Thanks to extensive wounded-warrior efforts, the nation is more aware of the dangers of traumatic brain injury and post- traumatic stress disorder, and of the challenges and possibilities for amputees using prosthetic devices. But military men and women, in far greater numbers than the Pentagon numbers reflect, have sacrificed something else that is too seldom acknowledged: their hearing.
As of last year, 414,000 veterans of Iraq and Afghanistan had experienced service-related hearing loss, tinnitus (ringing in the ears) or both. According to the Centers for Disease Control and Prevention, veterans are 30 percent more likely to have severe hearing impairment than nonveterans; those who served after September 2001 are four times more likely.
Tinnitus and hearing loss are the top two most compensated disabilities in the Veterans Benefits Administration. And the incidence of auditory injury among soldiers is rising by 13 percent to 18 percent a year. In 2009, 18.2 out of 1,000 Marines experienced hearing loss. By 2012, that number was 28.7 out of 1,000.
"I don't think any young man or woman joining the Marine Corps thinks that in four years or in 40 years, you will come away from your experience serving your country deaf," Major General Robert Hedelund said recently in an address to the American Cochlear Implant Alliance, a nonprofit organization. "Yet significant hearing loss is a big part of their lives after their service."
Service members are exposed both to sudden, loud noises such as from improvised explosive devices (50 percent of those wounded in blasts experience permanent hearing loss) and to the sustained roar of aircraft and ship engines, which can be just as damaging. Hedelund, the commanding officer of the 2nd Marine Aircraft Wing, speaks from experience. He has flown helicopters for much of his 30-year career. Even wearing double hearing protection, he developed tinnitus in the first 10 years, and his hearing thresholds have dropped three times.
In Hedelund's last tour, he was director of Marine and Family Programs, which meant that wounded-warrior issues were part of his portfolio. "Frankly, I'm a little embarrassed that doing all the work with wounded warriors that we did, we never delved into the hearing piece of it," he said.
The military has had hearing-conservation programs in place for decades. Audiology got its start as a field after World War II, when an increase in hearing loss was already noticeable among veterans. Given the statistics, it would be hard to argue that prevention efforts have yielded great results.
One roadblock has been military culture. Hearing has been undervalued. For a long time, according to Hedelund and others, hearing loss was regarded as a necessary evil, even a badge of honor -- an indication that someone saw combat or flew fighter planes or was otherwise close to the action. Many soldiers on the ground don't wear their regulation earplugs because they have to listen carefully for signs of trouble.
Treatment is complicated because hearing loss may be one of several conditions soldiers bring home. Six years ago in Iraq, Mark Brogan, then an Army captain, suffered brain and spinal wounds, and his right arm almost was severed when a bomb exploded nearby. Brogan, now 33 and retired, also lost almost all his hearing, and told NBC News last year that the hearing loss and the brain injury were the worst of his injuries.
A 2006 report on noise in the military called for improving prevention and treatment. (The Department of Defense is responsible for prevention; costs for treatment fall on the Veterans Benefits Administration.) All services have increased the number of required hearing tests to better document the problem, though not all are performing those tests.
In 2012, the Department of Defense established a Hearing Center of Excellence, which calls hearing loss an epidemic and reminds soldiers that "not all injuries bleed."
It is also pushing Congress for line-item funding for more research on all aspects of noise-induced hearing loss, to encourage the same ingenuity in hearing technology that has been employed in improving prosthetic limbs. Other priorities include expanding research on medication that could retard hair-cell damage, and cracking the mysteries of tinnitus, about which little is known and little can be done.
You can't solve a problem until you acknowledge you have one. Hedelund called for more research cooperation between the military and academia, as well as investigation into whether there could be a role for active service members who use cochlear implants, which provide artificial hearing to those with severe to profound hearing loss, just as limited-duty jobs have been found for amputees using prosthetic limbs. These are good ideas that are beginning to catch on. A handful of active- duty service members have cochlear implants.
There is a cost to hearing loss. It's linked to diminished earning potential, anxiety and depression. The VA spends $2 billion a year in hearing-related disability benefits -- a number that is expected to rise to $5 billion in five years. Hearing aids can cost thousands; cochlear implants cost more and require considerable rehabilitation.
Noise-induced hearing loss is largely preventable. The military might succeed in reducing it by continuing to expand the amount of research it sponsors and the role of the Hearing Center of Excellence -- investments that would benefit all Americans.
Lydia Denworth is the author of the forthcoming "I Can Hear You Whisper: An Intimate Journey through the Science of Sound and Language."
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