to the editor: With regard to Dr. Rabino-witz's fine article¹ on noise-induced hearing loss, I wanted to add a telltale sign of hearing damage that occurs in shooters of shoulder firearms.

Shooters, as do most persons exposed to high sound levels, have a characteristic “notch” of greatest hearing loss at 4,000 or 6,000 Hz; however, shooters of shoulder arms have an asymmetric hearing loss with a greater deficit in the ear opposite the shoulder from which the gun is fired. Because most people are right-handed and fire from the right shoulder, the majority of shoulder firearm shooters show a deeper “4,000 Hz notch” in the left ear. This may seem counter intuitive, but the ipsilateral ear is somewhat protected by the angle of the head when shooting. The contralateral ear is more exposed to the sound of the muzzle blast.

Counseling hunters presents a considerable challenge. As Dr. Rabinowitz¹ points out, the best way to prevent hearing damage is avoiding high-level sounds or using some barrier-like protection (plugs or muffs). Hunters are averse to wearing ear protection, claiming that they need to hear the movement of game they are hunting. I advise them to cover their ears when another person is shooting, to wear ear protection when the success of hunting depends more on vision than on hearing (watching for ducks to fly in rather than listening for the rustling of deer), not to fire unnecessarily and to wear ear protection during practice or sighting in.

I tell hunters that the choice is theirs: either practice hearing conservation or lose more hearing. I point out that communication difficulty will increase, social enjoyment and domestic tranquility will decrease, tinnitus may begin or worsen, and that a hearing aid may become necessary, although hearing aids are less successful with the notch patterns of noise-induced hearing loss than with most other patterns. I wonder if people would take the same risk with their vision?

in reply: I appreciate Dr. Peck's comments regarding the problem of recreational firearm use and noise-induced hearing loss. Results from a recent study¹ revealed an increased risk of marked high-frequency hearing loss among persons who had used recreational firearms. In addition to Dr. Peck's practical suggestions for counseling hunters about the use of hearing protection, physicians discussing the prevention of hearing loss with hunters should be aware of the existence of devices offering “level–dependent hearing protection.”² These devices can permit hearing of low-intensity sounds such as speech or animal movement, while attenuating louder sounds such as gunfire. These devices may be appropriate for use in certain hunting or shooting situations.²