SAN DIEGO - Soldiers and Marines caught in roadside bombings and firefights in Iraq and Afghanistan are coming home in epidemic numbers with permanent hearing loss and ringing in their ears, prompting the military to redouble its efforts to protect the troops from noise.
Hearing damage is the number one disability in the war on terror, according to the Department of Veterans Affairs, and some specialists say the true toll could take decades to become clear.
Nearly 70,000 of the more than 1.3 million troops who have served in the two war zones are collecting disability for tinnitus, a potentially debilitating ringing in the ears, and more than 58,000 are on disability for hearing loss, the VA said.
"The numbers are staggering," said Theresa Schulz, a former audiologist with the Air Force, past president of the National Hearing Conservation Association, and author of a 2004 report titled "Troops Return With Alarming Rates of Hearing Loss."
One explanation given is the insurgency's use of a fearsome weapon the Pentagon did not fully anticipate: powerful roadside bombs. Their blasts cause violent changes in air pressure that can rupture the eardrum and break bones inside the ear.
Also, much of the fighting consists of ambushes, bombings, and firefights, which come suddenly and unexpectedly, giving soldiers no time to use their military-issued hearing protection.
"They can't say, 'Wait a minute, let me put my earplugs in,' " said Dr. Michael E. Hoffer, a Navy captain and one of the country's leading inner-ear specialists. "They are in the fight of their lives."
In addition, some service members on patrol refuse to wear earplugs for fear of dulling their senses and missing sounds that can make the difference between life and death, Hoffer and others said. Others were not given earplugs or did not take them along when they were sent into the war zone. And some Marines were not told how to use their specialized earplugs and inserted them incorrectly.
Hearing damage has been a battlefield risk ever since the introduction of explosives and artillery, and the US military recognized it in Iraq and Afghanistan and issued earplugs early on. But the sheer number of injuries and their nature, particularly the high incidence of tinnitus, came as a surprise to specialists in and out of the military.
The military has responded over the past three years with better and easier-to-use earplugs, greater efforts to educate troops about protecting their hearing, and more testing in the war zone.
The number of service members on disability because of hearing damage is expected to grow by 18 percent a year, with payments of $1.1 billion annually by 2011, according to an analysis by the American Tinnitus Association. Any veteran with a 10 percent loss in hearing qualifies for disability.