Concussions and Ringing Ears: The Link Between Head Injuries and Tinnitus

What is a Concussion?

A concussion is a type of traumatic brain injury caused by a blow or jolt to the head. It results in a disruption of normal brain function, usually temporarily.

Concussions most often occur from:

• Sports collisions, like tackling in football
• Falling and hitting the head
• Car accidents
• Being struck in the head

The impact causes the brain to shift rapidly within the skull, stretching and potentially damaging soft brain tissue. This is often characterized as a "bruising" of the brain.

Concussion Symptoms

Common symptoms after a concussive head injury include:

• Headache or head pressure
• Nausea
• Dizziness
• Blurry vision
• Confusion
• Difficulty concentrating or remembering
• Fatigue
• Ringing in ears

These effects are usually temporary, but can persist for weeks or months in some cases, resulting in post-concussion syndrome.

Diagnosing a Concussion

Doctors diagnose concussions based on reported symptoms, descriptions of the injury event, and neurological exams. CT scans or MRIs may be used to rule out more serious complications like bleeding or swelling.

Cognitive and balance testing helps assess the severity and monitors recovery progress. Since the brain is complex, no single test definitively confirms or excludes a concussion - doctors must piece together evidence from various sources.

The Link Between Concussions and Tinnitus

For many concussion sufferers, tinnitus in one form or another is a common after-effect. Studies show between 30 to 60% of people experience tinnitus following a head injury.

But what exactly is the connection?

Research points to several possible explanations:

1. Damage to the Auditory Nerves

The force of a head trauma can cause stretching, inflammation, and swelling of the auditory nerves - the pathways responsible for transmitting sound from the inner ears to the brain.

Damaging these delicate nerves disrupts normal auditory signaling, resulting in false noise perceptions like ringing, buzzing or roaring.

2. Changes in Brain Activity

A concussion disturbs the brain's normal electrochemical function, including in centers like the thalamus that process hearing sensation. This neurological disruption can manifest as tinnitus.

Tinnitus may arise not from the ear itself, but from how the post-concussion brain misinterprets auditory signals.

3. Oxidative Stress

Evidence shows concussions create an imbalance between damaging free radicals and protective antioxidants in the brain. This biochemical state, called oxidative stress, harms nerve cells and has been linked to tinnitus.

Antioxidant therapy aims to counteract oxidative stress and may alleviate post-traumatic tinnitus in some cases.

4. Changes in Blood Flow

Alterations in cerebral blood flow frequently occur after a concussion, reducing oxygen supply to parts of the brain. This can damage nerve cells, including in auditory pathways.

Disrupting blood and oxygen flow in hearing centers precipitates tinnitus in some patients.

Characteristics of Post-Concussion Tinnitus

Tinnitus caused by a concussion or head trauma often exhibits certain characteristics:

• Occurs almost immediately following the injury
• Consists of a loud, high-pitched ringing
• Affects both ears, or primarily the ear on the injured side
• Accompanied by sensitivity to noise
• Fluctuates in volume and pitch

Unlike age-related tinnitus that onsets gradually, post-traumatic tinnitus comes on suddenly right after the concussion. Veterans exposed to bomb blasts report a similar immediate tinnitus.

The severity of the head injury correlates with the intensity of tinnitus experienced. Significant impacts produce louder, more bothersome ringing.

Pulsatile Tinnitus

Sometimes the perceived noise has a throbbing, pulsating quality in rhythm with the heartbeat. This "pulsatile tinnitus" can result from trauma-induced disruptions in blood flow.

Pulsing objective tinnitus may indicate a treatable underlying vascular condition, so warrants medical evaluation.

Other Auditory Effects of Concussions

In addition to tinnitus, concussions frequently generate other hearing-related disturbances:

Hyperacusis

Hyperacusis is an increased sensitivity to everyday sounds, causing previously normal volumes to seem uncomfortably loud. Altered auditory nerve signals make noise intolerable.

Hearing Loss

The mechanical forces from a head injury sometimes damage the delicate inner ear structures involved in hearing. Both temporary and permanent hearing loss can result.

