“You think about maybe getting wounded in battle, getting those kinds of scars,” Cripps said after his annual hearing test at a health center on post recently. “Losing your hearing is just not something you think about.”
But it’s a widespread problem that affects the quality of service members’ lives now and will worsen in decades to come. And it’s largely preventable.
At least a fourth of soldiers who have served in Iraq or Afghanistan show some hearing loss, Army audiologists say, and even those who don’t deploy often are exposed to constant or concussive noises in their work or training that can cause hearing loss or tinnitus, a ringing in the ears. As they grow older, their normal, age-related hearing loss will compound the problem.
Among veterans, tinnitus and hearing loss are the most common service-connected disabilities, with more than 1.5 million veterans receiving compensation for those problems at the end of 2011. Of about 805,000 veterans who began receiving disability compensation that year, nearly 148,000 were for tinnitus or hearing loss, according to a recent VA report. By comparison, the next most prevalent disability was post-traumatic stress disorder, for which about 42,700 veterans began receiving compensation in 2011.
The military tries to prevent hearing loss among active-duty soldiers, and for those who find themselves straining to hear years after they’re out of service, the Veterans Administration provides hearing aids. At both ends of the spectrum, audiologists find resistance among those they’re trying to help.
“For us, a lot of the work is in education,” said Capt. Latisha Scott, an Army audiologist at Fort Bragg. “Having the equipment to prevent hearing loss is not the problem. It’s getting the soldiers to buy into using it.”
Scott says she – and other specialists the Army has hired in recent years to combat hearing loss – are working against outdated ideas that hearing protection is uncomfortable, unnecessary, or looks silly.
“Hearing loss used to be kind of a badge of honor,” Scott said. “If you had hearing loss, you had heard the guns of war. Your loss of hearing was your proof.”
After test, a question of safety
For several years, each branch of the military has taught its members what causes hearing loss and tinnitus and drilled the lesson that once hearing is damaged it can almost never be repaired.
Most hearing loss and tinnitus in the military are noise-induced, specialists say. Depending on their jobs, service members may be exposed to the constant noise of machinery, engines or airplanes or to sudden loud sounds such as artillery and mortar fire or the explosion of a roadside bomb. For reasons not fully understood, not every soldier exposed to the same level of noise will experience a problem.
In the Army, all soldiers must have an annual hearing test, and those deploying are tested before they leave and after they return so there is a record of any change. To speed the process, clinics across Fort Bragg are set up with chambers where six to eight soldiers can be tested at a time. During busy deployment cycles, hundreds of soldiers may be tested each day.
If the test indicates hearing loss, the soldier is scheduled for a retest, in case the problem is a temporary issue such as fluid in the ear. If further testing shows a permanent loss, the soldier meets with Scott or another specialist to discuss the extent of the damage and ways to prevent it from getting worse.
In some cases, the loss may make it necessary for the soldier to be reassigned to another job, something Scott says most soldiers will do nearly anything to avoid, including starting to wear protection.
“You have to look at the whole picture,” she said. “Are you becoming a safety hazard to yourself and others because you can’t hear well enough? Can you effectively do the job?”
Just as important, she said, is understanding that with noise-induced hearing loss, returning to the same environment is likely to cause additional damage.
“You’re 21 years old and in the Army now,” Scott tells some of those soldiers. “But what about later, when you’re married and you can’t communicate with your spouse or your kids? It becomes a quality-of-life issue.”
The equipment conundrum
Part of Scott’s job is to go from the clinic to the places on post where soldiers train or work and teach them about hearing conservation. She takes along her “tackle box,” filled with hundreds of pairs of different types and sizes of earplugs for which the Army pays from a few pennies each to about $12. When they come into the Army, soldiers are issued a set of earplugs, but if they lose that set, many soldiers never bother to replace it. Scott hands out new ones like candy.
Even the best-fitting earplugs, though, only block about 23 decibels of sound, and hearing loss can occur at 85 decibels. An M16 generates about 155 decibels; an IED up to 170.
To counter one reason soldiers say they don’t wear protection, the newest generation of rubber plugs Scott hands out feature a toggle in the end that can be opened manually – with the plug still in the ear – to allow for normal conversation. A sudden loud noise automatically closes the flap.
