MILITARY MEDICINE, 173, 9:906, 2008

Military and Leisure-Time Noise Exposure and Hearing

Thresholds of Finnish Conscripts
Jaana Jokitulppo, MSc*†; Lt Col Markku Toivonen, Finnish Defence Forces (Med.)‡;
Rauno Pääkkönen, PhD§; Col Seppo Savolainen, Finnish Defence Forces (Ret.)¶储; Erkki Björk, PhD†;
CAPT Kyösti Lehtomäki, Finnish Defence Forces (Navy)#

ABSTRACT This study presents an evaluation of the total cumulative noise exposure of Finnish conscripts (N ⫽ 416)

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during military service. All of the conscripts underwent a hearing screening and filled out a noise exposure questionnaire at
the beginning and end of their military service. Eighty-nine percent of the conscripts were exposed weekly to military noise
of over 85 dBA during the service. Eighteen percent of the conscripts had already reached at the end of their military service
a cumulative noise dose corresponding to noise exposure of 85 dB for 40 years. During military service, permanent hearing
loss of ⬎20 dB in the frequency range of 0.5 to 8 kHz increased from 19 to 27% among the conscripts.

INTRODUCTION
Noise exposure during military service is thought to be one of
the riskiest factors for hearing loss during the lifetime of young
men.1 Heavy weapons such as cannons, mortars, bazookas, mis-
siles, and rockets cause high levels of impulse noise (140 –170
dB) that exceed the risk limit of hearing loss despite of the use
of hearing protectors.2,3 High levels of impulse noise also cause
other hearing symptoms.4 Studies on hearing handicaps among
young men starting military service indicate that the prevalence
of hearing loss varies from 15% to 19% before conscription. The
main cause of such hearing loss is primarily exposure to high
sound levels during leisure time.5–9
In an earlier study,9 we concluded that, according to criteria
set for occupational noise exposure,10 –12 one-third of the con-
scripts (ages 19 –20 years) are exposed weekly before conscrip-
tion to noise levels high enough to be a hearing risk. The high
incidence of hearing symptoms was related to high leisure-time
noise exposure. The measured hearing loss was assumed to be
related to exposure to high noise levels during leisure time
because this age group had no, or only short (1–2 years), expe-
rience with occupational noise exposure. The cumulative effect
of noise during military service raises a question about the
progression of hearing loss during conscription.
*Akukon Consulting Engineers, Ltd., Kornetintie 4A, FI-00380 Helsinki,
Finland.
†Department of Environmental Sciences, University of Kuopio, P.O. Box
1627, FI-70211 Kuopio, Finland.
‡Pori Brigade, Garrison Hospital, P.O. Box 38, FIN-27801 Säkylä,
Finland.
§Finnish Institute of Occupational Health, P.O. Box 486, FIN-33101
Tampere, Finland.
¶University of Kuopio, P.O. Box 1777, FI-70211 Kuopio, Finland.
储Centre for Military Medicine, P.O. Box 5, FI-15701 Lahti, Finland.
#Finnish Defence Forces/Logistics, P.O. Box 919, FI-00131 Helsinki,
Finland.
This manuscript was received for review in August 2007. The revised
manuscript was accepted for publication in March 2008.
Reprint & Copyright © by Association of Military Surgeons of U.S.,
2008.
The aim of our present study was to examine the difference
in the hearing thresholds of conscripts during their conscrip-
tion in the Pori Brigade in 2001, estimate their total cumu-
lative noise exposure and to determine the effects of their
personal noise exposure on hearing thresholds and self-re-
ported hearing symptoms.
MATERIALS AND METHODS
The study was carried out using a basic leisure-time noise
exposure questionnaire developed by Jokitulppo et al.8 The
questionnaire was administered at both the beginning9 and
end of the conscription period. The conscripts filled out the
questionnaire on a voluntary basis as part of their medical
examination, and they returned the questionnaire to the field
nurse (of the Pori Brigade), who sent all of the questionnaires
for analysis.
A total of 1,054 questionnaires was accepted for the first
part study.9 In the examination at the end of the conscription
period, 446 (response rate 42%) conscripts returned their
questionnaire. Altogether 416 of the questionnaires were fi-
nally accepted for the study and 30 were rejected due to
missing information or an overestimation of the time used in
specific activities. Unfortunately, the conscripts serving 9
months did not participate in the study. The conscripts who
served 6 (42%) or 12 months (58%) and remained in the
study were between the ages of 19 and 27 years (all males;
mean, 20.3 years). Most of them (97%) were between 19 and
21 years of age.
The questionnaire requested information on both noise expo-
sure in relation to each type of weapon separately and the total
number of shots to which the respondent was exposed, and on
exposure to leisure time noise. Information of the conscripts’
personal experience with hearing symptoms such as tinnitus and
temporary hearing loss was also collected.
All of the conscripts underwent an audiometric examination
at both the beginning and end of their military service. Pure tone
audiometry (air conduction) was performed using a Micromate

