Hearing Loss Is a Soldiers Dire Enemy

Mary Roach hits the firing range to discover what nearly every soldier knows: even mild hearing loss is devastating in battlefield situations, and earplugs, the common solution, may make things worse.”>

The United States Marine Corps buys a lot of earplugs. You find them all around Camp Pendleton: under the bleachers at the firing range, in the bottoms of washing machines. They are effective, and cheap as bullets,which also turn up in the washing machines. (And, though you didnt ask for it, heres one more similarity between bullets and earplugs: Both have been used by physicians to protect their ears from screams. The Army Medical Department Journal states that the real reason soldiers in the pre-anesthesia era were given a bullet to bite was not to help them endure the pain but to quiet their screams. And from a paper called The History and Development of the E-A-R Foam Earplug we learn that emergency room docs use foamies to block the screams of children during difficult procedures. This was part of a section on unusual applications, none of which were especially unusual. I may have had unreasonable expectations for the history of the foam earplug.)

For decades, earplugs and other passive hearing protection have been the main ammunition of military hearing conservation programs. There are those who would like this to change, who believe that the cost can be a great deal higher. That an earplug can be as lethal as a bullet.

Most earplugs reduce noise by 30-some decibels. This is helpful with a steady, grinding background dina Bradley Fighting Vehicle clattering over asphalt (130 decibels), or the thrum of a Black Hawk helicopter (106 decibels). Thirty decibels is more significant than it sounds. Every 3-decibel increase in a loud noise cuts in half the amount of time one can be exposed without risking hearing damage. An unprotected human ear can spend eight hours a day exposed to 85 decibels (freeway noise, crowded restaurant) without incurring a hearing loss. At 115 decibels (chainsaw, mosh pit), safe exposure time falls to half a minute. The 187-decibel boom of an AT4 anti-tank weapon lasts a second, but even that ultrabrief exposure would, to an unprotected ear, mean a permanent downtick in hearing.

Earplugs are less helpful when the sounds theyre dampening include a human voice yelling to get down, say, or the charging handle of an opponents rifle. A soldier with an average hearing loss of 30 decibels may need a waiver to go back out and do his job; depending on what that job is, he may be a danger to himself and his unit. What are we doing when we give them a pair of foam earplugs? says Eric Fallon, who runs a training simulation for military audiologists a few times a year at Camp Pendleton. Were degrading their hearing to the point where, if this were a natural hearing loss, wed be questioning whether theyre still deployable. If thats not insanity, I dont know what is.

Fallon is lecturing in a classroom at the moment, but after lunch the audiologists in attendance will experience some live-fire simulated combat. Working with the Department of Defense Hearing Center of Excellence, Fallon contracted a company, ArmorCorps, who in turn brought in a team of Marine Corps Special Operations forces, and together theyve set up a half day of warfare scenarios. The aim being to provide the hearing professionals with a firsthand feel for the frustrations and dangers of the current approach, with the hope that theyll become advocates for something better.

Fallon turns the class over to ArmorCorps Craig Blasingame, a former Marine with a wide superhero jaw and muscles so big that when he walks in front of the slide projector, entire images can be viewed on his forearm. Though its ten in the morning, Craig has a five oclock shadow.

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The hearing professionals and myself are joined for the tactical exercise by 12 men from a Marine Corps Special Operations unit, the name of which Ive been asked to omit. Aaron briefs the lot of us.

You are a Special Operations team heading into a village in Afghanistan, he begins. The mission is to make a liaison with the village elders. Engage the elders, ask about Taliban activity in the area. Ask them about their quality of life. What their problems are. Perhaps fit them for hearing aids. In support of the operation, we have a Predator drone in the overhead, and quick access to an assault weapons team: Cobras or Hueys. If things go kinetic we can call them up for supporting fire. Going kinetic is military shorthand for people are firing guns at you. In this case, theyre imaginary people, but the Spec Ops guys will be shooting back anyway, because this is an exercise about communicating in the chaos and clamor of combat.

Were instructed to turn our radios to channel 7 and line up behind one of the Special Ops guys, two of us per guy, as close as possible without hitting his boot heels. If he runs, you run, says Aaron. If he takes a knee, you take a knee. Myself and a middle-aged audiologist with braids poking down from her helmet get behind a short man who is hard to describe because all distinguishing features except his nose are obscured by gear of some kind. He introduces himself and says hi.

