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Feature Article

A hands-on, multimedia approach to prevent hearing loss

Hearing loss affects more than 30 million Americans. When combined with tinnitus (a ringing, buzzing, or other type of noise that originates in the head), hearing issues are the most frequently found service-connected disability among American Veterans.

In fiscal year 2010, VA provided more than 580,000 hearing aids to Veterans, at an estimated cost of almost $200 million. At least one type of hearing loss—noise-induced hearing loss (NIHL), a disorder that results from exposure to high intensity sound, especially over a long period of time—can be prevented by taking appropriate precautions.

VA's National Center for Rehabilitative Auditory Research (NCRAR) has recently developed a program that teaches Service members and Veterans about the effects of both occupational and recreational exposure to noises, and counsels them on hearing protection methods.

The program is described in an article by NCRAR researchers titled "Computer-based hearing loss prevention education program for Veterans and military personnel." i The article is published as a guest editorial in Volume 49, Number 4, of VA's own Journal of Rehabilitation Research and Development. (You can read the article at

"Hearing loss and tinnitus prevention are priorities for VA, as they should be," said Robert L. Folmer, PhD, a researcher at NCRAR and a member of the department of otolaryngology at the Oregon Health and Science University. "Previous studies of hearing loss prevention education programs have found that it is relatively easy to increase participants' knowledge about how hearing works, how hearing is damaged by loud sounds, and how and when to employ protective strategies. However, it is more difficult to inspire participants to change existing behavior and to implement new strategies in real-life situations."

Folmer and others at NCRAR developed a self-administered, multimedia, computer-based program that can be set up and used in an outpatient clinic or in any common area in a hospital. The program includes a sound attenuated booth (an area in which outside sounds are significantly reduced). On one wall of the outside of the booth is a flat screen television describing what goes on inside.

On another exterior wall is a life-size model of an ear. Passers-by can place an ear bud from their own MP3 players inside the ear. A digital display shows how loud the music they are playing is in decibels (db)—and informs the passer-by that 80 db or less is a safe level for extended listening.

Inside the enclosure is a workstation with a computer touch screen monitor, a pair of high-quality headphones, and a chair. A printer and a personal computer to power the system are locked away in a cabinet. On-screen video and audio instructions show visitors how to correctly put the headphones on their ears, and how to set the volume of the program at a comfortable listening level.

Once the participant has settled in, he or she is asked a few demographic questions, including Veteran status, age, sex, and whether he or she has been around loud sounds, including loud music; weapons; and power tools in the past year. A two-minute video introduces the program and provides basic information about hearing, noise exposure, and hearing protection. (Watch the video at

When the video is over, participants can select from 10 activities on the touch screen, including:

  • Why, when and how to protect my hearing;
  • How do loud sounds damage hearing;
  • How loud is too loud;
  • Take a hearing screening test;
  • What does hearing loss sound like;
  • Different types of hearing protection;
  • Do my ear plugs fit properly;
  • Tinnitus;
  • Hearing health care services at VA; and
  • Information about NCRAR.

It takes 30 to 40 minutes to go through all of these modules, but people with limited time can select only the ones that interest them. When they finish the program, visitors are asked to answer three questions about whether the program has been valuable to them.

Booths are now installed at three locations: the Portland VA Medical Center; Joint Base Lewis-McChord, Wash.; and Fort Stewart, Ga. More than 3,000 people (2,000 men and 1,000 women) visited the booth in Portland between July 1, 2010 and June 1, 2012. (Data from the two military bases were not analyzed for this article.) About two-thirds of the men, and one-third of the women, had been around loud sounds that made their ear hurt or "ring" in the past year, and more than 80 percent of the men had used power tools or loud machinery in that time.

Despite this, nearly 30 percent of men, and nearly 50 percent of women, said they never used earplugs or other hearing protectors—and only one-sixth of the men (16.6 percent) and 7 percent of women always wore them when around loud sounds.

About half of those who visited the booth took the time to answer the three questions asked at the end of the program. An overwhelming majority (98 percent) of responders thought the program was a good way to provide information about hearing protection; a similarly large percentage (97 percent) would recommend the program to family, friends, and co-workers; and 92 percent said they would now be more likely to protect their hearing from loud sounds.

"Although actual implementation of hearing protection strategies is a better measure of compliance or behavioral change," said Folmer, "we believe that the participants' stated willingness to better protect their hearing is encouraging. We hope to make this program available to all Veterans, military personnel, and other members of the public by providing access through the Internet and at medical centers throughout the country."

NCRAR is now conducting a formal evaluation of the program, using personal noise dosimeters (sound level meters designed to measure the noise exposure of a person over a period of time), behavior assessments, and a questionnaire to assess the knowledge, attitudes, and behaviors of participants before and after they visit the booth.

NCRAR was established in 1997 at the Portland VAMC to study auditory problems, primarily in Veterans, and to develop treatments that will help all Americans. The Center's mission is to alleviate communication, social, and economic problems resulting from hearing loss and tinnitus.

i RL Folmer, GH Saunders, SM Dann, SE Griest, E Porsov, SA Fausti, MR Leek, "Computer-based hearing loss prevention education program for Veterans and Military Personnel," JRRD, Volume 49, Number 4, 2012.

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