906 MILITARY MEDICINE, Vol. 173, September 2008

 Noise Exposure and Hearing Thresholds of Finnish Conscripts
304 Madsen Electronics Screening Audiometer (Audio &
Kuulo, Turku, Finland). The tests were carried out in sound-
insulated test rooms (Fin 2200; GN Otometrics, Turku, Finland
or T-booth; C-A Tegner Ab, Taastrup, Denmark). The following
test frequencies were used: 0.5, 1, 2, 3, 4, 6, and 8 kHz. Hearing
loss was defined as thresholds ⬎20 dB in one or more frequen-
cies for one or both ears according to the following national
classification system generally used in Finland: type 1: normal
hearing, hearing threshold ⱕ20 dB in both ears over all frequen-
cies; type 2: hearing threshold ⱕ20 dB in the speech frequencies
(0.5–2 kHz) and of a maximum of 40 dB at 3 kHz or a
maximum of 65 dB at 4 kHz; type 3: hearing threshold average
⬍20 dB in the speech frequencies but threshold exceeds 40 dB
at 3 kHz or 65 dB at 4 kHz; type 4: hearing threshold average
ⱖ20 dB also in the speech frequencies.
With the Microsoft Excel computer program (version
1997, SR-1; Redmond, Washington), we calculated weekly
noise exposure levels (LEX.40 hours) for each leisure-time activity
separately and for all leisure-time activities combined accord-
ing to the noise energy principle (equation 1). Leisure-time
noise exposure was calculated using the self-reported dura-
tion of exposure to noise in leisure-time activities (per week
or per year) and the subjectively estimated loudness levels
(on a scale from 1–5) of each activity.8 To simplify the
calculation, all of the leisure-time activities (impulse noise
such as fireworks included) were regarded as noise with a
constant level. The rating, from 1 to 5, was transformed into
A-weighted equivalent sound pressure levels as follows: 1 ⫽
60 dBA, 2 ⫽ 70 dBA, 3 ⫽ 80 dBA, 4 ⫽ 90 dBA, and 5 ⫽
100 dBA. If the hours engaged in an activity were estimated
as hours per year, the sum of the hours per year was divided
by 52 to obtain the weekly noise exposure.
LAeq.w⫽LAeq ⫹ 10 ⫻ log10(TW /T0) (1)
where LAeq.w is the weekly equivalent noise level of the
leisure-time activity; LAeq is the A-weighted sound pressure
level of the leisure-time activity, from 60 to 100 dB; Tw is the
duration (hours) of the leisure-time activity in an average
week; and T0 is the reference time exposure (40 hours).
We also calculated the total cumulative lifetime (LAeq.cum)
leisure-time noise exposure calculated using the self-re-
ported total number of years spent in each activity and in
all the activities combined (equation 2). If the total number
of years of exposure was not reported, 1 year was used in
the calculations. This assumption had to be made, because
more than half of the subjects had not answered this
question (74% of conscripts with 6 months served and 45%
of conscripts with 12 months served). The total cumulative
leisure-time exposure calculated is assumed to be a mini-
mum estimate for those who did not report years of expo-
sure because the average years of exposure was 5 years for
those who reported total number of years.
LAeq.cum⫽LAeq.w ⫹ 10 ⫻ log10Tyear (2)
MILITARY MEDICINE, Vol. 173, September 2008
where Tyear is the duration of the activity in an average year.
Military noise exposure during the time of conscription
(LAeq. mil) was calculated with equation 3 using the noise levels
LAeq.1s1–3 of each weapon type (Table I), the number of shots
(average of 1–10, 10 –100, or 100-1000 shots), and the length
of the conscription period (6 or 12 months). The total cumu-
lative military noise exposure during the conscription period
(LAeq.mil.cum) was also calculated for all weapons combined.
The weekly military noise exposure was calculated by divid-
ing LAeq.mil.cum by the time of conscription, 26 weeks (6
months) or 52 weeks (12 months), respectively.
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LAeq.mil⫽LAeq.1s ⫹ 10 ⫻ log10共N) ⫹ 10 ⫻ log10共t/T) (3)
where LAeq.1s ⫽ the equivalent noise level for each weapon
(Table I); N ⫽ the number of shots (5, 50, or 500); t ⫽ 1
second; T ⫽ total length of the conscription period (6 or 12
months) in seconds.
Finally, the total cumulative lifetime noise exposure to
both leisure-time and military noise was calculated (LAeq. cum. tot). The
LAeq.cum, LAeq.mil.cum, and LAeq.cum.tot of each conscript was com-
pared with exposure to 85, 80, and 75 dBA for 40 years, as
calculated by equation 2. The comparison was performed for
exposure to 101 dBA (85 dB for 40 years), 96 dB (80 dBA for
40 years), and 91 dBA (75 dBA for 40 years).
Basic statistical analyses were used to describe the data.
The limit for statistical significance was set at 0.05. All of the
statistical analyses were carried out with the SPSS program
(version 11.5; SPSS, Inc., Chicago, Illinois).
RESULTS
Leisure-Time Noise Exposure
The most popular activities were watching television, lis-
tening to a home stereo, and going to nightclubs and pubs
(Table II). Most of the time was spent watching television
and listening to a home stereo. The average total sum of
hours spent per week in all activities involving noise was
31.1 hour (range 1–120 hours). The calculated weekly
noise exposure averages of the different activities varied
from 52.5 to 72.1 dBA (Table II). The highest exposure
levels were found for playing in a band and going to
nightclubs and pubs.
TABLE I. Reference Values for the LAeq,1s of Each Weapon
Type (1–3)
Weapon Type LAeq.1s dB
9-mm pistol ⫹ machine gun 108
7.62-mm military rifle 122
Assault rifle 118
81-mm mortar 128
120-mm mortar 144
KES66 bazooka 138
95-mm bazooka 156
Explosives, 60 g of TNT 105
23-mm antiaircraft gun 123
907
 Noise Exposure and Hearing Thresholds of Finnish Conscripts

