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Hearing Conservation Toolbox
Occupational Health

The views, opinions and/or findings contained in this Toolbox are those of the author(s) and should not be construed as DoD official position, policy or decision, unless so designated by other official documentation. Citation of trade names or commercial products does not constitute endorsement of these commercial items.

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Contents

Module 1 - Introduction & History of Hearing Conservation in the Military

Module 2 – DoD Occupational Hearing Conservation Certification (CAOHC Approved)

  • Pertinent Regulations & Instructions
    • DoD: DoDI 6055.12
    • Army: DA PAM 40-501
    • Air Force: AFOSH Std 161-20 (under revision to become AFI 48-20)
    • Navy: OPNAVINST 5100.23, OPNAVINST 5100.19, TM 6260.99
    • Marine Corps: MCO 6260.1
  • HCP Differences between DoD, OSHA, MSHA, and NIOSH
  • Training Materials
    • Hearing Conservation Course Student Manual
    • Powerpoint Presentations
    • Practical Exam
    • Course Critiques
  • Instructor Guides
    • Setting up a CAOHC-sponsored Hearing Conservation Course
    • DOEHRS-HC Lesson Plan
    • Audiometer Set-up Instructions
    • Hearing Protection Fitting Guide
  • DoD Hearing Conservation POC’s & On-line Resources
    • Army
    • Air Force
    • Navy/Marine Corps
  • DOEHRS-HC Help

Module 3 – Directing a Hearing Conservation Program

  • Resources & Guidance for HCP Directors
    • Roles of the Director & OHC Technician
    • DOEHRS-HC & DR Structured Training Program for HCP Directors
    • Process for Directing the HCP
    • Hearing Conservation Best Practices Guidelines & Assessing HCP Effectiveness
  • Assessment Tools and Checklists
    • HCP Standard Operating Procedure Sample
    • HCP Self-Assessment Checklist
    • Assistance Visit Checklist
    • Assistance Visit After Action Report Sample
    • Audiometric Test Booth Certification Form

Module 4 – Educational Resources on Hearing Preservation

  • Educational Materials
    • Hearing Conservation Training
    • Army Hearing Protection Fitting, Care & Use Guide
    • HC Education Sheet
    • Noise Destroys
    • HC Briefing (Army)
    • HC Briefing (Navy)
    • HC Info Packet (Army)
    • HC Training Brochure
    • Hearing Conservation Fact Sheet
    • Hearing Conservation Brochure
    • HC Education for Commanders & Supervisors
    • NASA JeopEARdy Game
    • Common Military Noise Hazards
  • Educational Links

Module 5 – Hot Topics in Hearing Conservation

  • Hearing Conservation Issues during military deployment
    • Role of the Deployed Audiologist During Wartime
    • Audiology Treatment Protocol in an Operational Setting
    • Assessment of Vestibular Disorders in an Operational Setting
  • Current Research in Hearing Protection Technology
    • Combat Arms Earplug
    • Aircrew & Flight Deck/Flightline Protection
    • Ototoxins and Hearing Loss
    • Controversies/Issues/Current Info in Occupational Hearing Conservation
    • National Academy of Sciences Report on Noise & Military Service
    • Use of Age Correction Factors in Occupational Hearing Conservation
    • Pharmacological Intervention to Occupational Hearing Loss
    • Noise Measurement Exchange Rates
    • Veteran’s Affairs Audiology Best Practices & Procedures for Compensation & Pension Exams
    • Hearing Health Articles on Hearing Loss in the Military
    • OSHA Interpretation of Single-Ear Baseline Revisions
    • ICD-9 Noise Injury Codes
*For their guidance & assistance with this project, a special thank you goes to:

COL David Chandler, PhD (US Army)
LTCOL (Retired) Theresa Schulz, PhD (US Air Force)
LTC Lorraine Babeu, PhD (US Army)
Dr. John Muller (US Navy)
LCDR Joel Bealer (US Navy)

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Module 1 - Introduction & History of Hearing Conservation in the Military

Introduction

  The purpose of this toolbox is to provide DoD audiologists with the tools and resources necessary to:

  • Certify Occupational Hearing Conservation Technicians
  • Direct a Hearing Conservation Program (HCP)
  • Educate customers on prevention of noise-induced hearing loss
  • Provide current, useful information on important topics in Occupational Hearing Conservation

History of Hearing Conservation in the Military

The impact of excessive noise exposure on the hearing of military personnel was evident after World War II (1941-1945) and the Korean War (1950-1953). A significant number of veterans returned from these wars with service-connected hearing loss. Hearing conservation programs did not exist in the military at that time. Research programs were initiated to better understand and enhance communications and performance under combat conditions. The Army and Navy established aural rehabilitation programs at select military hospitals across the United States to assist hearing impaired veterans with transition to civilian life by providing training with hearing aids, lip reading and psychological counseling.

