Generalizability of clinically measured acoustic reflexes to brief sounds.

Middle ear muscle contractions (MEMC) can be elicited in response to high-level sounds, and have been used clinically as acoustic reflexes (ARs) during evaluations of auditory system integrity. The results of clinical AR evaluations do not necessarily generalize to different signal types or durations. The purpose of this study was to evaluate the likelihood of observing MEMC in response to brief sound stimuli (tones, recorded gunshots, noise) in adult participants (N = 190) exhibiting clinical ARs and excellent hearing sensitivity. Results revealed that the presence of clinical ARs was not a sufficient indication that listeners will also exhibit MEMC for brief sounds. Detection rates varied across stimulus types between approximately 20% and 80%. Probabilities of observing MEMC also differed by clinical AR magnitude and latency, and declined over the period of minutes during the course of the MEMC measurement series. These results provide no support for the inclusion of MEMC as a protective factor in damage-risk criteria for impulsive noises, and the limited predictability of whether a given individual will exhibit MEMC in response to a brief sound indicates a need to measure and control for MEMC in studies evaluating pharmaceutical interventions for hearing loss.

Acoustic reflexes are common but not pervasive: evidence using a diagnostic middle ear analyser.

OBJECTIVE: The objective of this study is to determine whether acoustic reflexes are pervasive (i.e. known with 95% confidence to be observed in at least 95% of people) by examining the frequency of occurrence using a friction-fit diagnostic middle ear analyser. DESIGN: Adult participants with very good hearing sensitivity underwent audiometric and middle ear testing. Acoustic reflexes were tested ipsilaterally and contralaterally in both ears across a range of elicitor frequencies. Reflex elicitors were 700 ms tones presented at maximum level of 100 dB HL. Two automated methods were used to detect the presence of an acoustic reflex. STUDY SAMPLE: A group of 285 adult volunteers with normal hearing. RESULTS: There were no conditions in which the proportion of participants exhibiting acoustic reflexes was high enough to be deemed pervasive. Ipsilateral reflexes were more likely to be observed than contralateral reflexes and reflexes were more common at 0.5 and 1 kHz elicitor frequencies as compared with 2 and 4 kHz elicitor frequencies. CONCLUSIONS: Acoustic reflexes are common among individuals with good hearing. However, acoustic reflexes are not pervasive and should not be included in damage risk criteria and health hazard assessments for impulsive noise.

Acoustic reflexes are common but not pervasive: evidence from the National Health and Nutrition Examination Survey, 1999-2012.

OBJECTIVE: To determine whether acoustic reflexes are pervasive (i.e. sufficiently prevalent to provide 95% confidence of at least 95% prevalence) and might be invoked in damage-risk criteria (DRC) and health hazard assessments (HHA) for impulsive noise. DESIGN: Cross-sectional analyses of a nationally-representative study. STUDY SAMPLE: National Health and Nutrition Examination Survey (NHANES) data collected between 1999 and 2012 were used. Over 60 thousand reflex traces obtained from 15,106 NHANES participants were used in the study, along with demographic, audiometric, health and exposure variables obtained in that study. RESULTS: Acoustic reflexes were not sufficiently prevalent to be deemed pervasive by any detection method or in any subgroup defined by age or audiometric characteristics. The odds of observing acoustic reflexes were greater for women, young adults, and people with better hearing sensitivity. Abnormally high tympanometric admittance and "Other" race/ethnicity (i.e. people who do not self-identify as exclusively Non-Hispanic White, Non-Hispanic Black, Mexican-American, or Hispanic) were associated with lower odds. CONCLUSIONS: Acoustic reflexes are not sufficiently prevalent to be included in DRC and HHA for impulsive noise.

Inter-laboratory comparison of three earplug fit-test systems.

