US Department of Defense
Advancing Blast Injury Research to Protect and Heal Those Who Serve

Auditory and Cognitive Health Consequences of TBI and Blast Exposure in Service Members and Veterans

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Traumatic brain injury (TBI) and hearing loss are common injuries Service members experience after suffering a blast injury. Cognitive, sensory, and other auditory symptoms can develop months and even years after the injury. The problem that Service members are facing is that these symptoms may not be detected during a clinical test. For example, some clinical tests may not capture speech recognition difficulties after a blast injury, which can impact Service members’ communication abilities and quality of life. To investigate these issues further, researchers at the Walter Reed National Military Medical Center and the Defense and Veterans Brain Injury Center conducted a preliminary analysis as part of the congressionally mandated 15-Year Longitudinal TBI study investigating the impact of TBI and blast-related injury on hearing loss and cognitive dysfunction.1

Researchers examined data from 212 Service members and Veterans with a history of TBI of varying severity who completed auditory and neuropsychological test batteries evaluating the following:

  • Aspects of speech recognition (i.e., identifying speech in a noisy environment)
  • Subjective auditory complaints (i.e., tinnitus and hearing loss)
  • Neurological symptoms (i.e., TBI history and severity, blast exposure, and self-reported post-traumatic stress disorder and quality of life surveys)
  • Cognition (i.e., memory and verbal fluency tests) that affect communication

Participants were also asked to self-report blast exposure, as this can impact hearing health, but is not usually accounted for during an auditory assessment.

Marines obtain their annual audiograms
Figure 1. Marines obtain their annual audiograms. (Photo credit: Cpl. Khoa Pelczar)

Results1 showed that those with self-reported blast exposure exhibited more severe auditory problems than those without. Additionally, a diagnosis of TBI was associated with decrements in speech recognition performance, with a more severe TBI resulting in a greater likelihood of experiencing tinnitus. These results confirm that standard audiogram testing procedures may not capture all hearing-related issues for Service members and Veterans who suffered a blast injury or TBI. As the study continues, researchers hope to find clinical tests that will close this gap. Being a 15-year study, the data will enable the tracking of hearing issues over time, and researchers hope to identify specific blast exposure levels or injury mechanisms responsible for hearing loss. This information will help inform injury protective standards, mitigation strategies, and both acute and chronic treatment efforts for Service members and Veterans.


1. Kuchinsky SE, Eitel MM, Lange RT, French LM, Brickell TA, Lippa SM and Brungart DS (2020). Objective and Subjective Auditory Effects of Traumatic Brain Injury and Blast Exposure in Service Members and Veterans. Front. Neurol., 11:613. doi: 10.3389/fneur.2020.00613.


This work was supported by the Defense and Veterans Brain Injury Center (DVBIC) 15-Year Longitudinal TBI Study (Sec721 NDAA FY2007).

Last modified: 10-Nov-2020