Estimated Prevalence of Functional Hearing Difficulties in Blast-Exposed Service Members With Normal to Near–Normal-Hearing Thresholds
Authors: Grant Ken W. , Kubli Lina R. , Phatak Sandeep A. , Galloza Hector , Brungart Douglas S. 
Published: June 2021

Objectives:
Over the past decade, U.S. Department of Defense and Veterans Affairs audiologists have reported large numbers of relatively young adult patients who have normal to near-normal audiometric thresholds but who report difficulty understanding speech in noisy environments. Many of these service members also reported having experienced exposure to explosive blasts as part of their military service. Recent studies suggest that some blast-exposed patients with normal to near–normal-hearing thresholds not only have an awareness of increased hearing difficulties, but also poor performance on various auditory tasks (sound source localization, speech recognition in noise, binaural integration, gap detection in noise, etc.). The purpose of this study was to determine the prevalence of functional hearing and communication deficits (FHCD) among healthy Active-Duty service men and women with normal to near-normal audiometric thresholds.

Design:
To estimate the prevalence of such FHCD in the overall military population, performance of roughly 3400 Active-Duty service members with hearing thresholds mostly within the normal range were measured on 4 hearing tests and a brief 6-question survey to assess FHCD. Subjects were subdivided into 6 groups depending on the severity of the blast exposure (3 levels: none, far away, or close enough to feel heat or pressure) and hearing thresholds (2 levels: audiometric thresholds of 20 dB HL or better, slight elevation in 1 or more thresholds between 500 and 4000 Hz in either ear).

Results:
While the probability of having hearing difficulty was low (≈4.2%) for the overall population tested, that probability increased by 2 to 3 times if the service member was blast-exposed from a close distance or had slightly elevated hearing thresholds (>20 dB HL). Service members having both blast exposure and mildly elevated hearing thresholds exhibited up to 4 times higher risk for performing abnormally on auditory tasks and more than 5 times higher risk for reporting abnormally low ratings on the subjective questionnaire, compared with service members with no history of blast exposure and audiometric thresholds ≤20 dB HL. Blast-exposed listeners were roughly 2.5 times more likely to experience subjective or objective hearing deficits than those with no-blast history.

Conclusions:
These elevated rates of abnormal performance suggest that roughly 33.6% of Active-Duty service members (or approximately 423,000) with normal to near–normal-hearing thresholds (i.e., H1 profile) are at some risk for FHCD, and about 5.7% (approximately 72,000) are at high risk, but are currently untested and undetected within the current fitness-for-duty standards. Service members identified as “at risk” for FHCD according to the metrics used in the present study, in spite of their excellent hearing thresholds, require further testing to determine whether they have sustained damage to peripheral and early-stage auditory processing (bottom-up processing), damage to cognitive processes for speech (top-down processing), or both. Understanding the extent of damage due to noise and blast exposures and the balance between bottom-up processing deficits and top-down deficits will likely lead to better therapeutic strategies.