This year’s course took place in sunny Kissimmee, Florida. Thanks again to all who presented at this year’s MASC. Those who present papers are given priority in funding for their presentation. Air Force presentations are listed. Army and Navy were unavailable at time of publishing.
Motivating Employees to Use Hearing Protection
Lt Col Julie Robinson, USAF, BSC Commander, Aerospace Medicine Flight and Chief, Public Health Kelly AFB, TX
Despite the fact that there are well organized Hearing Conservation Education Programs, non-compliance with the use of hearing protection still occurs in the workplace. This lack of compliance does not appear to be due to a lack of knowledge but due to preconceived ideas the employee has regarding the use of hearing protectors. A few of the identified barriers are: comfort, communication ability, and social-cultural concerns. The need to identify barriers is key to ensuring workers comply with the requirement to use hearing protection during all hazardous noise exposures.
The Military Health Services System, TRICARE, Utilization Management/Quality Monitoring and You.
Lt Col David B. Wirth, USAF, BSC Chief, Technology Integration, DoD Health Service Region 5 Wright-Patterson AFB, OH
The challenge of the Military Health Services System (MHSS) is to meet the healthcare needs of active duty members and other eligible beneficiaries during peacetime with accessible, cost-effective, quality healthcare while providing and maintaining medical care services to meet the needs of the armed forces during contingencies. Key tools in the TRICARE managed care arena are: utilization management (UM), the ongoing analysis of resource allocation and utilization; and quality monitoring (QM), the systematic tracking and evaluation of data to identify opportunities to improve care. UM/QM are interrelated programs that assure our eligible beneficiaries receive quality, optimally cost effective care based on timely access. We are faced with redefining our resources in the MHSS. UM/QM is a culture designed to develop a strategy to achieve the optimal value in healthcare. As direct care providers we need to determine the best application of scarce resources and put it into practice.
Synergistic Ototraumatic Effects of Toluene Exposure in Hazardous Noise Environments
Capt Cynthia A. Sabin, BSC, USAF Chief, Audiology Services Fairchild AFB, WA
Co-authors: Lt Col John Allen, Ph.D., William Jackson, Capt Keith Groth; Teresa Y. Schulz, Ph.D., Thais Morata, Ph.D.
Introduction: Hazardous noise in military and industrial environments has long been known to be the cause of hearing loss in noise exposed employees. Similarly, workers exposed to various neurotoxic industrial chemicals, such as toluene, have been found to exhibit a variety of auditory deficits. Recent literature suggests a possible synergistic ototraumatic effect between hazardous noise and toluene, where the amount of hearing loss is accelerated and exacerbated by combined exposures. The purpose of this study was to determine whether there was any increased risk of hearing loss for workers exposed to toluene and hazardous noise as compared to workers exposed to noise alone.
Methods: A retrospective cohort study design was used to compare the possible synergistic ototraumatic effects of toulene and hazardous noise to workers with similar noise exposures without toluene exposure. Evaluation of 1500+ employee records and 150 Bioenvironmental Engineering shop case files from Kelly Air Force Base, TX were evaluated to identify individuals who met study selection criteria. Worker’s records were included in the study if the workers met the exposure categories noted above and if complete exposure data for each individual was available over five consecutive years.
Results: Initial results were consistent with previous studies that focused on toluene exposure in hazardous noise. Preliminary statistical results suggest a dose-response relationship for individuals exposed to toluene in hazardous noise environments. Conclusions: Industrial chemicals appear to have an adverse effect on hearing. Additional measures may be necessary to monitor this effect and, where possible, prevent its occurrence.
Department of Defense HEARS – The Future is Coming!
