Month: January 1999

By LCDR Kelly Paul, USN

Selections for Promotion

Congratulations to LTjg Mari Schulz and LTjg Karen Strickland who have been selected for Lieutenant!

New Job Titles/Positions

• CDR Bob Rogers has taken over the Navy Audiology Specialty Leader position from CDR Kathy Hartmann.
• CDR Hartmann is enjoying her new job as Head of the largest branch clinic, the Fleet Support Clinic at Naval Station, San Diego. Even with this new challenging role, she continues to see patients one day a week!
• Ms. Marge Jylkka is the new Head of the Audiology Division, Otolaryngology Dept at National Naval Medical Center in Bethesda, MD.
• Mr. Tom Hutchinson has been promoted to Head of Specialty Clinics at Naval Medical Clinic, Portsmouth, New Hampshire. The Specialty Clinics include Audiology, Optometry, Social Work and Physical Therapy.
• Ms. Julie Foley of Naval Hospital, Otolaryngology/Audiology Division, Charleston, SC, has taken on the Occupational Hearing Conservation Program in addition to her clinical responsibilities in Otolaryngology.

New Children and Expecting Parents

• Congratulations to Kathy Hartmann, of Branch Clinic, Naval Station, San Diego, on the birth of her second son, Joshua Scott, born 6 July 98 weighing 5 lbs, 13 oz, 18 inches. Joshua already has two nicknames, “bruiser” and “Michelin baby” due to the number of fat rolls on his body!!!
• Ms. Ricki Gemmel, of Audiology Clinic, Portsmouth, VA, has just returned from maternity leave. She had a baby boy named Matthew Jason on 1 Sep 98.
• Ms. Susan Fletcher, of Naval Medical Center, San Deigo, is expecting a new baby near the end of Jan 99.
• LT Alan Ross, of Naval Hospital, Camp Pendelton, CA, is expecting his first child in Feb 99.
• Ms. Julie Foley, of Naval Hospital, Otolaryngology/Audiology Div, Charleston, SC, is expecting her first child at the end of June 99.

New Faces In Navy Audiology

• Michelle Lacitinola is a new Audiologist hired for resource sharing at Naval Hospital, Division of Otolaryngology, Camp Pendelton, CA.
• Two new Audiologists have been hired at Navy Hospital, Occupational Health/Prev Med Dept, Great Lakes, Illinois: Steven Bourgeois and Pat Kienzle. Steve is a former active duty Army Audiologist and was stationed at Fort Polk, LA from 1980-1984.
• Cynthia (Cindy) Zehner, a former active duty Army Audiologist, is a new contract Audiologist at National Naval Medical Center, Audiology Division, Bethesda, MD.
• Ricki Gemmel is a new Audiologist on staff at Navy Hospital, Audiology Clinic, Portsmouth, VA.

Farewell to

• LCDR Anne Shields transferred to Naval Reserves, but is still active in the MAA. Last duty station was the Center for Health Promotion and Preventive Medicine at Aberdeen Proving Ground, MD.
• Mr. Earl Brown retired from National Naval Medical Center, Audiology Division, Bethesda, MD.
• Mr. John Coie of Audiology Clinic, Portsmouth, VA, retired in Sep 98. Ms. Sharon Klavans resigned from League Island Branch Medical Clinic, US Naval Base, Philadelphia, PA, in December 1998.
• In mid-September 1998, Mr. Steven Hewkin of the Naval Shipyard Branch Medical Clinic in Bremerton, Washington took a position at a VA Hospital in Orlando, Florida.

Fair winds and following seas!

Research

At the ASHA Convention in San Antonio, Ms. Janet Sells, of Naval Hospital Audiology/Hearing Conservation, Newport, RI, won the 1997 ASHA Editor’s Award for the article of highest merit in the American Journal of Audiology: A Journal of Clinical Practice on “Autoimmune Inner Ear Disease (AIED): A Tutorial“. Note: The AJA is now on-line and is only offered in hard copy at the end of the year, when all articles for the year are printed.

