Co-occurrence of hearing loss and posttraumatic stress disorder among injured military personnel: a retrospective study

Abstract

Background: Posttraumatic stress disorder (PTSD) and hearing loss are hallmark public health issues related to military service in Iraq and Afghanistan. Although both are significant individual contributors to disability among veterans, their co-occurrence has not been specifically explored. Methods: A total of 1179 male U.S. military personnel who sustained an injury between 2004 and 2012 during operations in Iraq or Afghanistan were identified from clinical records. Pre-and postinjury audiometric data were used to define new-onset hearing loss, which was categorized as unilateral or bilateral. Diagnosed PTSD was abstracted from electronic medical records. Logistic regression analysis examined the relationship between hearing loss and PTSD, while adjusting for age, year of injury, occupation, injury severity, injury mechanism, and presence of concussion. Results: The majority of the study sample were aged 18-25 years (79.9%) and sustained mild-moderate injuries (94.6%). New-onset hearing loss was present in 14.4% of casualties (10.3% unilateral, 4.1% bilateral). Rates of diagnosed PTSD were 9.1, 13.9, and 29.2% for those with no hearing loss, unilateral hearing loss, and bilateral hearing loss, respectively. After adjusting for covariates, those with bilateral hearing loss had nearly three-times higher odds of PTSD (odds ratio = 2.92; 95% CI, 1.47-5.81) compared to those with no hearing loss. Unilateral hearing loss was not associated with PTSD. Conclusions: Both PTSD and hearing loss are frequent consequences of modern warfare that adversely affect the overall health of the military. Bilateral, but not unilateral, hearing loss was associated with a greater burden of PTSD. This has implications for warfighter rehabilitation and should encourage collaboration between audiology and mental health professionals.

Self-reported auditory problems are associated with adverse mental health outcomes and alcohol misuse in the UK Armed Forces

“…It may be that because of the treatable nature of hearing problems, as opposed to the difficulties associated with treating tinnitus, hearing problems are less of a persistent reminder of traumatic events [44]. In contrast to the present findings, a recent study in the US Armed Forces found that hearing loss was associated with a greater burden of PTSD [45]. However, the US study only examined people who sustained hearing loss through injuries during the Iraq or Afghanistan conflicts, suggesting that the cause of auditory problems may affect these associations.…”

Longitudinal mental health outcomes of combat‐injured service members

“…Substance use disorders, including alcohol use disorder, are prevalent among veterans of recent conflicts and have been associated with up to four times the odds of PTSD and depression (Seal et al., 2011). Opioid abuse (Beyer et al., 2019), chronic pain (Cifu et al., 2013; Higgins et al., 2014; Lee et al., 2019), low‐back pain (Watrous et al., 2020), headache (Jaramillo et al., 2016), and hearing loss (MacGregor et al., 2020) have also been associated with increased likelihood of mental health diagnoses among injured service members. Additionally, injured service members who report poorer sleep and more tobacco use are more likely to screen positive for mental health outcomes (McCabe et al., 2020).…”

The Effectiveness of Hearing Protection Devices: A Systematic Review and Meta-Analysis

“…It is clearly acknowledged that industrial workers and individuals in military service have inevitably faced more noise exposure and that exposure has increased the incidence of noise-induced hearing loss (NIHL) [ 1 , 2 ]. Not only temporary noise exposure of high intensity (i.e., more than 85 dBA) in terms of level of intensity, but also continuous exposure to moderate-intensity noise in terms of frequency can contribute seriously to negative effects on the human auditory system [ 1 , 2 ].…”