Hi, Im Mary, says the audiologist.

Me too, I say. Im also Mary.

Well, says our Special Ops guy, clearly unaccustomed to so much Mary. That does make it easy for me.

We set off into the scrub. Camp Pendleton is 200 square miles, with 17 miles of California coastline, much of it left wild for practice invasions and amphibious assaults. Its like a national park reserved for the U.S. Marine Corps and a lot of twitchy wildlife. (The grunts are forbidden to shoot the animals, but Im guessing it happens. Im guessing this because I recently visited the Camp Pendleton paintball range and asked to be shot to see what it feels like. Fifteen Marines volunteered. The one who did the deedfrom 70 feet, hitting me precisely where he wanted tocan be heard in the background of a researchers video going, That was very satisfying. [Its almost like he knows you, said the researcher.])

As we make our way across the terrain, a multiparty conversation unfolds in my ear cuffs. One man is talking with the drone operator, and someone else is communicating with the Cobra pilot and the attack controller. Everyone, including the president of the United States, if he wished to, can switch their comms to channel 7 and listen in. (When Navy SEALs stormed Osama bin Ladens compound, they were wearing TCAPS, and President Obama and Secretary of State Hillary Clinton were listening in.)

I dont know how often our guy has his talk button pressed and how far my voice behind him carries, but its possible that the transcript of this mission would be somewhat irregular:

Approaching village, over.

Copy, Liberty. Any update from the target site?

You need to put some sunscreen on the back of your neck.

This is Hammer in the overhead. We have four military-age (in Afghanistan, this means 12 and up, a designation we in the West innocently reserve for toys and board games ) males who appear to be orienting themselves to the objective area.

Copy that, Hammer.

So do the Taliban use hearing protection?

This is Hammer. Weve got an exodus of women and children from the village. Two other military-age males messing with something under a tarp.

Start surging assets.

Halo, you are approved for rockets and guns, over.

All these holes in the groundare they from mortars or, like

Prepare to attack!

gophers?

Attack imminent!

Simulated kinetics ensues. With Mary right behind me, I scramble to stay as close to our guys back as possible without rear-ending him when he stops to shoot. I try to picture what the group of us must look like, but my brain cant decide between Zero Dark Thirty and the Bunny Hop. I imagine officers walking back from lunch, one nudging the other: Whats going on out there?

Audiologists.

The mission ends back by the classroom. We turn in our gear and head inside for a Q&A session with the Special Operations men. They sit in mismatched office chairs in a row at the front of the room. How many of you, the first question goes, have hearing loss? All 12 raise a hand. By one (pre-TCAPS) study, Special Operators, as they are called, had the highest rates of hearing loss in the Army. Both in training and on the job, they spend a greater than average amount of time around explosives and large, noisy artillery. Unless theyre snipers. Theyre either very loud or very quiet, these men.

I dont understand, says a voice from the back row. As an audiologist, I never have people come in to my clinic going, Oh, my god, I cant hear! I had an incident, and now my hearing is diminished.

Chair number 8 explains: Guys want to go back in and do the job. If a hearing test turns up a loss in excess of a prescribed amount, it can mean being declared unfit for duty or having to secure a waiver to get around it. These are men who, by and large, love what they do. They avoid audiologists for the same reason they avoid doctors.

I dont want to stop doing what Im doing, agrees chair 3. When I take those tests How can I say this? I want to pass. So Im like, Okay, I think I hear a tone. Cheater!

Also? This is Special Operations. Oh, my god, I cant hear! is not in the script. When things go kinetic, theres a greater than 50 percent chance that a member of the team will be injured or killed. Hearing loss isnt something they spend time worrying about. Its a given. You expect, adds chair 2, that youre going to take some kind of degraded hearing on separation. Fallon told us that as an artilleryman, he wanted a hearing loss, because everyone in his unit had a hearing loss. If you didnt have a hearing loss, that meant you hadnt done anything. It might also mean you were born with a robust medialolivocochlear (MO) reflex, which directs the brain to lower the volume on egregiously loud sounds. Natures TCAPS. Naval Submarine Medical Research Laboratory researcher Lynne Marshall, who is here today, has been working to develop a simple test to identify people with weak MO reflexes so they can be given extra protection.

