{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T01:58:59Z","timestamp":1789610339010,"version":"build-2803163510"},"reference-count":47,"publisher":"Oxford University Press (OUP)","issue":"1-2","license":[{"start":{"date-parts":[[2021,1,25]],"date-time":"2021-01-25T00:00:00Z","timestamp":1611532800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/www.nationalarchives.gov.uk\/doc\/open-government-licence\/version\/3\/"}],"funder":[{"name":"National Defence and Canadian Forces Health Services"},{"name":"CAF Surgeon General\u2019s Health Research Program"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,1,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Recently, there has been increasing concern about the adverse health effects of long-term occupational exposure to low-level blast in military personnel. Occupational blast exposure occurs routinely in garrison through use of armaments and controlled blast detonations. In the current study, we focused on a population of breaching instructors and range staff. Breaching is a tactical technique that is used to gain entry into closed spaces, often through the use of explosives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>Initial measurements of blast overpressure collected during breaching courses found that up to 10% of the blasts for range staff and up to 32% of the blasts for instructors exceeded the recommended 3 psi exposure limit. Using a cross-sectional design, we used tests of balance, ataxia, and hearing to compare a sample of breachers (n\u2009=\u200919) to age-and sex-matched military controls (n\u2009=\u200919).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were no significant differences between the two groups on the balance and ataxia tests, although the average scores of both groups were lower than would be expected in a normative population. The prevalence of hearing loss was low in the breacher group (4 of 19), and hearing thresholds were not significantly different from the controls. However, the prevalence of self-reported tinnitus was significantly higher in the breacher group (12 of 19) compared with the controls (4 of 19), and all breachers who were identified as having hearing loss also reported tinnitus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our results suggest that basic tests of balance, ataxia, and hearing on their own were not sensitive to the effects of long-term occupational exposure to low-level blast. Some of the blast exposure levels exceeded limits, and there was a significant association of exposure with tinnitus. Future studies should supplement with additional information including exposure history and functional hearing assessments. These findings should be considered in the design of future acute and longitudinal studies of low-level blast exposure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usaa439","type":"journal-article","created":{"date-parts":[[2021,1,25]],"date-time":"2021-01-25T20:42:43Z","timestamp":1611607363000},"page":"e201-e208","source":"Crossref","is-referenced-by-count":31,"title":["Repeated Occupational Exposure to Low-level Blast in the Canadian Armed Forces: Effects on Hearing, Balance, and Ataxia"],"prefix":"10.1093","volume":"187","author":[{"suffix":"MASc","given":"Ann","family":"Nakashima","sequence":"first","affiliation":[{"name":"Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, M3K 2C9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"PhD","given":"Oshin","family":"Vartanian","sequence":"additional","affiliation":[{"name":"Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, M3K 2C9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"PhD","given":"Shawn G","family":"Rhind","sequence":"additional","affiliation":[{"name":"Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, M3K 2C9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"MSc","given":"Kristen","family":"King","sequence":"additional","affiliation":[{"name":"Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, M3K 2C9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"PhD","given":"Catherine","family":"Tenn","sequence":"additional","affiliation":[{"name":"Defence Research and Development Canada, Suffield Research Centre, Medicine Hat, AB, T1A 8K5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"MD","given":"Col Rakesh","family":"Jetly","sequence":"additional","affiliation":[{"name":"Canadian Forces Health Services, Ottawa, ON, K1A 0K2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,1,25]]},"reference":[{"issue":"6","key":"2022010614155292900_R1","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1682\/JRRD.2008.09.0118","article-title":"Auditory and vestibular dysfunction associated with blast-related traumatic brain