Leeann S. Domanico Hearing Conservation Program US Army Center for Health promotion and Preventive Medicine Aberdeen Proving Ground, MD
Co-authors: LCDR Anne R. Shields, Navy Executive Manager for Joint Service Hearing Conservation, Maj Theresa Y. Schulz, Ph.D., Air Force Executive Manager for Joint Service Hearing Conservation
The third time’s the charm! Previous DoD HEARS updates have discussed what will be included in the program and how it will work. This year you get to see a preview of the DoD HEARS as the DoD HEARS Proof of Concept Model is unveiled for DoD audiologists! For the past three years we have moved toward our goals for developing a tri-service automated monitoring audiometry system along a very unwieldy path. This past year we enjoyed success, through DoD recognition and support, when the potential for developing and fielding the DoD HEARS was realized. We have moved from a program with only well-defined functional and cursory technical requirements to a program with fully defined functional, technical and system design requirements and are rapidly proceeding toward programming the software. Our vision to combine forces to develop a common system and to reap the rewards of increased purchasing power, melding training strategies and providing shared technical services is rapidly coming into focus. The presentation will provide an update on challenges overcome and challenges still ahead. The future direction for the DoD HEARS software development effort, deployment strategies and training will be addressed. Our role in the Defense Occupational Health Readiness System (DOHRS) will be highlighted. Most importantly, the DoD HEARS Proof of Concept Model will be demonstrated and available for hands-on use.
Industrial Hearing Conservation and Cerebellopontine Angle Tumors
Maj Theresa Schulz, Ph.D., USAF, BSC Center for Health Promotion and Preventive Medicine Aberdeen Proving Ground, MD
Co-author: Moises A. Arriaga, MD, FACS, Allegheny Neuroscience Institute and Pittsburgh Ear Associates
The principle focus of hearing conservation programs (HCPs) is the prevention of noise induced hearing loss, however, HCPs can also identify otologic pathology including cerebellopontine angle (CPA) tumors. Many HCPs include criteria for referral in cases of atypical hearing loss patterns. This report utilizes data from the Air Force Hearing Conservation Data Registry to review: the numbers of individuals meeting several potential asymmetric referral criteria, and the cost of referral. This study also reviews recent experiences with cerebellopontine angle (CPA) tumors among Air Force personnel enrolled in HCPs. Hopefully, this information will stimulate a more appropriate referral criteria for otologic pathologies in hearing conservation programs.
Otovents
Capt Anne M. Thonsgard, USAF, BSC Chief, Audiology Offutt AFB, NE
This study analyzed the effect of Otovent use in children with a history of chronic middle ear disease. Chronic middle ear disease was defined as three or more acute episodes of otitis media within six months prior to the study or serous otitis media for one month prior to enrollment in the study. Use of the Otovent to prevent ear infections and for the treatment of SOM is 71% effective in compliant patients. Beconase is an effective adjunct to therapy in patients with allergies and/or chronic rhinitis. Use of Otovent and Beconase have been shown to decrease the amount of antibiotic use in patients with recurrent otitis media and serous otitis.
Use of Custom-Molded Ear Plugs Among Workers Exposed to Hazardous Noise
Maj Carolyn S. Bennett, USAF, BSC National Institute Occupational Safety and Health (NIOSH) Cincinnati, OH Co-authors: Mark Stephenson, Ph.D., Carol Merry, Ph.D.
The key to reducing a worker’s occupational noise exposure is to ensure hearing protection is properly fit and consistently worn. Ninety-five percent of all occupational noise is 95 dBA or less and under actual field conditions the average hearing protection device provides 10 dB of noise reduction. Therefore, it should be entirely feasible to reduce or eliminate occupational hearing loss among most workers with the use of hearing protection. Recent studies of workers hearing loss prevention behaviors have identified variables associated with hearing protector use/non-use: (1) barriers of comfort, fit, convenience and (2) self-efficacy. Self-efficacy is defined as the workers’ belief that they have the skills to properly use hearing protection and that hearing protection devices will prevent hearing loss. Use of custom-molded ear plugs may serve to: reduce the barriers of comfort, fit, convenience and increase workers¹ self-efficacy. The study hypotheses is that workers who are fit and trained to use custom-molded ear plugs will use them more consistently than workers fit with “standard” earplugs. Sixty workers at Wright-Patterson AFB were identified with STS. Thirty were fit with custom-molded ear plugs and trained in their use. The additional thirty workers served as the control group. The workers were observed periodically during a day shift under a guise of gaining air samples. The presence of noise was recorded as well as the observation of the utilization of hearing protection under hazardous noise conditions. Outcomes are discussed.