FEBRUARY 8, 2023 – According to the National Institutes of Health, roughly 10 percent of the adult population of the United States has experienced tinnitus in the past year – that’s more than 25 million people.
This health condition is a concern to the broader population, but it also can adversely impact Soldier readiness. The Hearing Conservation and Readiness Branch of the Defense Centers for Public Health–Aberdeen, formerly known as the Army Public Health Center, investigates this condition among service members to help identify trends, risk factors, the adverse impact on operational performance, and means to reduce its occurrence.
What is tinnitus?
Tinnitus is the perception of sound in the absence of an actual external sound source. It is commonly described as a ringing, but it also can sound like roaring, clicking, hissing or buzzing. It may be soft or loud, high- or low-pitched, heard in one or both ears, and intermittent or constant.
“Tinnitus is often associated with clinically measurable hearing loss but may also be present with normal hearing,” says Dr. LaGuinn Sherlock, a national tinnitus expert and senior investigator working jointly for the DCPH-A’s HCRB.
“Most people who have tinnitus are not bothered by it to the extent that it affects their quality of life,” says Sherlock. “But for some people, tinnitus is very bothersome.”
Tinnitus itself is not a disease but a symptom of a malfunction or injury to the hearing system: the ear, the auditory nerve that connects the inner ear to the brain, and the parts of the brain that process sound.
“Tinnitus is characterized as bothersome when it affects mood, emotions, sleep and ability to focus,” says Sherlock. “These effects can adversely impact soldiers’ abilities to carry out military duties.”
“Especially concerning,” Sherlock says, “is that tinnitus can also be a precursor to permanent hearing loss, which is a leading disability recognized by the Veterans Administration.”
What causes tinnitus?
“Unfortunately, we still don’t understand exactly how the brain creates the impression of sound when there is none,” says Sherlock. “But we do know it is a symptom of hearing loss, ear and sinus infections, certain diseases, and head injury, and is also a side effect of various medications.”
“However, noise-induced hearing loss, known as NIHL, is one of the most common causes of tinnitus, she says. “This appears to be the result of damage to the sensory hair cells of the inner ear.”
The NIH reports that people who work in noisy environments—such as factory or construction workers, road crews, or even musicians—are especially at risk of developing tinnitus and NIHL.
Sherlock says that Soldiers are also known to be exposed to noisy conditions. In fact, tinnitus is one of the most common service-related disabilities among veterans returning from Iraq and Afghanistan.
In particular, repeated exposures to loud noises such as from firing weapons, riding in vehicles and operating machinery increase Soldiers’ risk of tinnitus and NIHL.
Even single, extreme-noise exposures can cause hearing loss or tinnitus. For example, a bomb blast may cause tinnitus if the shock wave of the explosion damages brain tissue in areas that help process sound.
Dismounted Soldiers can also suffer permanent hearing loss when firing the multi-purpose anti-tank, anti-personnel weapon system just once without wearing proper hearing protection devices. Soldiers firing the system must wear double hearing protection confirmed with fit testing.
What should you do if you have tinnitus?
“Tinnitus isn’t always a sign of a serious health problem,” says Sherlock, “although, if it’s loud or doesn’t go away, it can cause fatigue, depression or anxiety, and problems with memory and concentration.”
Sherlock says tinnitus can also be an early sign of hearing loss. So for those who work in high-risk (loud-noise) occupations, such as the military, regular monitoring of hearing is critical to detect early signs of tinnitus or NIHL.
Soldiers are required to have annual hearing tests that identify measurable changes in hearing to detect hearing loss. During these annual hearing surveillance visits, Soldiers are screened for bothersome tinnitus and referred for an audiology follow-up visit as needed.
People with bothersome or severe tinnitus may benefit from various treatments that can be discussed with a doctor or audiologist. Examples of treatment include hearing aids, sound therapy, cochlear implants and counseling. Sherlock says the military hopes to reduce the risks and occurrence of tinnitus before treatment becomes necessary.
While DCPH-A experts like Sherlock continue to investigate tinnitus among Soldiers, every Soldier needs to do what they can to avoid developing tinnitus or prevent it from getting worse.
Here are some tips for reducing exposure to loud noise:
- Move away from loud sounds when feasible,
- Turn down the volume on communication and entertainment systems, and
- Wear appropriate hearing protection devices, such as earplugs or earmuffs, in work settings and during personal activities such as mowing, recreational shooting, using power tools and even listening to music.
All Soldiers are already enrolled in a local hearing conservation and protection program, but any Soldier who feels they have experienced a change in their hearing as a result of loud noise exposure, or has concerns about their hearing, should contact their local audiologist or learn more about the Army Hearing Program at:
https://phc.amedd.army.mil/topics/workplacehealth/hrc/Pages/default.aspx
The Defense Centers for Public Health-Aberdeen advances Joint Force health protection with agile public health enterprise solutions in support of the National Defense Strategy.
By V. Hauschild, MPH
Defense Centers for Public Health-Aberdeen