The National Institute for Occupational Safety and Health (NIOSH) sponsored tests of three earplug fit-test systems (NIOSH HPD Well-Fit, Michael & Associates FitCheck, and Honeywell Safety Products VeriPRO). Each system was compared to laboratory-based real-ear attenuation at threshold (REAT) measurements in a sound field according to ANSI/ASA S12.6-2008 at the NIOSH, Honeywell Safety Products, and Michael & Associates testing laboratories. An identical study was conducted independently at the U.S. Army Aeromedical Research Laboratory (USAARL), which provided their data for inclusion in this article. The Howard Leight Airsoft premolded earplug was tested with twenty subjects at each of the four participating laboratories. The occluded fit of the earplug was maintained during testing with a soundfield-based laboratory REAT system as well as all three headphone-based fit-test systems. The Michael & Associates lab had the highest average A-weighted attenuations and smallest standard deviations. The NIOSH lab had the lowest average attenuations and the largest standard deviations. Differences in octave-band attenuations between each fit-test system and the American National Standards Institute (ANSI) sound field method were calculated (Attenfit-test - AttenANSI). A-weighted attenuations measured with FitCheck and HPD Well-Fit systems demonstrated approximately ±2 dB agreement with the ANSI sound field method, but A-weighted attenuations measured with the VeriPRO system underestimated the ANSI laboratory attenuations. For each of the fit-test systems, the average A-weighted attenuation across the four laboratories was not significantly greater than the average of the ANSI sound field method. Standard deviations for residual attenuation differences were about ±2 dB for FitCheck and HPD Well-Fit compared to ±4 dB for VeriPRO. Individual labs exhibited a range of agreement from less than a dB to as much as 9.4 dB difference with ANSI and REAT estimates. Factors such as the experience of study participants and test administrators, and the fit-test psychometric tasks are suggested as possible contributors to the observed results.

Effects of unilateral eye closure on middle ear muscle contractions.

Middle ear muscle contractions (MEMCs) are most commonly considered a response to high-level acoustic stimuli. However, MEMCs have also been observed in the absence of sound, either as a response to somatosensory stimulation or in concert with other motor activity. The relationship between MEMCs and non-acoustic sources is unclear. This study examined associations between measures of voluntary unilateral eye closure and impedance-based measures indicative of middle ear muscle activity while controlling for demographic and clinical factors in a large group of participants (N=190) with present clinical acoustic reflexes and no evidence of auditory dysfunction. Participants were instructed to voluntarily close the eye ipsilateral to the ear canal containing a detection probe at three levels of effort. Orbicularis oculi muscle activity was measured using surface electromyography. Middle ear muscle activity was inferred from changes in total energy reflected in the ear canal using a filtered (0.2 to 8 kHz) click train. Results revealed that middle ear muscle activity was positively associated with eye muscle activity. MEMC occurrence rates for eye closure observed in this study were generally higher than previously published rates for high-level brief acoustic stimuli in the same participant pool suggesting that motor activity may be a more reliable elicitor of MEMCs than acoustic stimuli. These results suggest motor activity can serve as a confounding factor for auditory exposure studies as well as complicate the interpretation of any impulsive noise damage risk criteria that assume MEMCs serve as a consistent, uniform protective factor. The mechanism linking eye and middle ear muscle activity is not understood and is an avenue for future research.

Analysis of army-wide hearing conservation database for hearing profiles related to crew-served and individual weapon systems.

Damage-risk criteria (DRC) for noise exposures are designed to protect 95% of the exposed populations from hearing injuries caused by those noise exposures. The current DRC used by the US military follows OSHA guidelines for continuous noise. The current military DRC for impulse exposures follows the recommendations from the National Academy of Sciences--National Research Council Committee on Hearing, Bioacoustics, and Biomechanics (CHABA) and are contained in the current military standard, MIL-STD-1474D "Noise Limits." Suggesting that the MIL-STD for impulse exposure is too stringent, various individuals have proposed that the DRC for exposure to high-level impulses be relaxed. The purpose of this study is to evaluate the current hearing status of US Army Soldiers, some of whom can be, by their military occupational specialties (MOS), reasonably expected to be routinely exposed to high-level impulses from weapon systems. The Defense Occupational and Environmental Health Readiness System--Hearing Conservation (DOEHRS-HC) was queried for the hearing status of enlisted Soldiers of 32 different MOSs. The results indicated that less than 95% of the Soldiers in the DOEHRS-HC database were classified as having normal hearing. In other words, the goal of the DRC used for limiting noise injuries (from continuous and impulse exposures) was not stringent enough to prevent hearing injuries in all but the most susceptible Soldiers. These results suggest that the current military noise DRC should not be relaxed.

Results of the National Institute for Occupational Safety and Health-U.S. Environmental Protection Agency interlaboratory comparison of American National Standards Institute S12.6-1997 Methods A and B.

