Danger of auditory impairment from impulse noise: A comparative study of the CHABA damage-risk criteria and those of the Federal Republic of Germany

Noise Exposure and Hearing Loss among Workers at a Hammer Forge Company

The National Institute for Occupational Safety and Health (NIOSH) evaluated continuous and impact noise exposures and hearing loss among workers at a hammer forge company. Full-shift personal noise exposure measurements were collected on forge workers across 15 different job titles; impact noise characteristics and one-third octave band noise levels were assessed at the forge hammers; and 4,750 historic audiometric test records for 483 workers were evaluated for hearing loss trends. Nearly all workers' noise exposures exceeded regulatory and/or recommended exposure limits. Workers working in jobs at or near the hammers had full-shift time-weighted average noise exposures above 100 decibels, A-weighted. Impact noise at the hammers reached up to 148 decibels. Analysis of audiometric test records showed that 82% of workers had experienced a significant threshold shift, as defined by NIOSH, and 63% had experienced a standard threshold shift, as defined by the Occupational Safety and Health Administration (OSHA). All workers with an OSHA standard threshold shift had a preceding NIOSH significant threshold shift which occurred, on average, about 7 years prior. This evaluation highlights forge workers' exposures to high levels of noise, including impact noise, and how their hearing worsened with age and length of employment.

Modeling Injury Risk From Multiple-Impulse, Area-Distributed Flash-bangs Using an Uncertainty Bounding Approach to Dose Accumulation

INTRODUCTION

Modeling of injury risk from nonlethal weapons including flash-bangs is a critical step in the design, acquisition, and application of such devices for military purposes. One flash-bang design concept currently being developed involves multiple, area-distributed flash-bangs. It is particularly difficult to model the variation inherent in operational settings employing such devices due to the randomness of flash-bang detonation positioning relative to targets. The problem is exacerbated by uncertainty related to changes in the mechanical properties of auditory system tissues and contraction of muscles in the middle ear (the acoustic reflex), which can both immediately follow impulse-noise exposure. In this article, we demonstrate a methodology to quantify uncertainty in injury risk estimation related to exposure to multiple area-distributed flash-bang impulses in short periods of time and analyze the effects of factors such as the number of impulses, their spatial distribution, and the uncertainties in their parameters on estimated injury risk.

MATERIALS AND METHODS

We conducted Monte Carlo simulations of dispersion and timing of a mortar-and-submunition flash-bang device that distributes submunitions over an area, using the Auditory 4.5 model developed by L3 Applied Technologies to estimate the risk of hearing loss (permanent threshold shift) in an exposure area. We bound injury risk estimates by applying limiting assumptions for dose accumulation rules applied to short inter-pulse intervals and varied impulse-noise-intensity exposure characteristic of multi-impulse flash-bangs. The upper bound of risk assumes no trading of risk between the number of impulses and intensity of individual impulses, while the lower bound assumes a perfectly protective acoustic reflex.

RESULTS

In general, the risk to individuals standing in the most hazardous zone of the simulation is quite sensitive to the pattern of submunitions, relative to the sensitivity for those standing farther from that zone. Larger mortar burst radii (distributing submunitions over a wider area) reduce expected peak risk, while increasing the number of submunitions, the intensity of individual impulses, or the uncertainty in impulse intensity increases expected risk. We find that injury risk calculations must factor in device output variation because the injury risk curve in the flash-bang dose regime is asymmetric. We also find that increased numbers of submunitions increase the peak risk in an area more rapidly than scene-averaged risk and that the uncertainty related to dose accumulation in the acoustic reflex regime can be substantial for large numbers of submunitions and should not be ignored.

