Effects of Noise and Other Exposures on Auditory Functioning in Post-9/11 Veterans: NOISE Study 3.0

关于听力损失的流行病学、病因学、病理生理学和合并症知之甚少， 耳鸣在军队人口。因此，退伍军人事务部（VA）无法预测 暴露在噪音中的军人听力障碍的风险。除此之外，许多其他 军事和非军事暴露可导致听觉损伤，包括溶剂、爆炸和其他来源的辐射。 创伤性脑损伤（TBI）和某些其他损伤和医疗状况。非军事（例如，娱乐） 或军事后曝光（即，退伍军人的职业暴露）也可能导致长期风险。是 耳鸣的病因是什么？耳鸣的病因是什么？ 以及它们之间的相互关系。这样的理解可以帮助识别有听觉障碍风险的个体。 伤害，并最终导致急需的康复方法，针对根本原因。 2012年，为了响应医学研究所（IOM;现在的国家科学院）的建议， 医学）在他们的国会授权的报告，题为“噪音和军事服务： 听力损失和耳鸣”，我们组建了一个由听力学、流行病学和健康服务研究人员组成的团队 VA康复研究与发展（RR&D）国家康复听觉中心 研究（NCRAR）设计了一项纵向研究，重点关注最近退伍军人的听觉健康。噪声 2013年，在职成员流行病学研究（“NOISE研究”）获得资助[国会 定向医学研究计划（CDMRP）资助#W81XWH-12- PRMRP-IIRA]。该研究招募 退伍军人在2.5年的军事分离，使我们能够衡量他们的军事风险在一个 合理的召回期。2014年，美国国防部（DoD）听力卓越中心（HCE; San Antonio，TX）作为第二个研究中心加入，以增加入组人数并扩大目标人群，包括 现役军人。HCE的招生于2015年6月开始。现时的建议 申请资助，以继续开展NCRAR研究中心未来4年的研究活动。（HCE是否应该 没有从国防部获得持续的资金，他们的参与者将由NCRAR团队跟踪。） 自NOISE研究开始以来，已收集了NCRAR的644名退伍军人的基线数据， 373名服务人员参加了HCE（两个研究中心共招募了1，017名参与者）。基线检查 包括一个完整的听力测试电池与广泛的调查组成部分。参与者完成年度跟踪- 调查（在线），以捕获持续的暴露以及健康和功能的任何变化。面对面 听力学检查每5年重复一次，使我们能够识别随着时间的推移听觉功能的变化 并将这些变化与退伍军人过去的军事暴露和/或正在进行的非军事暴露进行对比。为 建议的继续研究（NOISE研究3.0），我们将扩大数据收集，以解决当前和 在听觉健康领域不断发展的兴趣，包括专注于爆炸作为一个危险因素的结果， 听觉功能，并测试中枢听觉处理障碍（CAPD）和耳蜗突触病。 这些努力将产生一个前所未有的流行病学数据集，揭示横截面和纵向 广泛的暴露、医疗和心理健康状况、外周听觉 功能、中枢听觉功能和耳鸣。可供查阅的资料包括一系列研究报告， 分析和建议，特别侧重于：估计事件耳鸣和听力损失 服兵役后，并确定处于危险中的亚群体; 听力和耳鸣;耳蜗突触病和中枢听觉 伴有耳鸣和感知听力的功能障碍;以及听觉功能障碍和 心理困扰对9/11后退伍军人生活质量的影响临床可交付成果包括以下调查的验证： 捕捉噪音和化学暴露，并区分偶尔从慢性耳鸣。

Little is known regarding the epidemiology, etiology, pathophysiology, and comorbidities of hearing loss and tinnitus in the military population. The Department of Veterans Affairs (VA) is consequently unable to predict the risk of auditory disorders in Service members exposed to noise. Compounding this problem, many other military and non-military exposures can cause auditory injury, including solvents, blasts and other sources of traumatic brain injury (TBI), and certain other injuries and medical conditions. Non-military (e.g., recreational) or post-military exposures (i.e., Veterans' occupational exposures) may also contribute to long-term risk. It is critical to attain a fundamental understanding of the epidemiology and pathophysiology of tinnitus and hearing loss, as well as their interrelatedness. Such an understanding could help identify individuals at risk for auditory injury, and ultimately lead toward much-needed rehabilitation methods that target the underlying causes. In 2012, in response to recommendations made by the Institute of Medicine (IOM; now the National Academies of Medicine) in their congressionally-mandated report titled, “Noise and Military Service: Implications for Hearing Loss and Tinnitus,” we assembled a team of audiology, epidemiology, and health services researchers at the VA Rehabilitation Research & Development (RR&D) National Center for Rehabilitative Auditory Research (NCRAR) to design a longitudinal study focused on auditory health in recent Veterans. The Noise Outcomes In Service members Epidemiology Study (“NOISE Study”) was funded in 2013 [Congressionally Directed Medical Research Programs (CDMRP) grant #W81XWH-12- PRMRP-IIRA]. The study enrolls Veterans within 2.5 years of military separation, allowing us to measure their military exposures within a reasonable recall period. In 2014, the Department of Defense (DoD) Hearing Center of Excellence (HCE; San Antonio, TX) was added as a second site to increase enrollment and to expand our target population to include active-duty military Service members. Enrollment at the HCE began in June 2015. The present proposal requests funding to continue study activities for the next 4-year period for the NCRAR site. (Should the HCE not receive continuation funding from the DoD, their participants will be followed by the NCRAR team.) Since the NOISE Study's inception, baseline data have been collected on 644 Veterans at the NCRAR and 373 Service members at the HCE (1,017 participants enrolled across the two sites). The baseline examination includes a full audiologic test battery with an extensive survey component. Participants complete annual follow- up surveys (online) to capture ongoing exposures and any changes in health and functioning. The in-person audiologic examination is repeated every 5 years, allowing us to identify changes in auditory function over time and contrast those changes with Veterans' past military exposures and/or ongoing non-military exposures. For the proposed continuation study (NOISE Study 3.0), we will expand data collection to address current and evolving interests in the field of auditory health, to include focusing on blast as a risk factor for outcomes of auditory functioning, and testing for central auditory processing disorder (CAPD) and cochlear synaptopathy. These efforts will produce an unprecedented epidemiologic dataset revealing cross-sectional and longitudinal associations between a wide range of exposures, medical and mental health conditions, peripheral auditory function, central auditory function, and tinnitus. Deliverables include a series of research reports containing analyses and recommendations with a special focus on: estimates of incident tinnitus and hearing loss following military service and identifying sub-populations at-risk; individual and population-level trajectories of hearing and tinnitus; estimates of the association between cochlear synaptopathy and central auditory dysfunction with incident tinnitus and perceived hearing ability; and confluence of auditory dysfunction and mental distress on quality of life in post-9/11 Veterans. Clinical deliverables include validation of surveys for capturing noise and chemical exposures and distinguishing occasional from chronic tinnitus.