One of the many causes of tinnitus includes traumatic injury of the brain and may warrant further investigations by a healthcare professional to best assess your medical needs and treatment. In fact, for more than one in ten suffering from chronic tinnitus (ringing ears) the problem stems from a previous neck or head injury. These symptoms can last from a timescale of days/weeks to even months or years in more severe cases and should be closely monitored. 

These head injuries or traumatic brain injuries (TBI) can have many consequences neurologically and physiologically on the body. More commonly known as concussions, head injuries can vary not only in their severity but also in their consequential effects on the body. It is important to consider if you or a loved one are at risk of being exposed to repeated head injuries and how this may impact you or your family member’s own health and wellbeing. 

Causes of head injuries

There are many causes of head injuries and they can vary in the severity of injury resulting in a wide variety of symptoms both physiologically and cognitively. Consider what risk factors you may have that have increased your exposure to traumatic brain injuries to best assess whether you may need to seek out treatment. Remember that brain injuries are a serious medical concern and if you believe that you may have experienced traumatic brain injuries, it is best to consult a medical professional to assess any potential damage you may have experienced. 

Common causes of head injuries can be due to physical activity such as contact sports (football, basketball, boxing),  extreme outdoor sports (mountain biking, downhill skiing/snowboarding, motocross), falling or tripping, assaults/fights, or motor vehicle accidents. If you have been frequently exposed to the following activities you may be at a higher risk of developing chronic brain damage due to repeated head injuries. These head injuries can be progressively damaging and have summative effects in that the more instances of minor head injuries, the greater the likelihood of significant brain damage. 

The reason that head injuries cause damage is due to the anatomical structure of the cranium (skull) that the brain sits in. The brain is suspended in a lining of fluid called cerebrospinal fluid (CSF) that cushions your brain against your skull such that the brain does not experience large amounts of force against the skull bones. However, in the case of traumatic head injuries, the brain can undergo significant amounts of force by impacting the cranium leading to brain damage. To better understand the physical mechanism of how this can occur, consider the brain as a squishy spring in the skull. If the head is rapidly moved, the brain will be pushed against one side of the skull and compress like a spring. This compression will then relieve itself rapidly by decompressing and end up springing over to the other side of the skull causing a ‘bouncing’ effect (contrecoup) on the brain. The brain will be rapidly pushed and pulled inside the cranium and impact the skull with very high force thus leading to a traumatic brain injury (TBI).

Symptoms of Head Injuries

The symptoms of head injuries can vary depending on the severity of the prior head injuries and the amount of head injuries incurred over time. Additionally, depending on the amount of exposure you have had to brain injuries, your symptoms can increase in number or severity over time. For example, an individual with one severe episode of head trauma can have similar degrees of brain damage as an individual with multiple minor episodes of head trauma.

These symptoms can be indicative of potential brain damage and include but are not limited to the following:

Physical

• Loss of consciousness: fainting spell/ falls
• Post-injury amnesia: inability to remember short-term on long-term memories
• Headaches/Migraines: severe headaches/migraines are often a common symptom following concussions or brain injuries
• Dizziness/vertigo: it may be difficult to maintain balance/posture
• Light Sensitivity: you may experience pain upon exposure to bright stimuli
• Sound Sensitivity: you may experience pain upon exposure to loud stimuli
• Seizures: a serious medical concern involving highly excitable brain activity and convulsions
• Blurred Vision: it may be difficult to see
• Dry Eyes: your eyes may be frequently dry or itchy
• Chronic Pain: you may experiencing chronic, undifferentiated pain in the body

Cognitive

• Diminished attention span: head injuries can affect the prefrontal cortex and diminish your focus or attention span
• Impaired decision making: similarly the prefrontal cortex is also involved with decision making and can be impaired with head injuries
• Lack of impulse control: also related to prefrontal cortex functioning, you may be experiencing impulsive behaviors such as excessive spending and sexual encounters
• Trouble concentrating: It may simply be difficult to concentrate on daily tasks
• Memory Lapses: you may forget what you are doing or who you are talking to
• Confusion: You may experiencing confusion relating to your identity or your orientation both spatially and temporally

Emotional

• Anxiety: generalized anxiety or nervousness can be increased following traumatic head injuries
• Apathy: the inability to feel emotions or a blunt affect 
• Aggression: people can become more aggressive for no apparent reason following repeated head injuries (common in retired NFL athletes)
• Depression: mood can be damped or depressed following repeated head trauma
• Personality changes over time: a family member or loved one may report that your personality has changed over time
• Post Traumatic Stress: PTSD can be a common symptoms reported by those who have experiencing multiple traumatic head events, especially in the case of motor vehicle accidents

Why does tinnitus occur with a head injury?