injury","volume":"46","author":"Fausti","year":"2009","journal-title":"J Rehabil Res Dev"},{"issue":"2","key":"2022010614155292900_R2","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1097\/MAO.0b013e3181c993c3","article-title":"Blast exposure: vestibular consequences and associated characteristics","volume":"31","author":"Hoffer","year":"2010","journal-title":"Otology & Neurotology"},{"issue":"1","key":"2022010614155292900_R3","doi-asserted-by":"crossref","DOI":"10.1186\/s12888-014-0325-5","article-title":"Deployment-related mild traumatic brain injury, mental health problems, and post-concussive symptoms in Canadian Armed Forces personnel","volume":"14","author":"Garber","year":"2014","journal-title":"BMC Psychiatry"},{"key":"2022010614155292900_R4","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2015-010780","article-title":"Occupational outcomes following mild traumatic brain injury in Canadian military personnel deployed in support of the mission in Afghanistan: a retrospective cohort study","volume":"6","author":"Garber","year":"2016","journal-title":"BMJ Open"},{"issue":"8","key":"2022010614155292900_R5","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1089\/neu.2017.5141","article-title":"A retrospective study of predictors of return to duty versus medical retirement in an active duty military population with blast-related mild traumatic brain injury","volume":"35","author":"Cook","year":"2018","journal-title":"J Neurotrauma"},{"issue":"1","key":"2022010614155292900_R6","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1097\/HTR.0b013e31819581d8","article-title":"Traumatic brain injury screening: preliminary findings in a US army brigade combat team","volume":"24","author":"Terrio","year":"2009","journal-title":"J Head Trauma Rehabil"},{"issue":"12","key":"2022010614155292900_R7","doi-asserted-by":"crossref","first-page":"1446","DOI":"10.1093\/aje\/kwn068","article-title":"Understanding sequelae of injury mechanisms and mild traumatic brain injury incurred during the conflicts in Iraq and Afghanistan: persistent postconcussive symptoms and posttraumatic stress disorder","volume":"167","author":"Schneiderman","year":"2008","journal-title":"Am J Epidemiol"},{"issue":"suppl_5","key":"2022010614155292900_R8","doi-asserted-by":"crossref","first-page":"28","DOI":"10.7205\/MILMED-D-15-00137","article-title":"Repeated low-level blast exposure: a descriptive human subjects study","volume":"181","author":"Carr","year":"2016","journal-title":"Mil Med"},{"key":"2022010614155292900_R9","doi-asserted-by":"crossref","DOI":"10.1115\/IMECE2014-38399","article-title":"Effects of common breaching practices on the overpressures recorded within the stack","author":"Walilko","year":"2014"},{"issue":"1","key":"2022010614155292900_R10","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1097\/HTR.0000000000000064","article-title":"Relation of repeated low-level blast exposure with symptomology similar to concussion","volume":"30","author":"Caplan","year":"2015","journal-title":"J Head Trauma Rehabi"},{"issue":"6","key":"2022010614155292900_R11","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1007\/s00193-017-0738-4","article-title":"Occupational overpressure exposure of breachers and military personnel","volume":"27","author":"Kamimori","year":"2017","journal-title":"Shock Waves"},{"key":"2022010614155292900_R12","doi-asserted-by":"publisher","DOI":"10.1007\/s00193-017-0766-0","article-title":"Perspectives on repeated lo-level blast and the measurement of neurotrauma in humans as an occupational exposure risk","author":"Carr","year":"2017","journal-title":"Shock Waves"},{"key":"2022010614155292900_R13","article-title":"The neurological effects of repeated exposure to military occupational blast: implications for prevention and health","author":"Engel","year":"2019"},{"key":"2022010614155292900_R14","doi-asserted-by":"crossref","DOI":"10.7249\/RR2350","volume-title":"Neurological Effects of Repeated Exposure to Military Occupational Levels of Blast: A Review of Recent Literature","author":"Simmons","year":"2020"},{"issue":"4","key":"2022010614155292900_R15","first-page":"87","article-title":"Shooter-experienced blast overpressure in. 50-caliber rifles","volume":"18","author":"Lang","year":"2018","journal-title":"J Special Oper Med a Peer Revi J SOF Med Prof"},{"key":"2022010614155292900_R16","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2019.00797","article-title":"Occupational blast wave exposure during multiday. 