Niebuhr David W, Completo John D, Helfer Thomas M, Chandler David W
Division of Preventive Medicine, Walter Reed Army Institute of Research, Silver Spring, MD 20910-7500, USA.
Mil Med. 2006 Feb;171(2):117-21. doi: 10.7205/milmed.171.2.117.
The Department of Defense Hearing Conservation Program requires that a reference audiogram be performed at initial entry training (IET), before noise exposure. In the Army, only Fort Sill, home of the field artillery, and Fort Benning, home of the infantry, are in compliance. All military applicants receive a screening audiogram at a military entrance processing station (MEPS) to qualify for service. This audiogram does not meet the Defense Occupational and Environmental Health Readiness System-Hearing Conservation (DOEHRS-HC) standard. Nevertheless, it has been proposed that the MEPS screen be used as the reference because of limited resources and time during IET medical in-processing.
A total of 11,816 individual reference audiograms performed at Fort Sill 95th Adjutant General Recruit Reception Center in 2000 were identified in the DOEHRS-HC database. Results of the MEPS screening audiograms were found for 11,311 (96%) of these individuals. The two audiograms were compared by frequency and ear and by using the two Department of Defense criteria for threshold shift.
A total of 14.49% (95% confidence interval, 14.48-14.50%) of audiograms using the three-frequency average difference and 23.19% (95% confidence interval, 23.18-23.20%) using the four-frequency difference in either ear demonstrated a threshold shift. The mean difference in intensity between the two audiograms ranged from 5 to 12 dB and varied by frequency and ear, with the greatest differences being seen at 500 and 6,000 kHz and in the left ear, compared with the right ear. The mean threshold level was higher for each frequency in the DOEHRS-HC audiogram, compared with the MEPS audiogram.
Approximately 15% of soldiers at Fort Sill in 2000 showed a clinically significant threshold difference between their MEPS screening and the DOEHRS-HC baseline audiogram. Methodological variations in testing and interval noise-induced hearing loss could account for these differences. The results do not support the use of the MEPS screening audiogram as the reference audiogram. Compliance with the Hearing Conservation Program in the Army would require either improving MEPS testing to DOEHRS-HC standards or performing baseline audiograms at all five IET sites.
美国国防部听力保护计划要求在初始入伍训练（IET）时、噪声暴露之前进行一次基准听力图检查。在陆军中，只有野战炮兵的驻地西尔堡和步兵的驻地本宁堡符合要求。所有军事申请人在军事入伍处理站（MEPS）接受一次筛查听力图检查以获得服役资格。这份听力图不符合国防职业与环境卫生准备系统-听力保护（DOEHRS-HC）标准。然而，由于在IET医疗入营过程中资源和时间有限，有人提议将MEPS筛查用作基准。
在DOEHRS-HC数据库中识别出2000年在西尔堡第95副官长新兵接待中心进行的总共11816份个人基准听力图。其中11311人（96%）有MEPS筛查听力图的结果。通过频率和耳朵，并使用国防部的两个阈值偏移标准对这两份听力图进行比较。
使用三频率平均差异时，任一耳朵的听力图中有14.49%（95%置信区间，14.48 - 14.50%）显示阈值偏移；使用四频率差异时，有23.19%（95%置信区间，23.18 - 23.20%）显示阈值偏移。两份听力图之间强度的平均差异在5至12分贝之间，随频率和耳朵而变化，与右耳相比，在500和6000千赫兹以及左耳处差异最大。与MEPS听力图相比，DOEHRS-HC听力图中每个频率的平均阈值水平更高。
2000年西尔堡约15%的士兵在MEPS筛查和DOEHRS-HC基线听力图之间显示出临床上显著的阈值差异。测试方法的差异和间隔期噪声性听力损失可能导致了这些差异。结果不支持将MEPS筛查听力图用作基准听力图。陆军要符合听力保护计划，要么将MEPS测试改进到DOEHRS-HC标准，要么在所有五个IET地点进行基线听力图检查。
