Increased risk of psychiatric disorder in patients with hearing loss: a nationwide population-based cohort study.

BACKGROUND: Hearing loss has been shown to be a risk factor for psychiatric disorders. In addition, long-term hearing loss is associated with increased hospitalization and mortality rates; however, the increased risk and duration of effect of hearing loss in combination with other chronic diseases on each psychiatric disorder are still not clearly defined. The purpose of this article is to clarify the risk of hearing loss for each disorder over time. METHODS: This was a retrospective cohort study, and a national health insurance research database in Taiwan was utilized. All (n = 1,949,101) Taiwanese residents who had a medical visit between 2000 and 2015 were included. Patients with hearing loss and a comparative retrospective cohort were analyzed. Every subject was tracked individually from their index date to identify the subjects who later received a diagnosis of a psychiatric disorder. The Kaplan‒Meier method was used to analyze the cumulative incidence of psychiatric disorders. Cox regression analysis was performed to identify the risk of psychiatric disorders. RESULTS: A total of 13,341 (15.42%) and 31,250 (9.03%) patients with and without hearing loss, respectively, were diagnosed with psychiatric disorders (P < 0.001). Multivariate analysis indicated that hearing loss significantly elevated the risk of psychiatric disorders (adjusted HR = 2.587, 95% CI 1.723-3.346, p < 0.001). CONCLUSION: Our findings indicate that patients with hearing loss are more likely to develop psychiatric disorders. Furthermore, the various psychiatric disorders are more likely to occur at different times. Our findings have important clinical implications, including a need for clinicians to implement early intervention for hearing loss and to pay close attention to patients' psychological status. Trial registration TSGHIRB No. E202216036.

C-Phycocyanin Attenuates Noise-Induced Cochlear Synaptopathy via the Inhibition of Oxidative Stress and Intercellular Adhesion Molecule-1 in the Cochlea.

The synapses between inner hair cells (IHCs) and spiral ganglion neurons (SGNs) are the most vulnerable structures in the noise-exposed cochlea. Cochlear synaptopathy results from the disruption of these synapses following noise exposure and is considered the main cause of poor speech understanding in noisy environments, even when audiogram results are normal. Cochlear synaptopathy leads to the degeneration of SGNs if damaged IHC-SGN synapses are not promptly recovered. Oxidative stress plays a central role in the pathogenesis of cochlear synaptopathy. C-Phycocyanin (C-PC) has antioxidant and anti-inflammatory activities and is widely utilized in the food and drug industry. However, the effect of the C-PC on noise-induced cochlear damage is unknown. We first investigated the therapeutic effect of C-PC on noise-induced cochlear synaptopathy. In vitro experiments revealed that C-PC reduced the H2O2-induced generation of reactive oxygen species in HEI-OC1 auditory cells. H2O2-induced cytotoxicity in HEI-OC1 cells was reduced with C-PC treatment. After white noise exposure for 3 h at a sound pressure of 118 dB, the guinea pigs intratympanically administered 5 µg/mL C-PC exhibited greater wave I amplitudes in the auditory brainstem response, more IHC synaptic ribbons and more IHC-SGN synapses according to microscopic analysis than the saline-treated guinea pigs. Furthermore, the group treated with C-PC had less intense 4-hydroxynonenal and intercellular adhesion molecule-1 staining in the cochlea compared with the saline group. Our results suggest that C-PC improves cochlear synaptopathy by inhibiting noise-induced oxidative stress and the inflammatory response in the cochlea.

Ultrasound Microbubbles Enhance the Efficacy of Insulin-Like Growth Factor-1 Therapy for the Treatment of Noise-Induced Hearing Loss.

The application of insulin-like growth factor 1 (IGF-1) to the round window membrane (RWM) is an emerging treatment for inner ear diseases. RWM permeability is the key factor for efficient IGF-1 delivery. Ultrasound microbubbles (USMBs) can increase drug permeation through the RWM. In the present study, the enhancing effect of USMBs on the efficacy of IGF-1 application and the treatment effect of USMB-mediated IGF-1 delivery for noise-induced hearing loss (NIHL) were investigated. Forty-seven guinea pigs were assigned to three groups: the USM group, which received local application of recombinant human IGF-1 (rhIGF-1, 10 µg/µL) following application of USMBs to the RWM; the RWS group, which received IGF-1 application alone; and the saline-treated group. The perilymphatic concentration of rhIGF-1 in the USM group was 1.95- and 1.67- fold of that in the RWS group, 2 and 24 h after treatment, respectively. After 5 h of 118 dB SPL noise exposure, the USM group had the lowest threshold shift in auditory brainstem response, least loss of cochlear outer hair cells, and least reduction in the number of synaptic ribbons on postexposure day 28 among the three groups. The combination of USMB and IGF-1 led to a better therapeutic response to NIHL. Two hours after treatment, the USM group had significantly higher levels of Akt1 and Mapk3 gene expression than the other two groups. The most intense immunostaining for phosphor-AKT and phospho-ERK1/2 was detected in the cochlea in the USM group. These results suggested that USMB can be applied to enhance the efficacy of IGF-1 therapy in the treatment of inner ear diseases.

