loss

Interview at follow-up examination:

Any tinnitus w/in past 6 months?

Frequency:

all the time/ once a day/ ≥ once a week/ < once a week/ not sure

Hearing loss (average of thresholds at 1, 2, 3 kHz)

Early: ≤ 25 dB HL

Intermediate: > 25, < 50 dB HL

Late: ≥ 50 dB HL

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Noise Exposure and Source of Exposure Data

Prevalence of Tinnitus

Prevalence of Tinnitus, by Hearing Level

Comments

Workplace exposure of 8-hr TWA of 90 dBA, or peak 140 dB

18% w/ tinnitus

10% maybe tinnitus

>10% NIHL

37% w/ tinnitus

0% NIHL

16% w/ tinnitus

No significant differences for age or number of years of noise exposure

Assumed to be 8-hr time weighted average ≥ 85 dBA (basis for requirement for annual testing)

23% w/ tinnitus

No significant differences by age, duration of noise exposure

W/ tinnitus (n=151)

Once a day or more: 34%

< once a week: 39%

Excluded cases

42% w/ tinnitus

Hearing loss

Early: 20% w/ tinnitus

Intermediate: 30% w/ tinnitus

Late: 27% w/ tinnitus

Prevalence significantly lower in early hearing loss cases than intermediate and late cases (X2, p = 0.02)

Consulted a doctor: 14%

Interfered w/ sleep: 14%

Interfered w/ some daily activity: 30%

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Study

Design, Population

Definition of Tinnitus

Definition of Hearing Level or Hearing Loss

Neuberger et al. (1992)

Austria, 1984–1986

Cross-sectional

110,647 noise-exposed factory workers

Documented noise-exposure history: > 4 hr daily, > 85 dBA for ≥ 6 months

Ages 15–65 yrs (median: 38 yrs)

Exclusions: insufficient or unspecified noise exposure

No definition provided

Roeser speech impairment index = 0.5 (HL 3 kHz) + HL 1 kHz − 15

Impairment: Index > 10%

Pure-tone thresholds at 0.25 to 8 kHz

(only results for left ears included in analysis)

Kamal et al. (1989)

Egypt

Cross-sectional

88 forge hammering workers

Age range: 30–60 yrs

Noise exposure: 9–25 yrs

Exclusions: ear infections

No definition provided

Interview to obtain tinnitus reports

Pure-tone audiometric testing at 0.25, 0.5, 1, 2, 4, 6, 8 kHz

Each worker tested before and after a work shift

Chung et al. (1984)

British Columbia

Cross-sectional

33,168 workers in industrial hearing conservation programs

Exclusions: history of ear disease, head injury, ear surgery, relative w/ hereditary hearing loss; current day-to-day changes in hearing, ruptured ear drum

From medical history interview: “do you now have ringing in your ears?”

(instruction to interviewers: tinnitus present more than momentarily and at least recurring if not continuous)

Audiometric surveillance records for annual testing for hearing conservation programs

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Noise Exposure and Source of Exposure Data

Prevalence of Tinnitus

Prevalence of Tinnitus, by Hearing Level

Comments

Median noise exposure: 90.5 dBA SPL

Worksite records of A-weighted noise levels

Self-report of previous noise exposure

Self-reported hearing protector use: seldom (< 10% of work time), occasional (10–50%), or continuous (> 50%)

7% w/ tinnitus

Rates described as higher w/ increasing hearing loss and w/ history of ear disease or head injury

 

93% exposed to steady-state noise

Noise levels recorded w/ most recent audiogram attributed to prior periods of noise-exposed work (attribution justified by low workforce turnover)

Noise measured at workers’ ears

Background: 92–94 dBA

Hammer: 120–135 dBA

No hearing protection used

88% w/ tinnitus

 

 

Assumed to be 8-hr TWA ≥ 85 dBA (basis for requirement for annual testing)

Reports on shooting history

7% w/ tinnitus

No association w/ age, smoking history (current or past), or shooting history after controlling for hearing thresholds

All thresholds ≤ 25 dB HL:

3% w/ tinnitus

 

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Study

Design, Population

Definition of Tinnitus

Definition of Hearing Level or Hearing Loss

c. Military Personnel

Attias et al. (2002)

Israel

Cross-sectional

2,200 male soldiers

Random selection of noise-exposed personnel routinely screened for hearing problems

Age: 22–50 yrs

Do you experience or hear sounds when no sound source appears to be present?

