Understanding The Prevalence Of Tinnitus In Military Veterans

Tinnitus disproportionately affects certain groups within the population, and military service members are particularly at risk. The frequent exposure to high-decibel sounds, coupled with a heightened susceptibility to various mental health and medical conditions, makes them substantially more vulnerable to developing both tinnitus and hearing loss compared to civilians. So, how do those in the armed forces manage these auditory challenges? In the following discussion, we will delve into the impact of tinnitus and hearing loss on both active-duty personnel and veterans, while also exploring why military service amplifies the chances of encountering these symptoms.

Military Hearing Loss & Tinnitus | VA Disability Compensation

Hearing problems, including tinnitus, are among the most prevalent service-related disability found amongst American veterans today. In the year 2020 alone, over 1.3 million veterans were receiving disability compensation to address hearing loss, while 2.3 million were receiving disability compensation for tinnitus symptoms. To address this issue, the department of veterans affairs provides a variety of hearing services, which typically include screening and prevention, the treatment of both hearing loss and balance disorders, tinnitus education and management, and rehabilitation for the auditory system, in order to optimize residual hearing.

Veterans however, are not the only service members impacted; tinnitus rates among active duty service members has also increased in recent years. In 2019, one study found that the rate of tinnitus had more than tripled between 2001 and 2015. In 2001, 1.8 out of every 1,000 service members reported experiencing symptoms of tinnitus, and by 2015, that number had increased to 6.3 out of 1,000 service members. While the most likely cause is consistent exposure to loud noises, there are numerous other potential causes to explain the spike in cases.

Types And Symptoms Of Hearing Problems

There are many different types of hearing loss and tinnitus, and understanding them can be a vital part of seeking aid. Conductive hearing loss is one type of hearing loss, and is caused by damage to the outer ear, the eardrum, or the middle ear structures. It can often be addressed and even reversed through surgery or medication, to remove growths or excessive ear wax occluding the ear, or to address infections within the ear.

Sensorineural hearing loss is another type, and is caused by damage to the inner ear and the auditory nerve. This type of hearing loss is most often permanent, but is often successfully addressed or managed through the use of hearing aids or cochlear implants.

Auditory processing disorder is another hearing issue, wherein hearing levels or hearing thresholds show up as normal in routine audiological evaluation, but the individual in question experiences difficulty understanding speech, especially in the presence of competing noise (i.e., background noise). It can be related to the sound of loud noises, such as blast exposure, and can have a significant impact on quality of life, particularly where social health and comfort are concerned. One study evaluating difficulties with speech found that individuals with auditory processing issues are more likely to be unable to experience the “cocktail party effect,” or the ability to understand a distinct voice within a crowded, noisy room. These individuals may struggle to separate individual voices within a noisy environment, in part as a result of difficulty focusing on a single source of auditory input.

Blast Exposure And Injuries

Many service members who served in Iraq and Afghanistan were exposed to explosions and blasts during their service, which negatively impacted hearing in one or both ears. The department of veterans affairs recognizes the impact loud noises can have on hearing health, and VA researchers continue to research the effects blast exposure has on the brain. Hearing loss and damage to the ear can lead to damaged connections between the ears and the brain, leading to hearing loss and tinnitus.

Veterans and service members who were exposed to blasts have also been found to have a greater risk of experiencing decreased sound tolerance. These individuals may experience negative responses to everyday sounds, which can lead to feelings of discomfort and overwhelm when exposed to the common background noise found in public spaces. 33% of service members and 48% of veterans who were exposed to blasts reported decreased sound tolerance, however, more research is needed to fully understand how hearing is impacted by blast exposure.

Numerous studies have assessed the auditory health of veterans who served in Iraq and Afghanistan. One such study focused on determining the prevalence of hearing loss and tinnitus among veterans, while also identifying any coexisting conditions that might contribute to these auditory issues. The study found that slightly less than 8% of veterans were diagnosed with hearing loss, just over 6% received a diagnosis for tinnitus, and an additional 6% were found to have both conditions.

Additionally, the presence of comorbidities such as traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), and depression were closely linked to elevated instances of hearing loss, tinnitus, or a combination of both. Specifically, veterans exposed to blasts were more susceptible to symptoms of tinnitus and noise-induced hearing loss. Likewise, those diagnosed with TBI, PTSD, depression, and other sensory impairments—including visual disturbances, vertigo, headaches, and dizziness—exhibited a heightened risk of developing these auditory conditions.

