Army and Marine Aviation Corps Exposome Signatures From the Pharmaceutical Impacts on Tinnitus and Hearing Loss

Both tinnitus and hearing loss (THL) have negative impacts on the health and readiness of our active duty military service members (ADSM). A 2019 Department of Defense (DoD) report to Congress included medical record data (2005-2015) indicating that active duty career helicopter pilots had a 12.45 incidence rate of hearing loss per 1,000 person-years. The report also informs on the burden of injuries and recovery times to mission readiness. Our current study also assesses potential links between rotary wing pilot occupation and acute and chronic medical conditions. Here, we examined the rates of hearing loss and tinnitus following the original investigation period, including exposure to antibiotic treatment as an additional risk factor.

A retrospective study was conducted using de-identified data spanning January 2013 to December 2022. Data were sourced from the Medical Assessment and Readiness System (MARS) at Womack Army Medical Center. Healthcare encounters, including Army and Marine Corps Aviation Community (AMAC) that involved antibiotic use before THL diagnosis were analyzed to capture corresponding health, sociodemographic, and occupational data. Multinomial mixed-effects logistic regression was used to assess the relationship between predictor variables, diagnoses of THL (e.g., ICD9: 389, ICD10: H93.19), and antibiotic classes prescribed.

Our AMAC population (N = 98,835) included THL diagnoses from 2013 to 2022. Over 10 years, helicopter pilots in our sample had almost 3 times the rate of tinnitus diagnosis and twice the rate of hearing loss when compared to ground crew controls. Antibiotic prescriptions for ADSM with diagnoses of hearing loss were also elevated. The rate of antibiotic prescription preceding diagnosis was doubled in AMAC service members with tinnitus. When adjusted for age, sex, race, body mass index, tobacco use, and alcohol use, the data showed that each prescription increased the odds of tinnitus diagnosis by 13.1% (95% CI, 11.3-14.9) and hearing loss diagnosis by 9.0% (95% CI, 7.2-10.8).

Our results identified tetracycline and macrolide class antibiotic use as a risk factor for THL within the AMAC. These tetracycline and macrolide class antibiotic prescriptions accounted for 90% of the prescriptions in our cohort. Our analyses also showed that aminoglycosides, known for causing hearing loss, were not a relevant class of prescription drugs associated with THL. Our approach combines big data science analytics from MARS in ADSMs suffering from THL after exposures to certain classes of antibiotics. Results from our analytics can inform objective biochemical indicator species observations. Our primary goal is to operationalize ADSMs' unique physiological markers with corresponding sociodemographic and occupational data to generate prospective personalized algorithms. These can be used as actionable predictive models to optimize ADSM-specific health and military readiness.