Army Presentations
Otologic Blast Injuries
Major Eric R. Helling, M.D., U.S. Army,
Staff Otolaryngologist,
Landstuhl Regional Medical Center
Traumatic tympanic membrane and ossicular chain injuries are common in the Military environment. We review our experience with the terrorist bombing victims at the U.S. Embassy, Nairobi, Kenya. Initial evaluation, findings and care of the patients evacuated to Landstuhl Regional Medical Center, Germany is reviewed. A combined Otologic and Audiologic team then deployed to Nairobi to assess all remaining Embassy personnel. A total of 147 audiologic evaluations and 30 physician evaluations are performed. A standardized injury diagram is used to assess and follow injuries. Perforations, and post traumatic cholesteatoma pearls are identified and surgical care is provided at Nairobi as appropriate. Two successful paper patch tympanoplasty and two cholesteatoma pearl excisions are performed. Out of the patient population, 16 initial perforations are identified and 5 persistent perforations at 5 months are identified. Perforation healing or failure is compared to overall size of perforation and presence of prior intervention. Our results are compared to Hostile Action Casualty System data and other large-scale otologic injury registries.
A Comparison of Adaptive & Percentage-Correct Speech-Recognition Procedures
Dale Ostler, MAJ, MS
University of Florida
Past studies have suggested at least three significant problems with percentage-correct testing procedures in evaluating speech-recognition ability: poor intra- and inter-subject reliability, floor and/or ceiling effects, and poor test validity. Adaptive speech-recognition testing has the potential to overcome these problems. Specifically, this study was designed to compare the within and between subject reliability between the two procedures. Twenty listeners with normal hearing ability were tested on both procedures using the Hearing In Noise Test (HINT). Results showed that the adaptive procedure has significantly better reliability than does the percentage-correct procedure for listeners with normal hearing. Adaptive procedures also have a greater potential to be more sensitive to subtle changes in speech-recognition performance by avoiding the floor and ceiling effects of percentage-correct procedures. In light of these results recommendations are made for use of adaptive speech-recognition procedures in the clinic. The challenges of implementing an adaptive procedure in the clinic are discussed.
User Satisfaction with the Combat Vehicle Crewman’s Helmet
Capt M. A. M. Grantham, MS, USA
In July 1998, a soldier being counseled about hearing conservation in track vehicles reported that the earcups currently in use by his unit degraded in the heat of tank operations in Kuwait. The CVC earcups presented by this soldier would probably not provide adequate hearing protection and significantly reduce communication abilities within the tank. Since asking track vehicle operators for anecdotal evidence about the pros and cons of the older, black earcups versus the gel and foam earcups used by the first soldier, a third earcup has slowly been entering the system – foam without gel. User satisfaction with the three different kinds of CVC earcups currently in use was assessed for 350 (number may reach 500) soldiers at Fort Stewart, Georgia.
Any differences noted may lead to practical recommendations to the manufacturer of the current earcups, aiding our track vehicle operators/users with both hearing conservation and better communications both in training and warfighting.
Audiology Support in Tactical Military Depolyments
COL David W. Chandler
Director, Army Audiology & Speech Center
Walter Reed Army Medical Center
Washington, D.C. 20307
Military deployments in recent years tend to be a joint force composition, with a mission to provide stabilization over an extended period of time. The nature of these deployments present many “real world” mission opportunities for military audiologists with regard to hearing conservation, medical surveillance and force health protection. This presentation will discuss audiology support of U.S. Implementation Forces (IFOR) in Bosnia, and of Task Force Hawk in Tirane, Albania. Specifically, the presentation will focus on establishing and supporting a hearing conservation program for deployed forces, and supporting forces in a tactical environment with regard to noise abatement and communication issues.”
Determining Hearing Aid Candidacy
MS Nancy Garrus Lindroth M.A., CCC-A
MS Sharon Beamer M.A., CCC-A
Walter Reed Army Medical Center
Washington, DC 20307
The advent of sophisticated hearing aid technology has significantly increased the range of amplification options. As audiologists we can successfully accommodate a wider range of audiometric configurations than in the past including precipitous sensorineural hearing loss commonly observed with noise related impairments and mild or minimal hearing loss. Concomitantly, with the availability of more cosmetically appealing instruments we can reach a population previously resistant to hearing aid use. The technological and cosmetic advancements bring new challenges for determining appropriate candidacy to include not only the audiometric configuration but the perceived measure of communication difficulty as well. Numerous investigators (Giolas1982 and Erdman 1994) have demonstrated pure tone and speech audiometric measures are not necessarily correlated with self-report measures of hearing difficulty. Similarly, challenges arise in counseling patients who exhibit some hearing loss, but may not be appropriate candidates for amplification. This paper examines the various factors that determine hearing aid candidacy including audiometric test results, self-assessment of communication difficulties, and motivational factors.
AMEDD/DVA Hearing Aid Programs
COL Richard W. Danielson Ph.D.
Madigan Army Medical Center
Tacoma WA, 98234
A review of the status of actions taken and strategies for future development of the Army Medical Department’s cooperative work in a complex hearing aid program with the Department of Veterans Affairs (DVA) in the past two years. AMEDD facilities (who order approximately 2,000 hearing aids per year) can now link with the DVA for volume buying, gain access to electronic hearing aid orders and patient registries, and provide batteries to soldiers in remote locations. These capabilities offer significant advantages through reduced cost savings and improved patient services, but DOD Audiology Clinic managers still report limited utilization of hearing aid programs shared with the DVA. This presentation will consolidate short-term wins experienced by users of this program, offer recommendations to resolve issues that have challenged implementation and discuss new approaches in the culture of DVA/military sharing.