The National Institute for Occupational Safety and Health and the Environmental Protection Agency sponsored the completion of an interlaboratory study to compare two fitting protocols specified by ANSI S12.6-1997 (R2002) [(2002). American National Standard Methods for the Measuring Real-Ear Attenuation of Hearing Protectors, American National Standards Institute, New York]. Six hearing protection devices (two earmuffs, foam, premolded, custom-molded earplugs, and canal-caps) were tested in six laboratories using the experimenter-supervised, Method A, and (naive) subject-fit, Method B, protocols with 24 subjects per laboratory. Within-subject, between-subject, and between-laboratory standard deviations were determined for individual frequencies and A-weighted attenuations. The differences for the within-subject standard deviations were not statistically significant between Methods A and B. Using between-subject standard deviations from Method A, 3-12 subjects would be required to identify 6-dB differences between attenuation distributions. Whereas using between-subject standard deviations from Method B, 5-19 subjects would be required to identify 6-dB differences in attenuation distributions of a product tested within the same laboratory. However, the between-laboratory standard deviations for Method B were -0.1 to 3.0 dB less than the Method A results. These differences resulted in considerably more subjects being required to identify statistically significant differences between laboratories for Method A (12-132 subjects) than for Method B (9-28 subjects).

A field investigation of hearing protection and hearing enhancement in one device: for soldiers whose ears and lives depend upon it.

Operational hearing protection and maintenance of audibility of signals and speech are considered force multipliers in military operations, increasing Soldier survivability and lethality. The in-field research described in this paper was conducted to examine operational performance effects of three different hearing enhancement protection systems (HEPS) that are intended to provide both protection and audibility. The experiment utilized operationally-defined measures in full-scale, simulated combat scenarios with Army ROTC Cadet Soldiers as subjects. The Soldiers' operational performance was evaluated in two missions: reconnaissance and raid (attack on enemy camp). Both missions had substantial hearing requirements, including communications, signal detection/recognition, and distance judgments. Operational performance was measured by objective metrics of Squad performance, including the distances required to detect an enemy insurgent camp under each HEPS, and by subjective metrics, such as the Army's dimensions of combat-related mission success as evaluated by Army Officers who served as training leaders/observers. Other subjective ratings were obtained after each training exercise from both the Officers and the Soldiers, including detailed impressions about each HEPS after extended use. Two of the three HEPS were electronic sound transmission devices (comprising an ambient sound pass-through filtering and amplification circuit): a Peltor Comtac II circumaural headset (NRR=21; 16 dB maximum gain); and a Communications Enhancement Protection System (CEPS) (NRR=29; 36 dB maximum gain). One passive, level-dependent HEPS was used, the yellow end of the Combat Arms Earplug, which provides amplitude-sensitive attenuation that sharply increases when the ambient sound is above about 110 dB (e.g., due to a gunshot), but which provides an NRR of 0 and very little attenuation below 1000 Hz in lower ambient noise levels. In the military mission entailing location of and attack on an enemy camp, the CEPS device resulted in the longest (earliest) average auditory detection distance of the camp (400 feet), followed by the Peltor (233 feet) and then the Combat Arms Earplug (150 feet), in comparison to detection by the unprotected, normal ear at about 220 feet. Commanding officers' ratings of mission performance and overall success slightly favored the electronic HEPS, but these ratings were dependent upon the particular mission undertaken. Ergonomics and usability issues abounded with the electronic HEPS, and the Soldiers' subjective ratings showed variability across all three devices, with device preference depending upon the particular dimension being rated (e.g., comfort vs. hearing ability). Clearly, the results of this in-field experiment demonstrate that more development is needed to achieve the levels of hearing performance and user acceptance from the HEPS that is desirable and needed for combat conditions. In this vein, it is important to note that HEPS designs are continually evolving, and certain upgrades to the three devices evaluated in the late 2006 timeframe of this study have occurred and further evaluations are thus warranted.

Human middle-ear muscles rarely contract in anticipation of acoustic impulses: Implications for hearing risk assessments.

The current study addressed the existence of an anticipatory middle-ear muscle contraction (MEMC) as a protective mechanism found in recent damage-risk criteria for impulse noise exposure. Specifically, the experiments reported here tested instances when an exposed individual was aware of and could anticipate the arrival of an acoustic impulse. In order to detect MEMCs in human subjects, a laser-Doppler vibrometer (LDV) was used to measure tympanic membrane (TM) motion in response to a probe tone. Here we directly measured the time course and relative magnitude changes of TM velocity in response to an acoustic reflex-eliciting (i.e. MEMC eliciting) impulse in 59 subjects with clinically assessable MEMCs. After verifying the presence of the MEMC, we used a classical conditioning paradigm pairing reflex-eliciting acoustic impulses (unconditioned stimulus, UCS) with various preceding stimuli (conditioned stimulus, CS). Changes in the time-course of the MEMC following conditioning were considered evidence of MEMC conditioning, and any indication of an MEMC prior to the onset of the acoustic elicitor was considered an anticipatory response. Nine subjects did not produce a MEMC measurable via LDV. For those subjects with an observable MEMC (n = 50), 48 subjects (96%) did not show evidence of an anticipatory response after conditioning, whereas only 2 subjects (4%) did. These findings reveal that MEMCs are not readily conditioned in most individuals, suggesting that anticipatory MEMCs are not prevalent within the general population. The prevalence of anticipatory MEMCs does not appear to be sufficient to justify inclusion as a protective mechanism in auditory injury risk assessments.