Sensitivity to sound is a normal response after concussion has occurred. Some people realized that they experience these symptoms more often such as when going to noisy places such as the grocery store and restaurants. Remember that tinnitus is a ringing, buzzing or hissing noise in your ears. It can happen due to damage to the inner ear or to the hearing nerves and the part of the brain that controls hearing known as the auditory cortex. Tinnitus can be there all the time or it may come and go. These changes usually get better after a while. However, a prolonged sensitivity to sound may be indicative of underlying tinnitus.

As mentioned earlier, tinnitus can be a resulting consequence of traumatic head injuries due to the whiplashing of the brain within the skull. The damaged parts of the brain attempt to adapt and recover which can result in symptoms of tinnitus. In the case of tinnitus, the auditory cortex or hair cells (specialized nerve cells found within the inner ear) which allow us to hear and process sounds may have been affected, causing these unpleasant sensations such as ringing in the ears.

According to one study, when compared with other tinnitus patients, the neck and head injury group often suffered from more daily problems because of their tinnitus. They had more difficulty sleeping, relaxing, thinking clearly, and remembering. They also estimate the noise level of their tinnitus to be one third higher than other tinnitus sufferers who had not experienced either a head or neck injury. On the so-called Tinnitus Severity Index, this places them at an average 41.9 points, which, according to the study authors, is significantly higher than the 38.1 point average for the other patients. So consider the severity of your tinnitus as it may correlate with the severity of the head injury exposure.

Management of tinnitus due to head injuries

You may be wondering how head injury related tinnitus may be treated by a clinician or healthcare provider which we will discuss. Additionally, those experiencing symptoms of tinnitus often find individualized methods that help them best manage their symptoms.

Hearing specialist

Consulting a hearing specialist may be a prudent option to be able to understand the severity of your tinnitus and ways to best manage it. A hearing specialist may conduct different hearing tests to determine the root cause of the tinnitus such that a clinically optimal treatment can be used. 

There are also a variety of treatment options such as medications to alleviate symptoms, hearing aids to reduce or mask noise, sound therapies to allow for neural retraining, as well as behavioral therapies to manage additional risk exposure. Consult with a specialist to determine what treatment options may be ideal for you. 

Masking

A common technique to manage symptoms of tinnitus used by many tinnitus patients is known as "masking.” Often times, this is a strategy individuals use to deal with life-long effects of concussion related tinnitus. 

In masking, a tiny device that looks like a hearing aid is worn by the patient (headphones can also be used).  The device creates customized noises that drown the irritating ringing sounds associated with tinnitus. 

Standard masking sounds like white noise from fans, nature sounds, or music can also be used. 

In certain individuals, masking engages aspects of neuroplasticity and entrainment to retrain the brain to tune out repetitive or annoying sounds. In the long run, the result will be that the individual won't have to use masking. But this method doesn't always work. Hence, it's common for most patients to have to depend on masking all their life.

Alternative Treatments

Other alternative techniques can be used to cut down the severity of tinnitus. Tinnitus symptoms can be exacerbated by high levels of stress and anxiety, so finding ways to reduce your anxiety can sometimes be helpful. Here are other ways you can decrease tinnitus symptoms:

• Acupuncture
• Cognitive-behavioral therapy
• Mindfulness meditation 
• Exercise 

While such methods may not directly treat tinnitus, they may help you reduce the effect of the disorder on your mental well-being.

Ways to avoid further damage

All in all, repetitive damage to the brain can further exacerbate symptoms of tinnitus and it is beneficial to reduce one’s exposure to future brain injuries or sound irritants to help with the recovery process.

You may want to consider using particular protective equipment such as helmets, shoulder padding, and foam protectors to reduce your risk of repeated head injuries from contact sports.

You may also want to reduce or limit your exposure to noisy environments (concerts, grocery stores, large auditoriums) such that further problems with your hearing or sound processing systems are not damaged. You can also wear noise-protection devices such as earplugs if such environments must be entered.

Head injury associated tinnitus can last anywhere from several days to several weeks or even be a lifetime health concern. As always, consult a healthcare professional if you believe you or a loved one is experiencing tinnitus related to a traumatic head injury to determine the best treatment methods and plan to alleviate your particular suite of symptoms.