Dr.’s Lynne Marshall (Audiologist) and Laurie Heller (research Psychologist) of Naval Submarine Med. Research Lab in Groton, CT, authored two papers on “Otoacoustic Emissions and Temporary Threshold Shifts” and “Otoacoustic Emissions and Permanent Threshold Shifts”, which were presented in Sydney, Australia, on 24 Nov 98 at the International Noise Congress.

LCDR Keith Wolgemuth, of Navy Medical Center, Occupational Audiology Dept, San Diego was awarded a grant to do a study on Genetic Pre-disposition to Noise-Induced Hearing Loss, funded by NIH. Team members for the study include, Dr. Wolgemuth (Navy Audiologist), Dr. Lynne Marshall (Navy Audiologist), LTC Rick Kopke (Army Physician), and LCDR Mike Hoffer (Navy Physician).

Other News

The Navy Audiologists would like to give a special thanks to CDR Kathy Hartmann for all the effort and hard work she invested toward the success of our profession as Navy Audiology Specialty Leader. Some of her major accomplishments include:

• Development of a Navy Audiology Senior Leadership Team
• Development of an Audiology Mentoring Program, including a Preceptor Program for new Navy Audiologists
• Marketing Navy Audiology at the Bureau of Medicine and Surgery level, resulting in command support for our programs
• Creating the “Navy Audiology Handbook” and the “Navy Audiology Clinical Manual” to be used by both new and current Navy Audiologists
• Development of a 5 week enroute training program for new active duty Audiologists at Naval Hospital, Portsmouth, VA, and Naval Hospital, San Diego, CA

We appreciate all that CDR Hartmann has done on our behalf and all the personal assistance she has given to each of us as Specialty Leader. We will miss your mentorship and the regular communications with you. Enjoy your new position and keep in touch with all of us!

Mr. John Page is finishing up changes to the Navy’s Bureau of Medicine and Surgery Instruction for Hearing Conservation. This updated Instruction will have more general information on Hearing Conservation and the specifics of the program will be spelled out in a Navy Environmental Health Center Technical Manual. The Technical Manual should be complete by the first of the year.

Mr. Tom Hutchinson will be finishing up his Master’s Degree in Health Care Administration in May 1999!!

National Naval Medical Center, Bethesda, MD, now has two clinical rotation positions for Audiology See Navy graduate students. Students come from Gallaudet, James Madison and University of Maryland.

Ms. Tammy George of Naval Hospital, Camp Lejeune, NC, recently began dispensing programmable hearing aids. Camp Lejeune will have its first Audiology student intern from East Carolina University beginning in January 1999.

LCDR Kelly Paul and LT Joel Bealer are making final changes to the proposed new Navy Audiometric Technician Training Package. The Navy Audiology Senior Leadership Team and the Navy Environmental Health Center will then make final recommendations and approval of the standardized training. The entire training package will be available on CD-ROM.

Due to the downsizing of Naval Hospital, Charleston, SC, the Audiology Clinic there is working more closely with patients from Charleston Air Force Base. Ms. Foley recently began dispensing hearing aids through the RACHAP Program.

Navy Audiology would like to extend a special thanks to LT Joel Bealer for all the hard work he has done as the Navy Functional Manager for the Joint Services Hearing Conservation Program with the new DOHRS-HC program/systems. Joel has gone above and beyond in communicating with the different commands regarding deployment of the new systems, giving personal attention to each site to ensure a smooth transition. His expertise and teamwork is also very much appreciated among the staff at Aberdeen Proving Ground. Thanks Joel!!!

