Improved hearing protection regulations in the prevention of military nihl and tinnitus
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Improved Hearing Protection Regulations in the Prevention of Military NIHL and Tinnitus. Roderik Mrena, MD University of Helsinki, Finland February 26, 2010 Rosen Plaza Hotel, Orlando, FL. Occupational NIHL in Finland. Occupational NIHL severity.

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Improved hearing protection regulations in the prevention of military nihl and tinnitus

Improved Hearing Protection Regulations in the Prevention of Military NIHL and Tinnitus

Roderik Mrena, MD

University of Helsinki, Finland

February 26, 2010

Rosen Plaza Hotel, Orlando, FL


Occupational nihl in finland
Occupational NIHL in Finland Military NIHL and Tinnitus


Occupational nihl severity
Occupational NIHL severity Military NIHL and Tinnitus

  • occupational NIHL cases are reported to the National Insurance Board

  • mostly mild


Occupational NIHL Military NIHL and TinnitusMrena, Ylikoski M, Mäkitie A, Pirvola, Ylikoski J. Occupational NIHL reports and tinnitus in Finland. Acta Otolaryngol 2007, Vol. 127, No. 7, p.729-735.

  • hearing loss = compensation

  • tinnitus ≠ compensation


Background
Background Military NIHL and Tinnitus

  • military proffessional are at risk of NIHL

  • awareness ↑

  • EU Directive 2003/10/EC (effective 2006)

    • lower exposure action value: 80 dB(A), 135 dB(C)

      • protectors available, possibility for AG

    • upper exposure action value: 85 dB(A), 137 dB(C)

      • protectors mandatory, noise cancellation program

    • exposure limit value: 87 dB(A), 140 dB(C)

      • exposure may not exceed


Regulations in the fdf
Regulations in the FDF Military NIHL and Tinnitus

  • 1968

    • hard ammunition

  • 1979

    • muffs in firing range, plugs in combat training

  • 1985

    • also with blanks

  • 1989, 1991

    • supervisor must order usage (but own responsibility)

    • education

  • still, annually 1-2% of conscripts suffer AAT

    • consequences

  • effective in preventing hearing loss / tinnitus?


Subjects
Subjects Military NIHL and Tinnitus

  • 246 military personnel ending active duty

  • Period 1 (1984-1986): n=123

  • Period 2 (2003-2005): n=129

  • retrospective review of medical records

    • AG

    • exposure time

    • ear symptoms


Subjects1
Subjects Military NIHL and Tinnitus


Results – Hearing Loss Military NIHL and TinnitusMrena R, Ylikoski J, Kiukaanniemi H, Mäkitie A, Savolainen S. The effect of improved hearing protection regulations in the prevention of military NIHL. Acta Oto-Laryngol 2008;128:997-1003.

  • hearing generally worse in the left ear

  • NCOs

    • improvement in both ears

    • statistically significant

  • Officers

    • improvement, but statistically insignificant


Ncos right ear
NCOs – Right Ear Military NIHL and Tinnitus


Ncos left ear
NCOs – Left Ear Military NIHL and Tinnitus


Regulations & Tinnitus Military NIHL and TinnitusMrena R, Savolainen S, Kiukaanniemi H, Ylikoski J, Mäkitie A. The effect of tightened hearing protection regulations on military noise-induced tinnitus. Int J Audiol 2009;48:394-400.


Results tinnitus prevalence
Results – Tinnitus Prevalence Military NIHL and Tinnitus

  • Total Tinnitus Prevalence

    • Period I (1984-1986): 71%

    • Period II (2003-2005): 68%

  • Officers

    • Period I: 68%

    • Period II: 63%

  • NCOs

    • Period I: 76%

    • Period II: 72%

  • significance


Results severe tinnitus
Results – Severe Tinnitus Military NIHL and Tinnitus

  • division:

    • no tinnitus / mild / constant or disturbing

    • constant or disturbing tinnitus Period II vs. I:

      • Cox regression analysis:

      • HR 0.6, 95% CI 0.37-0.96, p=0.032


Results tinnitus questionnaire
Results – Tinnitus Questionnaire Military NIHL and Tinnitus

  • available only during Period II (2003-2005)

  • localization: left 46% right 30% both 23%

  • high-pitched 90%


Tinnitus related problems
Tinnitus – Related Problems Military NIHL and Tinnitus


Conclusions
Conclusions Military NIHL and Tinnitus

  • regulations are effective in reducing hearing loss

  • regulations are effective in reducing serious tinnitus

  • tinnitus prevalence did not improve in direct relation to hearing loss improvement

  • retiring military professionals are young

    • NIHL & tinnitus are a serious threat to the quality of life - preventable !


Significance of Long-Term Tinnitus Military NIHL and TinnitusMrena R, Savolainen S, Kuokkanen J, Ylikoski J. Characteristics of tinnitus induced by acute acoustic trauma: a long-term follow-up. Audiol Neurotool 2002;7:122-130.

  • 418 conscripts with AAT: 100% tinnitus

  • 15 years later: 65% tinnitus


Results possible factors
Results – Possible Factors Military NIHL and Tinnitus

  • actual use of protectors

    • reasons?

  • leisure activities?


Always wear hearing protection
Always Wear Hearing Protection! Military NIHL and Tinnitus


Thank you ! Military NIHL and Tinnitus


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