Capt Tressie Waldo organized this year's short course which was held in Albuquerque, NM. Here's the abstracts from the course presented by AF members.
LtCol David Wirth, USAF, BSC
Wright-Patterson AFB, OH
Staffing requirements in the Military Health System (MHS) are driven by mission. A key pillar of the MHS is readiness. It is imperative that the role of audiology be linked to the readiness mission. Providing a first class hearing conservation program across all services certainly fits the bill. In the long run, the issue comes down to numbers. How do we collect the data? Where is it reported? Does it make a difference to the decision makers who are required to justify billet authorizations in the clinics and military treatment facilities of the MHS? CHCS, ADS and CHAMPUS data from the Region 5 MTFs will be presented. The purpose of this presentation is to review the data collection process, identify any gaps and consider opportunities for improvement.
Capt Linda Morris, USAF, BSC
Capt Joe Narrigan, USAF, BSC
Wright Patterson AFB, OH
Robin Smith-Karasopoulos, M.A.
Dayton VAMC, OH
The 1996 revisions to the Veterans' Health Care Eligibility Reform Act greatly simplifies the eligibility criteria for prosthetic services. Now any one who is ten percent of more service connected for any condition or zero percent or more for hearing loss/tinnitus is eligible. Each Veteran's Administration Center keeps a database on service connected disabilities. Access to this information can determine the best plan for care. By combining the Retiree Hearing Aid Purchase Program with the Veterans' Administration services, we can provide options for our Veterans while ensuring care is being provided by the appropriate facility and not duplicated.
Capt Cynthia Sabin, USAF, BSC
Fairchild AFB, WA
The three month absence of an Otolaryngologist (ENT) at the 92 Medical Group prompted the development and use of an Audiology Referral Triage system using the MedRx Video-Otoscope and Telestat Advanced Imaging Software. Prior to the ENT's absence a liaison referral network was established within the Medical Group with Pediatrics, Primary Care and Dermatology. All referrals to downtown were discussed and approved by the Medical Group's (SGH) Tri-Care Coordinator. Imaging procedures and image accuracy were found to be extremely effective in providing instant identification of: tympanic membrane perforations, otitis media, severe TM retractions, ossicular prosthesis dislocation, cerumen impaction, and skin cancer. Video-Otoscopy was also used to show follow-up and resolution of middle ear and TM pathologies. Images were used as a teaching tool for Primary Care and Pediatric physicians regarding TM and ear canal landmarks. Images were used to counsel parents on their children's middle ear status and adults on cerumen management. Telemedicine coordination with Tripler AMC was employed as an equipment test and for audiology consultation regarding difficult images. The cost impact of the Video-Otoscopy in audiology triage referrals during the 2 months actively used at the 92 Medical Group will be discussed. The valuable resource of telemedicine consultation to Tripler will be addressed.
LtCol John Allen, USAF, BSC
Andrews AFB, MD
The use on insert-type transducers for audiometric testing is widely accepted within the United States. These earphone systems have achieved acceptance for audiometric equipment ranging from pure tone audiometry to auditory evoked potentials, and in populations ranging from pediatrics to geriatrics. Their popularity is due in part to the higher degree of inter-aural attenuation they afford. In addition, a transducer that is coupled directly to the canal itself overcomes the problem of collapsing ear canals. However, audiometers used in the USAF Hearing Conservation Program (HCP) continue to employ TDH 39/40, circumaural earphones. Discrepancies between the results obtained with each of these systems has been reported anecdotally to the extent that the use of insert earphones has been discontinued in the AF for any testing in support of the HCP. This report reviews the current literature regarding insert transducers, exploring their advantages and disadvantages, and discussing potential areas of variability which may be contributing to the reports above.
Maj Carolyn S. Bennett, USAF, BSC
Wright Patterson AFB, OH
Noise-induced hearing loss is the most common work related disorder in the United States. Despite a vigorous hearing conservation program, recent data shows an increase in threshold shifts among USAF workers. Recognizing the need for new strategies, this study validated the hypothesis: custom-molded ear plugs increase hearing protector use in Pre-Intervention measures 50% of the Experimental Group and 5% of the Control Group used protection. After fitting custom-molded ear plugs, 81% of the Experimental Group used protection. Additionally for the experimental Group only, the consistency of hearing protector use increased. This study clearly indicates that custom molded hearing protectors have great potential in the battle to prevent noise-induced hearing loss.
