Tinnitus After a Concussion: Why Your Ears Keep Ringing

Is Ringing in the Ears Common After a Concussion?

It's a recognized result of head injury, and how common it is hasn't been pinned down. A 2024 systematic review of tinnitus after traumatic brain injuries not caused by a blast found that it occurred in adults with and without hearing loss, that studies measured it in too many different ways to give 1 number, and that most of the evidence sat in the lower tiers (Le, 2024).

The best prospective data come from the military. Among 1,647 servicemen assessed before and after deployment, a brain injury during deployment raised the odds of tinnitus 3 months afterward by 2.65 times, and more than 1 brain injury across the study raised the odds of new tinnitus by 2.27 times (Yurgil, 2016). In a tinnitus clinic, tinnitus that began with a head injury was louder than tinnitus from other causes and came with more episodes of dizziness (Vernon, 1994).

Where Does the Ringing Come From?

Our team breaks the question down along the path the sound takes: the cochlea in the inner ear, the cochlear nerve that carries the signal to the brainstem, and the brainstem passing it on to the brain. Anywhere along that path, if a range of frequencies gets knocked out, what you hear is a replacement. The classic high-pitched ring often follows an injury to the ear that damages the hair cells for 1 specific frequency. No signal comes through at that pitch, and a tone fills the gap.

Inner ear Brain Neck

After a concussion the ear itself often tests fine. A study took 20 people who had tinnitus after a head injury and normal or near-normal hearing thresholds, and compared them with 12 people who had a head injury and no tinnitus. The tinnitus group showed weaker suppression of the cochlea by the brain's own descending pathway, and the authors read the ringing as starting outside the cochlea, a loss of the brain's brake on the ear that they called a disinhibition syndrome (Ceranic, 1998). That matches how our team thinks about it: a normal hearing test tells you the ear is working, and the question moves to the brainstem and the brain.

Some ringing has an outside source. People notice it in 1 particular room, and a dimmer switch is a common culprit. Checking whether the sound follows you from place to place is a quick way to rule that out.

Why Does the Ringing Change When You Turn Your Head?

When someone can turn their head and hold it in a position, or move an arm and hold it, and the ringing gets louder, our team treats that as an important sign. It makes us think about how well blood is draining out of the head through the internal jugular veins on each side of the neck.

In our team's experience the veins get compressed in 1 of 2 places. The first is high in the neck, at the upper cervical spine. The second is lower, where the arm and collarbone meet at the thoracic outlet, and blood can back up toward the head from there. When drainage is slow the ear and the sinus on that side can feel congested, and some people hear their heartbeat or feel their pulse in the ear as it rings. A hit to the head usually loads the neck too, which is why our team checks this after a concussion or whiplash. That link is our team's view from the exam room, and it hasn't been tested in a trial.

Research describes 2 nearby ideas. Somatosensory tinnitus is tinnitus that's influenced by input from the head and neck, and a set of 4 clinical criteria identifies it with 82.2% accuracy (Michiels, 2023). Venous pulsatile tinnitus is a rhythmic sound produced by turbulent flow in the veins near the ear, with narrowing of a venous sinus, raised pressure inside the skull and jugular vein anomalies among its causes (Essibayi, 2021). How the neck squeezes the jugular veins is covered in ear fullness and popping, and neck pain after the injury is on neck pain after a concussion or whiplash.

How Long Does Tinnitus Last After a Concussion?

Nobody has followed it closely enough to say. The systematic review ended with a call for prospective, long-term studies of tinnitus after brain injury because so few exist (Le, 2024). The people in the tinnitus clinic study had constant, moderately severe to severe tinnitus by the time they were seen, which describes those who sought help and says nothing about how many others settled (Vernon, 1994).

Our team's view is that the source matters more than the calendar. Ringing from damaged hair cells behaves differently from ringing that comes and goes with head position, and the second kind gives the exam something to change.

What Does Our Team Check, and What Helps?

Ear ringing tends to get thrown away as a symptom, and our team doesn't look at it that way. The pitch matters, and so do which ear, how often and how loud. Then come the positions: your head turned and held, your arm raised and held, your neck and shoulder repositioned, to see whether the ringing rises or falls.

When position changes it, the work is often simple: taking load off the muscles along the front of the neck and changing how the neck is held. Sometimes the ear clicks as it starts to drain and the ringing drops. In our team's experience that also takes pressure out of the head and clears some of the fog, and it carries very little risk. That's what our team sees in patients whose ringing is position-dependent, and it won't apply to every kind of tinnitus.

The published version of this is physical therapy aimed at the neck and jaw. In somatosensory tinnitus, a combination of counseling, exercises and manual techniques decreases the severity or loudness of the tinnitus in most cases, and complete remission is rare (Michiels, 2023). What our team measures after a concussion is on concussion testing: what to expect.

When Does Ringing Need a Physician?

See a physician or an ear, nose and throat specialist promptly for sudden hearing loss, ringing in 1 ear that's new and constant, or a sound that pulses in time with your heartbeat. Pulsatile tinnitus has venous causes that imaging can find and that can be treated directly, which sets it apart from other types (Essibayi, 2021). A pulsing sound together with pressure that's worse lying flat or a change in vision is covered in head pressure after a concussion.

Tinnitus After a Concussion: FAQ