Speech intelligibility in noise using throat and acoustic microphones.

INTRODUCTION: Helicopter cockpits are very noisy and this noise must be reduced for effective communication. The standard U.S. Army aviation helmet is equipped with a noise-canceling acoustic microphone, but some ambient noise still is transmitted. Throat microphones are not sensitive to air molecule vibrations and thus, transmittal of ambient noise is reduced. It is possible that throat microphones could enhance speech communication in helicopters, but speech intelligibility with the devices must first be assessed. In the current study, speech intelligibility of signals generated by an acoustic microphone, a throat microphone, and by the combined output of the two microphones was assessed using the Modified Rhyme Test (MRT). METHODS: Stimulus words were recorded in a reverberant chamber with ambient broadband noise intensity at 90 and 106 dBA. Listeners completed the MRT task in the same settings, thus simulating the typical environment of a rotary-wing aircraft. RESULTS: Results show that speech intelligibility is significantly worse for the throat microphone (average percent correct = 55.97) than for the acoustic microphone (average percent correct = 69.70), particularly for the higher noise level. In addition, no benefit is gained by simultaneously using both microphones. A follow-up experiment evaluated different consonants using the Diagnostic Rhyme Test and replicated the MRT results. DISCUSSION: The current results show that intelligibility using throat microphones is poorer than with the use of boom microphones in noisy and in quiet environments. Therefore, throat microphones are not recommended for use in any situation where fast and accurate speech intelligibility is essential.

Effects of repetitive low-level blast exposure on visual system and ocular structures.

UNLABELLED: The purpose of this study was to determine whether repetitive exposure to low-level blasts during military breacher training produces acute and cumulative damage to the ocular tissues or visual system. The effects of low-level blast exposure on high-contrast visual acuity, contrast sensitivity, oculomotor function, color vision, visual field (VF), pupillary light reflex, corneal endothelial cell density (ECD), macular thickness, retinal nerve fiber layer thickness, and cup-to-disc ratio were assessed using a battery of standard clinical ophthalmic tests administered 10 times over a 2-year period. Data from nine breacher instructors (Cadre) were compared with data from four breacher engineers (CONTROL). The Cadre group showed higher vertical deviation at near than the CONTROL group over time. The VF mean deviation on the left eye that tended to be worse in the Cadre group was worse throughout the study, suggesting a decrease in VF sensitivity (Cadre: -0.20 +/- 0.15 dB; CONTROL: 1.05 +/- 0.15 dB; p = 0.03). The Cadre group had a reduced ECD (right eye: Cadre 2,502 cells/mm(2) vs CONTROL 2,808 cells/mm(2), p = 0.05; left eye: Cadre 2,558 cells/mm(2) vs CONTROL 2,892 cells/mm(2), p = 0.04). These results suggest that even low-level primary blast has the potential to produce occult eye injury.

Relations among early postexposure noise-induced threshold shifts and permanent threshold shifts in the chinchilla.

Threshold shifts (TS) were measured at various times following a wide variety of noise exposures on over 900 chinchillas. An analysis of postexposure TS measures and noise-induced permanent threshold shift (PTS) showed that, across audiometric test frequency, there was a consistent relation between these variables of the form PTS (dB) = alpha(e(TS/beta) - 1), where, for a given test frequency, alpha (dB) and beta (dB) are constants. TSs were measured immediately following exposure (TS0), 24 h after exposure (TS24), and at several intermediate times in order to estimate the maximum TS (TSmax). Correlation between TS and PTS at the various test frequencies was highest for TS24. An analysis of the 90th-percentile PTS showed a linear growth of PTS with TS24 of approximately 0.7 dB PTS/dB TS24. These data provide some support, in the chinchilla model, for a variation of the three postulates originally presented by Kryter et al. [J. Acoust. Soc. Am. 39, 451 (1966)]. Specifically: (i) TS24 is a consistent measure of the effects of a traumatic noise exposure. (ii) All exposures that produce a given TS24 will be equally hazardous. (iii) Noise-induced PTS in the most susceptible animals, following many years of exposure, is approximately equal to (0.7)TS24 measured after an 8-h exposure to the same noise.