While there are multiple symptoms associated with a concussion, hearing difficulties aren’t always at the top of the list. Sadly, an auditory issue—much like the proper diagnosis of a concussion—may be overlooked or even misdiagnosed. Understanding and recognizing the possible connections between concussions and hearing difficulties can help ensure proper treatment, and ensure proper measures are taken to prevent further impairment.
Concussions and Hearing Difficulties: An All Too Familiar Story of Invisible Injuries
After a head injury, whether due to a car accident, a fall or a sports mishap, visible signs of trauma tend to take precedence. Things like abrasions, lacerations and broken bones are easier to spot, so it makes sense that those kinds of injuries are noticed first. Symptoms of a concussion or other traumatic brain injuries (TBIs) are too often underreported at first because they are “invisible injuries.” This can be problematic because when the underlying conditions of mild, moderate or acute symptoms aren’t addressed, treatment and recovery can be delayed. This also holds true for hearing loss or other auditory symptoms.
Even when concussions are diagnosed, hearing issues are sometimes mistakenly overlooked by both patients and health care professionals as well. Hearing issues may also be considered merely a secondary symptom that may “go away on its own,” or not in need of screening right away. However, auditory issues after a concussion can impact even the simplest daily tasks, thus leading to a diminished quality of life and recovery.
Concussions and Hearing Problems: The Brain (Dis)Connection
Small nerve cells within the inner ear help detect sound. The registered sound is then carried to the brain for processing through a network of other nerve cells. This involves some complex coordinated teamwork among the body’s cognitive, sensory and limbic systems, according to auditory neuroscience researchers at Northwestern University cited in Science Report. The effects of a concussion can greatly impact the brain’s ability to process this auditory input, and may lead to additional issues if left undiagnosed. Traumatic injuries to the head can cause significant damage to the inner ear or the portion of the brain responsible for processing sound, according to the U.S. Defense Health Agency’s Hearing Center of Excellence (HCE). In many cases, symptom management is the best course of treatment. This may include addressing inflammation to reduce additional damage to the ear and brain.
“Hearing issues are often underreported in TBI patients, but auditory symptoms are beginning to be recognized more and more as heath care professionals and public become more informed about concussions in general,” says Vincent E. Schaller, MD, DABFM, CIC, medical director of Mid-Atlantic Concussion Alliance. “Hearing can be impaired due to damage to the brain and nerve cells that relay to and from the ear, and not just damage to the ear itself.”
Getting Diagnosed Properly Is Important
Regardless of where the hearing problem originates, a seemingly unresponsive patient may be misdiagnosed in several ways, says Dr. Schaller. These ways include:
- Diagnosed with an inner ear injury, while a concussion or TBI is not considered
- Diagnosed with a concussion or TBI, while auditory issues are overlooked or mistaken for just being tired or having brain fog
- Neither a concussion nor hearing issues are taken seriously at the time of injury, and the patient is told to just go home and wait it out
Because of the relationship between the brain and the ear, we can see how vital proper screening, diagnosis and treatment of concussions and TBI are. When concussed, the brain may have difficulty processing speech and sound. Sometimes, the typical signs of confusion, upon closer inspection, may actually have auditory issues contributing to the situation.
Recognizing Signs of Auditory Distress
Unfortunately, auditory issues don’t always present themselves immediately after a head-injury-related incident. That’s why it’s imperative for patients to report experiencing any difficulties with hearing, even weeks or months after a concussion.
The ability to rule out hearing problems due to a TBI can reduce the risks of misdiagnosis and further complications. According to a 2023 editorial on concussion management guidelines and auditory symptoms published in the Clinical Journal of Sports Medicine, important signs of auditory distress include:
- Tinnitus (ringing in the ears)
- dizziness
- vertigo
- noise sensitivity
- aphasia (language impairment)
- aural fullness (ears won’t pop)
Is it Post-Concussion Auditory Trauma or Cognitive Issues?
TBIs can have adverse effects on the brain’s auditory pathways, according to the HCE. Additionally, undiagnosed hearing problems can inhibit the effectiveness of a TBI patient’s treatment and rehabilitation. That is because trauma to the ear can result in an array of issues, including damage to the ossicles in the middle ear or the rupturing of the tympanic membrane, leading to mistaken signs of cognitive damage due to a TBI. According to the HCE, there are a variety of ways where a concussed individual with auditory concerns may exhibit difficulty, including the functions of:
- cognition
- attention
- noise sensitivity
- neuronal loss
- social/emotional responses
“With persistent auditory symptoms, we need to do some detective work to find out where the injuries are, in order to provide the most effective treatments,” says Dr. Schaller. “It really is a case-by-case approach.”
Hearing and Sport-Related Concussions
The impact that concussions can have on the auditory functions of college athletes has been documented by Northwestern University’s Auditory Neuroscience Laboratory (also known as Brain Volts), an organization investigating sound processing in the brain. Their research has found that some athletes can display what appears to be normal auditory functions, yet they are unable to discern other sounds upon further testing. And while studying electrical signals in auditory processing areas of the brain, difficulty distinguishing background noise from speech is a common finding.
Proper diagnosis and treatment of auditory concerns after a concussion can help prevent long-term damage in athletes. As health and sports professionals become increasingly more aware of the dangers of sports collisions and repeated impacts, particularly in sports such as football and hockey, baseline hearing exams are becoming more routine. Student athletes who are baselined can be more closely monitored to catch hearing changes that may otherwise go unnoticed.
Get the Diagnosis and Treatment You Need
At Mid-Atlantic Concussion Alliance, our network of certified medical professionals—including hearing specialists, physical therapists, occupational therapists, primary care doctors and more—are committed to your health. We can also coordinate with your doctors and specialists to optimize your concussion or TBI recovery program. For more information on concussions and auditory concerns, or to locate a MAC partner near you, contact us today.