TABLE II. Conscripts’ Participation in Leisure-Time Activities and Weekly Noise Exposure (LAeq.w) Levels of Different Leisure-Time
Activities at the End of the Conscription Period

LAeq.w
Activity Conscripts (%) Hours Spent/Week (mean) Means (dB) Range (dB)
Watching television 87 9.2 57.8 28.6–81.0
Listening to a home stereo/radio 86 10.1 64.6 34.0–98.0
Going to nightclubs or pubs 81 4.9 72.1 23.8–98.8
Playing computer games 47 4.6 52.5 26.4–74.0
Watching movies/plays 46 1.0 55.3 22.8–81.0
Attending music festivals 40 0.4 66.6 21.6–94.0
Listening to a home stereo/radio through headphones 35 3.8 59.6 29.8–97.0

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Exposure to other impulse noise; fireworks 29 0.6 53.2 16.8–91.0
Shooting firearms 16 1.9 66.7 19.8–93.0
Practicing a musical instrument 12 4.7 59.4 31.6–94.0
Attending indoor sports events 11 2.4 58.4 23.8–81.8
Participating in motor sports 11 3.2 64.3 37.0–86.8
Using noisy tools outdoors 9 3.7 63.9 23.8–95.7
Playing in a band or orchestra 9 2.7 69.0 36.8–95.4
Using noisy tools indoors 7 6.8 66.7 31.6–90.0
Total weekly noise exposure to all activities 31.1 77.2 41.6–100.5