Traumatic Brain Injury (TBI)

TBI is an injury to the head that disrupts the brain’s ability to function normally. Military service members may incur a traumatic brain injury from close proximity to a blast or explosion, a fragment wound or bullet wound that occurs above the shoulders, a blow to the head from any origin, a fall, or a vehicle accident. The most common symptoms that occur directly following a TBI include dizziness, confusion, memory changes or loss, and loss of consciousness. Some have also reported “seeing stars,” or experiencing changes to vision.

As time goes on, people with a TBI may also experience head or neck pain, sensitivities to light and noise, loss of balance, changes to vision (including blurred vision), exhaustion, decreased energy levels, ringing in the ears, mental changes (including depression, anxiety, and anhedonia), decreases in reading, thinking, and speaking ability, and difficulty with concentration and organization. A research project funded by veterans affairs and the Department of Defense, called Chronic Effects of Neurotrauma Consortium (CENC), addresses the long-term effects even a mild TBI can have on service members and veterans. A study found that TBI is associated with a 75% incidence of tinnitus. 33% of patients being seen through the US Veterans Administration were given a diagnosis of PTSD. Which of the factors are most likely to contribute to tinnitus or profound hearing loss remains unknown, but the study seeks to determine whether TBI and PTSD predict the onset of tinnitus, or a lack of recovery from or worsening tinnitus. Ultimately, it was found that tinnitus is more likely to progress when PTSD and TBI are present.

Selected Major Accomplishments In VA Research

Within the past 25 years, VA research has established a host of research projects looking into hearing losses and tinnitus among veterans and service members. A 2000 study determined the efficacy of hearing aids for different needs. Another, published in 2005, established a comprehensive protocol for tinnitus management. In 2019, veterans affairs research established the likelihood of decreased sound tolerance among service members and veterans, and a 2021 study determined that PTSD, depression, and anxiety are all higher in populations with tinnitus.

New, Ongoing, and Published Research

VA researchers are studying ways to prevent, diagnose, and treat hearing loss and related issues. They are also addressing a wide range of technological, medical, rehabilitative, and social issues associated with tinnitus and blast exposure. One study in 2019, for instance, evaluated deep brain stimulation (DBS) as a potential treatment avenue, and found the results encouraging. Another study in 2017 determined that using a sound emitting device worn overnight was useful for patients.

The National Center For Rehabilitative Auditory Research

Hearing problems in veterans are not new; the VA established a program to study hearing problems in 1997 with the mission to improve quality of life among veterans, and others with hearing and balance issues. NCRAR was developed to find effective treatments, conduct clinical research, develop technology, and create education tools to effectively improve patient care. Within NCRAR, researchers are developing the tools required to alleviate different communication, social, and economic problems found among veterans that come about as a result of tinnitus and hearing loss. Early detection of hearing loss, the effects of different diseases and conditions on the auditory system, and the impact of auditory system difficulties on speech perception are some of the most important areas of study currently underway.

NCRAR researchers looked at a sample of nearly 900 veterans diagnosed with tinnitus in 2021. The likelihood of receiving a positive screening for PTSD, depression, and anxiety were all increased for veterans who experienced moderate to severe tinnitus, concluding that mental health and moderate to severe tinnitus are closely linked. Hearing loss and tinnitus impact far more than the ears, as this study indicated: mental health symptoms have consistently been found in research put forth by different researchers within the broader department of veterans affairs.

NOISE Study

NOISE, or Noise Outcomes in Service Members Epidemiology is a longitudinal, epidemiological study addressing hearing health, including hearing loss and tinnitus, among military service members and veterans. The study is a collaborative effort between the department of veterans affairs and the department of defense, with the ultimate goal of improving hearing health among those who have served in the military.

Disability Ratings And VA Benefits

Compensation through VA disability benefits provides a tax-free payment to veterans who were sick or injured during their time served, and those whose service made a pre-existing condition worse. To determine if they qualify for VA disability benefits, veterans should report any physical conditions like a chronic illness or injury, and mental health symptoms, such as PTSD, that developed before, during, or after service, as doing so will help demonstrate the impact military service had on their health. The amount of monthly payments is based on a veteran’s disability rating and how many dependent family members are in the home. Standard rates range from $165 to $327 for 10-20% disability, or $500 to $1500, depending on the level of disability recorded and the number of dependents within the home.

