Hearing Loss Prevention for Veterans

Hearing loss and tinnitus are the two most prevalent service-connected disabilities in the
VA system for OEF/OIF Veterans, and Veterans from World War II, Korea, Vietnam, the Gulf War
and during Peacetime. Costs associated with health care utilization, provision of hearing
aids, rehabilitation services and reduced productivity for Veterans with hearing loss are
substantial, and continue to increase. On a personal level, hearing loss results in
communication difficulties, and often contributes to social isolation, frustration and
depression. A major cause of hearing impairment is cochlear damage from exposure to high
levels of sound. The longer the period of exposure and the more intense the sound pressure
level, the greater is the damage that occurs. The damage from noise exposure is cumulative
over time, and exacerbates the effects of aging. Veterans, who have been exposed to high
levels of sound in the military are therefore highly vulnerable to damage in civilian life,
thus they must protect their ears from further noise to avoid hearing loss as they age.
Unfortunately, most people are unaware of the damage noise can do to the auditory system,
and even when they are aware, few choose to use hearing protection. It is therefore critical
to educate Veterans about the dangers of noise exposure and the simple actions that can be
taken to protect hearing.

Our long-range goal is to disseminate an effective hearing loss prevention education program
that will help to reduce the prevalence and associated costs of noise induced hearing loss
in the Veteran population. Ultimately it is our intention to make the program available to
all Veterans, military personnel and other members of the public.

We have developed two forms of intervention to educate Veterans about hearing conservation.
One is a computerized multimedia interactive program; the other is a printed Hearing
Conservation Brochure. Both provide information about hearing, the damage noise can do to
the auditory system, the impact hearing loss has on communication, and the use of hearing
protection. In this study we will use a randomized controlled trial to evaluate the
effectiveness of these two forms of intervention at changing knowledge, attitudes and
behaviors toward hearing conservation. Effectiveness will be examined in three ways through
assessment of: (1) actual behavioral changes, as evidenced by decreased daily noise exposure
as measured with noise dosimetry; (2) reported behavioral changes, as evidenced by decreased
daily noise exposure assessed using a real-time log of daily activities and use of hearing
protection; and (3) increased knowledge, healthier attitudes and improved intended and
actual behavior towards hearing protection, as assessed with a self-report questionnaire.
Outcomes will be measured at baseline, immediately following the intervention and six month
post-intervention.

There are many challenges facing military personnel as they reintegrate into society after
leaving military service. Reducing their risk of acquiring noise induced hearing loss and
the associated problems with communication, will help to make this transition less difficult
and traumatic. This study will provide important information about the relative
effectiveness of two different forms of hearing conservation education. In the long term it
has the potential to reduce the prevalence and associated costs of hearing loss and tinnitus
among Veterans, and will demonstrate that prevention of hearing loss can reduce the need for
long-term rehabilitation.

Inclusion Criteria:

To be included in the study all participants will:

- be aged 55 years or less with no exclusions based on ethnicity or gender. The maximum
age of 55 years has been selected because hearing conservation programs have the
potential to be most effective for younger individuals.

- not use hearing aids

- have cognitive abilities sufficient to participate in the study, as determined by an
age/and educationally appropriate score on the Mini Mental State Exam (MMSE).

- ability to read and comprehend the study interventions (HLPP and Hearing conservation
brochure) as reflected by a Broad Reading Score of Grade 5 or above on the
Woodcock-Johnson III Tests of Achievement Letter-Word Identification, Reading Fluency
and Passage Comprehension subtests.

- no known neurological, psychiatric or physical disorders, or co-morbid diseases that
would prevent completion of the study as determined by chart review.

- adequate vision to participate in the study as determined with the Smith-Kettlewell
Institute Low Luminance (SKILL) Card. Participants will be required to have best
corrected vision of 20/63 (mild vision loss) or better.

- openness to using a wearable noise dosimeter and to logging daily activities using a
personal digital assistant for three periods of seven days each, as determined by
agreement to participate in the study.

Exclusion Criteria:

Individuals will not participate in the study if:

- they are age >55 years.

- wear hearing aids

- score less than the age- and educational-based norms on the MMSE.

- have a Broad Reading score on the Woodcock-Johnson III Tests of Achievement of less
than Grade 5.

- have neurological, psychiatric or physical disorders, or co-morbid diseases that
would prevent completion of the study.

- have corrected vision poorer than a Snellen equivalent of 20/63.

- be unwilling to use a wearable noise dosimeter and to logging daily activities using
a personal digital assistant for three periods of seven days each.