The total weekly leisure-time noise exposure median was
78.0 dBA and mean 77.2 dBA (range, 41.6 –100.5 dBA). The
median and mean of the total lifetime leisure-time noise
exposure (LAeq.cum) were 79.8 and 80.2 dBA (range, 41.6 –
106.0 dBA).
During their leisure time, altogether 21% of the conscripts
were exposed weekly to noise levels over the 85 dBA risk
limit for hearing loss. A cumulative (lifetime) noise exposure
of 101 dBA (85 dB for 40 years of exposure) had been
reached by 2% of the conscripts, 5% had a corresponding
value of over 96 dBA (80 dBA for 40 years) and 13% had a
cumulative value of 91 dBA (⬎75 dBA for 40 years).
Military Noise Exposure
The military noise exposure to different weapons varied be-
tween 49.9 and 96.3 dB on the average (Table III). The
highest exposures were caused by the 95-mm bazooka and
the 120-mm mortar. The total military cumulative noise ex-
posure (LAeq.mil.cum) for all the weapons combined averaged
85.3 dB, with a median of 94.4 dB (range, 10.9 –114.2 dB).
For the conscripts with 6 months of service, the military
exposure averaged 81.0 dB, with a median of 84.8 dB, and,
for those with 12 months of service, the mean was 88.5 dB
(median, 94.6 dB). This difference was statistically significant
(p ⬍ 0.001). Both the 95-mm bazooka and the 120-mm
mortar accounted for most (93%) of the cumulative military
noise exposure of the conscripts. The weekly military noise
exposure averaged 101.3 dBA, with a median of 111.5 dBA
(range, 25.1–131.4 dB). The weekly military noise exposure
was statistically significantly higher among the conscripts in
the mortar company (108.4 dB, p ⬍ 0.01) and the antitank
company (114.7 dB, p ⬍ 0.01) when compared with the
exposure of the rifle company (95.9 dB) and the pioneering
company (95.2 dB). The military police and other units also
had high weekly noise exposure (104.9 dB), but the differ-
ence was not significant. When these groups were compared
with respect to the LAeq.mil values, the difference was not
statistically significant. During their military service, alto-

TABLE III. Conscripts’ Military Noise Exposure (LAeq.mil) by Weapon Type

LAeq.mil
Weapon Conscripts % Mean dB Median dB Range dB
9-mm pistol ⫹ machine gun 46 50.7 49.3 46.2–69.3
7.62-mm military rifle 42 65.2 63.3 60.2–83.3
Assault rifle 91 74.7 76.2 56.2–79.3
81-mm mortar 51 72.1 69.3 66.2–89.3
120-mm mortar 47 91.2 85.3 82.2–85.3
KES66 bazooka 65 79.2 76.2 76.2–96.2
95-mm bazooka 38 96.3 94.2 94.2–114.2
Explosives, 60 g of TNT 61 50.9 53.2 43.2–66.3
23-mm anti-aircraft gun 54 68.8 71.2 61.2–84.3
Other 6 49.9 46.2 46.2–66.2
Total military noise exposure to all weapons 85.3 94.4 10.9–114.2
Weekly military noise exposure to all weapons 101.2 111.5 25.1–131.4