Capt Cynthia A. Sabin, USAF, BSC - Fairchild AFB, WA
LtCol John R. Allen, USAF - Andrews AFB, MD
Mr. William Jackson, Brooks AFB, TX
Hazardous noise exposure in military and industrial environments causes hearing loss in employees who are not adequately protected. Similarly, workers exposed to various neurotoxic, industrial chemicals, such as toluene, have been found to exhibit a variety of auditory deficits. Recent literature suggests that there may be a synergistic effect between hazardous noise and toluene; combined exposures appeared to accelerate and exacerbate hearing loss. The purpose of this study was to determine whether there was any increased risk of loss for workers exposed to both noise and toluene as compared with workers exposed to noise alone. A retrospective cohort study was employed. Subjects consisted of male and female workers at Kelly AFB, of which 1,011 were exposed to both agents, and 396 were exposed only to noise. Results failed to demonstrate a synergistic effect of noise and toluene. Further, there was no apparent effect of noise alone or toluene alone. Additionally, what had, on preliminary review of the data, appeared to be a dose- response relationship, did not hold up under further analysis. However, age and gender were significant (p<.001) factors, where older individuals had greater hearing loss than younger persons, and men had more hearing loss than women. Results suggest one or more of the following: 1) Kelly workers are better protected than those in other studies; 2) exposure levels are lower than those of other studies; 3) the period monitored was not sufficient to show a change in hearing; 4) confounding factors obscured any change. The authors discuss the implications of these results and make recommendations for further studies.
LtCol Craig Jordan, USAF, BSC
Brooks AFB, TX
The Air Force Audit Agency recently conducted an audit of the hearing conservation programs (HCPs) at 10 Reserve and Guard bases. The findings and common problems identified by the audit will be presented. Suggestions for improvements to the AF HCP will be discussed. A portion of the briefing will be set aside for group discussion of the issues presented.
Capt John Hall, USAF, BSC
Lakenheath RAF, UK
As commonly known, noise-induced hearing loss is one of the two largest occupational illnesses in the Air Force. As with any preventable disease, education and intervention are the keys to minimization of the epidemic. Air Fete '98 provided this audiologist with the perfect platform to launch the Auditory Readiness Information Center (ARIC) to educate military (and civilian) visitors on preventive hearing conservation topics. This presentation will discuss the efforts required to get the ARIC approved for Air Fete '98 and the outcome of such an endeavor.
Capt Cynthia Sabin, USAF, BSC
Fairchild AFB, WA
Introduction of the deep fitting Tympanette hearing aid has opened a door for the unilateral hearing loss patient. No longer is a CROS or BICROS hearing aid the only choice for obtaining sense of direction of sound and improved ability to understand in background noise. Historically, success of fitting a unilateral loss with trans-cranial crossover has been less than 50%. A protocol was developed at Fairchild AFB to serve as a guideline for fitting these individuals. Use of the FAFB protocol has succeeded in 100% success (3 of 3). The protocol will be discussed and individual case studies will be presented.
1Lt Kathy Niewijk, USAF, BSC
Chief, Public Health
Kunsan AB, Korea
There are many ways to approach problem solving and research in audiology. Epidemiology is a science that systematically identifies causal and preventable factors of human disease and injury. This session will describe the basic elements of epidemiology as the study of the distribution and determinants of health related states or events in specified populations, and the application of this sort of study to the field of audiology. The organization of biostatistical data and the use of various methods of analytic study design to explore the relationship of hearing loss and ballistics, ototoxic organic solvents, vibration, pharmaceuticals, and noise will be discussed. In addition, the use of epidemiologic principles to evaluate the effectiveness of hearing conservation programs and other training and motivational aspects of hearing loss prevention efforts will be reviewed.