Increased incidence in hospitalised patients with sudden sensorineural hearing loss: a 14-year nationwide population-based study.

Objective: To conduct a 14-year nationwide study on the epidemiologic incidence in patients with sudden sensorineural hearing loss (SSNHL). Design: Retrospective cross-sectional design. Study sample: Data of patients hospitalised with the diagnosis of SSNHL from 2000 to 2013, extracted from the Taiwan National Health Insurance Research Database. Results: In total, 31,258 patients were included. The mean age was 50.30 ± 16.70 years. Males (53.5%) were more commonly diagnosed with SSNHL than females (46.5%). The patients most commonly presented with SSNHL were in the age group of 45-64 years. The crude incidence of SSNHL from 2000 to 2013 was 9.76 per 100,000 people per year. The annual incidence rate shows a steady increased from 5.15 in 2000 to 13.97 per 100,000 people in 2013 with a statistical significance (p < 0.001). Conclusion: This 14-year nationwide study indicated an increased incidence rate of SSNHL. This necessitates the development of additional treatment modalities to enhance the prognosis and the clarification of the underlying mechanism of this enigmatic disease.

The association of superior attachment of uncinate process with pneumatization of middle turbinate: a computed tomographic analysis.

The frontal sinus outflow pathway is complex and can be influenced by the configuration of the uncinate process (UP). The UP can attach superior to the lamina papyracea, skull base, and middle turbinate. The factors associated with superior attachment remain unclear. This study analyzed the relationships between different types of superior UP attachment and characteristics of the surrounding structures including the agger nasi cell, skull base, and middle turbinate. This retrospective study utilized computed tomography images of 836 sides with identifiable sinus structure from 434 Taiwanese patients. Types of superior UP attachment, height of the ethmoid cribriform plate, prevalence of agger nasi cell, and degree of pneumatization of the middle turbinate were analyzed. In the current study, neither the presence of an agger nasi cell nor height of the cribriform plate had significant relationship with superior UP attachment type. However, UP attachment type was statistically significantly associated with pneumatized middle turbinate (PMT) type (p < 0.01). The PMT group had a higher incidence of UP attachment to the middle turbinate (38%) than the non-PMT group (18%). In the extensive PMT group, the incidence of UP attachment to the middle turbinate was high to 49%. In conclusion, superior UP attachment to the middle turbinate was associated with pneumatization of the middle turbinate. The UP has a greater tendency to attach to the middle turbinate in cases with more PMT.

Synergistic effects of TiO2 and Cu2O in UV/TiO2/zeolite-based systems on photodegradation of bisphenol A.

In this study, TiO2/zeolite (TZ)-based composite was utilized to degrade bisphenol A (BPA) under ultraviolet (UV) irradiation. The effects of the TiO2 and Cu2O doses in TZ and Cu2O/TiO2/zeolite (CTZ) on the rate of BPA removal were identified, respectively. The surface area of TZ declined as the TiO2 loading increased. The photodegradation rate (k) of BPA in the TZ and CTZ systems fitted pseudo-first-order kinetics. Under UV (365 nm) irradiation, the k values of TiO2 (20%)/zeolite (80%), TiO2 (40%)/zeolite (60%), TiO2 (60%)/zeolite (40%), and TiO2 (80%)/zeolite (20%) were 0.51, 0.55, 0.97, and 0.91 h-1, respectively. In the UV (365nm)/TiO2 (60%)/zeolite (40%) system, the k values of CTZ with 1%, 5%, 10%, 20%, and 30% Cu2O added were 1.50, 1.04, 1.15, 1.88, and 0.47h-1, respectively. The photocatalytic activity of TZ was enhanced by adding Cu2O. The optimal dosage of TiO2 in the TZ system was 60% and that of Cu20 in the CTZ system was 20%. p-Hydroxybenzaldehyde (p-HBA), p-hydroxyacetophenone (p-HAP), p-hydroxybenzoic acid (p-HBA acid) and hydroquinone (HQ) were intermediates ofBPA photodegradation in the UV/TZ system and the rates of degradation followed the order HQ > p - HBA acid > BPA > p - HAP > p - HBA.