Interview to determine tinnitus onset, variability, impact

Noise-induced hearing loss

Average threshold at 2–8 kHz ≥ 25 dB HL

Pure-tone audiometric testing

Ylikoski and Ylikoski (1994)

Finland

Cross-sectional

699 male Finnish army officers

Age-stratified random sample

Mean age: 39.8 yrs (median 41.0, range 25–61)

Exclusions: incomplete audiometric or questionnaire data; apparent ear disease

Continuous tinnitus: occurred practically always, steady-state character

Hearing loss, worse ear

Slight: > 20 dB, ≤ 40 dB at any freq 3–8 kHz; and ≤ 20 dB at 0.5, 1, 2 kHz

Moderate: 41 dB–64 dB at any freq 3–8 kHz; and ≤ 20 dB at 0.5, 1, 2 kHz

Severe: ≥ 65 dB at any freq 3–8 kHz; and ≤ 20 dB at 0.5, 1, 2 kHz

Disabling: > 20 dB at any freq 0.5, 1, 2 kHz

Christiansson and Wintzell (1993)

Sweden, Nov 1986–Feb 1987

Cross-sectional

204 male infantry officers (entire unit)

Providing training in use of small (rifles, machine guns) and heavy firearms (recoilless rifles, mortars)

Exclusions: acute, chronic, secretory otitis

Questionnaire: occurrence of tinnitus

No information on persistence

(no questions or definitions provided)

Audiometric testing at 0.25 to 8 kHz

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Noise Exposure and Source of Exposure Data

Prevalence of Tinnitus

Prevalence of Tinnitus, by Hearing Level

Comments

Interview to determine previous noise exposure

14% w/ tinnitus

Normal hearing

3% w/ tinnitus

Hearing loss

19% w/ tinnitus

 

Questionnaire to establish exposure to weapons fire

Continuous tinnitus: 9%

Occasional tinnitus: 34%

Correlations:

Number of weapons impulses: r = 0.27, p < 0.001

Small-caliber weapons: r = 0.26, p < 0.001

Large-caliber weapons: r = 0.1, p < 0.005

Frequent use of hearing protectors: r = −0.17, p < 0.001

Normal hearing

2% continuous tinnitus

33% occasional tinnitus

Slight/moderate loss

3% continuous

31% occasional

Severe loss

20% continuous

32% occasional

Disabling loss

26% continuous

43% occasional

Data on other noise exposure may be incomplete

Questionnaire on type of service, previous impulse noise exposure, use of hearing protectors

Sound pressure levels for weapons measured at gunner’s ear and likely position of instructor

17% w/ “annoyance of tinnitus”

Ever exposed to heavy detonations:

Yes: 26% w/ tinnitus

No: 5% w/ tinnitus

(X2, p < 0.001)

Age (yrs)

< 30 11%

31–40 19%

41–50 16%

> 50 24%

 

Possible recall bias in link between tinnitus and exposure to heavy detonations

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Study

Design, Population

Definition of Tinnitus

Definition of Hearing Level or Hearing Loss

d. Acoustic Trauma

Mrena et al. (2002)

Finland, 1999

Longitudinal

Former conscripts, Finnish Defense Forces

418 soldiers treated for acoustic trauma July 1984–April 1989, all w/ tinnitus

122 w/ persistent tinnitus at discharge, 1984–1989

101 reached in 1999 (83%), 66 still w/ tinnitus

Mean age at exposure: 21 yrs (18.8–30.4)

Age at follow-up 30–41 yrs

Duration of tinnitus: 12 yrs (9.8–14.3)

No prior tinnitus

Tinnitus Handicap Questionnaire

Rating scales for intensity, level of annoyance (0–100, least to most)

Hearing loss: threshold > 20 dB HL at any frequency at discharge

6 cases w/ hearing loss on entering military service

No indication of audiometric testing at follow-up

Temmel et al. (1999)

Austrian military service, Jan 1995–June 1996

Cross-sectional

81 male acoustic trauma patients

Mean age: 22 yrs

Treated 3 days after exposure

Exclusions: hearing threshold > 20 dB HL at any frequency at start of service; illnesses, conditions that might affect auditory system

No questions/ definition provided

Acute acoustic trauma: acute acoustic exposure producing temporary or permanent pure-tone threshold shift

Hearing loss: threshold > 20 dB HL

Hearing thresholds at 0.125–8 kHz

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Noise Exposure and Source of Exposure Data

Prevalence of Tinnitus

Prevalence of Hearing Level Tinnitus, by

Comments

Assault rifle: 42 cases

Bazooka: 3 cases

Single cases: handguns, cannons, grenades

73% had fired the weapon

2 cases wore hearing protection (ear plugs)

Other exposure history from medical records

At discharge

29% (122 of 418) w/ tinnitus

At follow-up (10–15 yrs)

66% (66 of 101) w/ tinnitus

Normal hearing

4 cases (at time of discharge)

Greater hearing impairment associated w/ greater tinnitus disturbance

Perceived problems

33% tinnitus worse than hearing loss

33% hearing loss worse than tinnitus

79% response (52 of 66)

80% not wearing hearing protection (accidental discharges, loss of protectors, etc.)

84% w/ tinnitus

Hearing loss

83% w/ tinnitus

No hearing loss

100% w/ tinnitus

75% had hearing loss at frequencies above 2 kHz

No significant differences for:

a. blank/live ammunition

b. number of shots

c. use of hearing protection

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Study

Design, Population

Definition of Tinnitus

Definition of Hearing Level or Hearing Loss

Man and Naggan (1981)

Israel

Cross-sectional

102 patients w/ acoustic trauma; 81 w/ tinnitus

Age: 18–35

Selected for evidence of “cochlear trauma” (high-frequency hearing loss?)