CONCLUSIONS

This work provides a methodology for exploring both the role of device parameters and the choice of dose accumulation rule in estimating the risk of significant injury and associated uncertainty for multi-impulse, area-distributed flash-bang exposures. This analysis can inform decisions about the design of flash-bangs and training for their operational usage. The methodology can be extended to other device designs or deployment concepts to generate risk maps and injury risk uncertainty ranges. This work does not account for additional injury types beyond permanent threshold shift that may occur as a result of flash-bang exposure. A useful extension of this work would be similar work connecting design and operational parameters to human effectiveness.

Analytical and numerical modeling of the hearing system: Advances towards the assessment of hearing damage

Hearing is an extremely complex phenomenon, involving a large number of interrelated variables that are difficult to measure in vivo. In order to investigate such process under simplified and well-controlled conditions, models of sound transmission have been developed through many decades of research. The value of modeling the hearing system is not only to explain the normal function of the hearing system and account for experimental and clinical observations, but to simulate a variety of pathological conditions that lead to hearing damage and hearing loss, as well as for development of auditory implants, effective ear protections and auditory hazard countermeasures. In this paper, we provide a review of the strategies used to model the auditory function of the external, middle, inner ear, and the micromechanics of the organ of Corti, along with some of the key results obtained from such modeling efforts. Recent analytical and numerical approaches have incorporated the nonlinear behavior of some parameters and structures into their models. Few models of the integrated hearing system exist; in particular, we describe the evolution of the Auditory Hazard Assessment Algorithm for Human (AHAAH) model, used for prediction of hearing damage due to high intensity sound pressure. Unlike the AHAAH model, 3D finite element models of the entire hearing system are not able yet to predict auditory risk and threshold shifts. It is expected that both AHAAH and FE models will evolve towards a more accurate assessment of threshold shifts and hearing loss under a variety of stimuli conditions and pathologies.

Impulse noise injury prediction based on the cochlear energy

The current impulse noise criteria for the protection against impulse noise injury do not incorporate an objective measure of hearing protection. A new biomechanically-based model has been developed based on improvement of the Auditory Hazard Assessment Algorithm for the Human (AHAAH) using the integrated cochlear energy (ICE) as the damage risk correlate (DRC). The model parameters have been corrected using the latest literature data. The anomalous dose-response inversion behavior of the AHAAH model was eliminated. The modeling results show that the annular ligament (AL) parameters are the dominant cause of the non-monotonic dose-response behavior of AHAAH. Based on parametric optimization analysis, a 40% reduction of the AL compliance from the AHAAH default value removed the dose-response inversion problem, and this value was found to be within the physiological range when compared with experimental data. The transfer functions from the new model are in good agreement with those of the human ear. A dose-response curve based on ICE was developed using the human walk-up temporary threshold shift (TTS) data. Furthermore, the ICE values calculated for the German rifle noise tests show excellent comparison with the injury outcomes, hence providing a significant independent validation of the improved model. The ICE was found to be the best DRC to both large weapons and small arms noise injury data, covering both protected and unprotected exposures, respectively. The new AHAAH model with ICE as the dose metric is adequate for use as a medical standard against impulse noise injury.

Increased vitamin plasma levels in Swedish military personnel treated with nutrients prior to automatic weapon training

Noise-induced hearing loss (NIHL) is a significant clinical, social, and economic issue. The development of novel therapeutic agents to reduce NIHL will potentially benefit multiple very large noise-exposed populations. Oxidative stress has been identified as a significant contributor to noise-induced sensory cell death and NIHL, and several antioxidant strategies have now been suggested for potential translation to human subjects. One such strategy is a combination of beta-carotene, vitamins C and E, and magnesium, which has shown promise for protection against NIHL in rodent models, and is being evaluated in a series of international human clinical trials using temporary (military gunfire, audio player use) and permanent (stamping factory, military airbase) threshold shift models (NCT00808470). The noise exposures used in the recently completed Swedish military gunfire study described in this report did not, on average, result in measurable changes in auditory function using conventional pure-tone thresholds and distortion product otoacoustic emission (DPOAE) amplitudes as metrics. However, analysis of the plasma samples confirmed significant elevations in the bloodstream 2 hours after oral consumption of active clinical supplies, indicating the dose is realistic. The plasma outcomes are encouraging, but clinical acceptance of any novel therapeutic critically depends on demonstration that the agent reduces noise-induced threshold shift in randomized, placebo-controlled, prospective human clinical trials. Although this noise insult did not induce hearing loss, the trial design and study protocol can be applied to other populations exposed to different noise insults.

