The short course was held on 24–26 February 2002, at the Radisson Hotel, Dallas North at Richardson, Texas. In this entry we offer a content overview from this course.
Army
Presentation abstracts from the Army include the following:
Office of Workers’ Compensation Hearing Loss Costs as a Measure of Hearing Conservation Program Effectiveness
MAJ Cheryl Cameron
Hearing Conservation program managers in the Army are charged with the responsibility of reporting program effectiveness to the Installation Medical Authority annually. The Potential Civilian Hearing Loss Compensation report was one of the means by which program effectiveness was reported for civilian personnel. The Hearing Evaluation Automated Registry System (HEARS) Managers Module generated the report. Since deployment of DOEHRS-HC in 1998, this report has not been available. However, the requirement to report program effectiveness remains. More importantly, programs managers need a means to monitor the effectiveness of their programs for program planning and budgeting purposes.
Each year the USACHPPM Hearing Conservation Program provides a summary of civilian hearing loss compensation for the previous year, this data has traditionally been reported for the Army, Air Force Navy and Marines. Use of the data that comprise the annual summary can also be used to determine hearing loss compensation costs by MACOM and installation. Thus, hearing loss compensation data may be a viable substitute for the Potential Hearing Loss Compensation report. However, the Office of Workers’ Compensation (OWCP) data is not without complexities that will cause reports to be imprecise.
This presentation will discuss the complexities of OWCP data collection that can affect hearing loss compensation reports especially at the installation level and explore the practicality of using actual OWCP data as means of monitoring and reporting program effectiveness.
Early Hearing Detection and Intervention as a Population Health Management Approach
Thomas Helfer, Ph.D.
Universal newborn hearing screening (NBHS) and early intervention in cases of hearing loss discovery have been presented in guidelines for early hearing detection and intervention (EHDI) set by the Joint Committee on Infant Hearing (JCIH). The federal government has set goals for EHDI within the Healthy People 2010 program of the Department of Health and Human Services. However, to the authors’ knowledge, there has not yet been proposed a uniform data set for collecting outcomes metrics information nationally on the number of hospitals providing EHDI services.
Helfer, Shields, and Gates (2000) posited that a uniform coding structure for occupational hearing loss services would allow outcomes analyses to be performed across a range of hearing conservation programs. They further argued that a EHDI data modeling exercise should be performed to support outcomes analysis for NBHS services and rates of discovery of hearing loss in newborns for public health reporting purposes.
The current paper presents a data model for EHDI based on the methods presented in Helfer, Shields, and Gates (2000). Outcomes metrics from EHDI performed within the Military Health System could be furnished from the hospitals and audiology practices providing EHDI services to the Standard Inpatient Data Record (SIDR) repository and the Standard Ambulatory Data Record (SADR) repository. The authors present a “strawman” of such a data model.
Analysis of these data could be performed as a decision aid in case management activities and to allow providers to perform statistical quality control of their practices. The information derived from these data could also serve as a decision aid to public health officials and healthcare policy makers to support services to infants who are congenitally hard of hearing and their families in the civilian sector.
The Hearing Conservation Officer’s Course
MAJ Marjorie Grantham
In addition to the Occupational Hearing Conservationist, the Army’s DA PAM 40-501 describes the role of the “Hearing Conservation Officer” (HCO): inspecting unit HPD’s, ensuring all sizes and types of approved HPD’s are available/used, advising re:/monitoring the use of engineering controls, ensuring the monitoring audiometry algorithm is followed, and ensuring all unit personnel “attend hearing health education briefings.” HCO courses are offered at Ft. Lewis, WA, where we train them to do all of the above, as well as medical record surveillance (DD2215/2216 review), in a four hour course. This gives us a “manager’-level POC at the battalion-sized unit who can serve as a liaison among the HC Program Manager (Audiologist), the unit’s certified OHC’s and the unit chain of command. HCO’s are usually between the ranks of Sergeant (E-5) and Captain and can be 91W (formerly Medical Specialists), Safety NCOs, Medical Platoon Leaders or even Physician’s Assistants. This talk will demonstrate one more tool in the HCPM’s toolbox.
The Effects of Antioxidant, Chloroquine and Noise Exposure on Auditory Brainstem Response Threshold In Guinea Pigs
LTC Lorraine Babeu
The purpose of this study was to evaluate if an antioxidant (U74389G) has a protective effect against the combined ototoxicity of exposure to noise and chloroquine. Fifty-six pigmented guinea pigs were divided into eight groups. The animals received one or combinations of the following treatments: daily 1 ml subcutaneous injection of chloroquine diphosphate in saline (35 mg/ml) for five consecutive days, a .3 ml oral solution of antioxidant U74389G in citrate NaCl twice daily for three days, and exposed to 93 dB SPL of broadband noise for 48 hours. Auditory brainstem response (ABR) to tone bursts at 4, 8, 12 & 16 kHz and clicks were recorded at three periods. The first was baseline. The second measurement (post-treatment) was taken at the end of the 48 hours of noise exposure and the third measurement (recovery) was taken 24 hours after the second measurement. The ABR measurements indicated that chloroquine appeared to create some change in hearing sensitivity. The antioxidant appeared to have a protective effect against the combined ototoxic effects of chloroquine and noise exposure. In the antioxidant and noise exposure condition the antioxidant did not decrease the amount of the threshold shift but it appeared to aid in the recovery from noise exposure.
Idiopathic Sudden Sensorineural Hearing Loss-On the Other Side of the Audiometer
COL Nancy Vause
Sudden hearing loss (SHL) is a medical emergency defined as sensorineural hearing loss of 30 dB over less than three days affecting three contiguous frequencies. Worldwide, 15,000 cases/year are reported with 4,000 in the US. One in every 15,000 people will suffer this condition with only 2% presenting with bilateral symptoms. In most cases (85-90%) it is of unknown etiology (idiopathic sudden sensorineural hearing loss—ISSHL). Accounting for ~ 1% of all sensorineural hearing loss, the most credited hypotheses for origin are: viral, immunitary and vascular. The authors will present 3 ISSHL case studies among two area audiology families over two months. The paper will present a review of possible etiologies, recommended BAMC differential diagnosis, audiometric, laboratory and radiological diagnostic results, medical management and outcomes of these three patients. Additionally, primary care providers misdiagnosed the ISSHL as serous otitis media in two of the patients presenting with an upper respiratory infection (present in ~30% of the ISSHL cases). These two patients only received specialty ENT care and immediate treatment as a result of their Audiology and ENT clinic connections indicating an immediate need for continuing education of ISSHL among emergency room and troop medical clinic health care providers. Read more…