by Barry Keate
Hearing loss and tinnitus have been battlefield risks ever since the introduction of explosives and artillery. From World War II and through Vietnam, hearing damage has been a leading disability for returning US veterans.
Tinnitus is currently the number one service connected disability of veterans returning from Iraq and Afghanistan. The total number of vets awarded disability compensation for tinnitus at the end of 2009 surpassed 760,000. Since 2005, the number of veterans receiving service-connected disability for tinnitus has increased by at least 15% each year. At this alarming rate, 2014 will see 1.5 million vets receiving military compensation for tinnitus, at a cost to American taxpayers of over $2.26 billion. (1)
The US military recognized the risk of hearing loss and tinnitus in Iraq and Afghanistan and issued earplugs early on. But the sheer number of hearing loss injuries came as a surprise to medical specialists in the military and to outside experts.
Higher Rates of Hearing Damage Despite advances in hearing protection, US troops are suffering hearing damage at about the same rate as World War II vets. (2) But there are many differences in combat between the two wars. WW II was a different kind of war than that fought today. It was waged to a much greater extent by way of vast artillery barrages, bombing raids and epic tank battles. Today’s battles in the war on terrorism are characterized by roadside bombs, ambushes and sudden firefights.
“They can’t say, ‘Wait a minute, let me put my earplugs in,’ “ said Michael Hoffer, MD, a Navy Commander and one of the country’s leading inner ear specialists. “They are in the fight of their lives.”
Additionally, many service members in combat situations refuse to wear earplugs for fear of dulling their senses and missing sounds that can make the difference between life and death.
Initially, marines were issued a pair of $7.40 double-sided earplugs. One side was to protect against weapons fire and explosives while the other side was for aircraft and tank noise. These earplugs were often not used at all or used improperly.
According to Air Force Staff Sgt. Lee Adams, an ear, nose and throat (ENT) technician at Bagram Air Field in Iraq, more than 50% of patients seen in the ENT walk-in clinics are there for hearing-related issues.
“The first question I ask a patient who comes in with a hearing complaint is, ‘Were you wearing ear protection?’“ says Air Force Col. Joseph Brennan, MD. Dr Brennan is the ENT physician at Bagram Airfield in Iraq. “Since I arrived here in May, 2009, I have not had one service member answer yes to that question.” (3)
No matter what is used or whether it is used, hearing protection has its limits. While damage can occur at 80 to 85 decibels, the noise level of a moving tank, the best protection cuts that by only 20 to 25 decibels. That is not nearly enough to protect the ears against an improvised explosive device (IED) or a firefight, which can range upwards of 183 decibels.
Hearing damage in war zones occurs in one of two ways. The constant noise of tanks, planes and heavy equipment coupled with sudden firefights creates noise induced hearing loss. The other way hearing is damaged is by blast injury. This occurs when an individual experiences concussive shock waves from a blast, sudden acceleration-deceleration from collisions, or an impact or penetration directly to the skull. These types of injuries are classified as traumatic brain injury (TBI). They are classified into severe, moderate or mild. Mild TBI is generally referred to as concussion.
When not in Iraq or Afghanistan, Dr. Michael Hoffer is stationed at the United States Naval Medical Center in San Diego, CA. He has spent his career helping both veterans and deployed military personnel deal with hearing loss and blast-induced trauma.
At the 2007 International Tinnitus Forum in Washington, DC, Dr. Hoffer presented his findings on blast injury, head trauma and tinnitus.(4) He found four types of tinnitus due to warfare:
1 – Noise-induced hearing loss and tinnitus, 2 – Blast-induced hearing loss and tinnitus, 3 – Tinnitus without hearing loss, 4 – Post traumatic Meniere’s disease.
He stated that blast induced tinnitus is disproportionate to the degree of hearing loss. Tinnitus without hearing loss is poorly understood and seems to accompany cognitive difficulties.
Audiologists at the Army Audiology and Speech Center conducted a retrospective study of military personnel who had been exposed to blast damage. They found that 49% of all soldiers exposed to blasts in Iraq and Afghanistan had tinnitus. A total of 60% had hearing loss. (5)
The Navy and Marines have begun distributing state-of-the-art earplugs, known as QuietPro. This system includes digital processors that block out damaging sound waves from gunshots and explosions and still allow users to hear everyday noises. They cost about $600 per pair. This may help reduce noise-induced hearing loss in the future but for now, hundreds of thousands of returning veterans are left trying to cope with their disability.
Dr. Hoffer has begun a field clinical study to determine if the antioxidant N-Acetyl Cysteine (NAC) can prevent some of the worst damage from TBI. He believes that if NAC is administered within 24 hours of a blast injury, the patients will recover much faster and more fully.
Solutions There is no cure for tinnitus. There are strategies to mitigate the effects of the nerve damage and reduce tinnitus sound levels.
Michael Seidman, MD is one of the USA’s leading Ear, Nose & Throat physicians and an expert on tinnitus and conditions of the inner ear. He says that people with tinnitus should reduce or eliminate intake of salt, fatty foods, highly sugared foods, artificial sweeteners and dyes, caffeine, nicotine and alcohol. This is not guaranteed to help but will in many cases because these are some of the most common triggers for increased tinnitus.
Dr. Seidman also recommends Arches Tinnitus Formulas. He states, "It has been my experience in treating tinnitus with Arches Tinnitus Formulas that approximately 5% of my patients enjoy a complete reduction of tinnitus, 75% experience a varying reduction of symptoms and 20% remain unchanged. Approximately half of my patients are satisfied with their results and elect to continue taking the products, requiring no further treatment from me. I recommend Arches Tinnitus Combo Pack, a three-month supply of Arches Tinnitus Relief, Stress and B-12 Formulas. At a minimum, I tell my patients to take at least four bottles (three months) of Arches Tinnitus Formula (ATF) to determine their total degree of reduction."
Ginkgo Biloba Extract (GBE), a main ingredient in ATF, has proved effective in numerous clinical studies for tinnitus. A review of 19 clinical studies on ginkgo for tinnitus, by Norbert Holstein, MD, concluded that ginkgo was shown to be especially helpful for noise induced tinnitus when treated early on. Dr. Holstein stated, “The clinically relevant conclusion to be drawn (from the studies) is to start treatment as early as possible.” (6)
Arches Tinnitus Formulas are not a cure for hearing loss and tinnitus. However, they have helped thousands of people reduce the ringing. An article describing the science behind the product and the mechanisms of action.
My own tinnitus came about through military service in the 1960’s and industrial noise exposure following that. It has been reduced by about 2/3 due to the use of Arches Tinnitus Formulas. I hope many returned veterans can find success using our products or other clinically relevant alternatives.
1 – American Tinnitus Association; How Tinnitus Affects Our Military Personnel, www.ata.org/for-patients/at-risk 2 – Hidden Toll in Iraq – 70,000 US Soldiers Suffering from Hearing Damage, Associated Press, March 08, 2008. 3 –Opal Hood; Hearing Loss: No. 1 Diagnosis for US Soldiers in Afghanistan, Hearing Health , Winter, 2010. 4 - Notes from the 25th Annual Meeting of the International Tinnitus Forum, Washington, DC, 2007 (www.tinnitusformula.com/infocenter/articles/treatments/itf_07.aspx). 5 – www.hearinglossweb.com/Medical/Tinnitus/ata.htm. 6 – Holstein, N.; Ginkgo Special Extract EGb 761 in the Treatment of Tinnitus; A survey of the results obtained in clinical trials; Fortschr. Med. 118 (2000), p.157-164