50 caliber rifle course","volume":"10","author":"Skotak","year":"2019","journal-title":"Front Neurol"},{"issue":"1","key":"2022010614155292900_R17","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1017\/S1355617710001207","article-title":"Comparison of concussive symptoms, cognitive performance, and psychological symptoms between acute blast-versus nonblast-induced mild traumatic brain injury","volume":"17","author":"Luethcke","year":"2011","journal-title":"J Int Neuropsychol Society"},{"issue":"sup2","key":"2022010614155292900_R18","doi-asserted-by":"crossref","first-page":"S43","DOI":"10.3109\/14992027.2013.860489","article-title":"Warfighter auditory situation awareness: effects of augmented hearing protection\/enhancement devices and TCAPS for military ground combat applications","volume":"53","author":"Clasing","year":"2014","journal-title":"Int J Audiol"},{"key":"2022010614155292900_R19","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1080\/14992027.2017.1411623","article-title":"\u201cEvidence-based occupational hearing screening II: validation of a screening methodology using measures of functional hearing ability,\u201d Int","volume":"57","author":"Soli","year":"2018","journal-title":"J Audiol"},{"issue":"3-16","key":"2022010614155292900_R20","first-page":"52","article-title":"Hearing loss and tinnitus in military personnel with deployment-related mild traumatic brain injury","author":"Karch","year":"2016","journal-title":"U.S. Army Med Department J"},{"key":"2022010614155292900_R21","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.heares.2017.01.013","article-title":"Prevalence of hearing loss and tinnitus in Iraq and Afghanistan veterans: a chronic effects of neurotrauma consortium study","volume":"349","author":"Swan","year":"2017","journal-title":"Hear Res"},{"key":"2022010614155292900_R22","doi-asserted-by":"crossref","DOI":"10.1682\/JRRD.2014.11.0275","article-title":"Auditory difficulties in blast-exposed Veterans with clinically normal hearing","volume":"52","author":"Saunders","year":"2015","journal-title":"J Rehabil Res Dev"},{"issue":"9","key":"2022010614155292900_R23","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.1080\/02699052.2016.1274781","article-title":"Hearing complaints among veterans following traumatic brain injury","volume":"31","author":"Gallun","year":"2017","journal-title":"Brain Injury"},{"issue":"90","key":"2022010614155292900_R24","doi-asserted-by":"crossref","DOI":"10.4103\/nah.NAH_58_16","article-title":"The effects of repeated low-level blast exposure on hearing in marines","volume":"19","author":"Kubli","year":"2017","journal-title":"Noise Health"},{"issue":"11","key":"2022010614155292900_R25","doi-asserted-by":"crossref","first-page":"1423","DOI":"10.1080\/02699052.2018.1496476","article-title":"Preliminary study of hearing protection and non-impact, blast-induced concussion in US military personnel","volume":"32","author":"Dougherty","year":"2018","journal-title":"Brain Injury"},{"issue":"4","key":"2022010614155292900_R26","doi-asserted-by":"crossref","first-page":"540","DOI":"10.4085\/1062-6050-49.3.32","article-title":"Reliability and validity evidence of multiple balance assessments in athletes with a concussion","volume":"49","author":"Murray","year":"2014","journal-title":"J Athl Train"},{"issue":"5","key":"2022010614155292900_R27","doi-asserted-by":"crossref","first-page":"S472","DOI":"10.1097\/TA.0b013e318232e7da","article-title":"Controlled blast exposure during forced explosive entry training and mild traumatic brain injury","volume":"71","author":"Baker","year":"2011","journal-title":"J Trauma Acute Care Surg"},{"key":"2022010614155292900_R28","volume-title":"Blast in Context: The Neuropsychological and Neurocognitive Effects of Long-term Occupational Exposure to Repeated Low-level Explosives on Canadian Armed Forces Breaching Instructors and Range Staff","author":"Vartanian"},{"key":"2022010614155292900_R29","volume-title":"Tactical Breaching - Tactics, Techniques and Procedures (TTP)","author":"Director of Army Doctrine","year":"2013"},{"key":"2022010614155292900_R30","first-page":"p. 134","volume-title":"A Test Battery for the Assessment of Psychological and Physiological Performance following Primary Blast Wave Exposure, in Shaping the Future: Military and Veteran Health Research","author":"Nakashima","year":"2011"},{"issue":"1-6","key":"2022010614155292900_R31","doi-asserted-by":"crossref","first-page":"292","DOI":"10.3109\/00016486609127066","article-title":"A new quantitative ataxia test battery: appendix a. postural equilibrium tests and clinical-type ataxia tests: apparatus, administration, and scoring procedures","volume":"61","author":"Graybiel","year":"1966","journal-title":"Acta Otolaryngol"},{"key":"2022010614155292900_R32","volume-title":"Walk on Floor Eyes Closed (WOFEC): A New Addition to an Ataxia Test Battery (No. 1144)","author":"Fregly","year":"1971"},{"key":"2022010614155292900_R33","article-title":"Occupational noise