Update--noise induced hearing loss and the military environment.

Although Noise Induced Hearing Loss (NIHL) is well recognised there are an increasing number of associations that are important in its study and to a lesser extent in clinical practice. For many there is controversy over whether there is a causal relationship or a confounding effect but of these presbyacusis is the most important. The PULHHEEMS assessment H3 is currently the first level of abnormal hearing. Between H2 and H3 there is a performance decrement and compensation is awarded at levels of NIHL less than H3. If the measurement of NIHL is to be used as a tool in the Army Hearing Conservation Program (AHCP) then the emphasis must be placed on the change from H1 to H2 and not from H2 to H3.