How Head Injuries Impact Hearing and Balance

With football season getting underway, you may be wondering about head injuries. Also called traumatic brain injuries or concussions, these serious conditions affect anywhere from 27 to 69 million people each year. And the consequences can run deep, including major disability or death and billions in economic costs.

Many people don’t realize that traumatic brain injuries (TBI) can go hand in hand with hearing loss and vestibular or balance dysfunction. In fact, an estimated 30–65% of those with TBI also experience dizziness and trouble balancing, and in one study of more than 2500 participants 17 and older, 17% reported having a TBI-related hearing problem.

Let’s take a closer look at head injuries, hearing loss, and balance problems.

What Exactly Is a Traumatic Brain Injury?

Traumatic brain injury is a disruption in normal brain function caused by an external force. The force could be a blow, jolt, bump, or penetrating injury. There are three main types of TBI — mild, also known as a concussion; moderate; or severe — with the classifications based at least in part on the severity of symptoms.

Though often associated with football, TBI isn’t limited to those who play on the gridiron. Other sports, such as soccer, boxing, basketball, hockey, and rugby have also yielded serious head injuries. In addition, activities in everyday life can lead to an incident. Car crashes, workplace accidents, falls, assaults, and gun-related injuries all contribute to prevalence as well.

TBIs require medical attention and can have profound consequences, including long-term or permanent neurological impairment. They can affect physical, sensorial, cognitive, mental/emotional, and behavioral functions. Severity may turn on factors such as the force of impact, the area of the brain affected, and additional injuries or complications.

Some potential TBI symptoms:

• Physical — headaches, dizziness, nausea, fatigue, sweating, seizures or convulsions, bleeding in the brain, weakness, open head wound, problems maintaining balance
• Sensorial — light sensitivity; loss of consciousness; ringing in the ears; changes in or reduced sense of taste, smell, hearing, touch, or vision; hyperacusis (decreased sound tolerance)
• Cognitive — confusion, memory issues, trouble concentrating, difficulty learning or problem-solving, reduced awareness of self or other people, inability to follow instructions
• Mental/emotional/behavioral — mood or personality changes, irritability, sadness, anxiety or nervousness, aggression, impulsiveness, disinhibition, restlessness, reduced impulse control

How Is TBI Connected to Hearing & Balance Problems?

Both the brain and parts of the ear structure are involved in hearing and balance, so it’s no wonder that head injuries can affect both functions. Let’s take a closer look at each function separately to understand potential impacts, including how TBI can also lead to tinnitus (ringing, buzzing, or humming in the ears or head):

Hearing

The force of a traumatic brain injury can damage or displace the sensitive bones of the inner ear, rupture the eardrum, and interfere with parts of the brain responsible for auditory processing. This disruption can show up in different ways, including conductive, sensorineural, or mixed hearing loss.

Conductive hearing loss can occur if the structures within the ear, such as the middle ear bones or ear canal, are damaged during the injury, obstructing sound transmission. Sensorineural hearing loss can stem from auditory nerve damage or injury to the brain’s auditory processing centers, affecting the ability to interpret and understand sounds.

Mixed hearing loss involves a combination of both conductive and sensorineural hearing loss. TBI can lead to mixed hearing loss by damaging the ear’s auditory structures — for example, the cochlea, a critical part of hearing — and the neural pathways that contribute to processing sound within the brain.

Tinnitus

As many as 53% of people with traumatic brain injury experience tinnitus, per a study published in The Journal of Head Trauma Rehabilitation. TBI can cause tinnitus through damage to the cochlea, auditory nerve, or brain areas involved in auditory processing, resulting in abnormal neural activity that generates tinnitus.

TBI-related changes in brain function, such as altered neural pathways or increased sensitivity to auditory stimuli, can also contribute to development or aggravation of tinnitus. In addition, hearing loss — which can directly result from head injury — is a common cause of tinnitus. An estimated 90% of people with tinnitus additionally have hearing loss.

Balance

Equilibrium or balance is controlled by the body’s vestibular system, involving parts of the body such as the brain, eyes, inner-ear structures, skin, muscles, and more. Thus damage or other changes to the functions that help support your vestibular system and sense of balance can lead to problems.

Given the vestibular system’s role in balance and spatial orientation, damage from traumatic brain injury can result in dizziness, vertigo, imbalance, nausea, and other serious conditions. It not only can make it difficult to stay steady on your feet but also reduces your overall mobility, independence, and quality of life.

What’s the Treatment for TBI & Related Hearing Loss/Balance Problems?

Treatment for traumatic brain injury may vary per the severity. The first step is to seek immediate medical attention with a physician who can perform a comprehensive evaluation, including potential assessments such as a Glasgow Coma Scale to gauge consciousness, imaging tests for a more detailed look at the brain and ears, blood tests, a neurological exam, and other tools.

The range of treatments may involve:

• Rest, allowing the brain time to recuperate and rebuild from the trauma, helping reduce inflammation, optimizing rehabilitation efforts, and minimizing the risk of additional injury
• Medication to address inflammation, curb pressure in the brain, prevent seizures, or induce a coma to support healing
• Physical, occupational, or speech-language rehabilitation to help restore the person’s functioning, including the ability to move, interact, and communicate
• Surgery, which in some cases may be needed to address issues such as brain bleeding, skull fractures, blood clots, pressure around the brain, or other problems

Most cases of hearing loss resulting from a TBI resolve on their own within a few months, as the brain undergoes natural healing processes. It can also be permanent, however, in the case of cochlear damage. Keeping an eye on hearing levels can help determine whether the loss is temporary or permanent and what next steps are needed.

With such strong connections among TBI, hearing loss, balance problems, and tinnitus, it’s important to see a licensed and trained hearing care professional, especially if the injury is accompanied by dizziness, difficulty hearing, ringing in the ears, sensitivity to sound, or trouble staying steady on your feet. As part of your evaluation, the hearing care provider can:

• Test and monitor your hearing to determine the extent of any loss and appropriate treatment
• Conduct vestibular testing to help assess balance problems and offer effective solutions
• Evaluate ringing in the ears or head and recommend appropriate management strategies

The most important approach to traumatic brain injuries is awareness and prevention. Understanding the risks and activities that can lead to head injuries — and taking effective steps to protect yourself or your loved ones — can go a long way toward avoiding potential problems in the first place.

Using seatbelts while riding in vehicles; wearing appropriate headgear when cycling, skateboarding, or engaging in other potentially hazardous sports; holding on to railings when taking the stairs or icy/wet conditions; entering/exiting the tub or shower carefully; and installing good lighting indoors and out are just a few important precautions. Making them a habit is crucial.

If you or someone you know has suffered a head injury and is experiencing hearing difficulties, ringing in the ears, or trouble with balance, don’t wait. Schedule an evaluation with our board certified doctors of audiology team today. We’re HEAR to help!