Yet while all the armed services are scrambling to come up with better hearing protection, the Army is slashing its staff of military audiologists – the specialists who combat hearing loss – to make room for more "trigger pullers" at the front. Only two military audiologists, for example, are at Fort Hood, home base for more than 40,000 soldiers.

"It's frankly alarming," Theresa Schulz, a former Air Force audiologist and incoming president-elect of the National Hearing Conservation Association, said of the reduction in military audiologists even as noise-induced hearing loss is on the rise.

Army officials say that most or all of the military audiologists lost will be replaced by civilians and that the service has enough audiologists in any event.

A review of recent studies and interviews with experts by The Dallas Morning News show that:

• Perhaps a fourth – and probably more – of troops who have served in Iraq since March 2003 have returned with hearing loss from gunfire, bomb blasts or other noise.

• Exact figures on how many troops have suffered hearing damage in Iraq or Afghanistan don't exist, in part because the Army failed until recently to give most troops hearing tests at both the beginning and end of their service, a 2005 study by the independent Institute of Medicine found. And as the American Journal of Audiology recently noted, Army Reserve and Guard members may be "underrepresented" in Army medical evaluations because "they are more likely to seek care through civilian providers."

• Despite the evidence of rapidly rising hearing damage, the Army plans to cut the number of uniformed audiologists in its ranks from 36 to a projected 19. The Army had 70 uniformed audiologists in 1991, before a post-Cold War reduction in the Army's overall size.

• The bill to taxpayers for disability payments for hearing damage to all veterans – already roughly $1 billion annually – is likely to soar in future years as increasing numbers of those who served in Iraq and Afghanistan realize the extent of their hearing loss.

"As they're coming back, they're just starting to come into our system," said Lucille Beck, director of audiology and speech pathology for the Veterans Affairs Department.

Hearing loss, she said, is often "a gradual decline. You're the last one to know, because you don't know what you're missing. You think that everyone else is mumbling."

Short on earplugs

The simplest form of hearing protection is earplugs. But according to an article in the December issue of the American Journal of Audiology by three Army scientists, "there were not adequate supplies of earplugs to fit all deploying soldiers" in the months before the invasion of Iraq.

In any event, many infantrymen resist wearing them for fear of missing critical commands or movement by the enemy – anything that might alert them to danger or help keep them alive in combat.

"You use the hearing protection when you're in a training environment, but when you go to combat, most guys don't wear that," said Sgt. Maj. Michael Sienda, a 20-year Army veteran.

"They think they're not going to hear the enemy. And they think that they can't communicate with their squad or their element" while wearing hearing protection.

The Army and Marines have distributed thousands of pairs of an innovative device designed to overcome that reluctance – the Combat Arms Earplug, which blocks hazardous noise while allowing nearly normal hearing. But audiologists and combat veterans say many troops who got the earplugs either ignored or misused them for lack of instruction.

The yellow-and-green earplug has been available since 1998. But Sgt. Maj. Sienda said he was unaware of it when he went to Iraq with the 1st Armored Division in May 2003.

He could have used the earplugs that July, when a roadside bomb on notorious Haifa Street in Baghdad hit his Humvee, he said.

"I had not heard about it because the Army didn't do a very good job of getting the word out," Sgt. Maj. Sienda said.

Recalling how his ears rang for days after the ambush, he said, "I definitely have some hearing loss, and I'm sure it was from that day."

Disagreeing on dangers

Military audiologists focus on overcoming such ignorance, which why is Dr. Schulz, the former Air Force audiologist, calls the reductions "scandalous." Army leaders appear to be so eager to civilianize the service's medical care to create combat slots that they simply aren't "connecting the dots," she said.

Herbert Coley, manpower director for the Army Medical Command in San Antonio, said the cut in uniformed audiologists would cause no harm.

"We are not reducing the number of audiologists in the Army," Mr. Coley said. "We are reducing the number of military audiologists in the Army. Every [uniformed] audiologist who is designated a mil-to-civ conversion should be replaced" by a civilian.

Mr. Coley added that in addition to its current 36 military audiologists, the Army has 36 civilian audiologists, even though it calculates that it only needs one for every 18,000 soldiers on active duty, or about 33 in all.

Audiologists, however, say there is a qualitative difference between what the Army's military and civilian audiologists do.

All but one of the Army's civilian audiologists are focused on treating patients who already have hearing damage, not on preventing it, as military audiologists are focused on, by and large, experts said.

That leaves the job of "hearing conservation" – educating troops to prevent hearing damage – almost exclusively to uniformed audiologists. And civilian audiologists can't be sent to combat zones such as Iraq, as military audiologists have been.

"If we can put that audiologist on the forward battlefield, as unusual as that may sound, talking to soldiers about hearing protection ... we're much better served than if we have that audiologist in a clinic," Maj. Eric Fallon, an Army audiologist who served two tours in Iraq, said while hosting a hearing conservation exhibit at a military convention. "Folks don't show up at a clinic to prevent something."