908 MILITARY MEDICINE, Vol. 173, September 2008

 Noise Exposure and Hearing Thresholds of Finnish Conscripts
gether 89% of the conscripts were exposed weekly to military
noise levels exceeding the 85 dBA risk limit for hearing loss.
A total lifetime military noise exposure of 101 dB was
reached by 18% of the conscripts, 30% had a value exceeding
96 dBA, and that of 55% was 91 dBA.
The mean total cumulative lifetime noise exposure (LAeq
cum. tot) of the military and leisure-time noise combined was
90.7 dB, with a median of 94.7 dB (range, 16.2–114.2 dB).
For 20% of the conscripts, this value was 101 dBA, whereas
36% had a value exceeding 96 dBA, and of that 62% was 91
dBA. There was a very significant (p ⬍ 0.001) difference
between the noise exposure of the 6-month (87.5 dB) and
12-month conscripts (92.9 dB).
Hearing Loss and Hearing Symptoms
Hearing loss rated as types 2 to 4 was found for 27% of the
conscripts (n ⫽ 114). There was a statistically significant
difference (p ⬍ 0.001) between the hearing thresholds of the
conscripts who served 6 months (38.5%) and those who
served 12 months (19.8%). There was also a statistically
significant difference (p ⬍ 0.05) between service units of the
military police (35%), the rifle companies (32%), and the
mortar units (33%) compared to pioneering (19%) and anti-
tank (5%) companies.
The correlation between hearing loss in the right ear at
frequencies of 1 kHz (r 0.371, p ⬍ 0.05), 2 kHz (r 0.626, p ⬍
0.001), 4 kHz (r 0.480, p ⬍ 0.01), and exposure to noise from
pistols and machine guns was statistically significant. For the
left ear, the relationship between hearing loss at frequencies
of 0.5 kHz (r 0.488, p ⬍ 0.01), 1 kHz (r 0.403, p ⬍ 0.05), and
3 kHz (r 0.437, p ⬍ 0.05), and exposure to noise from pistols
and machine guns was statistically significant. In addition,
exposure to noise from 120-mm mortars correlated with
hearing loss in the right ear at 6 kHz (r 0.372, p ⬍ 0.05). The
highest threshold shift was found at 6000 kHz (mean, 24.5 dB
and 27.9 dB for the right and left ears, respectively). No other
significant difference was found between the different fre-
quencies and hearing losses.
Altogether 55% of the conscripts experienced tinnitus
sometimes during noise exposure, and tinnitus occurred often
or continuously for 2% (Table IV). The degree of tinnitus was
described as moderate by 61% and as annoying or very
annoying by 3%. Bilateral tinnitus was reported by 37%,
TABLE IV. Distribution of Self-Reported Hearing Symptoms at the Beginning (B) and End (E) of the Conscription Period
Never (%)
Symptom B E
Tinnitus related to noise 25.0 37.7
Tinnitus for another reason 62.8 68.0
Pain in ear 66.3 70.0
Sound annoyance 29.9 40.4
Sound distortion 67.5 68.3
TTS 51.0 64.2
TTS, Temporary threshold shift.
MILITARY MEDICINE, Vol. 173, September 2008
whereas unilateral tinnitus was reported by 13%. The 12-
month conscripts experienced tinnitus-related noise statisti-
cally significantly (p ⬍ 0.01) more often (sometimes and
often 66%) than the 6-month conscripts (sometimes and often
50%). Exposure to explosions correlated with tinnitus (r
0.137, p ⬍ 0.5), and exposure to mortar noise correlated with
sound distortion (80-mm mortar, r 0.141; 120-mm mortar, r
0.171; both p ⬍ 0.5). There were no other significant differ-
ences between other hearing symptoms and the length of the
conscription, the service unit, or the weapon type.
Temporary hearing loss due to noise exposure occurred
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sometimes among 28% of the conscripts and often or contin-
uously among 1%. Altogether 51% of the conscripts de-
scribed annoyance sometimes due to noise exposure, whereas
2% claimed it occurred often or continuously. Sound distor-
tion was reported sometimes by 24% of the conscripts, and
often or continuously by 1% (Table IV). There was a statis-
tically significant (p ⬍ 0.05) difference between the cumula-
tive leisure-time noise exposure and both tinnitus and pain in
the ear, and temporary hearing loss (p ⬍ 0.01) with conscripts
with high leisure-time noise exposure (Table V).
Altogether 7% of the conscripts reported subjective
permanent hearing loss. The most common reason given
for this perception was exposure to (1) loud music (46%),
(2) impulse noise (28%), (3) shooting firearms (11%), (4)
otitis media (9%), or (5) genetic condition (2%). A total of
6% claimed that their hearing had worsened during their
military service, whereas 41% of those with hearing loss
did not know whether or not their hearing had worsened or
they stated that their hearing loss had not worsened. Only
7% actually realized that their hearing was not normal, and
27% could not say whether their hearing was normal or
not. Almost all of the conscripts (99%) had used hearing
protection on the shooting range, but, during combat train-
ing exercises, only 86% reported doing so. The conscripts
who had not used hearing protectors at all times had
tinnitus statistically significantly (p ⬍ 0.001) more often
(18.5%) than those who always used hearing protection
(6.4%).
DISCUSSION
According to this study, 89% of the conscripts were exposed
weekly to military noise of over 85 dB. Altogether 18% of the
Sometimes (%) Often (%) Continuously (%)
B E B E B E
66.6 54.6 6.8 1.9 0.9 0.2
28.1 19.5 1.2 0.2 0.2 0.2
31.5 23.1 0.8 0.5
65.0 51.0 3.5 1.9 0.2 0.2
28.8 23.6 1.2 0.5 0.1
45.0 28.4 1.6 0.7 0.3
909
 Noise Exposure and Hearing Thresholds of Finnish Conscripts