In 1947, with establishment of the US Air Force as a separate branch of service from the Army Air Corps, jet aircraft were introduced into the military. This transition to jet aircraft also introduced more harmful noise levels and related negative health effects from these aircraft than seen with propeller aircraft. Concern developed over the proximity of this high level noise and the potential safety risks, as well as the negative impact on Navy flight deck operations. At this time, the Navy requested assistance from the National Academy of Sciences - National Research Council (NAS-NRC) to determine auditory and non-auditory health effects from the noise. In 1952, the Committee on Hearing and Bioacoustics (CHABA) was established with joint participation from the three services, and a benchmark study was conducted on the biological effects of noise.

In 1953, this team published the Biological Effects of Noise Exploratory Study (BENOX) report, which concluded that high intensity noise exposure causes aural pain, hearing loss, communication problems, difficulty with orientation in space, central nervous system effects, psychological effects and it identified limiting factors on the ability to protect the ear from this noise. Several other studies followed, looking at other types of military noise exposures, such as blast effects. As these studies continued to reveal the harmful effects of noise, interest in prevention efforts increased.
Consequently, hearing conservation programs began within the military. A review of military hearing conservation would be incomplete without recognizing the early contributions of Air Force Lt Col Elizabeth (Betsy) Guild. In 1942, Lt Col Guild was selected for the first class of Women’s Auxiliary Corps. While assigned to the Aerospace Medical Research Laboratory at Wright-Patterson AFB, she pioneered hearing conservation before it was accepted policy by the government, industry or the Armed Services. She contributed immensely toward efforts to solve noise and communication problems for flight and ground personnel.

In 1948, the Air Force published the first hearing conservation regulation, Air Force Regulation (AFR) 160-3, “Precautionary Measures Against Noise Hazards”, which set limits to noise exposures from jets and rocket power plants, and mandated audiometric testing procedures. In 1953, the Navy published the Bureau of Medicine and Surgery (BUMED) Instruction “Hearing Conservation Program”. In October 1956, AFR 160-3 was updated and titled, “Hazardous Noise Exposure”. This publication became the first recognized comprehensive HCP, both within and outside the military and served as the template used by successive government and non-government organizations for establishing HCPs within their respective agencies. AFR 160-3 was again revised in 1973. In 1957, the Air Force recruited its first two military audiologists.

In 1965, CHABA published the first criteria on “Hazardous Exposure to Intermittent and Steady State noise”, and in collaboration with the Army in 1968, published “Proposed Damage-Risk Criterion for Impulse Noise (Gunfire)”. The Army recruited its first 11 audiologists in 1966, and initiated the first military audiology and speech pathology conference in 1967 through an organization called Military Audiology and Speech Pathology (MASPS), now known as the Military Audiology Association (MAA). The Navy acquired its first 10 audiologists in 1979.

In 1969, the Department of Labor, Safety and Health Standards Department amended the Walsh-Healy Public Contracts Act of 1935, requiring that hearing protection be worn when average noise levels exceeded 90 dBA in an 8 hour period (using a 5 dB exchange rate), and when impulse/impact noise exceeded 140 dB Peak. In 1971, this standard was incorporated into Occupational Safety and Health Act of 1970, eventually leading to the OSHA Hearing Conservation Amendment in 1983. In 1970, the Navy adopted the OSHA noise standard as part of their HCP in BUMEDINST 6260.6B, mandating enrollment in HCPs when the noise levels exceeded 90 dBA.

In the early 1970’s the Environmental Protection Agency, Office of Noise Abatement and Control (ONAC) was formed. They produced important research on the effects of noise, along with several documents that established noise level criteria. Funding for this office ceased in the early 1980’s and it has never been re-established.

In 1972, the Army established a daily exposure limit of 85 dBA with a 5 dB exchange rate in TB MED 251, “Noise and Conservation of Hearing”. This document established guidelines, but no requirements, for implementing a HCP.

