Veterans and tinnitus
Many people hear phantom sounds in one or both ears, which can be hissing, buzzing, chirping, or ringing. Veterans who have seen combat or worked in certain fields, such as aeronautics, are at particular risk.
Called tinnitus – (either tih-NITE-us or TIN-ih-tus is correct) – a persistent ringing in the ears is the number one disability among American veterans. Tinnitus is also a growing problem among active duty military members, according to a 2019 study.
Because many people in the military don’t seek care, “there are no definitive data on the prevalence of tinnitus in veterans,” said Katie Edmonds, audiologist at Bay Pines, Florida Veterans Affairs Health. System. “The most common mistake is to assume that since tinnitus cannot be cured, nothing can help.”
The impact of tinnitus varies greatly. Some people find that it doesn’t bother them. But for others, tinnitus interrupts their sleep or concentration and can trigger negative emotions. In a 2021 study of nearly 900 veterans with tinnitus, those with moderate to severe cases were more likely to suffer from post-traumatic stress disorder, depression or anxiety. About a third of all tinnitus sufferers also suffer from hyperacusis, or hypersensitivity to noise.
The VA has developed a program that can help veterans “manage feedback” and reduce its impact, Edmonds says.
What causes tinnitus in veterans?
Like the general population, tinnitus in veterans is strongly linked to hearing loss. Between half and 90% of people with tinnitus have some hearing loss. If your tinnitus is high-pitched, the hearing loss is likely to be in these registers, which are essential for understanding speech.
Loud noises and head injuries
Loud sounds damage the ears. They are the leading cause of hearing loss and tinnitus, especially among veterans exposed to explosions and gunfire noise. Loud noises not only shake the eardrum, but also the small bones of the inner ear and the cochlea, a fluid-filled organ with thousands of tiny hair-like structures that convert sounds into electrical impulses. Even a single shot can permanently damage your ear at one of these junctions. Combat and infantry veterans are especially susceptible to a pattern of hearing loss called “shooter’s ear.”
In 2019, researchers at the VA San Diego Healthcare System assessed the hearing of 2,600 Marines before and after their combat deployment. Predictably, the fight tended to worsen the tinnitus they had before. PTSD and traumatic brain injury (TBI) were linked to worsening tinnitus, particularly among Marines who had TBI because they had been exposed to an explosion.
Sometimes tinnitus appears or becomes bothersome years after the fight. The effects of head trauma may be delayed. Hearing loss related to age or trauma can cause tinnitus to increase over time. To compensate for the unclear signals, your hearing system may turn up the volume and, according to one explanation, begin to mistake random electrical discharges as important. Your brain can then assume that the random shots will return, just as you might hear more anger or sadness in someone’s voice once you’re ready to notice.
Additionally, tinnitus can be a symptom of some 200 different health conditions that your doctors might want to rule out, including Meniere’s disease, thyroid problems, high blood pressure, head and neck trauma, jaw pain due to a disorder of the temporomandibular joint (TMJ) and even severe nasal congestion.
What can you do?
If you haven’t already, take steps to get VA health benefits for hearing care, which includes help with tinnitus.
Even if you don’t think you have any hearing loss, your audiologist will likely recommend that you have your hearing checked. Many people live for years with damaged hearing. Sometimes the problem is as simple as having too much earwax.
Audiologists can’t always distinguish between shooter’s ear or other noise-related damage and age-related hearing loss, Edmonds says. However, hearing aids can help.
“Most hearing loss can be treated with hearing aids, but the benefits will vary depending on a person’s remaining hearing and their ability to distinguish between quiet speech and background noise,” he said. she told Healthy Hearing. State-of-the-art hearing aids can be programmed to mask your tinnitus.
Some tinnitus sufferers benefit from low-loss anti-anxiety drugs or a steroid in the middle ear.
If you also suffer from hyperacusis, it is possible to desensitize yourself to noise with daily practice, using a tinnitus retraining therapy (TRT) device that plays extremely quiet statics and gradually increases the volume.
VA program for tinnitus
The VA has created a program in which veterans work with a team to manage their response to tinnitus. A manual titled How to Manage Your Tinnitus: A Step-by-Step Manual is widely used in VA clinics.
As part of the team approach, patients can benefit from training in relaxation and sound therapy. This includes three types of sounds: soothing sound, which makes you feel better; background noise, which makes tinnitus easier to ignore; or an interesting sound, which helps distract from the condition. In addition to specially designed sound generators, everyday devices like headphones and radios, tabletop fountains and electric fans can play a role.
Are new tinnitus treatments on the way?
There are several approaches being studied by the VA, the leading tinnitus research institution.
Deep brain stimulation. The brain functions thanks to electrical signals which can become abnormal. Deep brain stimulation, interrupting these abnormal signals, has been used to treat severe depression, Parkinson’s disease and other illnesses.
How it works: A surgeon implants electrodes in key areas of the brain and connects them to a battery-operated device implanted under the skin. The device sends pulses to the electrodes that help regulate brain activity. In a 2019 study, researchers from the VA San Francisco Health Care System and the University of California investigated the safety and effectiveness of deep brain stimulation (DBS) for treating severe tinnitus in five patients. Four improved and there were no other adverse effects.
Re-educate the brain during sleep. According to researchers from the VA Portland Health Care System and Oregon Health and Science University, a sound-emitting device worn in the ear during sleep can train the brain to ignore tinnitus. In a 2017 study, the team randomly assigned 60 patients with tinnitus to sleep with one of three sound therapy devices. After three months, patients fitted with all three devices reported being less bothered by their tinnitus. A custom in-the-ear device produced the greatest volume reduction.
Military noise study
Whether or not you have hearing loss or tinnitus, you may want to participate in a study on the effects of military noise. The NOISE study is currently recruiting participants who have left active military service or separated from the National Guard and reserves within the past 2.5 years.
Is tinnitus always an emergency?
Usually, tinnitus is harmless (although annoying). However, if you hear pulsating heartbeats, or have ear pain, discharge from the ears, or dizziness, seek prompt medical attention. If you are suffering from extreme anxiety, depression or suicidal thoughts, get emergency help right away. Healthy Hearing has also prepared a page on managing suicidal thoughts when you have tinnitus.
The American Tinnitus Association provides information, advice, links to clinicians and support groups online.
The views and opinions expressed in this article are those of the interviewees and do not necessarily reflect the views or positions of the Department of Veterans Affairs or the entities they represent.