Skin Pathology Prevalence in Deployed Fighter Aircrew Using Custom Molded Hearing Protection

INTRODUCTION: During a deployment of a fighter unit, aircrew began to exhibit ear discomfort and episodes of auricular irritation and ulceration. All affected were using the Attenuating Custom Communications Earpiece System (ACCES). Discomfort was previously discussed in the literature, but neither the prevalence of discomfort nor the occurrence of skin ulcerations had been previously described.METHODS: An anonymous paper questionnaire was used with three fighter squadrons while deployed in 2019. A total of 59 aircrew in the F-15C/E and F-16 airframes participated; aircrew not using ACCES were excluded.RESULTS: Response rate was 57.3%, spread evenly among airframes, with 78% being pilots. A majority of respondents (79.7%) stated they had ACCES problems in the deployed setting. Among those noting problems in the deployed setting, 89% reported ear discomfort and a smaller portion reported skin redness, erosion, and bleeding.DISCUSSION: This study was able to provide a small sample estimate of the prevalence of ear problems among fighter aircrew ACCES users while deployed. This sample exhibited an increase in prevalence of ear discomfort during the deployment. It also showed pathological features absent in home-station flying, such as skin redness and erosion. However, the sample size and study design prevented risk factor characterization, confounder control, or causal inference. While ACCES may contribute to these problems, other confounders such as air characteristics, recall bias, aircrew motivation to report problems, and baseline dermatologic pathology could not be excluded. This data should serve as a baseline for larger studies, which are better equipped for confounder control and assessment of other potential risk factors.Strawbridge PA, Steinkraus LW, Girsch RM.