Recommended Audiological Test Battery Following Combat Noise Exposure: A Clinical Approach

Purpose: The purpose of this study was to establish a standardized, evidence-based audiological protocol for evaluating combat-exposed personnel and civilians. This comprehensive test battery emphasizes early detection, detailed assessment, and practical clinical implementation. This protocol addresses the current gap in assessment approaches for combat-related hearing injuries. Method: This protocol represents a comprehensive audiological assessment framework for combat noise exposure based on evidence-based practice developed by a working group of clinical audiologists. The protocol integrates a specialized form for documenting combat noise exposure history, conventional audiometry (0.25–8.0 kHz), extended high-frequency audiometry (9.0–20.0 kHz), otoacoustic emissions, immittance testing, and auditory evoked potentials. The recommended testing sequence begins with a comprehensive medical history intake followed by otoscopic examination, with the subsequent assessment order determined by clinician judgment and patient capacity. The interpretation criteria account for combat noise exposure characteristics, including blast effects and confounding factors such as traumatic brain injury and psychological trauma. This protocol enables auditory dysfunction detection even when standard audiometric results appear normal, facilitating a more accurate assessment of combat-related hearing impairment and early detection. Conclusions: This protocol advances the current clinical practice by providing a standardized and comprehensive approach for evaluating combat noise–induced auditory dysfunction. The test battery's integration of multiple assessment tools and specific interpretation guidelines enhances the clinicians' ability to detect and monitor auditory changes following combat noise exposure. The protocol's emphasis on early detection and practical implementation guidelines supports clinical decision-making and long-term monitoring strategies. While this protocol advances the current practice of evaluating combat-related auditory dysfunction, validation studies in military and clinical settings are required to establish its effectiveness.