Exclusions: head injury, history of ear disease

 

Audiometric testing, ISO calibration

Worst threshold: 6 kHz for 76%

Ears pooled

Melinek et al. (1976)

Israel, 1967–1970

Cross-sectional and longitudinal

433 soldiers treated for acute acoustic trauma

313 transferred to noncombat unit

120 continued in field units

Inclusion criteria:

Age 18 to 25 yrs; abrupt onset of tinnitus or hearing loss w/in 2 mos; audiometric grade of 2+ in at least one ear; diagnostic audiometry 1 wk or more after exposure; no history of prior industrial noise exposure; no history of ear disease; audiometric follow-up w/in 1 to 24 mos

No definition provided

Acute acoustic trauma: abrupt onset of symptoms (tinnitus or hearing loss) generally associated w/ unusually loud impact noise

Severity grouping

Normal: all thresholds except 8 kHz ≤ 15 dB

Mild: thresholds 20–25 dB at 4 kHz and up to 30 dB or more at 6 kHz

Moderate: thresholds ≥ 20 dB at 4 kHz w/ or w/out elevated thresholds at 3 kHz

Severe: thresholds of ≥ 45 dB at 4 kHz w/ thresholds ≥ 35 dB at 2 kHz or thresholds of ≥ 25 dB at 1 kHz

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Noise Exposure and Source of Exposure Data

Prevalence of Tinnitus

Prevalence of Tinnitus, by Hearing Level

Comments

Questionnaire on noise exposure and complaints about hearing, tinnitus

79% of subjects

Always present: 70% (of ears)

Sometimes present: 30% (of ears)

Tinnitus matched at frequencies between 4 and 8 kHz (37% at 6; 23% at 4; 24% at 8)

Higher intensity tinnitus associated w/ greater hearing loss (r = 0.71, p < 0.001)

No statistical association between tinnitus level and disturbed sleep or concentration

Potential selection effect from use of clinic population

No ear protection used

61% (of ears) w/ tinnitus

Change in subjective symptoms (including tinnitus) at follow-up:

Transferred

Deterioration: 2%

Improvement: 34%

Continued field unit

Deterioration: 15%

Improvement: 22%

Normal

42%

Mild AT

60%

Moderate AT

66%

Severe

66%

Some hearing loss may have existed before acoustic trauma

Lower initial severity rating for group continuing in field units

Statistical significance of differences not reported

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Study

Design, Population

Definition of Tinnitus

Definition of Hearing Loss Hearing Level or

 

Analysis based on ears because of differences in severity

 

Pure-tone audiometric testing at 0.5, 1, 2, 4, 8 kHz; at 3 and 6 kHz for some subjects

Salmivalli (1967)

Cross-sectional

No questions or definitions provided

Severity grades

I: narrow dip, thresholds ≤ 30 dB HL

II: thresholds 30–60 dB HL only at frequencies above 2 kcps

III: thresholds > 60 dB HL above 2 kcps or elevated at 0.5 to 2 kcps

IV: thresholds elevated at 0.5 to 1 kcps

Finland, 1963

197 male infantry and artillery soldiers (officers and enlisted) exposed to gunfire or blast

basis for selection not specified

 

 

 

Pure-tone testing at 0.25, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, kc/ sec

NOTE: AT, acoustic trauma; CI, confidence interval; NIHL, noise-induced hearing loss; OR, odds ratio; PTA, pure-tone average; TWA, time-weighted average.

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

Noise Exposure and Source of Exposure Data

Prevalence of Tinnitus

Prevalence of Tinnitus, by Hearing Level

Comments

Noise levels measured under field conditions

No overall prevalence reported

Prevalence of tinnitus

Normal: 15.7%

I: 33%

II: 25%

III: 35%

IV: 56%

 

No estimate of rounds fired by individuals

 

 

Prevalence of tinnitus after firing

Normal: 41%

I: 49%

II: 49%

III: 57%

IV: 64%

Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

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Table D-2

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Table D-3

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Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

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Table D-5

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Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

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Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

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Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×

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Suggested Citation:"Appendix D Summary Tables on Epidemiological Studies." Institute of Medicine. 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. doi: 10.17226/11443.
×
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Next: Appendix E Results from Alternative Analyses of Data on Reports of Audiometric Testing in Service Medical Records »
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The Institute of Medicine carried out a study mandated by Congress and sponsored by the Department of Veterans Affairs to provide an assessment of several issues related to noise-induced hearing loss and tinnitus associated with service in the Armed Forces since World War II. The resulting book, Noise and Military Service: Implications for Hearing Loss and Tinnitus, presents findings on the presence of hazardous noise in military settings, levels of noise exposure necessary to cause hearing loss or tinnitus, risk factors for noise-induced hearing loss and tinnitus, the timing of the effects of noise exposure on hearing, and the adequacy of military hearing conservation programs and audiometric testing. The book stresses the importance of conducting hearing tests (audiograms) at the beginning and end of military service for all military personnel and recommends several steps aimed at improving the military services’ prevention of and surveillance for hearing loss and tinnitus. The book also identifies research needs, emphasizing topics specifically related to military service.

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