The first Department of Defense Instruction (DODI) was published in 1978 in order to implement uniform and consistent HCPs across the services. Subsequently, the Navy’s OPNAVINST 6260.2, the Army’s TB MED 501, and the Air Force’s AFR 160-3 were updated to comply with the DOD Instruction. The DODI mandated that each service meet or exceed OSHA standards, whose implementing criteria is 90 dBA with a 5 dB exchange rate. Currently, the Navy uses a 4 dB exchange rate, while the Army and Air Force use a 3 dB exchange rate. The DODI has been updated several times since it was originally published, as have the service specific regulations. In 1979, the responsibility for the Navy’s hearing conservation program was transferred from BUMED to the Chief of Naval Operations (CNO), ensuring that all Navy personnel would be included in the program. In 1999, all three services began using a common microprocessor-based hearing conservation test system and a common web-based data repository.

Hearing conservation in the military continues to be critically important toward force health protection and preserving hearing readiness of DOD personnel. In 2005, service connected hearing loss and auditory problems comprised the second most common reason for new Veterans Affairs awards for disability. Claims by veterans for hearing loss and tinnitus have risen at such an alarming rate that Congress mandated an investigation by the Institute of Medicine (IOM) to evaluate noise-induced hearing loss and tinnitus associated with military service. Results were published in September 2005. This report has renewed interest in DOD HCPs at all levels.

* Above information was summarized from the article: Nixon, C.W. (1996), “A Glimpse of History: Hearing Conservation in the Military,” Spectrum Suppl. 1, 13, p.29. Additional input was provided by Mr. John Page from the Navy Environmental Health Center, Col David Chandler, US Army, and Col Ben Sierra, US Air Force (Retired).

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Module 2 – DoD Occupational Hearing Conservation Certification (CAOHC Approved)

Pertinent Regulations & Instructions

OSHA vs DoD Courtesy, Dr. Theresa Schulz
OSHA, MSHA & NIOSH Comparison Courtesy, Elliott Berger, E-A-R/Aearo Technology

Student Training Materials

HC Course Training Manual / Workbook

Powerpoint Presentations - Special thanks to LCDR Joel Bealer

DOEHRS-HC Practical Exam

HC Course Critiques

Hearing Protection Fitting Guide

Instructor Guides

DoD Hearing Conservation Points of Contact

Army:

Center for Health Promotion & Preventive Medicine
United States Army Center for Health Promotion & Preventive Medicine
5158 Blackhawk Road
Aberdeen Proving Ground, MD 21010-5403
(410) 436-3797, DSN 584

Army On-line Resources

Air Force:

Hearing Conservation Data Registry
AFIOH/RSHE
2513 Kennedy Circle Suite 32
Brooks City-Base, TX 78235-5123
(210) 536-2940/6132, DSN 240

Air Force On-line Resources

Navy:

Navy Environmental Health Center
Audiology Team
620 John Paul Jones Circle, Suite 1100
Portsmouth, VA 23708-2103
(757) 953-0773/0772, DSN 377-0773/0772

Marine Corps:

Commandant of the Marine Corps
Safety Division
2 Navy Annex, Room 2122
Washington, D.C. 20380-1775
(703) 614-2505

Marine Corps On-line Resources

DOEHRS-HC Help

DOEHRS Assistance Contact Information

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Module 3 – Directing a Hearing Conservation Program

Resources & Guidance for HCP Directors

Role of the Director & OHC Technician

Assessment Tools & Checklists

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Module 4 – Educational Resources on Hearing Preservation

Educational Materials

Non-Auditory Effects of Noise

NASA Hearing Conservation Resources

Common Military Noise Hazards

Educational Links

HEARING CONSERVATION HEALTH EDUCATION MATERIALS

On-Line materials. The following are some recommended sources of hearing conservation training materials that are available on-line. Any good search engine will identify additional entries.

http://www.cdc.gov/niosh/topics/noise/ The National Institute for Occupational Safety and Health (NIOSH) maintains this hearing loss prevention site, with a wide variety of information on every aspect of noise exposure and prevention. There are several good publications available at no charge or via free download, such as “Preventing Occupational Hearing Loss – A Practical Guide” and the “Industrial Noise Control Manual,” a practical guide to engineering controls in industry.

http://www.e-a-r.com/hearingconservation/ E-A-R / Aero Company has long been one of the best sources for comprehensive hearing conservation training information. Start your search here! Everything from posters to training videos is available at little or no charge.

http://www.audiology.org/store/metools/educational.php The American Academy of Audiology has useful information about how the ear works, interpreting audiograms, understanding tinnitus, and so forth.

http://www.militaryaudiology.org/ The Military Audiology Association homepage is primarily for professionals, but has a lot of specialized information, including PowerPoint presentations and/or abstracts from professional meetings

http://www.asha.org The American Speech-Language-Hearing Association website is similar to the American Academy of Audiology site. Click on “public” and take your pick.

