The short course was held 5–7 April 2004, in Park City, Utah. In this entry we offer a content overview from this course.
Presentation abstracts from the meeting
Invited Speakers
Each year MAA invites ex-military or prominent non-military affiliated speakers to address our organization.
Directional Microphone Hearing Aids: How and When they Work
Dr Brian Walden
The most frequent complaint of persons with impaired hearing is difficulty understanding speech in background noise. Persons with impaired hearing require a more favorable signal-to-noise ratio (S/N) to understanding speech in background noise than do normal-hearing persons. Although many digital hearing aids on the market feature noise reduction circuits, they do little to improve S/N and, therefore, have little effect on speech understanding. Hearing aids equipped with directional microphones can improve the S/N, but are dependent upon certain conditions existing in the listening environment. This presentation will discuss how directional microphones work and under what environmental conditions they can be expected to provide benefit to the patient. A simple strategy will be presented that allows patients to set their switchable omnidirectional-directional hearing aids in the preferred microphone mode in any listening situation encountered in everyday life.
Coding, Documentation, and Reimbursement
Dr Kyle Dennis
Procedure and disease codes are used for a variety of purposes in the Department of Defense, as they are in other private and government health care facilities: revenue generation, workload and utilization, productivity and staffing, provider privileging, analysis of health care trends, and health-related research. Department of Defense health care providers must possess a working knowledge of coding, documentation, and reimbursement in order to meet the compliance, revenue, and program management demands of contemporary health care. This presentation will provide practical knowledge on code systems, coding and documentation, and reimbursement. The presentation will consist of a general overview of coding and documentation, clinical examples, and discussion.
Clinical applications of Otoacoustic Emissions
Dr Martin Robinette
Course content will include: (1) physiological correlates of EOAEs, (2) normative data for TEOAEs and DPOAEs, (3) clinical applications including test-retest variability, patients with pseudohypacusis, sudden and fluctuating hearing loss, acoustic neuroma, auditory neuropathy and central auditory pathway disorders, and cochlear implant candidates. Case studies will be presented for each of the pathologies reviewed.
Army
Presentation abstracts from the Army include the following:
Application of the Trantheoretical Model of the Stages of Change in Hearing Conservation
LTC Lorraine Babeu
There are military and federal statutes that require personnel exposed to high intensity noise to use hearing protection. Although traditional hearing conservation programs have made great strides in reducing the prevalence of noise-induced hearing loss in the military, noise-induced hearing loss continues to be a problem. The main reason is difficulty getting exposed individuals motivated to wear hearing protection on a consistent basis. The Transtheoretical Model of stages and processes of change can provide a framework that hearing conservationists can use to help patients want to use hearing protection properly and consistently. The model looks at the stages and processes of change that an individual will process through as they make the decision to alter their behavior. The goal of this presentation will be to provide interventions that could be used during health education briefings and beyond to assist individuals in moving through the stages to consistent use of hearing protection.
Hearing Conservation Compliance Reporting: The Fort Drum Experience
CPT John Merkley
Reporting hearing conservation compliance to unit commanders is a critical slice of an installation hearing conservation program. This presentation will discuss how to communicate with supervisors and commanders about hearing conservation and outline the success in this area using Lingle’s Spreadsheet for Auditory Compliance (L.S.A.C.). L.S.A.C monitors unit level hearing conservation activity for both testing and training. It provides unit commanders with up-to-date information on individual unit performance and alerts hearing conservation personnel to units falling out of compliance and in need of assistance. This program enabled hearing conservation personnel at Ft. Drum, NY to improve compliance by 40%. It is easy to use and can be adapted to almost any hearing conservation program.
Observation of the DPOAE After Exposure to Small Arms Fire
LTC Lorraine Babeu, Mary Ginseel, M.S., MSG Lamar Garrett, Tomasz Letowski, Ph.D.
Level dependent hearing protection provides little to no attenuation when the noise levels are low; however, when impulse noise such as weapons fire is present and the attenuation mechanisms of the protector are activated, level dependent hearing protection is key to a safe listening environment. This type of hearing protection is well suited for dismounted troop movement and field artillery. Within the last ten years there has been great interest in level dependent earmuffs and earplugs starting with the system developed at the French-German Institute and in use by the French Army. The American version, the combat earplug, has two sides. The yellow side is the level-dependent side and the green side is a standard earplug. Twelve soldiers received pre and post audiogram and distortion product otoacoustic emission (DPOAE) testing after firing the M16 or M4 semi-automatic rifle. During firing they wore either the French or American version of the combat arms earplug. The goal was to determine if there was a change in the audiogram or the DPOAE as result of the exposure to weapons fire.
Noise Attenuation in HALO Vertical Wind Tunnel Training
LTC Dale Ostler, MAJ Eric Fallon
The Vertical Wind Tunnel (VWT) at Ft. Bragg, NC is one of the Army’s training grounds for High Altitude Low Opening (HALO) parachute jumpers. Due to the nature of the operation (i.e., jet engine and high wind stream) personnel using the VWT are exposed to steady-state noise levels in excess of 120 dBA SPL (sound pressure level). These levels exceed the safe noise exposure limits stipulated in DA PAM 40-501 even when double hearing protection is worn; therefore, time limits on noise exposure must be enforced. These time limits substantially curtail training efforts and impact military readiness status. Efforts have been made to increase the high attenuation provided by the helmets worn in the VWT. An innovative approach was used to measure the at-the-ear noise levels under five different parachutist’s helmets in the VWT.
Subsequently, and estimate was made to determine the maximum allowable time of noise exposure. Results suggest that one of the helmets provides superior hearing protection to the others, thus allowing sufficient training time in the VWT. Application of these results and recommendations will be discussed.
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