Epidermal inclusion cyst of the soft palate and uvula in an infant.

Congenital epidermal inclusion cysts of the soft palate or the uvula are uncommon mass lesions, and there have been only limited case reports of these in the literature. Although epidermal cysts are benign in nature and develop slowly, mass lesions growing near the soft palate or the uvula can result in velopharyngeal insufficiency, affecting both speech and swallowing. We present such a condition in a 7-month-old male infant with an epidermal inclusion cyst involving both the soft palate and the uvula.

Synergistic effects between TiO2 and carbon nanotubes (CNTs) in a TiO2/CNTs system under visible light irradiation.

This study synthesized a TiO2/carbon nanotubes (CNTs) composite via the sol-gel method. The surface characteristics of the TiO2/CNTs composite were determined by X-ray diffraction, transmission electron microscopy, specific surface area analyser, ultraviolent (UV)-vis spectroscopy, X-ray photoelectron spectroscopy and Raman spectrometer. The photocatalytic activity ofthe TiO2/CNTs composite was evaluated by decolourizing C.I. Reactive Red 2 (RR2) under visible light irradiation. Furthermore, the effects of calcination temperature, pH, RR2 concentration, and the TiO2/CNTs composite dosage on RR2 decolourization were determined simultaneously. The optimal calcination temperature to generate TiO2 and the TiO2/CNTs composite was 673 K, as the percentage of anatase crystallization at this temperature was highest. The specific surface area of the TiO2/CNTs composite and TiO2 were 45 and 42 m2/g, respectively. The band gap of TiO2 and the TiO2/CNTs composite was 2.97 and 2.71 eV by UV-vis measurements, respectively. Experimental data indicate that the Ti-O-C bond formed in the TiO2/CNTs composite. The RR2 decolourization rates can be approximated by pseudo-first-order kinetics; moreover, only the TiO2/CNTs composite had photocatalytic activity under visible light irradiation. At pH 7, the RR2 decolourization rate constant of 0.5, 1 and 2 g/L TiO2/CNTs addition was 0.005, 0.0015, and 0.0047 min(-1), respectively. Decolourization rate increased as pH and the RR2 concentration decreased. The CNTs functioned as electron acceptors, promoting separation of photoinduced electron-hole pairs to retard their recombination; thus, photocatalytic activity of the TiO2/CNTs composite exceeded that of TiO2.

The role of carrier spectral composition in the perception of musical pitch.

Temporal envelope fluctuations of natural sounds convey critical information to speech and music processing. In particular, musical pitch perception is assumed to be primarily underlined by temporal envelope encoding. While increasing evidence demonstrates the importance of carrier fine structure to complex pitch perception, how carrier spectral information affects musical pitch perception is less clear. Here, transposed tones designed to convey identical envelope information across different carriers were used to assess the effects of carrier spectral composition to pitch discrimination and musical-interval and melody identifications. Results showed that pitch discrimination thresholds became lower (better) with increasing carrier frequencies from 1k to 10k Hz, with performance comparable to that of pure sinusoids. Musical interval and melody defined by the periodicity of sine- or harmonic complex envelopes across carriers were identified with greater than 85% accuracy even on a 10k-Hz carrier. Moreover, enhanced interval and melody identification performance was observed with increasing carrier frequency up to 6k Hz. Findings suggest a perceptual enhancement of temporal envelope information with increasing carrier spectral region in musical pitch processing, at least for frequencies up to 6k Hz. For carriers in the extended high-frequency region (8-20k Hz), the use of temporal envelope information to music pitch processing may vary depending on task requirement. Collectively, these results implicate the fidelity of temporal envelope information to musical pitch perception is more pronounced than previously considered, with ecological implications.

GRAIL gene knockout mice protect against aging-related and noise-induced hearing loss.

