Veterans and tinnitus - Healthy Hearing

Many people hear phantom sounds in one or both ears, which might be a whistle, buzz, chirp or ringing sound. Veterans who have seen combat or worked in certain fields, such as aeronautics, are at special 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 U.S. veterans. Tinnitus is also a growing problem among active-duty service members, according to a 2019 study.

Because many people in the military do not seek care, "there is not definitive data about the prevalence of tinnitus in veterans," said Katie Edmonds, an audiologist in the Bay Pines, Florida Veterans Affairs Health System. "The most common mistake is assuming that since tinnitus cannot be cured, there is nothing that can help."

The impact of tinnitus varies a great deal. Some people find it doesn't bother them. But in others tinnitus interrupts their sleep or concentration and can trigger negative emotions. In a 2021 study of nearly 900 veterans with tinnitus, people with moderate to severe cases were more likely to have post traumatic stress disorder, depression or anxiety. About a third of all people with tinnitus also have hyperacusis, which is hypersensitivity to noise.  

The VA has developed a program that can help veterans "manage reactions" and cut its impact, Edmonds explains. 

What causes tinnitus in veterans?

Hearing loss

Like the general population, tinnitus in veterans is strongly linked to hearing loss. Anywhere from half to 90 percent of people with tinnitus have hearing loss. If your tinnitus is a high-pitched sound, the hearing loss is likely to be in those registers, which are key to understanding speech.

Loud sounds and head injuries

Loud sounds damage ears. They are a prime cause for both hearing loss and tinnitus, especially among veterans who are exposed to blasts and gun noise. Loud noises rattle not just the eardrum, but also the little bones in 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 gunshot can permanently damage your ear at any of these junctions. Combat and infantry veterans are especially likely to have a hearing loss pattern called "shooter's ear."

In 2019, researchers at the VA San Diego Healthcare System assessed the hearing of 2,600 Marines before and after they were deployed into combat. Predictably, combat tended to aggravate any tinnitus they had before. Both PTSD and traumatic brain injury (TBI) were linked to worsening tinnitus, especially among the Marines who had a TBI because they were exposed to a blast.

Delayed effect

Sometimes the tinnitus emerges or becomes bothersome years after combat. The effects of TBIs can be delayed. Age- or trauma-related hearing loss can make tinnitus increase over time. To compensate for unclear signals, your auditory system may turn up the volume, and according to one explanation, begin to mistake random electrical firings as important. Your brain may then assume the random firings will return—much as you might hear more anger or sadness in someone's voice once you're primed to notice it.  

In addition, tinnitus can be a symptom of some 200 different health issues that your doctors might want to rule out, including Ménière's disease, thyroid issues, high blood pressure, head and neck trauma, jaw pain from temporomandibular joint disorder (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 for tinnitus.

Even if you don't think you have hearing loss, your audiologist will likely recommend you get your hearing checked. Many people live for years with damaged hearing. Sometimes the problem is as simple as having too much ear wax.

Audiologists cannot always distinguish between shooter's ear or other noise-related damage and age-related hearing loss, Edmonds explains. However, hearing aids can help.

"Most hearing loss can be addressed with hearing aids, but the benefit will vary depending on how much hearing a person has left and their ability to distinguish speech in quiet and background noise," she told Healthy Hearing. State-of-the art hearing aids can be programmed to mask your tinnitus.

Some people with tinnitus benefit from low loses of anti-anxiety drugs, or a steroid in the middle ear.

If you also have hyperacusis, it is possible to desensitize yourself to noise with daily practice, using a device for tinnitus retraining therapy (TRT) that plays extremely quiet static and gradually builds up the volume.

VA's program for tinnitus

The VA has created a program in which veterans work with a team to manage their response to tinnitus. A manual called How to manage your tinnitus: a step-by-step workbook is widely used in VA clinics.

As part of the team approach, patients may benefit from training in relaxation and sound therapy. This includes three types of sound: soothing sound, which makes you feel better; background sound, which makes the tinnitus easier to ignore; or interesting sound, which helps shift attention away from the condition. Along with specially designed sound generators, everyday devices like earbuds and radios to tabletop fountains and electric fans can play a role.

Are new treatments for tinnitus on the way?

There are several approaches under investigation by the VA, the premier institution for tinnitus research.

Deep brain stimulation. The brain works through electrical signals that can become abnormal. Deep brain stimulation, interrupting those abnormal signals, has been used to treat severe depression, Parkinson's 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 the electrodes pulses 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 efficacy of deep brain stimulation (DBS) to treat severe tinnitus in five patients. Four improved and there were no other adverse effects.  

Retraining the brain during sleep. A sound-emitting device worn in the ear during sleep may train the brain to ignore tinnitus, according to researchers from the VA Portland Health Care System and Oregon Health and Science University. 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 with all three devices reported being less bothered by their tinnitus. A customized in-ear device produced the greatest cut in the volume.

Military noise study

Whether or not you have hearing loss or tinnitus, you may want to participate in study of 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 ever an emergency?

Usually tinnitus is harmless (though annoying). However, if you hear a pulsing heartbeat, or have ear pain, ear discharge or dizziness, seek out prompt medical care. If you're having extreme anxiety, depression, or suicidal thoughts, get emergency help immediately. Healthy Hearing also has prepared a page on dealing with suicidal thoughts when you have tinnitus.

Other resources

The American Tinnitus Association provides information, advocacy, links to clinicians, and online support groups.

The views and opinions expressed in this article are those of the individuals interviewed and do not necessarily reflect the views or positions of the Department of Veterans Affairs or any entities they represent.