LM309 - Translating Military Epidemiology Research to the Clinic: Tools from the NOISE Study

Abstract:
The Noise Outcomes in Service members Epidemiology (NOISE) study is a longitudinal, epidemiologic study on hearing health in military Service members and Veterans. Several questionnaires, including the Tinnitus Screener (TS), Tinnitus and Hearing Survey (THS), and Lifetime Exposure to Noise and Solvents Questionnaire (LENS-Q) were developed by the NOISE Study team. These instruments can help us gather information about how a patient perceives their tinnitus and hearing and assesses their noise exposure history. Capturing the noise exposure profile of a patient through questionnaires can help us facilitate patient management and understand how auditory and non-auditory disorders impact quality of life.

Summary:
The Noise Outcomes in Service Member Epidemiology (NOISE) study explores relationships between military and non-military exposures on the prevalence and effects of auditory-related problems among active Service members (SM) and recently-separated Veterans. Active-duty military SMs and Veterans have a higher risk of experiencing tinnitus and hearing loss, likely due to noise exposure and other factors related to military service. An epidemiology study allows us to capture an abundance of information on the prevalence, etiology and effects of early-onset tinnitus and hearing loss which may help inform preventative and clinical services. Currently, there is no universal method to identify individuals who are at an increased risk of hearing loss or tinnitus due to noise exposure.

Tinnitus Screener (TS):
The Tinnitus Screener is a 6-item questionnaire that determines whether tinnitus is present and if so, if the perception is constant or intermittent. This instrument allows us to distinguish between chronic versus acute tinnitus duration. Overall, this tool can be used both as a positive/negative screen for tinnitus as well as classify the frequency of its occurrence.

Tinnitus and Hearing Survey (THS):
Oftentimes, patients may misattribute their hearing difficulties due to their tinnitus, or vice versa. The Tinnitus and Hearing Survey is a brief questionnaire that can be used to distinguish tinnitus-related problems from hearing-related difficulties. It is a very helpful counseling tool to help patients and clinicians discuss the underlying nature of their hearing healthcare needs.

Lifetime Exposure to Noise and Solvents Questionnaire (LENS-Q):
The Lifetime Exposure to Noise and Solvents Questionnaire is a comprehensive questionnaire used to capture lifetime history of noise exposure events, including exposure to potentially ototoxic chemicals/solvents from military service, non-military service and non-occupational or recreational sources. The instrument consists of yes or no questions to gather important information concerning exposure duration, frequency, and use of hearing protection of other safety equipment.

Clinical Application:
The instruments described in this learning module can be used as quick tools to help assess for tinnitus and hearing dysfunction related to recreational noise exposure, noise exposure related to military service and occupational noise exposure that is not related to military service. The TS can be used if a patient has specific questions about tinnitus, part of a routine case history, or before or after an audiologic assessment to determine if a patient has tinnitus and if they would like to pursue further tinnitus management. The THS allows the clinician to determine the source of the patient’s auditory complaint and proceed with the appropriate intervention. The results of the LENS-Q are essential in characterizing the noise exposure profile of a patient to understand potential risk factors for hearing loss and tinnitus. The instruments developed by the NOISE Study may help benefit patient outcomes in an audiology clinic setting and guide patient management. Additionally, all measures may be completed before or after audiologic assessment to be used as a framework for patient counseling. The TS, THS and LENS-Q are freely available online to download for use in an audiology clinic.