BACKGROUND: Hearing loss is a global health issue and its etiopathologies involve complex molecular pathways. The ubiquitin-proteasome system has been reported to be associated with cochlear development and hearing loss. The gene related to anergy in lymphocytes ( GRAIL ), as an E3 ubiquitin ligase, has not, as yet, been examined in aging-related and noise-induced hearing loss mice models. METHODS: This study used wild-type (WT) and GRAIL knockout (KO) mice to examine cochlear hair cells and synaptic ribbons using immunofluorescence staining. The hearing in WT and KO mice was detected using auditory brainstem response. Gene expression patterns were compared using RNA-sequencing to identify potential targets during the pathogenesis of noise-induced hearing loss in WT and KO mice. RESULTS: At the 12-month follow-up, GRAIL KO mice had significantly less elevation in threshold level and immunofluorescence staining showed less loss of outer hair cells and synaptic ribbons in the hook region compared with GRAIL WT mice. At days 1, 14, and 28 after noise exposure, GRAIL KO mice had significantly less elevation in threshold level than WT mice. After noise exposure, GRAIL KO mice showed less loss of outer hair cells in the cochlear hook and basal regions compared with WT mice. Moreover, immunofluorescence staining showed less loss of synaptic ribbons in the hook regions of GRAIL KO mice than of WT mice. RNA-seq analysis results showed significant differences in C-C motif chemokine ligand 19 ( CCL19 ), C-C motif chemokine ligand 21 ( CCL21 ), interleukin 25 ( IL25 ), glutathione peroxidase 6 ( GPX6 ), and nicotinamide adenine dinucleotide phosphate (NADPH) oxidase 1 ( NOX1 ) genes after noise exposure. CONCLUSION: The present data demonstrated that GRAIL deficiency protects against aging-related and noise-induced hearing loss. The mechanism involved needs to be further clarified from the potential association with synaptic modulation, inflammation, and oxidative stress.

Verifying the accuracy of self-reported smoking behavior in female volunteer soldiers.

Smoking rates in the military are evaluated through questionnaire surveying. Because the accurate identification of smokers facilitates the provision of smoking cessation services, this study conducted urine cotinine concentration testing to verify the accuracy of self-reported smoking behavior by female volunteer soldiers and analyzed the effects of second-hand smoking on urine cotinine concentrations. This study is a cross-sectional study conducted using purposive sampling on female volunteer soldiers receiving training at the Taichung Recruit Training Center in May 2014. This study simultaneously collected questionnaires and urine samples, and urine samples were analyzed with an enzyme-linked immunosorbent assay. The self-reported smoking rate of female volunteer soldiers was 19.3%, whereas the smoking rate as determined by urine cotinine concentration testing was 26.3%, indicating an overall underestimation of 7.0%. Chi-square (χ2) goodness of fit test results indicated that the distribution of self-reported smoking behaviors and that verified from urine cotinine concentration testing were significantly different. The sensitivity of self-reported smoking behavior was 66.7% with a specificity of 97.6%. There was no significant association between second-hand smoking and urine cotinine concentrations. Questionnaire survey self-reporting methods could underestimate the smoking behavior of female volunteer soldiers and routine testing with biochemical verification is necessary.

Application of cuprous oxide synthesized from copper-containing waste liquid to treat aqueous reactive dye.

Cuprous oxide that was prepared from Cu-containing waste liquid from a printed circuit board manufacturer was used to carry out Fenton-like and photo-Fenton-like oxidation reactions to decolorize a reactive dye (RB19). A microwave hydrothermal method was applied in the synthesis. The highest recovery rate of Cu from wastewater was 87% and was obtained when the synthesis was performed at a power of 200 W for 15 min. An RB19 decolorization efficiency of 99.9% was achieved when the Fenton-like reaction was conducted with 50 mmol/L H(2)O(2) and 0.9 g/L of Cu(2)O. The decolorization of RB19 was more effective when the system was irradiated with visible light than with UV light. Under irradiation, the decolorization rate was the highest when the decolorization was performed in the RB19 solution that contained 50 mmol/L H(2)O(2) and 0.9 g/L CuO(2) in the Fenton-like and the 365 nm-irradiated photo-Fenton-like reactions. In the case of irradiation under 410 nm visible light, the system was operated with lower H(2)O(2) (30 mmol/L) and Cu(2)O (0.5 g/L) to achieve a decolorization rate higher than 365 nm-irradiated photo-Fenton-like reactions.

Photodegradation of aqueous reactive dye using TiO(2)/zeolite admixtures in a continuous flow reactor.

