The impacts of hearing loss and tinnitus – a hearing impairment characterised by ringing or buzzing in the ears – can often be under-estimated. Both conditions can severely affect a person’s ability to engage or connect with others, and the more severe the hearing loss or tinnitus, the more difficulty it can cause.
New research by Phoenix Australia has found that one in two veterans receiving PTSD treatment in Australia report having tinnitus or hearing loss, and 40 per cent of veterans receiving treatment say they are living with both conditions.
Researcher Dr Sonia Terhaag says this relatively high prevalence of hearing conditions among veterans has implications for how treatment for PTSD is most effectively delivered.
“PTSD is prevalent in the veteran community because they have an elevated chance of being exposed to traumatic events through the work they do. Similarly, hearing loss and tinnitus are prevalent in the veteran community because, as part of military service and deployment, they are more likely to be exposed to very loud noises, like exposure to hostile and friendly fire and explosives,” says Dr Terhaag.
“Our research looked at how tinnitus and hearing can impact on veterans’ ability to benefit from PTSD treatment and whether we can help improve those treatments for veterans with hearing conditions.”
The Phoenix Australia study involved 523 veterans engaging with the Australian Department of Veterans’ Affairs Trauma Recovery Programs across Australia for posttraumatic stress disorder.
It found that veterans with tinnitus or hearing loss, or both, were able to benefit from PTSD treatment as much as veterans without those hearing conditions, but recognising and accommodating an existing hearing condition was key to delivering effective PTSD treatment.
“A key finding from the study is that one or both of those hearing conditions are prevalent in veterans seeking PTSD treatment. So, clinicians need to be aware of that and screen patients for these hearing conditions when they seek treatment. I don’t think that is routinely done at the moment,” says Dr Terhaag.
“Where a hearing condition is diagnosed, clinicians may then need to discuss with the veteran what adjustments need to be made in their treatment for PTSD to maximise the benefit they get from that treatment. The subjective impairment caused by the hearing condition can range from no impact to very severe and this needs to be considered when planning treatment.
“For example, a lot of PTSD treatments are talk-based psychological therapies which may be more challenging for a veteran with hearing loss or tinnitus. There may be opportunities for veterans with those hearing conditions to use written or visual tasks rather than treatment that relies on verbal communication.”
Larger studies are now needed to test the effectiveness of PTSD therapies that are adapted for veterans with hearing loss. For example, in the US, studies are being carried out to test the acceptability and efficacy of veterans using hearing aids to assist with their PTSD treatment.
Dr Terhaag says screening veterans for hearing conditions before beginning PTSD treatment may help expand the inclusiveness and accessibility of treatment and help ensure those with severe hearing impairments fully benefit from treatment programs.
She believes some veterans with severe tinnitus or hearing loss might avoid seeking help for PTSD because of the challenges of their hearing condition and a belief that they won’t be able to fully engage in PTSD treatment programs.
Dr Terhaag says the encouraging finding from the Phoenix Australia study was that for participant in the study with hearing conditions but who only reported mild or moderate hearing impairment as a result, PTSD symptoms and quality of life outcomes were the same for veterans with or without hearing conditions.
“Both groups of veterans were able to benefit from PTSD treatment and that is very encouraging,” says Dr Terhaag.
“Looking ahead, it would be interesting to take a more in-depth look at veterans with hearing conditions and what specific types of PTSD treatment they choose to engage in, such as group work, exposure therapy or relaxation techniques for example. Their preferred choices could inform how we tailor PTSD treatments to be most accessible and effective going forward.”