http://www.hearingconservation.org The National Hearing Conservation Association website contains excellent public and professional information of interest.

http://www.caohc.org/ The Council for the Accreditation in Occupational Hearing Conservation, while professionally oriented, contains information that will be useful to Hearing Conservation Technicians.

http://www.nonoise.org/ The Noise Pollution Clearinghouse website has as its mission to create more civil cities and more natural and wilderness areas by reducing noise pollution at the source.

http://www.osha.gov/Publications/osha3074.pdf OSHA on Hearing Conservation

http://www.lhh.org/noise/ The League for the Hard of Hearing has many articles and other resources on noise

http://www.hei.org/education/soundpartners/sp.htm House Ear Institute has a unique educational program for raising hearing conservation awareness.

http://www.occupationalhearingloss.com/homepagehtml.htm Information on occupational hearing loss and calculators for determining hearing impairment.

http://net.unl.edu/artsFeat/deafening_sound/ds_splash.html Deafening Sound, a program produced by Nebraska’s ETV and Public Radio program. This is a hip website targeted towards younger populations that discusses our noisy world.

http://www.nidcd.nih.gov/health/education/decibel/decibel.asp National Institutes of Deafness and other Communication Disorders. This website exhibits a handy interactive sound ruler, and WISE EARS tips are located at: http://www.nidcd.nih.gov/health/wise/tips.asp.

http://www.hearnet.com/index.shtml Hearing Education and Awareness for Rockers.

http://www.abelard.org/hear/hear.htm Hearing damage and loud music information, directed towards the younger population.

http://www.who.int/docstore/peh/noise/guidelines2.html World Health Organization guidelines on community noise.

http://www.grc.nasa.gov/WWW/AcousticalTest/HearingConservation/index.html NASA Glenn Research Center Acoustical Testing Laboratory.

http://www.noisefree.org/ Noise Free America website targets noise pollution in the environment and legislative efforts to reduce noise.

Video Tapes. The CDC/NIOSH website provides ordering information for a number of hearing conservation training videos. The list is available at http://www.cdc.gov/niosh/96-110s.html and links to the hearing conservation websites of individual Services.

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Module 5 – Hot Topics in Hearing Conservation

*Above articles reprinted with permission from Deafness Research Foundation, www.drf.org, and Hearing Health.

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References & Contributers

References

Herdman, S.J., Assessment and Treatment of Patients with Benign Paroxysmal Positional Vertigo (Chapter 19) in Vestibular Rehabilitation, 2 nd Ed. F.A. Davis Company: Philadelphia, pp. 451-475. (2002).

Jacobson GP, Calder JH. A screening version of the Dizziness Handicap Inventory (DHI-S). Am J Otol 19:804-808;1998.

Contributors

COL David Chandler, PhD (US Army)
LTCOL (Retired) Theresa Schulz, PhD (US Air Force)
LTC Lorraine Babeu, PhD (US Army)
Dr. John Muller (US Navy)
CAPT (Retired) Alan Frost (US Navy)
LCDR Joel Bealer (US Navy)
Mr. John Page (US Navy)
COL (Retired) Ben Sierra (US Air Force)
LTCOL (Retired) Don Gasaway (US Air Force)
Dr. Doug Ohlin (US Army)
LTC Kathy Gates (US Army)
MAJ Eric Fallon (US Army)
CPT Lisa Whitney (US Army)
Dr. Lynn Cook (US Navy)
CDR Glen Rovig (US Navy)
CPT Deepa Hariprasad (US Army)
MAJ Marjorie Grantham (US Army)
CPT Dan Ohama (US Army)
LTCOL Angela Williamson (US Air Force)
CPT Kel Kratzer (US Army)
CPT Andy Merkely (US Army)
MAJ Cheryl Cameron (US Army)
Ms. Valerie Bjorn (US Navy)
Mr. Jim Wilt (US Navy)
Dr. Derin Wester (US Navy)
Dr. Michael Hoffer (US Navy)
Dr. William Ahroon (US Army)
Dr. Jeffery Kuhn (US Navy)
MAJ Jenny Rainwater (US Air Force)
Dr. Donald Henderson (University at Buffalo)
Dr. Thais Morata (NIOSH)
Dr. Stephen Fausti (Dept of Veterans Affairs)
CPT Leanne Cleveland (US Army)
Council for Accreditation in Occupational Hearing Conservation (CAOHC)
LT Michelle Kee
LT Anne Jarrett



This page last updated on June 11th, 2009.
Content last reviewed on June 11th, 2009.