The photocatalytic degradation of an organic dye, i.e. reactive blue 19 (RB19), was studied by employing different TiO(2)/zeolite (TZ) photocatalysts, which have TiO(2)/(TiO(2) + zeolite) weight ratios ranging from 20 to 80%, in a continuous flow system. Three light sources including two UV lights (i.e. λ(max,254 nm) and λ(max,365 nm)) and natural sunlight were used. The results showed that the decoloring rate of RB19 increased as the amount of TiO(2) in the TZ catalyst increased. The photodegradation of RB19 exhibited pseudo-first-order kinetics with respect to the concentration of RB19. Almost 100% of initial RB19 was mineralized under the controlled conditions in this study. And the activities of the prepared photocatalysts were retained after long-term durability experiments. Compared with UV lights (i.e. λ(max,254 nm) and λ(max,365 nm)), the decoloring efficiency of RB19 was significantly increased under natural sunlight illumination, which is likely due to the long-wavelength incident light that photoexcited RB19 and accelerated the degradation rate of RB19 radicals by the UV fraction of sunlight.

Effect of non-metal doping on the photocatalytic activity of titanium dioxide on the photodegradation of aqueous bisphenol A.

Non-metals B, N, P and I were doped into titanium dioxide (TiO2) to form photocatalyst particles. TiO2 doped with various ratios of B, N, P and I were thus formed and these photocatalyst particles were bonded to fix each other in a column system under sunlight as a result of the photocatalytic degradation of bisphenol A (BPA). The doped TiO2 was characterized by X-ray diffraction (XRD), UV-visible absorption spectroscopy, and X-ray photoelectron spectroscopy (XPS) to elucidate the mechanism of doping reaction. Doping with B, N, P and I to form the photocatalyst greatly red-shifted the absorption wavelength, increasing the effectiveness of the photocatalyst in reducing BPA. XPS analysis following doping revealed the bonding of B, N, P, I and other functional groups of the surface of the photocatalyst. Results of an experiment that involved the photocatalysts revealed that BPA degradations of 88%, 94%, 93% and 100% in 66.5 min under sunlight using B, N, P, and I-doped titanium dioxide, respectively. The doped photocatalysts were all superior to the undoped titanium dioxide.

Combined Acupuncture-Hyperbaric Oxygen-Steroids Therapy for Idiopathic Sudden Sensorineural Hearing Loss: A Retrospective Observational Study.

Objectives: Acupuncture, widely used in Chinese society, has been studied as an adjunct treatment of idiopathic sudden sensorineural hearing loss (ISSNHL). The purpose of this study is to investigate the effectiveness of combined acupuncture and hyperbaric oxygen therapy (HBOT) with conventional steroid therapy for ISSNHL. Methods: This retrospective chart review enrolled 154 patients who met the ISSNHL criteria and were categorized into three groups according to the different treatment regimens. Among these patients, 43 underwent steroid therapy only (S) group, 74 received steroid and HBOT (S-H) group, and the remaining 37 were treated with combined acupuncture-HBOT in addition to steroid therapy (S-H-A) group. The outcome was determined by comparing the differences in pure-tone thresholds and absolute hearing gains after treatment calculated at each audiometric octave frequency or grouped frequencies of audiograms. Hearing recoveries classified into three grades: complete, partial, and poor were also analyzed and compared among different treatment groups. Results: All subjects presented with initial severe hearing loss with averaged hearing thresholds >70 dB. The S-H-A group exhibited good hearing improvement outcomes at each audiometric octave frequency and grouped frequencies of audiograms, with greater hearing gain and had more favorable outcomes in hearing recovery grades compared with the S group and the S-H group. Conclusions: The results obtained in this study revealed a preliminary finding of ISSNHL patients benefiting from combined acupuncture, HBOT, and conventional steroid therapy. Acupuncture is a safe and nonpharmacologic treatment option and can be considered as an initial treatment strategy in such a clinical scenario.

Inhibition of Cochlear HMGB1 Expression Attenuates Oxidative Stress and Inflammation in an Experimental Murine Model of Noise-Induced Hearing Loss.

