Traumatic brain injury can lead to hearing loss and tinnitus


Have you been diagnosed with a head injury (TBI) or concussion? Remember your ears. Airbag injuries or explosions, for example, can affect them and trigger ringing in the ears, dizziness and hearing loss.

Anyone can have TBI, but these events are more likely to be serious in older people. In the United States, people aged 75 and over have the highest number and rates of hospitalizations for TBI.

The primary goal of physicians following TBI is to stabilize the patient. It may take some time before “the patient reports signs and symptoms of audiological disorders or family members begin to notice the signs,” notes Shahrzad Cohen, an audiologist based in Sherman Oaks, Calif., In a report. online seminar for the Hearing Loss Association of America.

Sometimes the problems are identified a long time later. If you have a TBI in your history, even a mild one, be sure to tell your doctor or hearing care professional. Hearing loss and other hearing problems may have been missed or misdiagnosed.

What is traumatic brain injury (TBI)?

The medical definition of traumatic brain injury is head trauma that temporarily interferes with normal brain function. Falls cause almost half of all head injuries, followed by car crashes and assaults. Any bump, blow, or jerk that causes the head and brain to move quickly back and forth can cause the brain to bounce or twist in the skull, triggering chemical changes. It can also damage cells, as you can see in this drawing Centers for Disease Control and Prevention.

Note that the blow does not have to be directly on your head; for example, if you have a car accident and you rush forward violently, you might have a head injury even if your head doesn’t hit anything. In addition, your brain can be injured even if you have not passed out.

Doctors may use the word “concussion” rather than brain injury, especially when talking to parents, because it is less alarming. But a concussion is still a TBI. There is some evidence that hospitals contract out TBIs that are considered benign. In one to study of 395 patients aged 14 and over who came to an urban hospital with mild TBI, among those who met the usual criteria to be discharged home without follow-up, 27% were found to have lasting cognitive problems, said the researchers, and therapy needed.

What hearing problems can be triggered by a TBI?

Hearing (hearing) problems can include:

  • tinnitus (ringing in the ears)
  • hearing loss
  • noise sensitivity or volume intolerance
  • decreased sound tolerance for specific sounds
  • hearing fullness (ears feel like they can’t burst)
  • hearing processing problems (you pass a hearing test but have difficulty understanding speech)

Vestibular (balance) problems can include:

  • dizziness
  • vertigo attacks
  • balance problems
  • BPPV, or benign paroxysmal positional vertigo (sensation of spinning)
  • travel sickness
  • general instability

Tinnitus after concussion or brain injury

More than half of TBI patients develop tinnitus, also known as ringing in the ears, and this number is higher if they have had an explosion. Phantom sounds, which range from hissing to buzzing, “are the first and most reported problem with traumatic brain injury,” Cohen said. Tinnitus can have a big emotional impact. “This is a major problem for our patients,” she added.

Tinnitus can be a direct result of injury or a side effect of medications commonly used to treat symptoms of TBI, including SSRI antidepressants (Prozac and others), regular over-the-counter pain relievers (aspirin and others), and anti-anxiety benzodiazepines (Xanax, Klonopin and more).

Most people with tinnitus also have hearing loss, even if they don’t realize it. State-of-the-art hearing aids can be programmed to mask phantom sounds and are particularly useful with cognitive behavioral therapy and / or tinnitus sound therapy.

Persistent inflammation

In mild cases, standard neuroimaging is unlikely to find structural brain damage. However, it may be missing subtle changes that are common with mild TBIs, Cohen reports. As the brain moves and spins inside the bony skull, long connecting nerve fibers can be torn, a problem technically called diffuse axonal injury. These tears are often microscopic and may not be evident on computed tomography (CT) or magnetic resonance imaging (MRI). Yet, they can lead to continued inflammation.

If you have a head injury in your history, even a mild one, be sure to let your doctor or hearing care professional know. Hearing loss and other hearing problems may have been missed or misdiagnosed.

To support this idea, blood tests revealed unusual signs of inflammation in veterans with a history of mild TBI, even years later, a to study find.

In other evidence of long-lasting effects, CBTs increase your risk for insomnia, sleep apnea and other sleep problems for up to 14 years later, according to a to study nearly 200,000 veterans. The risk of having a sleep disorder was higher if your TBI was mild. This could be because people in this group are more likely to have sustained repeated injuries that led to diffuse inflammation rather than a single severe TBI, the researchers suggested.

Hearing loss is a common result of TBI

A man suffering from tinnitus.
Tinnitus (ringing in the ears) is common
after a head injury.

A 2018 review of existing science concluded that even among TBI patients who did not break their head bones, 58% had related hearing loss, although sometimes only temporarily. In one to study in over 1.6 million people in Taiwan, TBIs more than double the risk of hearing loss over the next decade

Why would that be? It helps to review the functioning of the ear. The middle ear contains the eardrum, a layer of tissue that vibrates in response to sound. It communicates this vibration to three small bones, called bony bones. The vibration from these bones travels to the fluid in the inner ear and the cochlea, which communicates with the auditory nerve.

Problems can arise at any point in this process, for example:

  • If the eardrum is torn, blood can collect in the middle ear, a condition called a hemotympanum.
  • If the bony bones are damaged or dislodged, the sound may not travel properly. The three bones can fuse together and become stiff and stop vibrating, a condition called otosclerosis.
  • Sometimes brain damage triggers abnormal bone growth, called heterotopic ossification, which can affect your hearing if it occurs in the ear.
  • Ménière’s syndrome, also known as hydrops, is caused by excessive pressure in the chambers of the inner ear that contain fluid. It could develop a month after a TBI or years later.
  • Injury or blowing air bags can damage the hair cells in the cochlea, even if there are no other bone fractures, causing tinnitus, dizziness, and hearing loss.
  • A bone fracture can sever the auditory nerve.
  • A TBI can damage the hair cells in the cochlea (which are responsible for detecting sound waves).
  • A TBI can damage the auditory regions of the deep brain that process language or sound.

How is CBT-related hearing loss treated?

If you notice symptoms after any type of head injury, be sure to have your hearing checked as part of your checkup.

Treatment will depend on the symptom and its cause. A ruptured eardrum, for example, can recover on its own in about a month. Damaged bone bones can be repaired or replaced surgically. Meniere’s syndrome dizziness can be treated with medication, but you won’t be able to reverse the hearing loss. A hearing aid will help.

Key Message: Make sure you get a hearing assessment after any incident that may have injured your brain, and include your history when talking to a doctor about any current hearing or balance issues.


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