Chair 6 chimes in: Theyre pushing TCAPS for, like, Hey, protect your ears. But for us the main function is the comms. The situational awareness. According to a Hearing Center of Excellence fact sheet, 50 to 60 percent of ones situational awareness comes from hearing.

Fallon calls for one last question before we leave for dinner. Again, it comes from the back row. Its almost more of a plea: Has an audiologist ever done anything positive for any of you?

Yes, volunteers chair 5, a dark-haired, dark-eyed, just generally dark sort who hasnt said much until now. They fitted me for my hearing aids.

Whomp, wha? Virile, omnipotent Special Ops man wears hearing aids? My reaction is the same mildly stunned one I had upon reading that Angelina Jolie had had her breasts removed. The man went on to question the policy of declaring someone like him unfit for duty. We let people have devices for corrective vision. Well, I have a device that helps my hearing. Whats the difference? It occurs to me that the U.S. Special Operations Command may succeed at something perhaps more challenging than killing Osama bin Laden: erasing the stigma of hearing aids.

It is an interesting fact that retired four-star general David Petraeus was shot in the chest on a firing range but not, at the moment, a comforting one. Not that its Craig Blasingames job to be comforting. His job here at the Camp Pendleton firing range, and hes doing it nicely, is to knock out of us any complacence that might be lingering after the run-through of the nearest helicopter medevac points and what to do if searing hot bullet fragments fly down the back of our shirt while were firing our semiautomatic M16A4 assault rifle. (Just say, Hey, I got some brass.)

The Special Ops guys will be serving as our shooting tutors. Well be firing two magazines of ammo each, one with earplugs, one with TCAPS. Ostensibly, this is to demonstrate how hard it is to hear commands while shooting with passive hearing protection in place. It was also, Im guessing, audiologist bait: Come shoot M16s with the men of Special Operations! (Worked on me.)

Craig splits us into two groups, half on the firing line and the rest, including me, a few yards back in the ready box. Now if this isnt for you, Craig is saying, if you start to freak out, you can put your weapon down, put your hand up, and say, This isnt for me. If only war were like that.

To get an earplug far enough in to do its job, the pinnapart of the outer earmust be pulled out and back, an impossible task while wearing a combat helmet. No one, in the heat of a firefight, is going to pause to take off her helmet, pull back her ear, insert the plug, and repeat the whole process on the other side, and then restrap the helmet. Theres time for this on a firing range, and there might have been time on a Civil War battlefield, where soldiers got into formation before the call to charge. Back then, or out here, you knew when the mayhem was about to start, and you had time to prepare, whether that meant affixing bayonets or messing with foamies.

Theres no linear battlefield any more. The front line is everywhere. IEDs go off and things go kinetic with no warning. To protect your hearing using earplugs, youd have to leave them in for entire 13-hour patrols where, 95 percent of the time, nothing loud is happening. No one does that. Thats why Fallon says, The military doesnt have a noise problem. It has a quiet problem.

Group 2, yells Craig. Thats me. Advance to the firing line!

Hey, how are you? says my instructor. My names Jack. Jack is unlike the Special Ops guys I have met elsewhere. Hes friendly as a Labrador retriever, clean-shaven as a regional sales manager. Perhaps hes carrying out covert ops in San Diego or Scottsdale and, like the bearded Special Operators in al-Qaeda country, needs to blend in with the local male populace. Perhaps hes between missions.

Jack points to my helmet. Those straps need to go over your ear cuffs. Now thats going to make your helmet tighter, so you probably need to loosen them a little bit. One of the problems with over-the-ear TCAPS is not the equipment per se but the order in which gear is distributed. Helmet fittings used to happen before TCAPS gear was handed out. Guys would try to put their helmet on with the TCAPS headset and now it would be too tight. This seemingly minor planning boner has cost a lot of men a lot of hearing. The one time an IED exploded near Jack, he wasnt wearing his TCAPS. It was hot, and they were giving me a headache, so I opted not to wear them on that one patrol. And that was the one I got blown up on and had significant hearing loss. Aaron had the same thing.

To my right, an extremely lethal hearing professional has already emptied his first magazine. Im still battling my helmet straps. Let me help you, Jack says. I drop my hands to my lap and let him take over. Oops, I dont want to pull your hair. The gentle sniper.