TABLE V. Cumulative (lifetime) Exposure to Leisure-Time Noise (LAeq.cum), Military Noise (LAeq.mil), and the Total Cumulative Noise
Exposure (LAeq.cum.tot) to Both Leisure-Time and Military Noise

Leisure-Time Noise Military Noise Leisure and Military

LAeq.cum LAeq.mil LAeq cum. tot
Symptom No Yes No Yes No Yes
Tinnitus related to noise 78.1 81.0 p ⱕ 0.01 86.4 87.0 ns 91.7 92.3 ns
Tinnitus for another reason 79.4 81.0 ns 87.3 85.2 ns 91.9 92.7 ns
Pain in ear 79.2 81.7 p ⱕ 0.05 87.5 84.8 ns 92.3 91.8 ns
Sound annoyance 79.1 80.5 ns 86.0 87.7 ns 91.0 93.0 ns
Sound distortion 79.4 81.1 ns 87.1 86.8 ns 91.6 94.1 p ⱕ 0.05
THL 78.8 82.2 p ⱕ 0.01 86.2 88.1 ns 91.3 94.1 p ⱕ 0.05

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The reference groups are: no symptoms (No) and sometimes, often or continuously (Yes). ns, Not significant; THL, temporary hearing loss.

conscripts had already reached a cumulative noise exposure
level equivalent to 85 dB for 40 years. Most of their military
noise exposure had been caused by 95-mm bazookas and
120-mm mortars, which accounted for most of the conscripts’
military noise exposure. The most exposed conscripts were
those who had served in the mortar or antitank companies and
who had served a 12-month conscription period.
During their military service 21% of the conscripts had
been exposed weekly to equivalent noise levels of over 85
dBA during their leisure time. Before their conscription,
27% had a weekly noise exposure of over 85 dB.9 The
main reason for the decreased leisure-time noise exposure
during military service was less time (mean of 12 hours or
less) spent on such activities. Our earlier studies with the
same type of calculation method indicated that 50% of
teenagers (12–16 years of age) and 9% of adults (25–55
years of age) are exposed weekly to equivalent sound
levels of over 85 dBA.8,13 Our current results seem to fall
between those of teenagers and adults. Altogether 2% of
the conscripts in this study had reached a 40-year cumu-
lative noise exposure equivalent to 85 dB. When the mil-
itary and leisure-time noise exposure were combined, 20%
of the conscripts had been cumulatively exposed to noise
levels equivalent to exposure to 85 dB over a period of 40
years. Most of this exposure had been caused by military
noise.
In the initial examination, hearing loss was more com-
mon among the conscripts who then served 6 months than
among those who served 12 months, and the difference had
often increased by the time the conscripts were discharged.
These groups had also differed in the first examination,
but, at that time, the difference was not significant. Klock-
hoff et al.14 and Muhr et al.15 found the same type of
results. Both studies concluded that conscripts who had
mild hearing loss already at the time they reported for
training had a higher risk of a significant threshold shift
than those who initially had normal hearing. One expla-
nation for this result was the fact that the conscripts with
moderate and severe hearing loss (type 3 or 4) before their
military service began served for a shorter time. Another
reason could be the high noise exposure levels (such as
those of mortar noise) during military service and its effect
on the further development of hearing loss among those
with mild hearing loss.
Our study seemed to confirm the assumption that young
men in their early 20s engage in certain noisy activities,
such as going to nightclubs.16 Frequent attendance at dis-
cotheques and music bars could be related especially to
poorer hearing among this age group.17 The effect of lei-
sure-time noise exposure during military service plays a
minor role, however, when compared with that of military
noise exposure. Nevertheless, leisure-time noise exposure
contributes to the progression of hearing loss before and
after the time of conscription.
In our study population, tinnitus was experienced some-
times by 54 to 67%, and often by 2 to 7%, of the conscripts
in relation to noise exposure. Temporary hearing loss was
reported sometimes by 28 to 45% and often by 2%. Jokit-
ulppo et al.8 reported tinnitus sometimes for 69.6%, and
often for 2.5%, of teenagers (aged 12–17 years), and
temporary hearing loss was experienced sometimes by
42.5% and often by 2.7%. Similar results have been re-
ported by Smith et al.18 for 66% of their study population,
which comprised 18- to 25-year olds who attended night-
clubs or rock concerts and reported temporary effects on
their hearing or tinnitus. In our study, personal experience
with tinnitus was related both to the longer service time
and to the high levels of noise exposure. The long exposure
time could have been related to the more frequent report of
tinnitus lasting a long period of time after the cession of
noise exposure.19 In our study, the conscripts with a high
personal cumulative (lifetime) leisure-time noise exposure
complained of tinnitus, pain in the ear, and temporary
hearing loss. However, an overall relation between mili-
tary noise exposure and hearing symptoms was not found
despite the high levels of military noise exposure. Only
noise from explosives was found to be related to personal
experience of tinnitus, whereas sound distortion was asso-
ciated with mortar noise. The main reason for this finding

