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: 10604297
• 负责人: Kathleen F. Carlson
• 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 2025-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10604297
• 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; Noise; Occupational Exposure; Occupations; Outcome; Participant; Pathway interactions; Pattern; Peripheral; Persons; Phase; Physiological; Population; Prevention; Prevention strategy; Psyche structure; Quality of life; Recommendation; Recreation; 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; blast exposure; cell injury; cochlear synaptopathy; comorbidity; cost; design; disability; early onset; epidemiologic data; epidemiology study; follow up assessment; follow-up; hearing impairment; hearing loss risk; improved; information gathering; insight; interest; military service; noise exposure; ototoxicity; participant enrollment; physical conditioning; post 9/11; prevent hearing loss; programs; rehabilitation research; research and development; response; risk prediction; 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.

关于流行病学，病理学，病理生理学和听力丧失和合并症的知名度知之甚少 军事人口中的耳鸣。因此，退伍军人事务部（VA）无法预测 服务成员中听觉障碍的风险暴露于噪音。加剧了这个问题，许多其他 军事和非军事暴露会导致听觉伤害，包括解决方案，爆炸和其他来源 创伤性脑损伤（TBI）以及某些其他损伤和医疗状况。非军事（例如，娱乐活动） 或后军事暴露（即退伍军人的职业曝光）也可能导致长期风险。这是 至关重要的是对耳鸣的流行病学和病理生理学的基本理解和听力 损失以及他们的相互关系。这样的理解可以帮助识别有听觉风险的人 受伤，并最终导致急需的康复方法，这些方法针对潜在的原因。 2012年，为了回应医学研究所（IOM；现在的国家科学院）的建议 医学的）在其国会规定的报告中，标题为“噪音和兵役：对 听力损失和耳鸣，”我们组建了一个听力学，流行病学和卫生服务研究人员的团队 在VA康复研究与发展（RR＆D）国家康复礼堂中心 研究（NCRAR）设计了一项纵向研究，重点是最近退伍军人的听觉健康。噪音 服务成员的结果流行病学研究（“噪声研究”）于2013年资助[国会上 定向医学研究计划（CDMRP）授予＃W81XWH-12- PRMRP-IIRA]。研究注册 军事分离的2。5年之内的退伍军人，使我们能够在一个人中衡量他们的军事暴露 合理的召回期。 2014年，国防部（国防部）卓越听证会（HCE； SAN） 添加了安东尼奥，德克萨斯州）作为增加入学人数并扩大目标人群的第二个地点 现役兵役成员。 HCE的入学率从2015年6月开始。 请求资金继续在NCRAR网站的接下来的4年期间继续学习活动。 （应该是HCE 不收到国防部的延续资金，他们的参与者将在NCRAR团队之后。 自从噪声研究的成立以来，已经在Ncrar的644名退伍军人上收集了基线数据 HCE的373名服务成员（在两个站点中招募了1,017名参与者）。基线检查 包括带有广泛调查组件的完整听力测试电池。参与者完成年度关注 - 进行调查（在线）以捕获正在进行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，使我们能够随着时间的推移确定听觉功能的变化 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。为了 拟议的延续研究（噪声研究3.0），我们将扩展数据收集以解决当前和 在听觉健康领域不断发展的兴趣，包括将爆炸作为结果的风险因素 听觉功能以及中央听觉加工障碍（CAPD）和人工耳蜗突触病的测试。 这些努力将产生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，周围听觉之间的关联 功能，中央听觉功能和耳鸣。可交付成果包括一系列包含的研究报告 分析和建议特别关注：事件耳鸣和听力损失的估计值 服兵役并确定处于危险中的亚人群；个人和人口水平的轨迹 听力和耳鸣；人工耳蜗突触病与中央听觉之间的关联估计值 耳鸣和感知的听力能力的功能障碍；和听觉功能障碍和 9/11后退伍军人的生活质量的心理困扰。临床可交付成果包括对调查的验证 捕获噪声和化学曝光，并偶尔与慢性耳鸣区分开。