Attenuation of high-level impulses by earmuffs

Attenuation of high-level acoustic impulses (noise reduction) by various types of earmuffs was measured using a laboratory source of type A impulses and an artificial test fixture compatible with the ISO 4869-3 standard. The measurements were made for impulses of peak sound-pressure levels (SPLs) from 150 to 170 dB. The rise time and A duration of the impulses depended on their SPL and were within a range of 12-400 mus (rise time) and 0.4-1.1 ms (A duration). The results showed that earmuff peak level attenuation increases by about 10 dB when the impulse's rise time and the A duration are reduced. The results also demonstrated that the signals under the earmuff cup have a longer rise and A duration than the original impulses recorded outside the earmuff. Results of the measurements were used to check the validity of various hearing damage risk criteria that specify the maximum permissible exposure to impulse noise. The present data lead to the conclusion that procedures in which hearing damage risk is assessed only from signal attenuation, without taking into consideration changes in the signal waveform under the earmuff, tend to underestimate the risk of hearing damage.

Assessment of noise exposure for indoor and outdoor firing ranges

The National Institute for Occupational Safety and Health (NIOSH) received an employee request for a health hazard evaluation of a Special Weapons Assault Team (SWAT) in January 2002. The department was concerned about noise exposures and potential hearing damage from weapons training on their indoor and outdoor firing ranges. NIOSH investigators conducted noise sampling with an acoustic mannequin head and 1/4 -inch microphone to characterize the noise exposures that officers might experience during small arms qualification and training when wearing a variety of hearing protection devices provided by the department. The peak sound pressure levels for the various weapons ranged from 156 to 170 decibels (dB SPL), which are greater than the recommended allowable 140 dB SPL exposure guideline from NIOSH. The earplugs, ear muffs, and customized SWAT team hearing protectors provided between 25 and 35 dB of peak reduction. Double hearing protection (plugs plus muffs) added 15-20 dB of peak reduction.

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.

Evaluation of impulse noise criteria using human volunteer data

Four impulse noise auditory injury criteria adopted by NATO countries, namely, the MIL-STD-1474D (USA), Pfander (Germany), Smoorenburg (Netherlands), and L(Aeq8) (France), are evaluated against human volunteer data. Data from subjects wearing single-hearing protection exposed to increasing blast overpressure effects were obtained from tests sponsored by the US Army Medical Research and Material Command. Using logistic regression, the four criteria were each correlated with the test data. The analysis shows that all four criteria are overly conservative by 9.6-21.2 dB for the subjects as tested. The MIL-STD-1474D for single-hearing protection is 9.6 dB lower than the observed injury threshold for 95% protection with 95% confidence for this particular group of subjects as tested. Similar conclusions can be drawn for the other three criteria.

Monitoring noise susceptibility: sensitivity of otoacoustic emissions and subjective audiometry

