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Innovative Hearing Injury Therapies Help Doctors Improve Patient Outcomes

Image of Innovative Hearing Injury Therapies Help Doctors Improve Patient Outcomes. Lt. Cmdr. Mancini, assigned to Navy Medicine Readiness and Training Command Sigonella, performs an ear exam on Hospital Corpsman 3rd Class Maci Briscoe, assigned to Helicopter Maritime Strike Squadron (HSM) 46, aboard the Nimitz-class aircraft carrier USS George H. W. Bush.

Hearing loss can impact readiness and is a serious issue for service members. According to the Department of Veterans Affairs, hearing problems are one of the most prevalent service-connected disabilities among American veterans.

However, advancements in hearing health care, including new 3D ear models and updated guidance for treating sudden sensorineural hearing loss and acute noise-induced hearing loss, may lead to better outcomes for those impacted by hearing issues.

Two experts from the Defense Health Agency’s Hearing Center of Excellence recently updated military health providers on these developments during a September 2023 Clinical Community Speaker Series briefing, provided by the DHA Continuing Education Program Office. The series offers continuing education credits and helps ensure health care professionals actively treating military patients are afforded the latest in evidence-based professional development to improve health and

Guidance on Management of Sudden Sensorineural Hearing Loss

Dr. Carlos Esquivel, HCE’s chief medical officer, offered guidance on diagnosis and treatment of sudden sensorineural hearing loss, commonly known as sudden deafness, a serious problem requiring immediate treatment.

“SSNHL hearing loss occurs rapidly over a 72-hour period,” said Esquivel. “It is often very difficult to diagnose and treat.”

Patients with SSNHL may not present with a complaint of hearing loss at first, said Esquivel, which can be confusing for the provider. Instead, around 80% of patients will have acute symptoms of tinnitus.

“Tinnitus is an abnormal sound heard in the ears or head,” said Esquivel. “It can be described in various ways from crickets to buzzing to hissing.”

Other symptoms include a feeling of fullness in the ear. About a third of patients may have vertigo, a feeling of dizziness or movement.

According to Esquivel, there are about 4,000 cases of SSNHL per year in the U.S. with highest rates occurring in 50- to 60-year-olds. The cause of sudden hearing loss is unknown.

Esquivel emphasized the importance of early treatment for the best chance of recovery. He recommended patients be referred to an ear, nose, and throat physician and audiology within 24-72 hours. Treatment may include prednisone, a steroid medicine.

Providers should refamiliarize themselves with tuning fork exams to help with diagnosis, Esquivel said. “We all learned as medical students how valuable they are. In otolaryngology, we walk around with one of these in our pocket. This can give us a lot of clinical insight into people's hearing.”

Acute Noise-Induced Hearing Loss

Esquivel also provided the Acoustic Trauma Protocol, new guidance for acute noise-induced hearing loss, an injury to the inner ear caused by sharp, sudden noises.

“Noise exposure can decrease our hearing momentarily lasting from days to weeks,” said Esquivel. “They may recover. However, for a good portion of patients, they do not recover.”

Service members can be exposed to harmful noise during military service in combat, training, and general job duties. Noise can come from gunfire, explosives, rockets, heavy weapons, jets and other aircraft, and machinery, according to HCE.

“Unfortunately, we do have high incidence of hearing loss in the military, for both acute and chronic noise exposure,” said Esquivel.

A Fiscal Year 2021 Military Hearing Conservation Report showed the percent of hearing-impaired service members increased slightly from 14.5% in fiscal year 2020 to 14.7% in FY21. Civilians saw a gradual decrease from 46.1% in FY13 to 42.2% in FY21.

Like SSNHL, noise-induced hearing loss symptoms include ear fullness and tinnitus. Treatment is also similar.

“When the patient presents with ear fullness and tinnitus after a recent exposure to a sound, you would work these individuals very similar to sudden sensorineural hearing loss,” said Esquivel. “Get them to an audiologist as quickly as possible… once they get beyond one or two weeks, successful treatment for these individuals falls off quite considerably and the probability of permanent hearing loss increases.”

3D Ear Models

A new, interactive 3D ear model is now available on Health.mil, as an educational tool to help people better understand the complex anatomy of the ear.

“3D ear models can be used to better communicate with patients and educate providers,” said Dr. Theresa Schulz, HCE’s chief of prevention and surveillance. “When we think of the ear, we think of this thing that holds up our glasses, and this is not all there is to it,” said Schulz. “There’s a lot more inside, and these 3D interactive models give us vision to be able to see that,” Schulz said.

With the model now available, Schulz said it will enable use and access across the MHS and beyond. “We hope that patients, educators, providers, and others will find these models useful,” she said.

Schulz and her team worked with the ear, nose, and throat otolaryngology community and the audiology community to compile a list of 14 common ear issues, including barotrauma, canal cancer, ear tubes, mastoiditis, and swimmer’s ear. They developed the models in partnership with the Army Game Studio.

“It started as one model and evolved into 17 different 3D files,” said Schulz. “There are two normal anatomy files. One is an unlabeled cross section of the ear you're used to seeing. The other is labeled for use in training programs, or anybody who's trying to learn the anatomy of the ear.”

Schulz shared that the models are already in use and gave an example of one provider discussing ear tube insertion with parents before surgery using the model to explain the process.

Schulz also shared the significance of getting feedback from the field.

“We would really love for you to let us know how you're using them,” she said. “I hope you find unique ways to use them.”

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