The Link Between Trauma and Hearing Loss
Published: October 25, 2021
Updated: July 22, 2022
Trauma can be described as a deeply distressing or disturbing experience or a physical injury. In the case of hearing, trauma can result in hearing loss, and there are different variations of trauma that can cause different types of hearing loss.
In addition to the 3 main types of hearing loss, the function of hearing can also be impaired when the centre of the brain that is responsible for processing the auditory signals is affected by trauma. Furthermore, the vestibular organs responsible for balance and form part of the auditory system, also face the risk of impairment from trauma.
Trauma and Hearing Loss
There are different types of trauma that can affect one or more of the different areas of the auditory system. As a result, based on the extent of the trauma and areas affected, this will pose the person at risk to one or more of the types of hearing impairments mentioned above. We now look at the different types of trauma and the effect that it has on each part of the auditory system:
Outer ear trauma
The external ear (pinna or auricle) can be damaged by trauma or inflammation. This can occur from direct injury to the outer ear or head. It can also involve the insertion of foreign bodies in the ear canal (matchsticks, hairpins) that can cause damage to the skin in the ear canal or rupture the eardrum.
Symptoms to look out for include noticeable hearing loss which will only arise if the entrance to the ear canal is obstructed or closed up preventing sound entry. A rupture to the eardrum or damage to the skin in the ear canal will be accompanied by pain and possibly bleeding.
Middle ear trauma
Any abnormal pressure in the middle ear cavity, due to inadequate ventilation and drainage of the middle ear cavity, can put the eardrum under such stress that it causes it to perforate. Significant atmospheric pressure changes, such as when flying or diving, can cause pain and hearing loss sometimes resulting in eardrum rupture (called barotrauma). Flying or diving with a head cold increases the likelihood of barotrauma and can result in complications, even permanent hearing loss.
Trauma can also occur to the middle ear bones. The chain of three tiny bones in the middle ear (ossicles or ossicular chain) transmits sound vibrations from the outer ear to the cochlea in the inner ear. These tiny bones can suffer dislocation from head trauma such as in a road traffic accident or in contact sports such as boxing or rugby.
Inner ear trauma
Trauma to the inner ear can cause certain noises or pitches to become extremely loud or soft. This, in turn, causes a condition called hyperacusis which is the extreme sensitivity to sounds that becomes debilitating to the person’s daily functioning. Currently, there is no cure for hyperacusis but there are many effective strategies to manage this condition, such as using hearing protection to reduce sound sensitivity.
Acoustic trauma is caused by injury to the inner ear as a result of exposure to high-decibel noise (exceeding regulated levels of noise exposure without ear protection). This injury can occur after exposure to a single, very loud noise or from exposure to noises at significant decibels over a longer period of time.
Traumatic brain injury
A traumatic brain injury (TBI) is any kind of injury that causes structural or physiological changes to brain function. It is usually the result of an external force like a blast, a direct blow, or a fall, and can present with the occurrence or worsening of any of the following signs:
- Loss or decreased level of consciousness
- Memory loss
- Feeling dazed, confused, or disoriented
- Neurological changes including weakness, loss of balance or changes in vision
Research suggests about 1.5 per 1,000 people in the USA are admitted to the hospital each year for TBI, and hearing healthcare professionals are likely to have some of them as patients. TBI may result in hearing loss and vestibular and central auditory problems.
Due to the sudden and violent nature of TBI, it may cause concurrent damage to the auditory pathway. Damage can occur at any point within the auditory pathway, from the outer ear to the cortex, which can result in a variety of complex symptoms.
Impairment due to trauma can produce conductive and sensorineural hearing loss, central auditory processing deficits, vestibular impairments, and tinnitus. The tympanic membrane, middle ear, and cochlea are the most common sites of peripheral injury as they are often directly in the line of trauma. This, in turn, can cause displacement of the middle ear bones and vestibular apparatus. The hair cells are the most vulnerable elements of the cochlea and, when damaged, can produce sensorineural hearing loss and tinnitus.
Injury to the auditory cortex where auditory signals are processed in the brain can result in the person experiencing difficulty interpreting auditory input. In some cases, the person will not present with hearing loss but struggle to decode what he/she is hearing.
Post-traumatic Stress Disorder (PTSD)
PTSD is a disorder that can develop after a person witnesses or experiences a traumatic or terrifying event. Given the nature of combat and war zone environments, Service members are at heightened risk for PTSD.
Tinnitus (ringing or buzzing in the ear) has been associated with PTSD. Although the person may not present with hearing loss, tinnitus can cause impairment to their daily functioning. Hearing loss can sometimes have an isolating effect and tinnitus can be stressful, while both can aggravate PTSD symptoms, such as depression, anxiety, obsession, and sleep disturbances.
Treatment Options for Trauma-Induced Hearing Loss
One of the most apparent signs of trauma-induced hearing loss is the immediate symptoms of hearing loss and associated factors like pain, dizziness, or imbalance. It is crucial that the person undergoes a comprehensive medical examination to ensure that the injuries can be addressed and healing facilitated in a timely manner.
The type of treatment needed will depend on both the type of trauma and type of hearing loss. Here are a few common treatment options.
Removal of foreign object
Outer ear obstructions, such as earwax and other foreign objects, can often be removed by an ENT specialist. Middle and inner obstructions, such as scarring of the eardrum, skin, or excess fluid, are usually a bit more difficult to treat, but there are still likely to be non-invasive (surgery-free) treatment options available.
More complex scenarios such as the displacement of the middle ear bones may require surgery. The surgery and treatment will depend on the extent of damage that occurred in the middle ear.
Certain types of trauma, such as vestibular trauma or traumatic brain injury, will likely require rehabilitation, as well as other forms of treatment as needed.
For example, vestibular trauma can be treated by an Audiologist or ENT through the appropriate vestibular rehabilitation techniques based on the assessment findings. Vestibular rehabilitation usually includes specific exercises, which may include medication and rest.
Patients with TBI present a distinctive and challenging population for the hearing healthcare practitioner. In addition to hearing loss, patients can endure a period or permanent disability, amongst other disruptions to the person’s functioning. The treatment and rehabilitation of auditory and vestibular injury associated with TBI will require a multidisciplinary approach between otolaryngology, audiology, speech-language pathology and other allied health professionals.
Psychological treatment or counseling
Specifically, in the case of PTSD, psychological management for the specific cause of trauma is needed. This can include counseling and techniques to reduce anxiety or sleep disturbances.
Amplification (hearing aids or other devices)
For trauma-induced hearing loss that is considered permanent, such as trauma to the inner ear and acoustic trauma, amplification is the most common form of treatment. Typically, this comes in the form of hearing aids, but could also include other amplification devices such as cochlear implants.
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