The capacity of different audiological methods to detect a high noise susceptibility was examined in 20 normally hearing and 26 especially noise-susceptible subjects. The latter were selected from 422 soldiers in field studies: they had shown a temporary threshold shift (TTS) in pure tone audiometry (PTA) after regular training with firearms. In laboratory experiments, the TTS-positive soldiers were re-examined using greatly reduced sound intensities, which caused no TTS in a control subject group. Before and after acoustic stimulation, different subjective (PTA, high frequency audiometry (HFA), upper limit of hearing (ULH)) and objective (transiently evoked otoacoustic emissions (TEOAE), distortion products (DPOAE)) audiological tests were performed. After exposure to low impact noise in the laboratory, in both PTA and HFA, a TTS was observed in 11.5% (N = 3) of the noise-susceptible group (compared to 0% in the control group). In the TTS-positive group, deterioration of the ULH occurred in 28% (N = 7) (compared to 15% (N = 3) in the control group). An ULH improvement occurred in only one subject (3.8%) (compared to 25% (N = 5) in the control group). Significant alterations of click-evoked OAE-amplitudes were found in 26.9% (N = 7) of the selected groups, whereas stable emissions were observed in all but one subject (5%) of the control group. However, DPOAE alterations were seen in 19.2% (N = 5) of the TTS-positive soldiers but also in 25% (N = 5) of the control group. These results suggest that TEOAE provides a more sensitive and more objective method of detecting a subtle noise-induced disturbance of cochlear function than do PTA or DPOAE.

Effects of impulse noise on cortical response threshold and inner ear activity of succinic dehydrogenase and acetylcholinesterase in guinea pigs

The effects of impulse noise (firecrackers at 170 dB SPL, 1, 10, 20 rounds) on auditory cortical response threshold (CRT) and activity of succinic dehydrogenase (SDH) and acetylcholinesterase (AchE) in the inner ear were studied in 37 guinea pigs. The results showed that extent of damage in the cochlea was related to amount of exposure to the noise. Exposure to 10 rounds resulted in temporal threshold shift (TTS); to 20 rounds the result was permanent threshold shift (PTS). For the period when TTS existed, inverse correlation was noticed between enzyme activity change and CRT shift. The correlation could not be established when PTS was induced. The results suggest that the pathomechanism of PTS was more complex than that of TTS. The significance of the results is discussed.

Impulse noise and acute acoustic trauma in Finnish conscripts. Number of shots fired and safe distances

This prospective study of acute acoustic trauma (AAT) from exposure to impulse noise during compulsory military service focused on three issues the number of shot or explosion impulses that the conscript was exposed to at the time of AAT, distance of injured ear from causal firearm, and the circumstances under which AAT occurred protected ears. The series includes 449 consecutive, verified cases of AAT seen at the Central Military Hospital in Helsinki, Finland, in the period 1989-1993. AAT usually occurred during combat training (87%) as a result of exposure to impulses from small arms (83%). In 41%. AAT was caused by a single shot or detonation impulse. As many as 92% of all AATs occurred within 2 m of the causal firearm. Fourteen percent were wearing hearing protectors when the accident took place, but every third had badly fitting protectors or had neglected safety regulations and used insufficient protection. Of all AATs caused by one noise impulse in protected ears. 83% were attributable to heavy arms and only 14% to small arms. The results of the study suggest that combined use of earmuffs and earplugs in association with a safe distance of over 5 m from the noise source gives adequate protection against AAT. However, for conscripts using certain heavy arms e.g. hazooka. more effective hearing protection should be developed.

Physical characteristics of gunfire impulse noise and its attenuation by hearing protectors

The peak sound pressure level (SPL), spreading of pressure wave and other physical characteristics of the impulse noise from weapons were studied in actual shooting conditions for assessment of gunfire noise exposure. Additionally, the attenuation of SPL by hearing protectors was measured with miniature microphones to evaluate protection efficiency in real shooting conditions. The peak SPLs at the shooter's ear ranged from 132 dB (miniature rifle) to 183 dB (howitzer). The spectral content of the main part of the acoustic energy was less than 400 Hz (peak 16-100 Hz) for large-caliber weapons and 150-2,500 Hz (peak 900-1,500 Hz) for small-caliber weapons (rifles). The safe distances from the noise source (less than 140 dB peak SPL) were 50-200 m for large-caliber weapons. Rifle impulses (assault rifle, caliber 7.62) had a peak SPL of 154 dB at a distance of 4 m from the muzzle. The peak SPLs of different explosives ranged from 125 to 185 dB at distances of 10 to 300 m. In rifle shooting, the attenuation efficiency of earplugs (16dB) or small-volume (thin) earmuffs (17 dB) was not sufficient and their use as sole protectors cannot be recommended. Instead, large-volume earmuffs should be used. Impulses from pistol and shotgun were fairly effectively attenuated both by small-volume and large-volume earmuffs. All kinds of earmuffs appeared to be ineffective (attenuation less than 15 dB) against impulses from large-caliber weapons with energy content at very low frequencies. Therefore, the combined use of earmuffs and earplugs is recommended for the most noisy operations. On the basis of the present data, wider safety zones were adopted in the Finish Defence Forces at shooting with different weapons.

