Hearing Loss Prevention

People depend largely on their sense of hearing to provide essential cues for carrying out fundamental activities of daily living. When hearing is impaired to the extent that it affects speech intelligibility, it can restrict employment and recreational and social activities. Hearing loss compromises an individual's safety by hindering appropriate responses to alarms and warning signals such as doorbells, smoke alarms, and sirens. Permanent hearing loss also contributes to psychosocial and physical health problems resulting in job and revenue loss, depression, and social isolation. Such symptoms may continue despite costly and lengthy aural rehabilitation efforts. Data indicate an alarming increase in the prevalence and incidence of hearing loss at earlier stages in life, especially among men in the 35-to-60 age group. Widespread implementation of hearing loss prevention programs to reduce or eliminate preventable hearing loss is a tremendous public health need. Strategies for fulfilling this need include education on hearing loss prevention and research on causes of and evidence-based treatments for hearing loss, which can be translated into clinical practice.

The configuration of hearing loss is typically used to describe where an individual's hearing thresholds fall along a horizontal axis that represents the traditional speech frequency range, with lower frequencies first and higher frequencies later on the continuum. Thus, a sloping, high-frequency hearing loss configuration would describe the hearing impairment of an individual whose hearing thresholds are better at lower frequencies and progressively poorer at higher frequencies. This sloping, high-frequency configuration is commonly seen in age- (presbycusis), noise-, and medication-induced hearing losses, all of which tend to affect the higher-frequency regions first, then subsequently progress toward the mid- and lower-frequency regions. While some individuals are predisposed to presbycusis, hearing loss resulting from noise and ototoxic medications may be preventable if appropriate hearing preservation and early identification strategies are used.

Implementation of hearing loss prevention methods is preferable to and more cost-effective than aural rehabilitation. Surprisingly, no systematic model for hearing loss prevention, conservation, or early identification of either noise- or ototoxic-induced hearing loss exists within the Department of Veterans Affairs (VA) or the majority of other healthcare institutions. Hence, evidence-based hearing loss prevention and hearing conservation strategies have not as yet been widely implemented as standards of practice for audiologists. Early detection of hearing loss is paramount to creating opportunities for behavior changes that can prevent further damage. It is imperative that hearing loss prevention, conservation, early identification, and best practices for hearing healthcare delivery, quality, and outcomes be developed and implemented across the VA healthcare system and the nation.

Hearing conservation programs in the workplace and in the general population seek to increase compliance and effectiveness of hearing loss prevention protocols through audiometric screening tests and education on the dangers of noise exposure. Evidence has suggested that tailored, multimedia hearing loss prevention programs can improve attitudes, knowledge, and behavior concerning the prevention of hearing loss. An effective hearing loss prevention program consists of:

Audits performed to determine needs of work environment, labor, and management; assessment of noise exposures; engineering and administrative control of noise exposures; audiometric evaluation and monitoring of hearing; appropriate use of personal hearing protection devices; education and motivation; record keeping; evaluation of program effectiveness

While best practice procedures for hearing loss prevention and hearing conservation by early identification exist in other sectors including the Department of Defense and some private industry settings, the VA and the majority of other medical care institutions lack systematic models and system-wide implementation. The associated communication disabilities individuals with hearing loss encounter often render them socially disadvantaged or isolated and with a compromised quality of life. The VA and the national public health community bear the ethical and professional responsibility to ensure that patients receive appropriate hearing loss prevention and hearing conservation interventions to avoid or minimize preventable hearing losses. In addition, hearing loss prevention programs must be maintained in the workplace to eliminate noise-induced hearing loss.

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