ABSTRACT
PURPOSE: To evaluate noise-induced hearing injury (NIHI) and blast-related comorbidities among U.S. Army soldiers in an effort to understand the morbidity burden and future health service requirements for wounded war fighters returning from the Central Command Area of Responsibility, predominantly from Iraq and Afghanistan deployments. METHOD: Inpatient and outpatient records with diagnosed NIHI or blast-related comorbidities (e.g., significant threshold shift [STS], noise-induced hearing loss, tinnitus, sensorineural hearing loss, eardrum perforations, mild traumatic brain injury, and posttraumatic stress disorder) were extracted for active duty soldiers returning from combat deployments. Records were limited to those within 6 months of the soldier's return date from April 2003 through June 2009. To account for changes in STS coding practice, STS rates observed after October 1, 2006, were used to extrapolate prior probable postdeployment STS. RESULTS: Statistically significant increases were observed for tinnitus, dizziness, eardrum perforations, and speech-language disorders. The combination of observed and extrapolated STS yielded a conservative estimate of 27,427 cases. CONCLUSIONS: Estimates can be used to forecast resource requirements for hearing services among veterans. This article could serve as a guide for resourcing and innovating prevention measures and treatment in this population. Data provided may also serve as a baseline for evaluating prevention measures.
Subject(s)
Afghan Campaign 2001- , Hearing Loss, Noise-Induced/diagnosis , Iraq War, 2003-2011 , Military Personnel , Adolescent , Adult , Blast Injuries/complications , Blast Injuries/diagnosis , Brain Injuries/complications , Female , Hearing Loss, Noise-Induced/complications , Humans , Male , Middle Aged , Speech Disorders/complications , Speech Disorders/diagnosis , Stress Disorders, Post-Traumatic/complications , Stress Disorders, Post-Traumatic/diagnosis , Tinnitus/complications , Tinnitus/diagnosis , Tympanic Membrane Perforation/complications , Tympanic Membrane Perforation/diagnosis , Young AdultABSTRACT
BACKGROUND: Mefloquine has historically been considered safe and well-tolerated for long-term malaria chemoprophylaxis, but its prescribing requires careful attention to rule out contraindications to its use, including a history of certain psychiatric and neurological disorders. The prevalence of these disorders has not been defined in cohorts of U.S. military personnel deployed to areas where long-term malaria chemoprophylaxis is indicated. METHODS: Military medical surveillance and pharmacosurveillance databases were utilized to identify contraindications to mefloquine use among a cohort of 11,725 active duty U.S. military personnel recently deployed to Afghanistan. RESULTS: A total of 9.6% of the cohort had evidence of a contraindication. Females were more than twice as likely as males to have a contraindication (OR = 2.48, P < 0.001). CONCLUSION: These findings underscore the importance of proper systematic screening prior to prescribing and dispensing mefloquine, and the need to provide alternatives to mefloquine suitable for long-term administration among deployed U.S. military personnel.