Noise-induced hearing loss (NIHL) is a common inner ear disease but has complex pathological mechanisms, one of which is increased oxidative stress in the cochlea. The high-mobility group box 1 (HMGB1) protein acts as an inflammatory mediator and shows different activities with redox modifications linked to the generation of reactive oxygen species (ROS). We aimed to investigate whether manipulation of cochlear HMGB1 during noise exposure could prevent noise-induced oxidative stress and hearing loss. Sixty CBA/CaJ mice were divided into two groups. An intraperitoneal injection of anti-HMGB1 antibodies was administered to the experimental group; the control group was injected with saline. Thirty minutes later, all mice were subjected to white noise exposure. Subsequent cochlear damage, including auditory threshold shifts, hair cell loss, expression of cochlear HMGB1, and free radical activity, was then evaluated. The levels of HMGB1 and 4-hydroxynonenal (4-HNE), as respective markers of reactive nitrogen species (RNS) and ROS formation, showed slight increases on post-exposure day 1 and achieved their highest levels on post-exposure day 4. After noise exposure, the antibody-treated mice showed markedly less ROS formation and lower expression of NADPH oxidase 4 (NOX4), nitrotyrosine, inducible nitric oxide synthase (iNOS), and intercellular adhesion molecule-1 (ICAM-1) than the saline-treated control mice. A significant amelioration was also observed in the threshold shifts of the auditory brainstem response and the loss of outer hair cells in the antibody-treated versus the saline-treated mice. Our results suggest that inhibition of HMGB1 by neutralization with anti-HMGB1 antibodies prior to noise exposure effectively attenuated oxidative stress and subsequent inflammation. This procedure could therefore have potential as a therapy for NIHL.

Ultrasound Microbubble-Facilitated Inner Ear Delivery of Gold Nanoparticles Involves Transient Disruption of the Tight Junction Barrier in the Round Window Membrane.

The application of ultrasound microbubbles (USMBs) enhances the permeability of the round window membrane (RWM) and improves drug delivery to the inner ear. In this study, we investigated the efficiency of USMB-aided delivery of chitosan-coated gold nanoparticles (CS-AuNPs) and the mechanism of USMB-mediated enhancement of RMW permeability. We exposed mouse inner ears to USMBs at an intensity of 2 W/cm2 and then filled the tympanic bulla with CS-AuNPs or fluorescein isothiocyanate-decorated CS-AuNPs (FITC-CS-AuNPs). The membrane uptake of FITC-CS-AuNPs and their depth of permeation into the three-layer structure of the RWM, with or without prior USMB treatment, were visualized by z-stack confocal laser scanning microscopy. Ultrastructural changes in the RWM due to USMB-mediated cavitation appeared as sunburn-like peeling and various degrees of depression in the RWM surface, with pore-like openings forming in the outer epithelium. This disruption of the outer epithelium was paralleled by a transient reduction in tight junction (TJ)-associated protein levels in the RWM and an enhanced delivery of FITC-CS-AuNPs into the RWM. Without prior USMB exposure, the treatment with CS-AuNPs also caused a noticeable reduction in TJ proteins of the RWM. Our findings indicated that the combined treatment with USMBs and CS-AuNPs represents a promising and efficient drug and gene delivery vehicle for a trans-RWM approach for inner ear therapy. The outer epithelial layer of the RWM plays a decisive role in controlling the transmembrane transport of substances such as CS-AuNPs following the administration of USMBs. Most importantly, the enhanced permeation of AuNPs involved the transient disruption of the TJ-created paracellular barrier in the outer epithelium of the RWM.

The Immediate and Long-Term Impact of Military Aircraft Noise on Hearing: A Cross-Sectional Comparison of Fighter Pilots and Ground Staff.

We examined the immediate and long-term impacts of military aircraft noise exposure on noise-induced hearing loss (NIHL) in fighter pilots and ground staff. We recruited 40 pilots, 40 ground staff, and 136 age-matched controls; all participants underwent hearing tests, including conventional pure-tone audiometry (PTA) (0.25-8.0 kHz), extended high-frequency (EHF) audiometry (9.0-18.0 kHz), and distortion-product otoacoustic emission (DPOAE) as a recent reference. A subsequent hearing test immediately after flight-mission noise exposure was requested. The results revealed higher recent hearing thresholds in pilots and ground staff than in controls. Threshold shifts at many octave band frequencies were also significantly elevated in ground staff. The grouped frequency threshold was significantly elevated in the 4-8 kHz high-frequency range. After a single flight-mission noise exposure, both ground staff and pilots showed decreased signal-to-noise ratios for DPOAE (1-8 kHz), whereas only ground staff showed significantly elevated left-ear hearing thresholds at 3, 11.2, and 12.5 kHz by conventional and EHF PTA. Fighter pilots and ground staff serve in hazardous noise-exposed environments that cause hearing damage and subsequent NIHL, but ground staff may be more vulnerable. A comprehensive hearing conservation program should be implemented to protect high-risk service members, and especially ground staff, from high-intensity noise exposure.