Soldiers in Special Forces and certain other units are outfitted with high-end electronic headphones that protect against noise but can amplify desired sounds, such as a whispered voice, and can be connected to military radios and other devices. They cost the military up to $700 a set.
Spec. Cripps says most of his damage is to his left ear, and the ringing he hears is not bad enough to keep him awake at night. At 34, he can’t hear certain high-pitched sounds such as a fan or water running somewhere in his house. He says he hears everything his son and daughter say, and most of what his wife tells him, “unless it has to do with the trash or the dishes.”
Cripps admits he often did not wear the ear protection he was issued while he was in Iraq, for the same reason other soldiers don’t. They worry earplugs might dull their senses, saving their hearing but maybe costing their lives.
“You want to hear the whistling of the mortars,” Cripps said, “before you hear the boom.”
Mickey Bullock heard the boom more than once when he was in the service.
Bullock, of Battleboro, volunteered for the Navy in 1955 as a way to travel, and once he got out of boot camp, he says, he was on one ship after another.
He spent more than a year on the USS Macon, a heavy cruiser built in 1943, decommissioned, then put back into service in 1950 at the start of the Korean War.
Bullock was on the boilermaker crew, helping to supply steam for the engines. It was a clattering, hissing workplace.
The VA: No. 1 aid consumer
But Bullock figures most of his hearing loss came from two instances when he was asleep in his bunk and missed the call to battle stations. The 16-inch guns went off practically in his ear.
“The noise, it was just beyond anything,” Bullock said. It was a week before he could hear people talk again.
Over the years, Bullock’s hearing slowly worsened, “until finally, it got to the place where I couldn’t hear nothing.”
In mid-2012, he sought help from the VA, which has become the nation’s largest consumer of hearing aids in recent years as policy changes have allowed it to provide devices to nearly every veteran who needs them at little or no cost.
Bullock used the VA Medical Center in Durham, which outfitted more than 2,500 veterans with hearing aids in 2012.
Bullock had no idea how much hearing aids had changed. Once clunky, blunt instruments that amplified all sound, today’s models are smaller and more sophisticated. They’re digital, can be synced with Bluetooth devices and, most important, can be fine-tuned to amplify only sound in the frequency ranges where the wearer has hearing loss.
Starting last year, the Durham VA began to make those kinds of adjustments from 100 miles away. Patients in Eastern North Carolina can travel to the VA’s Audiology Clinic in Greenville, and technicians there put a tiny microphone into the patient’s ear to test the level of sound a hearing aid transmits. The sound shows up as a graph on the computer screen of Dr. Nancy Jones, chief of Audiology and Speech Pathology, in Durham. That graph is overlaid on one showing Bullock’s hearing loss, and Jones amps the sound up or down in the specific frequencies where Bullock needs it. Bullock and the doctor talk over a webcam.
“I’ve been doing this for a year, and it still blows my mind,” said Jones, who started doing audiology at the VA when hearing aids were adjusted with screw drivers.
An emotional process
The majority of the Durham VA’s hearing loss and tinnitus patients are Vietnam War-era vets, but the audiology section has patients who served in World War II all the way up to the most recent conflicts, and during periods of peace in between.
If they went outside the VA, these veterans could expect to pay up to $7,000 for hearing aids, a cost rarely covered by insurance.
Noise-induced tinnitus, like hearing loss, is usually irreversible and can be frustrating for active-duty soldiers and veterans. Sometimes described as “the candle in the lit room,” tinnitus is most bothersome when its sufferer gets into a quiet place. Military and VA audiologists teach patients ways to manage tinnitus, such as using other sounds to mask the ringing or roaring, and avoiding medications and loud environments that make it worse. For some tinnitus patients, a hearing aid can help.
Getting a hearing aid can be an emotional experience for people who have gradually lost their hearing and may not even have realized how much they were missing. Hearing loss often correlates to feelings of loneliness, isolation and depression. Reconnecting to the world can be a revelation.
Jones often sees tears at the first fitting – sometimes from the patient, sometimes from the family member who accompanied them to the appointment.
When they leave, patients often try to thank VA staff for giving them the devices. Jones sets them straight.