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.
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