As it is, only about 20 of the Army's military audiologists work primarily in hearing conservation, said Lt. Col Kathy Gates, the Army surgeon general's top audiology adviser. Those 20 are responsible for getting the hearing conservation message to about 324,000 soldiers – those routinely exposed to hazardous noise – out of the 600,000 regular Army, Army Reserve and National Guard troops on active duty.

Mr. Coley, a former helicopter pilot who retired from the Army as a colonel in 1998, said civilian audiologists could be trained to do what military audiologists do now.

"The civilians who come into the Army need to understand that their job is going to be hearing conservation," he said.

Douglas Ohlin, a civilian audiologist who has managed the Army's hearing conservation program for 26 years, said Mr. Coley's vision of reorienting civilian audiologists from treating patients to teaching hearing conservation was "either wishful thinking or he's blowing smoke, because that is not what has happened in the past."

"That isn't going to work and has not worked because they [civilian audiologists] are clinic-bound," Dr. Ohlin said. "The hospital commanders want them ... in the clinics.

"They could be possibly taught, but they not only have to learn hearing conservation, they have to learn military hearing conservation, and they have to learn the Army," Dr. Ohlin said.

Damaging sounds

Audiologists use complex and intricate scientific scales to measure sound, but simply put, any noise louder than 85 decibels – a measure of the air pressure that sound causes – can damage a person's hearing if it is loud enough or lasts long enough. Short loud sounds are called "impulse noise." Loud sounds that last are called "steady-state noise."

A typical vacuum cleaner registers 84 decibels to 89 decibels, according to the Noise Pollution Clearinghouse, an anti-noise group. The shooter of an M-16 rifle is exposed to 157 decibels. Other weapons can be far louder.

"If you have to raise your voice to be heard within one meter of [another] person, chances are you are in a noise-hazardous, steady-state environment," Dr. Ohlin said. "As far as impulse noise is concerned, all weapons are hazardous."

Improvised explosive devices, the bombs planted by insurgents in Iraq, have ruptured the eardrums or otherwise damaged the hearing of thousands of U.S. troops by most estimates.

"If you're wearing hearing protection, that's not going to happen to you," Dr. Ohlin said.

Lawmakers from both parties have asked the Army to do more to protect soldiers' hearing.

"If we are cutting back on military audiologists who can go out into the field and prevent loss of hearing, that would be unconscionable," said Rep. Chet Edwards of Waco, senior Democrat on the House Appropriations Subcommittee on Military Quality of Life. "For the taxpayers, it makes a lot more sense to prevent loss of hearing than to provide a lifetime of disability payments."

The House subcommittee said in a report last year that "as a result of ongoing combat operations, one in three post-deploying soldiers report acute acoustic trauma and one in four report hearing loss and/or hearing complaints."

Its chairman, Rep. Jim Walsh, R-N.Y., said he was shocked to learn how many troops were suffering hearing loss.

"Once I found out it was that big a number, I put it in the report," he said. "This is a way for us as legislators to express our opinion that they need to look at this."

Seeing positive steps

Col. Gates said the estimate that a fourth of troops serving were suffering hearing loss was only "a snapshot that occurred early on" in the Iraq conflict. Since then the Army has begun giving hearing tests to all deploying soldiers and fitting them with ear protection, she said.

Beyond the Army's purchases of Combat Arms Earplugs, its Communications Electronics Command has spent $64 million over the past 17 months on 100,000 pairs of "noise cancellation" headsets for soldiers, Marines and Air Force troops who use noisy vehicles. Many of the headsets went to units going to Iraq.

Lt. Gen. Kevin Kiley, the Army surgeon general, "recognizes a concern over audiology," Mr. Coley said, and has asked higher-ups to seek Pentagon permission to postpone conversions while the medical command considers the issue.

The percentage of troops whose hearing has been damaged in Iraq could be higher than one fourth, some experts said, for a soldier who loses an arm or leg in a roadside bomb blast often suffers hearing damage, too, but is listed as an amputee rather than a hearing casualty.

The Institute of Medicine study cited "reports of hearing loss among 62 percent of personnel with blast injuries who were treated at Walter Reed Army Medical Center from March 2003 through May 2005."

Whatever the actual number, the future cost to taxpayers will be billions, experts predicted.

"We know that it's a problem, and we expect to see a high incidence of hearing loss among returning veterans," VA audiology director Dr. Beck said.

That needn't be, hearing protection advocate Dr. Schulz said.

"People should be as militant about noise as they are about asbestos," she said. "It's the same kind of hazard. There's no blood, there's no pain. It's a slow, insidious damage.

"And 30 years later you're standing there like the chief of staff of the Army, wearing hearing aids."

By Richard Whittle
http://www.dallasnews.com/sharedcontent/dws/news/world/stories/DN-noise_05int.ART.North.Edition2.3ef1b8c.html