Skip main navigation

Military Health System

Clear Your Browser Cache

This website has recently undergone changes. Users finding unexpected concerns may care to clear their browser's cache to ensure a seamless experience.

How Hearing and Vision Problems Can be Related to Brain Injury

Image of How Hearing and Vision Problems Can be Related to Brain Injury. U.S. Air Force Staff Sgt. Kristin Terry, 436th Operational Medical Readiness Squadron non-commissioned officer in charge of mental health, carries out a Military Acute Concussion Evaluation on U.S. Air Force Senior Airman Timothy McCrary, 436th Operational Medical Readiness Squadron bioenvironmental engineering technician, during MEDIC-X training at Dover Air Force Base, Delaware, on Aug. 9, 2023. Brain injury, including concussion, can produce vision and hearing problems. (Photo by Airman 1st Class Dieondiere Jefferies, 436th Airlift Wing Public Affairs)

Traumatic brain injuries, including concussion, may lead to hearing and vision problems. Sometimes, these hearing and vision injuries are either not immediately apparent or require additional testing to be diagnosed, according to experts from the Defense Health Agency. These injuries may show up together.

If you think you have a concussion, known as mild TBI, and may be experiencing hearing or vision changes, here’s what to know.

Those diagnosed with mild TBI should have a complete set of hearing tests to see if they’ve been affected.

“Oftentimes, TBI patients are informed they do not have hearing loss despite their perceived listening difficulties, which is why additional measures to establish auditory processing abilities are required,” said National Intrepid Center of Excellence researcher Melissa Kokx-Ryan, who holds a doctorate in audiology and in hearing, speech, and language sciences. NICoE is the center of DHA’s TBI clinical care, research, and education and is located at Walter Reed National Military Medical Center in Bethesda, Maryland.

“A standard audiometric evaluation for a TBI patient should start with a traditional hearing test but also include measures of auditory processing abilities in complex environments,” she explained. Complex environments can be situations with multiple talkers or a lot of background noise such as a restaurant or meeting. “Typically, these patients do well in quiet listening environments with one talker who is looking at them but add in background noise and someone not facing them while talking and they start to struggle.”

According to DHA’s Hearing Center of Excellence, auditory processing disorder symptoms may include struggling to understand speech in noisy settings; problems recognizing spoken words or keeping up with telephone conversations; finding it hard to tell the difference between words that sound alike; and feeling uncertain about where the words you hear are coming from.

Tinnitus, a buzzing, hissing, humming, or high-pitched tonal and continual ringing sound heard in the head or ears, can also be associated with hearing loss and TBI.

How Hearing Injuries are Treated

Audiologists use communication strategies and hearing aids to treat hearing loss and tinnitus. Depending on the patient’s individual needs, the clinician may “supplement tinnitus treatment with additional ambient noise smartphone or machines, and refer to the Progressive Tinnitus Management course when appropriate,” Kokx-Ryan said. The course is a stepped-care approach at military bases run by an audiologist and a behavioral health provider.

NICoE works extensively with DHA’s Traumatic Brain Injury Center of Excellence through the NICoE Brain Fitness Center in Bethesda on research and “auditory training to supplement when appropriate,” Kokx-Ryan said. The Brain Fitness Center is an adjunct to traditional cognitive therapies offered by speech and occupational therapy and receives referrals from the entire multi-disciplinary team at NICoE and Walter Reed for multiple symptoms and patient populations beyond auditory concerns.

“NICoE was among the first military audiology clinics pioneering the use of low-gain hearing aids to treat auditory processing deficits despite normal hearing sensitivity, which is now becoming more mainstream,” Kokx-Ryan explained. These devices enhance speech while making loud sounds quieter and reducing background noise.

Her current TBI research focuses on providing evidence to support the use of low-gain hearing aids for treating auditory processing disorders. Kokx-Ryan works primarily with the TBI population; however, her research applies to “other service members with perceived hearing difficulties who have a history of significant noise or blast exposure in the absence of a formal TBI diagnosis,” she said.

She’s also involved with several protocols looking into “multisystem integration,” such as how vision, vestibular, and hearing affect one another. The vestibular system relates to movement, gravity, or your balance system. The HCE trains clinicians how to treat dizziness and imbalance in patients with concussion.

The Department of Defense and the Department of Veterans Affairs issued new practice guidelines for evaluating and managing dizziness associated with TBI in October 2023.

Military sensory research—and the development of clinical best practices—are fueled by vision and hearing injury registries that collect bidirectional data on service members and veterans from their point of injury to recovery or rehabilitation.

HCE hosts the Joint Hearing Loss and Auditory Injury Registry. and Vision Center of Excellence hosts the Defense and Veterans Eye Injury Vision Registry.

Vision Injury Common with TBI But May Not Be Readily Apparent

Visual dysfunction is common in even mild TBI patients, but not everyone who sustains a TBI will have vision dysfunction. “Many visual symptoms after a TBI resolve on their own without treatment,” said Natasha Merezhinskaya, a health science specialist at the VA and VCE, who holds a doctorate in biophysics.

According to Merezhinskaya, a number of studies have found that visual dysfunctions were reported in as many as 43% of patients diagnosed with mild traumatic brain injury.