Jack passes me the M16. Have you shot a gun like this before? I shake my very heavy head. He hands me a magazine and shows me where to load it. Ive seen this in moviesthe quick slap with the heel of the hand.

Hmm.

Other way. So the bullets are facing forward.

The M16 has a scope with a small red arrow in the center of the sight. You align the arrow with what or (jeez) whom you wish to shoot and squeeze the trigger. Both squeeze and pull are exaggerations of the motion applied to this trigger. Its a trivial, tiny movement, the twitch of a dreaming child. So quick and so effortless is it that its hard for me to associate it with any but the most inconsequential of acts. Flipping a page. Typing an M. Scratching an itch. Ending a life wants a little more muscle.

The crack of an M16 is around 160 decibels. Jack estimates hes fired a hundred thousand rounds in his ten-plus years in Special Operations. Weapons and explosions, rather than ongoing steady-state noise from vehicle engines and rotors (and MP3 playersaccording to the Department of Defense Hearing Center of Excellence, 12 to 16 percent of American children ages 6 to 19 have noise-induced hearing loss. And not from vacuuming and mowing the lawn. Full volume on an MP3 player is 112 decibels, enough to cause hearing loss after one minute. Have you seen Die Antwoord live? [120130 decibels.] Im sorry for your loss) are the biggest contributors to the $1 billion a year the Veterans Administration spends on hearing loss and tinnitus.

Most of those hundred thousand rounds may not even have registered, not because Jack had hearing protection on but because his attention was elsewhere. When you get in a gun fight and youre up close and personal, he says, your mind triages whats most important to you. Its a survival mechanism, called auditory exclusion. The possibility that you may lose a little hearing doesnt make the cut.

A sniper also doesnt, Im guessing, pay much mind to the kind of thing Im focused on right now: that raising your arms to hold a rifle while lying on your belly causes your ballistic vest to ride up and hit the back of your helmet, tilting it down over your forehead so that it pushes on your eye protection, causing the lenses to knife into your cheeks.

How do you do this job? The petulant writer. Jack doesnt answer for a moment. He must get this question a fair amount, and most of the people asking are not thinking about the aggravations of incompatible ballistic protection items.

Theres a lot to get used to.

Imagine the Special Operators were paid for their time today, but its also possible they did it for the steak. The Camp Pendleton catering staff have placed in front of Jack and myself a filet mignon the size of a grenade. Fallon got the fish. He looks like hes about to cry.

You know what the hardest thing for us is? (Apparently nothing. In 2008, a team of psychologists asked 19 snipers who had served in Afghanistan what theyd found most troubling. Ninety to 95 percent reported having little or no trouble with killing an enemy, handling or uncovering human remains, engaging in hand-to-hand combat, being wounded, having a buddy shot nearby, or seeing dead Canadians. [It was a Canadian study.]) Jack glances around the table. This right here.

Yeah. I get it. Strangers with their questions and assumptions.

It turns out Jack wasnt referring to any of that. By us he didnt mean snipers or Special Operators. He meant the hard of hearing. And this right here meant a loud dinner table. Jack says some of his peers cope by asking a lot of questions and pretending to hear the answers. You see them sitting there nodding, going, Uh huh, uh huh. Others just withdraw from the interaction.

A version of this withdrawal happens in combat. I tell Jack and Fallon about the work of a team of researchers with Walter Reeds National Military Audiology and Speech Center. Doug Brungart and Ben Sheffield have been documenting the effects of hearing loss on lethality and survivability. (Because the data-gathering requires Sheffield, with his clipboard, to run around in the midst of the action, military exercises stand in for actual combat.) Members of the 101st Airborne Division agreed to wear special helmets rigged with hearing loss simulators. Among the top-performing teams, even mild hearing loss caused a 50 percent decrease in kill ratio (the number of enemies eliminated divided by the number of surviving teammates). Not so much because their difficulty hearing was causing them to shoot or run in the wrong direction, but because they were unsure of what was going on. With their ability to communicate compromised, their actions were more tentative.

Withdrawal carries over to the home front. Brungart told me about a Marine hed worked with who had lost an arm and a leg and ruptured both eardrums in a blast. He told me far and away the worst of the injuries was the hearing loss, because he couldnt communicate with his wife and kids. Despite or possibly because of their low profile, the less visible injuries of war can be the hardest kind to have.

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