Dizziness

Since balance integrates input from the ears, concussions often cause vertigo and dizziness. Nausea may accompany auditory-induced imbalance.

Ear Pressure

Changes in cranial pressure from swelling or structural shifts after a concussion commonly make patients feel ear fullness or discomfort, especially when changing positions.

These auditory disruptions frequently overlap with tinnitus, complicating concussion recovery.

Tinnitus and Post-Concussion Syndrome

When concussion symptoms like headaches, dizziness, and tinnitus persist for weeks or months, a diagnosis of post-concussion syndrome may be warranted.

Post-concussion syndrome develops in 15-30% of patients. Tinnitus is one of the more common lingering symptoms.

Those at highest risk include:

• People with prior concussions
• Those with pre-existing neurological disorders
• Patients who lost consciousness
• High-impact sports players

Since causes remain uncertain, treatment focuses on managing individual symptoms. Tinnitus retraining and cognitive behavioral therapy help patients cope with persistent noise disturbances.

Second Impact Syndrome

Sustaining a second concussion before fully recovering poses serious risks. Second impact syndrome produces severe swelling and often catastrophic consequences.

Tinnitus after a concussion warrants strictly avoiding further head impacts. Let the brain fully heal before resuming sports or hazardous activities.

Treating Tinnitus After a Concussion

While some cases fade on their own, tinnitus requires proactive management for many concussion patients. Helpful strategies include:

Avoid Noise Exposure

Loud environments can exacerbate post-traumatic tinnitus and delay healing. Wear hearing protection around hazardous noise until symptoms improve.

Low-Level Sound Therapy

Soothing background sounds like fans or quiet music help mask unpleasant tinnitus. This "sound enrichment" also promotes auditory system recalibration.

Stress Reduction

Relaxation techniques like yoga, massage, mindfulness meditation and cognitive behavioral therapy alleviate stress known to aggravate tinnitus.

Medications

Drugs including antidepressants, anticonvulsants, and anti-anxiety agents sometimes relieve head injury-related tinnitus.

Hyperbaric Oxygen Therapy

Increasing oxygen delivery to the brain via pressurized, pure oxygen chambers shows promising results for post-traumatic tinnitus.

Follow up regularly with your doctor and audiologist to monitor progress and try additional therapies as needed.

Preventing Concussion-Induced Tinnitus

While not always avoidable, taking precautions helps minimize concussion risk:

• Wear helmets for sports like bicycling, skiing, or horseback riding
• Use protective headgear and proper tackling technique in contact sports
• Drive vehicles defensively and obey speed limits
• Remove tripping hazards and install grab bars in showers
• Avoid falls by clearing walkways and using chairs with armrests

Prompt evaluation of head injuries establishes a record in case persistent problems develop. Let your doctor know about any tinnitus that arises.

Long-Term Consequences of Concussions

Multiple concussions have cumulative effects, each leaving the brain more vulnerable. Increased risks include:

Cumulative Brain Damage

Repeated concussions promote progressive, permanent cognitive and motor deficits. Changes may indicate chronic traumatic encephalopathy (CTE).

Alzheimer's Disease

A history of head trauma correlating with earlier Alzheimer's onset. Concussions may trigger pathological processes in the brain.

Depression

Due to persistent post-concussion symptoms lowering quality of life. Also from concussion-induced hormonal and neurotransmitter abnormalities.

Minimizing concussions protects long-term brain health and reduces tinnitus risk. Be aware of activities that produce jarring head impacts.

Seeking Medical Care for Post-Concussion Tinnitus

Ringing or buzzing after a concussion warrants evaluation, especially if:

• Symptoms worsen or do not improve after 2 weeks
• Tinnitus is constant and severely bothersome
• Hearing loss or dizziness accompanies tinnitus
• You experience vision problems, numbness, or difficulty speaking or walking

Consult a doctor promptly if warning signs of serious injury develop. Ongoing problems may necessitate neurology, audiology, and otology referrals.

With a coordinated treatment plan, most cases of post-concussion tinnitus improve substantially. But persisting effects highlight the importance of avoiding and protecting against head trauma when possible.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.