910 MILITARY MEDICINE, Vol. 173, September 2008

 Noise Exposure and Hearing Thresholds of Finnish Conscripts
may be the high level of hearing protection use during the
exposure to military noise, in contrast to the less frequent
use of hearing protection during leisure time.
The prevalence of permanent hearing loss (⬎20 dB) in
this study population was 19% before the beginning of
military service. Other studies have had similar results for
hearing loss (15–18%).5,6,20 The results of our present study
seem to indicate a similar incidence, rather than an in-
crease in recent years. However, the prevalence of hearing
loss increased to 27% during the military service. This
increase in hearing loss may be explained by the high
military noise exposure levels during this period. Yliko-
ski21 reported a similar finding with professional soldiers
of the same age group as our conscripts. In his study, more
than one-fourth (26%) of the officers under 30 years of age
had the same level of hearing loss. The main cause of
hearing loss in our study was possibly acute acoustic
traumas that occur during combat training in the field. In
our study, the less frequent use of hearing protection
during combat training could have been related to the
hearing loss that occurred. The significant correlation with
hearing thresholds of different frequencies was primarily
related to noise from pistols and machine guns. The same
result has also been reported by Mrena et al.22 and Savol-
ainen and Lehtomäki,4 as the main cause of acute acoustic
traumas in their studies was exposure to noise impulses
from small arms. This type of exposure also seems to be
related to the high prevalence of tinnitus among the con-
scripts in our study who did not always use hearing pro-
tectors in combat training. So far, the effects of acute
acoustic traumas and possible compensation have gener-
ally been evaluated by audiometric findings, but, in some
cases, tinnitus may be an even more serious threat to life
satisfaction than mild hearing impairment.19
There are some limitations which may have effect of the
results of the study. Low response rate, and the blank
answers left in the final questionnaire survey decreased the
total sum of the accepted questionnaires. Also the assumed
1-year minimum with the calculation of LAeq.cum may have
effect on those subjects who did not report the leisure-time
exposure of years. This effect was seen especially with the
difference between the noise exposure of the 6-month and
12-month conscripts. However, the lack of motivation to
answer the questions may have an effect on results; this is
seen especially on the results of the hearing symptoms. In
the final examination at the end of the conscription period
in our study, fewer hearing symptoms were reported than
in the initial examination at the beginning of the conscrip-
tion period. One reason for this finding may be less time
exposed to leisure-time noise during the time of conscrip-
tion. Another reason could also be the attitudes and moti-
vation for answering the questionnaire of the conscripts at
the time they finished their military service. When con-
scripts arrive in their military unit, they are eager to
MILITARY MEDICINE, Vol. 173, September 2008
receive the best hearing threshold rating, but, when they
are leaving, they no longer care.
CONCLUSIONS
During military service in our study the progression of hear-
ing loss was notable, as the percentage of hearing loss in-
creased from 19 to 27%. Military noise exposure seems to
have had the most effect on this increase, as the exposure to
leisure-time noise was less during military service than pre-
ceding it. Although the time of exposure to military noise is
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short, the noise is powerful, and both military and leisure-
time noise affect the total cumulative lifetime noise exposure.
One of five of the conscripts included in our study was at risk
of experiencing hearing loss during leisure-time activities.
The high incidence of hearing symptoms and hearing loss
with high exposure levels seems to confirm the assumption
that leisure-time noise exposure is a significant cofactor in the
further development of hearing loss and hearing symptoms
such as tinnitus.
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MILITARY MEDICINE, Vol. 173, September 2008