2018 HRRP Programmatic Panel Member Vignette

Title: Addressing Both Immediate Needs and Long-Term Consequences

LTC Amy Blank, AuD; Office of the Surgeon General, U.S. Army

When I talk about Service members and hearing loss and hearing issues, often we talk about before the boom and after the boom.

Before the boom are things that we do to try and prevent hearing loss before it occurs. So those things can include advanced hearing protection, trying to mitigate noise to begin with through engineering controls. After the boom is how we handle Soldiers once they acquire hearing loss. So those include any type of aural rehabilitation, providing Soldiers with amplification, and fitness for duty is another big area that we’re concentrating on right now. We know some of our Soldiers do have hearing loss, and we’re trying to determine what do they need minimally for their hearing and their auditory comprehension and understanding to be able to function effectively on the battlefield.

In the complex environment of war, there’s a lot of background noise. There’s a lot of communication happening on a radio, as well as in front of them, often in a very difficult listening environment, riding in a vehicle, flying in a helicopter—that situation requires the Soldier to not only be able to hear, but to understand what’s happening in their environment.

Hearing is the only sense that we have that is on 24 hours a day; even when you sleep you can hear; and it’s 360 degrees around us. So I don’t have to look behind me necessarily to know that something is happening behind me because I can hear that auditory cue. So Soldiers need to be able to have the best hearing possible when they go into that complex listening environment to have that survivability and lethality.

The hearing loss in the Military is significant. Because of that, you can imagine there’s a lot of concern about hearing loss. What are we doing to prevent it? And how are we treating it?

This is the first year that money has become available specifically for hearing restoration.

We’re looking at focusing on the translational research, as well as the functional research, to kind of balance the portfolio between looking at cellular changes and things that could be done to manipulate the inner ear mechanism to try and prevent hearing loss or treat it after it happens, as well as things that are more clinically—we would call them, maybe not easy, but quicker wins—so that clinicians can have tools in their hands to better apply to the Soldier that’s sitting in front of them, or Sailor or Airman.

So we’re looking at what can we do in maybe 2 or 3 years and have some wins that are a little more short-term? And then some of the things that we’re looking at, we might not have that translation until 8 or 10 years.

Beyond hearing restoration, we have more Soldiers now that have mild traumatic brain injury, and associated with that can be cognitive issues. There is certainly a kind of evolving understanding of something called hidden hearing loss—when a person that has complaints that they can't hear and understand very well in background noise, but when you do the audiogram, when you do the traditional hearing tests, everything looks normal. So there is some damage in the auditory system. This is more common with people that have mild traumatic brain injury, and so really getting a handle of understanding what that damage is, how to assess it, and how to treat it would be another focus that the HRRP may look into in the future.

The good news story is that, over the last 10 years, we have certainly trended down with the amount of Soldiers with auditory dysfunction or hearing loss. And in that 10 years, we have been at war in Iraq and Afghanistan. So despite the fact that our Soldiers often have repeated battlefield experiences, our trend for overall hearing loss has gone down.

The goal is not just to help the Soldier while they’re on active duty, although certainly that’s a focus, and readiness is a focus, but also quality of life throughout the Service member’s lifetime. So we’re looking at modalities that would help the Veterans population, as well as the active duty population.