exposure","author":"OSHA Occupational Safety and Health Standards"},{"issue":"38","key":"2022010614155292900_R34","doi-asserted-by":"crossref","first-page":"13452","DOI":"10.1523\/JNEUROSCI.2156-11.2011","article-title":"Tinnitus with a normal audiogram: physiological evidence for hidden hearing loss and computational model","volume":"31","author":"Schaette and McAlpine","year":"2011","journal-title":"J Neurosci"},{"key":"2022010614155292900_R35","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.heares.2012.04.016","article-title":"Prelude: noise-induced tinnitus and hearing loss in the military","volume":"295","author":"Yankaskas","year":"2013","journal-title":"Hear Res"},{"issue":"4","key":"2022010614155292900_R36","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.1121\/1.398699","article-title":"Comparison of the noise attenuation of three audiometric earphones, with additional data on masking near threshold","volume":"86","author":"Berger","year":"1989","journal-title":"J Acoust Soc Am"},{"key":"2022010614155292900_R37","volume-title":"Maximum Permissible Ambient Noise Levels for Audiometric Test Rooms","author":"American National Standards Institute\/Acoustical Society of America","year":"1999"},{"issue":"sup1","key":"2022010614155292900_R38","doi-asserted-by":"crossref","first-page":"S49","DOI":"10.1080\/14992027.2018.1534012","article-title":"In-ear and on-body measurements of impulse-noise exposure","volume":"58","author":"Davis","year":"2019","journal-title":"Int J Audiol"},{"issue":"1","key":"2022010614155292900_R39","doi-asserted-by":"crossref","first-page":"98","DOI":"10.3138\/jmvfh-2019-0035","article-title":"Toward an improved hearing safety standard for impulse noise exposure in the Canadian Armed Forces","volume":"6","author":"Nakashima","year":"2020","journal-title":"J Mil Veterans and Family Health"},{"key":"2022010614155292900_R40","volume-title":"MIL-STD","author":"Department of Defence","year":"2015"},{"key":"2022010614155292900_R41","volume-title":"Hearing Protection: Needs, Technologies and Performance","author":"NATO RTO","year":"2010"},{"issue":"3","key":"2022010614155292900_R42","first-page":"3","article-title":"Tinnitus in Canada. Statistics Canada, Catalogue no. 82-003-X","volume":"30","author":"Ramage-Morin","year":"2019","journal-title":"Health Rep"},{"issue":"1","key":"2022010614155292900_R43","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1097\/AUD.0000000000000370","article-title":"Auditory brainstem response altered in humans with noise exposure despite normal outer hair cell function","volume":"38","author":"Bramhall","year":"2017","journal-title":"Ear Hear"},{"issue":"9\/10","key":"2022010614155292900_R44","doi-asserted-by":"crossref","first-page":"e1785","DOI":"10.7205\/MILMED-D-17-00025","article-title":"Hidden hearing injury: the emerging science and military relevance of cochlear synaptopathy","volume":"182","author":"Tepe","year":"2017","journal-title":"Mil Med"},{"issue":"3","key":"2022010614155292900_R45","doi-asserted-by":"crossref","first-page":"251","DOI":"10.22462\/13.15.2019.4","article-title":"Hidden hearing deficits in military service members with persistent post concussive symptoms","volume":"46","author":"Meehan","year":"2019","journal-title":"Undersea Hyperbaric Med J"},{"issue":"6","key":"2022010614155292900_R46","doi-asserted-by":"crossref","first-page":"313","DOI":"10.3766\/jaaa.22.6.2","article-title":"Evaluation of auditory functions for Royal Canadian Mounted Police officers","volume":"22","author":"Vaillancourt","year":"2011","journal-title":"J Am Acad Audiol"},{"issue":"sup1","key":"2022010614155292900_R47","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1080\/14992027.2016.1256505","article-title":"Development of an auditory situation awareness test battery for advanced hearing protectors and TCAPS: detection subtest of DRILCOM (detection-recognition\/identification-localization-communication)","volume":"56","author":"Lee","year":"2017","journal-title":"Int J Audiol"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/187\/1-2\/e201\/42076539\/usaa439.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/187\/1-2\/e201\/42076539\/usaa439.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,1,6]],"date-time":"2022-01-06T09:20:04Z","timestamp":1641460804000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/187\/1-2\/e201\/6119327"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,25]]},"references-count":47,"journal-issue":{"issue":"1-2","published-online":{"date-parts":[[2021,1,25]]},"published-print":{"date-parts":[[2022,1,4]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usaa439","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,1,1]]},"published":{"date-parts":[[2021,1,25]]}}}