Risk of noise-induced hearing loss following exposure to Chinese firecrackers

Firecrackers produce sound impulses reaching peak levels measured at the ear sometimes in excess of 160 dB when fired at 2 m distance. These sound levels are potentially hazardous to the ear. Current damage risk criteria for impulse sounds show that for 10 impulses the peak levels should not exceed 149 dB(lin,peak) at the ear. The A-weighted, impulse (integration time 35 ms) levels should not exceed 125 dB(A,imp) at the ear for 10 impulses.

Hearing loss risk from exposure to shooting impulses in workers exposed to occupational noise

The effect of shooting impulses on hearing was analysed in 150 professional forest workers exposed to noise from chain saws. The exposure to shooting impulses (Lesi) was designed to take into account the peak levels of shooting impulses, their number and use of hearing protectors. Hearing loss was dependent on Lesi even after allowing for the age of subjects and their exposure to chain saw noise. Hearing threshold levels were compared between pairwise matched groups with high and low Lesi. Proper matching was achieved for age, chain saw noise, salicylate consumption, blood pressure, cholesterol, smoking and vibration-induced white finger symptoms. The workers with high Lesi had 9 dB greater hearing loss at 4 kHz and 10 dB greater hearing loss at 8 kHz than those with low Lesi, the difference being significant at P < 0.05 level. In evaluation of noise-induced hearing loss the exposure to shooting impulses from different calibre weapons should be determined since they increase the extent of hearing loss. The present study describes the Lesi method which more accurately evaluates the harmful effects of shooting noise impulses on hearing.

Delayed temporary threshold shift induced by impulse noises (weapon noises) in men

Most of the available information on the effects of impulse noise on hearing is derived from temporary threshold shift (TTS2) measurements performed 2 min after a single exposure to small-weapon noises. TTS is known to recover as a linear function of the logarithm of time when it is induced by a continuous noise of moderate intensity. Following the exposure to impulse noise, several investigators have reported individual exceptions to the log-time relation, e.g. increases in TTS during the first hour of recovery. These authors observed a 'rebound recovery function' for most of the exposed men, and they conclude that this phenomenon '... has implications for the use of TTS in the construction of damage risk criteria for hazardous noise exposure ..., a single measure, such as the widely used TTS2 may not be an adequate index of the magnitude of the TTS'. In order to thoroughly investigate in man the existence of 'delayed' TTS following the exposure to actual weapon noises, the 'French Committee on Weapon Noises' carried out the following study. Three groups of soldiers (28 subjects) wearing no hearing protection were exposed in the free field over 2 days to impulse noises produced by a rifle. Békésy audiograms were obtained from each subject just before the exposure, and at 5 min, 1 h and 4 h after exposure. All audiometric tests were carried out even when no TTS was observable in the first postexposure audiogram. A significant number of subjects showed a 'delayed TTS' and/or 'rebound recovery'. The maximum TTS was observed at 1 h after exposure, but the observation of a delayed recovery and a rebound recovery indicate that audiometric tests should be performed in all cases at least up to 4 h after the exposure. More detailed work is necessary to establish what changes may be necessary in the present damage risk criteria for impulse noises of a very high level.