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

噪音和其他暴露对 9/11 后退伍军人听觉功能的影响：噪音研究 3.0

• 批准号: 10188321
• 负责人: JAMES A HENRY
• 金额: --
• 依托单位: PORTLAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10188321
• 关键词: Academy; Acoustic Nerve; Address; Adverse effects; Affect; Animals; Audiology; Auditory; Award; Behavioral; Central Auditory Diseases; Central Auditory Processing Disorder; Chemical Exposure; Chemicals; Chronic; Clinical; Clinical Research; Cochlea; Communication; Data; Data Collection; Data Set; Department of Defense; Distress; Electrophysiology (science); Enrollment; Environmental Exposure; Epidemiology; Etiology; Evaluation; Event; Explosion; Exposure to; Functional disorder; Funding; Future; Goals; Grant; Hair Cells; Health; Health Services; Healthcare; Hearing; Hearing problem; High-Frequency Hearing Loss; Human; Individual; Injury; Inner Hair Cells; Institute of Medicine (U.S.); Intervention; Lead; Life Cycle Stages; Longitudinal Studies; Measures; Medical; Medical Research; Medicine; Mental Health; Methods; Military Personnel; Modeling; Nerve Fibers; Nervous system structure; Noise; Occupational Exposure; Occupations; Outcome; Participant; Pathway interactions; Pattern; Peripheral; Persons; Phase; Physiological; Population; Prevention; Prevention strategy; Psyche structure; Quality of life; Recommendation; Rehabilitation Centers; Rehabilitation therapy; Reporting; Request for Proposals; Research; Research Personnel; Research Support; Risk; Risk Factors; Role; Seminal; Series; Services; Site; Societies; Solvents; Source; Surveys; Synapses; Target Populations; Testing; Time; Tinnitus; Traumatic Brain Injury; United States Department of Veterans Affairs; Validation; Veterans; Work; active duty; auditory processing; auditory rehabilitation; blast exposure; cell injury; cochlear synaptopathy; comorbidity; cost; design; disability; early onset; epidemiology study; follow up assessment; follow-up; hearing impairment; hearing loss risk; insight; interest; military service; ototoxicity; physical conditioning; post 9/11; prevent hearing loss; programs; rehabilitation research; research and development; response; service member; treatment strategy

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.

关于听力损失和听力损失的流行病学、病因学、病理生理学和合并症，人们知之甚少。 因此，退伍军人事务部 (VA) 无法预测军人耳鸣的情况。 暴露在噪音中的军人有听力障碍的风险，还有许多其他问题使这一问题变得更加复杂。 军事和非军事暴露可能导致听觉损伤，包括溶剂、爆炸和其他来源的 创伤性脑损伤 (TBI) 以及某些其他非军事损伤和医疗状况（例如娱乐性损伤）。 或退伍后暴露（即退伍军人的职业暴露）也可能导致长期风险。 对于耳鸣和听力的流行病学和病理生理学有基本的了解至关重要 损失以及它们的相互关系可以帮助识别面临听力风险的个体。 损伤，并最终导致针对根本原因的急需的康复方法。 2012 年，响应医学研究所 (IOM；现为国家科学院) 提出的建议 医学）在他们的帝国授权报告中，题为“噪音和兵役：对 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 退伍军人管理局康复研究与发展 (RR&D) 国家听力康复中心 研究 (NCRAR) 设计了一项针对近期退伍军人听觉健康的纵向研究。 Outcomes In Service 成员流行病学研究（“NOISE 研究”）于 2013 年获得资助 [国会批准 定向医学研究计划 (CDMRP) 拨款#W81XWH-12- PRMRP-IIRA]。 退伍军人在军事分离 2.5 年内，使我们能够在一段时间内衡量他们的军事暴露程度 2014 年，国防部 (DoD) 听力卓越中心 (HCE；San) 德克萨斯州安东尼奥）被添加为第二个站点，以增加入学人数并扩大我们的目标人群以包括 HCE 于 2015 年 6 月开始招收现役军人。目前的提案 请求资金以在未来 4 年期间继续 NCRAR 站点的研究活动。 （如果没有获得国防部的持续资助，他们的参与者将由 NCRAR 团队跟踪。） 自噪声研究启动以来，NCRAR 和 NCRAR 已收集了 644 名退伍军人的基线数据 HCE 共有 373 名军人（两个基地共注册了 1,017 名参与者）。 包括完整的听力测试电池和广泛的调查组件，参与者完成年度跟踪。 进行调查（在线）以捕获持续的暴露以及健康和功能的任何变化。 听力学检查每 5 年重复一次，使我们能够识别听觉功能随时间的变化 并将这些变化与退伍军人过去的军事暴露和/或持续的非军事暴露进行对比。 在拟议的继续研究（噪声研究 3.0）中，我们将扩大数据收集以解决当前和 人们对听觉健康领域的兴趣不断变化，其中包括将爆炸作为导致听觉健康结果的危险因素 听觉功能，以及中枢听觉处理障碍（CAPD）和耳蜗突触病的测试。 这些将产生前所未有的流行病学工作数据集，揭示横截面和纵向 各种暴露、医疗和心理健康状况、外周听觉之间的关联 功能、中枢听觉功能和耳鸣的可交付成果包括一系列研究报告，其中包含。 分析和建议，特别关注： 耳鸣和听力损失事件的估计 跟踪服兵役情况并确定有风险的亚人群； 听力和耳鸣；耳蜗突触病与中枢听觉之间关联的估计 伴有耳鸣和感知听力能力的功能障碍；以及听觉功能障碍和 9/11 事件后退伍军人生活质量的精神困扰包括对调查的验证。 捕捉噪音和化学物质暴露并区分偶尔耳鸣和慢性耳鸣。