“Often these injuries are not visible if one just looks at the eye,” said Chrystyna Rakoczy, a doctor of optometry with the VA and VCE. “Instead, TBI can affect the ability of the eyes to work together, follow objects, or focus well. As a result, a person can experience blurry vision, difficulties reading, and increased sensitivity to light. Sometimes the ability of the eyes to see objects on the side of the vision (vision fields) can be affected as well,” she explained.

Merezhinskaya and Rakoczy focus on characterizing eye and vision injuries in service members and veterans after TBI and the development of the recommendations for eye doctors to diagnose and treat these injuries.

Some people can experience TBI-related symptoms for a long period of time.

“These individuals may not realize that their visual system has been affected as symptoms such as headaches, poor reaction time, poor concentration, and loss of balance are typically not associated with eyes and vision. These conditions require accurate evaluation of visual function and performance to tease out dysfunctions of our sensory systems,” Merezhinskaya said.

The way we see and interpret visual information involves many different areas of our brain.

“Seventy percent of all sensory data enters through the eyes, which serve like a camera. The images are then evaluated for a form, color, depth perception, motion, and the sense of body position, and compared with known images using cognitive memory,” Merezhinskaya said.

Multiple areas of the brain participate in image processing.

“For example, the vestibular/balance system keeps visual images generated by both eyes superimposed and locked while our heads and bodies are in motion so we don’t feel dizzy,” Rakoczy said. “Different systems in the brain need to process visual information appropriately and efficiently for us to function properly and to be safe. If the brain cannot interpret data coming through the eyes because it is damaged, our bodies cannot react appropriately in a timely manner.”

The Brain’s Response

Our brain and bodies work together, and if injured, treatment needs to address all aspects of those injuries.

“Vision, vestibular, hearing, and cognitive dysfunction often occur simultaneously as the result of a brain injury. Assessment and rehabilitation of vision dysfunction in those cases cannot occur in isolation. State-of-the-art treatment of sensory deficits associated with TBI for best and quickest return to duty depends on coordinated multisensory interdisciplinary rehabilitation,” Rakoczy said.

If you suspect you have hearing or vision injuries as the result of a concussion, see your provider. Early diagnosis and treatment may lessen the impact of those injuries.

You also may be interested in...

Jul 11, 2024

Vision Center of Excellence

The Vision Center of Excellence leads and advocates for programs and initiatives with the following three inter-related goals: to improve vision health, optimize readiness, and enhance quality of life for service members and Veterans.

Jul 10, 2024

Infographic: NDAA FY07 Section 721 Program Structure, Methodology, and Timeline

.PDF | 586.92 KB

This infographic describes the congressional mandate, the program structure, timeline, and TBICoE's role related to Section 721 of the John Warner National Defense Authorization Act for fiscal year 2007: Longitudinal Study on Traumatic Brain Injury Incurred by Members of the Armed Forces in Operation Iraqi Freedom and Operation Enduring Freedom.

Jul 8, 2024

The National Intrepid Center of Excellence

The NICoE is a Department of Defense organization and the senior member of Defense Intrepid Network for Traumatic Brain Injury and Brain Health. The NICoE is dedicated to improving the lives of patients and families affected by traumatic brain injury (TBI) through collaborative efforts with patients, families, referring providers, and researchers.

Jul 8, 2024

Hearing Center of Excellence

The Hearing Center of Excellence, or HCE, fosters and promotes the prevention, diagnosis, mitigation, treatment, rehabilitation, and research of hearing loss and auditory injury. The goal is to reduce the tangible and intangible costs of hearing loss and auditory injuries among U.S. military personnel and Veterans. HCE works with the Department of ...

Jun 28, 2024

Accessing Information: Assistive Technology for People Experiencing Vision Loss

AT with audio

This video will introduce you to how people with blindness or low vision can access information and be productive using assistive technology; and will present different types of software, specialized devices, and widely available options that may help them access information to be productive and efficient, and get back doing the things they want to do.

Jun 28, 2024

Assessing Information: Assistive Technology for People experiencing Vision Loss (audio description)


This video will introduce you to how people with blindness or low vision can access information and be productive using assistive technology; and will present different types of software, specialized devices, and widely available options that may help them access information to be productive and efficient, and get back doing the things they want to do.

Jun 28, 2024

Sept. 20, 2024, TBICoE QES Event: TBI and Mental Health

.PDF | 104.10 KB

The topic of military traumatic brain injury and mental health has gained attention in the media over the last decade. Join us for a discussion as we explore the relationships between TBI, suicide, and posttraumatic stress disorder.

Jun 28, 2024

Acute Concussion Care Pathway: MACE 2 and PRA Training Flyer

.PDF | 236.96 KB

The Traumatic Brain Injury Center of Excellence hosts a combined Military Acute Concussion Evaluation and Progressive Return to Activity clinical recommendation virtual training. Attendees may earn two CEUs through the Defense Health Agency Continuing Education Program Office. Download the flier for the complete 2024 training schedule.

Jun 28, 2024

2024 TBICoE Quarterly Education Series Schedule

.PDF | 216.89 KB

Save the dates with a complete 2024 schedule of the Traumatic Brain Injury Center of Excellence's Quarterly Education Series. The QES is an enterprise-wide learning opportunity for Military Health System stakeholders. Since inception, the QES provides trainings and education events that are relevant to the MHS, discussing specialty topics and current ...

Skip subpage navigation
Refine your search
Last Updated: March 22, 2024
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on X Follow us on YouTube Sign up on GovDelivery