Evidence For Your Tinnitus VA Claim

The VA reviews all available evidence to determine the eligibility of the veteran in question. The evidence typically required includes:

• Evidence of a current physical or mental disability, that makes you less or totally unable to do everyday tasks, including meaningful work.
• Evidence of an event, injury, or illness that occurred while you were serving in the military and led to your disability.
• DD214 and other separation documents
• Service treatment records
• Additional medical evidence, including doctor’s reports, X-rays, medical test results, and more.

The VA is required, by law, to tell veterans what evidence exactly is required to process and subsequently support a disability claim. If you are unsure whether or not you qualify, reach out to the VA for more information regarding qualification requirements and application processes.

How Much VA Compensation Do You Get for Tinnitus?

Although the precise amount of money provided to veterans with tinnitus will vary, most tinnitus cases warrant a rating of 10 percent. The most recent estimates suggest that a 10% disability compensation rate is equal to just over $150 per month. This can help defray the cost of treatments and support services.

Have Questions About Appealing Your Claim Or Understanding How The Claims Process Works?

Visit the VA website to appeal claims or learn more about how the claims process works.

Hearing Aids And Listening Devices

While hearing aids are most frequently recognized as a treatment option for hearing loss, they can also be used to manage tinnitus symptoms, whether that is through providing amplification, or delivering sound therapy. Hearing aids are small, electronic devices worn inside or behind the ear. The VA policy is that all veterans who are enrolled in VA healthcare are eligible for medical services, including diagnostic audiology, or hearing healthcare. Many are also eligible for VA-supported hearing aids. The National Institute for Health and VA partnered together in 1996 to create the Hearing Aid Clinical Trial, or the first large-scale clinical trial used to demonstrate the efficacy of three different types of hearing loss. The result was a source of proof that hearing aids provide substantial improvements to hearing in both loss and tinnitus.

Cochlear Implants

The VA provides cochlear implants and follow-up care for veterans who require the procedure. Many veterans have sensorineural hearing loss as a result of age related hearing loss, or as a result of exposure to loud noise in combat or training. While the availability is often there, one study found that many veterans in need of cochlear implants experience difficulty actually accessing specialized hearing services. The geographic location of the veterans plays a significant role in access to care; while veterans as a whole are in a high risk group for the development of sensorineural hearing loss that requires treatment with cochlear implants, not all patients have access to Veterans Health Administration (VHA) facilities that are able to deliver specialized services, such as cochlear device implantation.

While the VA as a whole does address hearing loss in one or both ears, this study determined that there were large disparities among veterans’ ability to access care. The placement of new facilities and remote programming and healthcare options are vital to make sure that veteran populations receive appropriate care.

Tinnitus Management

The precise way that tinnitus impacts an individual person will vary from person to person. As a result, the VA has developed an interdisciplinary approach to tinnitus treatment. In most instances, there is not a cure for tinnitus; instead, the goal of the VA and other treating bodies is to make sounds less noticeable and help veterans develop healthier and more effective coping mechanisms. The first step for veterans is usually to take a hearing test and undergo evaluation from a trained audiologist. The tinnitus management approach developed by the NCRAR in 2006, Progressive Tinnitus Management, is the approach utilized by the VA to help veterans treat severe tinnitus, hearing loss, and other hearing conditions.

During the PTM approach, veterans will be able to work with a team of clinicians to develop a personalized action plan to help manage their tinnitus symptoms. There are five levels of management, which include triage, evaluation, group education, interdisciplinary evaluation, and individualized support. Treatments may or may not include hearing aids and cochlear implants, sound therapy, CBT, and more evidence-based interventions for hearing loss and tinnitus. The Tinnitus Functional Index (TFI), Tinnitus and Hearing Survey (THS), and Speech, Spacial, and Qualities (SSQ) hearing scale will be utilized in the intake stage to determine the severity of symptoms.

Are New Treatments For Tinnitus On The Way?

Ongoing studies are still being conducted by the VA and other organizations and researchers eager to help those with tinnitus and hearing loss. Although current recommendations, like hearing aids, mental health intervention, and sound therapy have all demonstrated immense value, the need for tinnitus care is crucial, especially among veterans. Consequently, there are many researchers looking into the many different underlying causes of tinnitus, and how those underlying causes can be addressed to more effectively manage and treat tinnitus.