The Washington PostDemocracy Dies in Darkness

We treat hearing loss as an inevitable cost of war. It shouldn’t be.

U.S. Marines attached to India Battery, 3rd Battalion, 12th Marine Regiment cover their ears as a 500 pound bomb is dropped on an enemy position during a 2010 firefight in Kajaki, Afghanistan. (Scott Olson/Getty Images)

I don’t remember the moment the bomb went off, but I do know that when I landed, stunned, at the bottom of the gun turret of my vehicle, blood was leaking from my ears. I was quickly evacuated to Bagram Air Force Base, where I saw an audiologist. I could barely hear a word he said, so he showed me a drawing of my eardrums. Only hanging shreds remained.

For weeks people would have to shout at me to even get me to notice them, and I was now stuck with the supremely tedious duty of mixing and pouring concrete into the fortified command post we would eventually abandon. Nothing is worse than watching your platoon roll out on patrol without you.

It was assumed that I would be permanently deaf.

If there is a single injury that afflicts military personnel more than any other, it would be hearing loss and and tinnitus, a ringing in the ears. Much of it is minor, but among troops who deployed multiple times, it becomes less of a nuisance and more of a disability and, depending on the nature of the damage, even standard solutions like hearing aids or surgery may not be much help.

It’s beyond simply having to ask people to repeat themselves over and over whenever there’s the least bit of background noise. Conversation among even small groups of friends becomes difficult. When other people are hanging out and talking, you find yourself retreating to quiet spaces to be alone. Your friends may understand, but you start feeling rude when you have to step away every 10 minutes.

The vague sense of isolation at first starts to wear thin. Then it turns into something more. Whole conversations are missed, or, at best, your wife is repeating every other line to you. Meeting new people and making small talk can feel extraordinarily difficult. Turning the side of your head to a stranger while nodding blankly can be off-putting.

The dangers to hearing in the military are too many to count. The number of high-capacity engines involved are legion, from jets to tanks to the massive turbines powering ships. The crack of a standard M16A2 rifle is 152 decibels, nearly twice what is needed to inflict slow but permanent injury. Even electrical generators can inflict serious damage over a long period of time. Throw in training exercises involving machine guns, artillery and explosives, and at least some hearing damage is inevitable. This is a problem as old as gunpowder.

By the time the roadside bomb targeted my vehicle in 2009, my hearing had already been damaged. During my first tour in Afghanistan, one of my friends once fired his light machine gun during a firefight outside Bermel, the muzzle only inches from my ear. It’s an incident we joke about to this day, but it left me practically deaf for a week. Some time later a close call with a rocket-propelled grenade only added to the problem, and that was on top of thousands of rounds of machine gun fire.

Even under the controlled conditions of training, I kept losing hearing. During an urban warfare course I learned to blow down doors using explosives, and though it may have been the most fun I ever had in the Army, my ears rang for days afterward.

Reliable data on hearing loss and tinnitus in the military is sparse, even though they are the two most reported service-connected disabilities. Blast injuries accounted for approximately 75 percent of casualties from Iraq and Afghanistan, with the attendant hearing loss. The Department of Veterans Affairs has a specialized department for auditory research in Portland, Ore., but its most recent studies have concluded that they simply do not know how prevalent the problem really is. The data is mostly based on self-reported health surveys from returning troops and those applying to the VA for care, and the numbers vary wildly based on service branch, whether the soldier was in combat arms, and gender.

A study by the Journal of General Internal Medicine, which covered over 90,000 veterans of Afghanistan and Iraq seeking VA care from fiscal 2006-2007, may serve as a general guide. Among male veterans seeking VA care, 16.4 percent to 26.6 percent suffer from serious hearing loss and tinnitus, and 7.3 percent to 13.4 percent of female veterans are affected. How much of this is combat-related or due to environmental factors such as background noise, training and even medication is unknown.

Even less is known about how these conditions affect quality of life, but my own experience and anecdotal evidence indicates that hearing loss permeates how I move through the world every day. Retired Army Capt. Mark Brogan, who suffered a nearly severed arm, along with spine and brain damage from a suicide bomber in Iraq, thinks hearing loss and tinnitus are among his worst injuries. As Brogan put it, “You’ve been to a concert, you know how your ears are ringing afterward? It’s just like that my entire life. A lot of guys get home and they probably don’t even think of getting their hearing checked.”

The Pentagon has done what it can to mitigate the issue. The old days of soldiers sticking cigarette butts or bootleg earplugs made out of melted paraffin into their ears are over. Hearing protection is both standard issue and mandatory across the services, ranging from large headphones to noise-canceling combat earplugs that supposedly only block sound at a loud decibel level. In practice, though, the earplugs never work that well.

For a deployed soldier on patrol, those little bits of rubber start to turn into a real liability. Riding in a gun turret, you cannot hear what the truck commander is saying, and on foot you cannot hear the small sounds that just might make a life-or-death difference. In the filth of days or weeks in the field, where dirt becomes part of your epidermis, it becomes hard to tell the difference between the earwax and the earplug. Most infantry did their best to never wear the stupid things, and it showed. Few combat soldiers came back from war with anything resembling their former hearing.

In the scheme of things, hearing loss is a small issue. Compared to the amputations, paralysis and colostomy bags that come with many war injuries, it’s like whining about a hangnail. The utter psychological destruction that PTSD can inflict overshadows the more subtle effects of hearing loss. But it has changed the lives of hundreds of thousands of veterans, and they generally accept it as a cost of doing business. It does not have to be that way.

After six years, I finally decided that a hearing aid, which I had completely abhorred, was better than walking through life either not knowing what the hell people were talking about or having my wife doing her best interpreter impression. The VA doctor who examined me said, “We can fix this, no problem.” The video footage he showed of a weird twisted mass of scar tissue and a gigantic hole in my eardrum was all it took to convince me.

The surgery itself was pretty straightforward, with a lot of slicing and cartilage implants, but the aftermath was simply horrible. I thought it would be a minor procedure, but it turned into weeks of terrible headaches, drum-like percussion sounds in my right ear, and insomnia that left me a sleep-deprived zombie. But then one day I went out for a smoke on my balcony and realized my hearing was getting better. For the first time since 2009, my ear was working better than I ever expected. It’s strange to realize how many birds are chirping in your backyard after years of barely noticing them. A small blessing, but one that was worth the trip. (Thank you, Dr. Johnson.)

Hundreds of thousands of troops have come back with at least moderate hearing loss, and the nature of the injury can often be degenerative. Veterans Affairs pays out more than a billion dollars a year on disability payments for severe hearing loss, and as those men and women age the issue is only going to worsen. More attention needs to be paid toward researching solutions to hearing damage. In the long run it would be better for the soldiers and cheaper for the government.

Stephen Carlson served two tours in Afghanistan as an infantryman with the 10th Mountain Division. He lives in Austin.