Tinnitus and decreased sound tolerance in military Veterans: Relationship with cochlear deafferentation

Military Veterans are at high risk for noise-induced cochlear synaptopathy, a type of cochlear deafferentation. Predicted perceptual consequences of deafferentation include tinnitus and hyperacusis. The objective of this study was to determine if compared to young non-Veteran controls with minimal noise exposure, Veterans with normal audiograms who report constant tinnitus and/or decreased sound tolerance (DST) show...

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✦ The floor

Discussion

Signed responses from readers of the wire.

✦ Clinical Takeaway ✦

Audiologists evaluating veterans with tinnitus and sound tolerance issues should consider assessing for cochlear deafferentation (hidden noise-induced nerve damage detectable via extended test measures such as electrocochleography or suprathreshold ABR) even when pure-tone thresholds appear normal.

✦ Why It Matters ✦

Establishing a shared cochlear deafferentation mechanism for tinnitus and decreased sound tolerance in veterans could reshape how audiologists screen, counsel, and eventually treat noise-exposed patients who present with normal audiograms.

✦ Key Points ✦

01Published in Hearing Research (DOI: 10.1016/j.heares.2026.109789); focuses on military veterans.
02Investigates cochlear synaptopathy (hidden damage to nerve-hair cell connections) as a shared mechanism for tinnitus and decreased sound tolerance.
03Veterans can have significant noise-induced inner ear damage even with clinically normal hearing thresholds.
04Both tinnitus and decreased sound tolerance (including hyperacusis) may share a common deafferentation pathway.
05Findings support expanded audiological assessment beyond standard pure-tone audiometry in noise-exposed populations.

✦ Claims & Evidence ✦

ClaimEvidenceSupport

Tinnitus and decreased sound tolerance in veterans are both associated with noise-induced cochlear deafferentation/synaptopathy.

studypartially supported

Cochlear deafferentation can occur in veterans even when standard audiometric thresholds appear normal.

studysupported

✦ Research metadata ✦

PMID: 42743862
DOI: 10.1016/j.heares.2026.109789.
Journal: Hearing Research
Publication type: research_article
Evidence level: 2b
Population: Military veterans with tinnitus and/or decreased sound tolerance
Intervention: Assessment of cochlear deafferentation/synaptopathy markers in relation to tinnitus and decreased sound tolerance

Primary outcomes

Relationship between tinnitus severity and cochlear deafferentation measures; Relationship between decreased sound tolerance and cochlear deafferentation measures

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