By CDR Glen Rovig, MSC
Operational Audiology Officer

You have probably seen some recent national publicity concerning research into new types of treatment and prophylaxis for sensorineural hearing loss. Two researchers at NAVMEDCEN San Diego are working with a micro-catheter to deliver medication to the cochlear fluids via absorption through the round window. They (and others) are also looking at the contribution of free radicals to noise and toxin-induced hearing loss, and the preventive effects of antioxidants. After doing some background reading, I communicated with one of the researchers, otolaryngologist LCDR Mike Hoffer, MC, USN. He was kind enough to answer a series of questions for me, and I thought the information might be useful to the Occupational Health community.

First, a few basics:

Loud noise causes reduced microcirculation within cochlear blood vessels.

This somehow releases higher than normal numbers of radical oxygen species (ROS) or “free radicals” which can react with and damage cellular protein, DNA, and unsaturated lipids. (My grasp of autocatalytic events is a bit tenuous, so I cannot give you much clarification here.)

The body’s normal antioxidant defenses cannot counter the excess free radicals. TTS and PTS may follow with prolonged noise exposure. This is a gradual, noise-induced permanent threshold shift model, as opposed to acoustic trauma, which may physically damage the tectorial and/or basilar membranes and associated structures.

One study involving chinchillas is representative. Each animal was treated with saline (control) applied to the distal surface of one round window membrane, and an antioxidant applied to the opposite round window. The animals were then exposed to 4 kHz noise at 105 dBSPL for four hours. Antioxidant-treated ears showed significantly less TTS and reduced PTS as well as significantly less outer hair cell loss compared to the control ears.

Augmenting the antioxidant defense system with additional “free radical scavengers” holds promise for preventing/minimizing hearing loss from toxins and noise exposure.

A second area of research is delivering medications to the cochlear fluids via micro-catheter. Entering the middle ear via a small hole in the TM, the catheter is placed against the round window, where medication is absorbed through the membrane over a period of several days. A major benefit is that medication goes directly to the target area and avoids side effects associated with oral administration.

Here are LCDR Hoffer’s replies to my emailed questions:

Q: What types of patient care are being envisioned for the catheter?

A: The catheter is a FDA-approved device for irrigation of the round window membrane. We have done all of the pioneering basic research with the device and had the original and largest experiment on humans. The catheter is, however, being used for multiple indications at other (select) institutions. Most of these institutions are following protocols which we established. Indications for the catheter include, but are not limited to, Meniere’s Disease, sudden sensorineural hearing loss of a variety of etiologies, tinnitus treatment, and toxic insults to the inner ear (hearing and balance). The catheter has been used on approximately thirty patients at our institution. Six patients with sudden hearing loss have been treated. All three patients who were seen in under four weeks showed a dramatic improvement after treatment. The other three patients seen (longer time since injury) had no improvement. Contraindications to catheter use include all standard ear surgery contraindications and all contraindications to surgery. We have seen no complications directly caused by the catheter.

Q: Is there any projection to use catheters to deliver antioxidants to humans, either before or after noise exposure?
A: The treatment of inner ear disorders (hearing and balance) is a complicated issue. For many disorders the treatment depends on using the right medicine (antioxidant, etc.) and having the appropriate concentration reach the target organ at the appropriate time. If oral administration achieves this end, and surgery can be avoided, that’s fine. Undoubtedly, certain medicines (and certain antioxidants) will need to be delivered in an other than oral fashion. Severe sudden noise induced hearing loss (e.g. after a blast injury), is one example, of a disorder that may only be rescued with microcatheter delivery of antioxidants. Prophylaxis will be accomplished through some type of oral medication.

Q: The news release focuses on prednisone/steroid therapy for acute cochlear conditions. Is there an application for prednisone with NIHL? Does prednisone act the same way as an antioxidant?
A: There is basic science work that indicates that corticosteroids can rescue noise induced hearing loss and have antioxidant properties. Methylprednisolone, for example, up-regulates antioxidant enzyme activity in neural tissue. It also has other effects such as neuroprotection, increasing cochlear blood flow, and antiapoptotic and anti-inflammatory effects.