{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T08:16:28Z","timestamp":1788509788896,"version":"build-2803163510"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"9-10","license":[{"start":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T00:00:00Z","timestamp":1769558400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"U.S. Army Medical Research Command"},{"name":"Advanced Medical Technology Initiative","award":["#12687"],"award-info":[{"award-number":["#12687"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Tinnitus is prevalent among U.S. military Service Members (SMs). Current Department of Defense (DOD) Hearing Conservation Program (HCP) protocols use a standardized annual screening question to identify bothersome tinnitus. However, this question fails to distinguish transient ear noise\u2014a benign, short-lived auditory phenomenon\u2014from tinnitus. The Department of Veterans Affairs (VA)\/DOD Tinnitus Working Group consequently modified the screening question to integrate symptom duration, frequency, and impact on life. The purpose of this study was to evaluate whether the modified screening question improves identification of SMs who require referral for tinnitus evaluation and management. Secondary aims examined how responses to both screening questions aligned with validated tinnitus questionnaires, referral preferences, and diagnostic outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>This observational study included 4,922 SMs screened for tinnitus during routine HCP visits at Kimbrough Ambulatory Care Center, Fort Meade, MD and was approved by the Defense Centers for Public Health-Aberdeen. Participants answered the current annual screening question (Question A: \u201cDuring the past month, how much have you been bothered by noises in your head or ears, such as ringing, buzzing, crickets, humming, or a tone?\u201d) and the VA\/DOD question (Question B: \u201cDo you have noises in your ears or head that occur at least twice a week and last for 5 or more minutes that affect your ability to concentrate, sleep, and\/or affect your mood?\u201d). Those indicating they were bothered in response to Question A or B completed the Tinnitus and Hearing Survey\u2014Tinnitus Subscale (THS-T) and the Tinnitus Functional Index (TFI). A subset of participants answered 2 referral questions and another subset was evaluated by an audiologist. Statistical analysis included non-parametric tests (Wilcoxon, Kruskal-Wallis, Dunn\u2019s post-hoc), Welch\u2019s t-tests, and sensitivity\/specificity analysis, performed in RStudio v4.5.0.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of SMs who reported being \u201cbothered a little\u201d on Question A, 56% responded \u201cno\u201d to the more specific Question B, indicating they may be bothered by transient ear noise. Sensitivity and specificity were found to be 98% and 94%, respectively, for individuals who responded \u201cyes\u201d and were either \u201cbothered a little\u201d or \u201cbothered a lot\u201d to Question B. These results indicated that Question B better identified clinically significant tinnitus needing referral. Among those who underwent audiological evaluation based on Question A response, 28.6% were determined to have transient ear noise and over half received tinnitus-related interventions. Service members requesting referral had significantly higher THS-T and TFI scores than those who did not (P\u2009&amp;lt;\u2009.001), further validating the clinical relevance of self-reported impact.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The modified tinnitus screening question more accurately identifies individuals requiring referral to audiology for tinnitus evaluation and management, improving referral accuracy and reducing unnecessary clinical workload. Strengths of the study include its large sample size, use of validated instruments, and real-world clinical integration. Limitations include incomplete follow-through data on referred SMs because of decentralized care access. Findings support the replacement of the current question with the modified version and incorporating brief validated questionnaires (e.g., THS-T) and self-reported referral interest to improve triage.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usaf640","type":"journal-article","created":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T12:42:55Z","timestamp":1767098575000},"page":"e1928-e1935","source":"Crossref","is-referenced-by-count":0,"title":["Improving Sensitivity of Tinnitus Screening in Hearing Conservation Programs"],"prefix":"10.1093","volume":"191","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-4863-2464","authenticated-orcid":false,"given":"Michele L","family":"Spencer","sequence":"first","affiliation":[{"name":"Audiology and Speech Pathology Center, Walter Reed National Military Medical Center , Bethesda, MD 20889,","place":["United States"]},{"name":"Po\u2019okela Solutions, LLC , Honolulu, HI 96814,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"LaGuinn P","family":"Sherlock","sequence":"additional","affiliation":[{"name":"Audiology and Speech Pathology Center, Walter Reed National Military Medical Center , Bethesda, MD 20889,","place":["United States"]},{"name":"Hearing Conservation and Readiness Branch, Defense Centers for Public Health-Aberdeen , Aberdeen Proving Ground, MD 21010,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin M","family":"Sheffield","sequence":"additional","affiliation":[{"name":"Audiology and Speech Pathology Center, Walter Reed National Military Medical Center , Bethesda, MD 20889,","place":["United States"]},{"name":"Hearing Conservation and Readiness Branch, Defense Centers for Public Health-Aberdeen , Aberdeen Proving Ground, MD 21010,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria A","family":"Bugtong","sequence":"additional","affiliation":[{"name":"Hearing Center of Excellence, Defense Health Agency , JBSA-Lackland, TX 78236,","place":["United States"]},{"name":"zCore Business Solutions, Inc , Round Rock, TX 78681,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas S","family":"Brungart","sequence":"additional","affiliation":[{"name":"Audiology and Speech Pathology Center, Walter Reed National Military Medical Center , Bethesda, MD 20889,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,1,28]]},"reference":[{"key":"2026090403511175400_usaf640-B1","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1044\/2025_AJA-24-00198","article-title":"Incidence and risk factors for tinnitus among military service members in the Millennium Cohort Study","volume":"34","author":"Geronimo-Hara","year":"2025","journal-title":"Am J Audiol"},{"key":"2026090403511175400_usaf640-B2","volume-title":"Annual Benefits Report Fiscal Year 2024","author":"US Veterans Benefits Administration","year":"2025"},{"key":"2026090403511175400_usaf640-B3","volume-title":"Noise and Military Service: Implications for Hearing Loss and Tinnitus","author":"Humes","year":"2006"},{"key":"2026090403511175400_usaf640-B4","author":"VA National Center for Rehabilitative Auditory Research; 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