The Auditory Processing Problem After Concussion Concussion reduces the brain's auditory processing bandwidth. Before concussion, the brain automatically filters environmental sounds, prioritizes speech, and suppresses irrelevant noise without conscious effort. After concussion, this automatic filtering is impaired. Every sound demands conscious processing resources. The processing capacity that was previously unlimited now has a measurable ceiling, and hearing aids push the total auditory input above that ceiling (Turgeon et al., 2020). Hearing aids amplify everything, not selectively. Modern hearing aids have noise-reduction algorithms, but these algorithms were designed for the intact auditory processing system. After concussion, the brain's ability to use these filtered signals is impaired. The amplified signal still contains more auditory information than the concussed brain processes comfortably. The total signal-to-noise ratio improves, but the total processing demand increases. The vestibular-auditory connection amplifies the problem. The auditory and vestibular systems share neural pathways in the brainstem (the vestibulocochlear nerve, CN VIII). Concussion commonly damages both systems simultaneously. Increased auditory input through hearing aids activates vestibular pathways that are also dysfunctional, producing dizziness and spatial disorientation alongside the auditory overload. The systems cannot be separated; stimulating one stimulates both. Specific Mechanisms of Symptom Triggering Headache from auditory cortex overactivation. The concussed auditory cortex requires more metabolic resources to process the same amount of sound. Hearing aids increase the input volume, further increasing metabolic demand. This demand exceeds the brain's ability to deliver glucose and oxygen (due to impaired cerebrovascular reactivity), producing activity-dependent headache. The headache worsens with duration of hearing aid use and improves with removal. Fatigue from sustained processing effort. Effortful listening (processing speech in noise, discriminating multiple sound sources) depletes cognitive resources faster in the concussed brain. Hearing aid users already experience "listening fatigue." After concussion, this fatigue is dramatically amplified because the cognitive reserve is reduced. A few hours of hearing aid use produces the fatigue equivalent of a full day. Dizziness from vestibular-auditory crosstalk. Loud or sudden sounds processed through hearing aids trigger the acoustic reflex and vestibulocular pathways. In the concussed brain, these pathways are sensitized. Sound stimuli that previously caused no vestibular response now produce brief dizziness, spatial disorientation, or nausea. This is a form of sound-induced vestibular disturbance. Exercises to Reduce Auditory-Triggered Symptoms JME 155 Diaphragmatic breathing before putting in hearing aids primes the autonomic nervous system for sensory processing. Parasympathetic activation expands the brain's processing capacity and raises the threshold for sensory overload. Performing 10 breaths before hearing aid insertion and during breaks reduces the autonomic reactivity that amplifies auditory symptoms. 4-second inhale, 6-second exhale. JME 14 Chin tucks address the cervical component that contributes to both headache and dizziness during hearing aid use. The cervical proprioceptive system influences auditory processing and spatial orientation. Upper cervical dysfunction amplifies the dizziness and headache triggered by auditory stimulation. Reducing cervical dysfunction lowers the total symptom burden. 10 repetitions with 5-second holds, 3 times daily. JME 1 Cervical rotation provides vestibular-proprioceptive recalibration that reduces the cross-modal sensory sensitivity. The cervical rotation challenges the vestibular-cervical integration pathway gently, improving the brain's ability to process multisensory input without overload. This recalibration reduces the vestibular symptoms triggered by auditory input. 10 repetitions each direction, slow and controlled. JME 150 Seated thoracic rotation supports the breathing mechanics needed for autonomic regulation during hearing aid use. Thoracic stiffness restricts the diaphragmatic breathing that manages auditory-triggered autonomic responses. Maintaining thoracic mobility ensures the breathing exercises remain effective. 8 repetitions per direction. Start your 3-day free trial for sensory management programming during concussion recovery. Managing Hearing Aid Use During Recovery Graduated exposure protocol: Start with 30-60 minutes of hearing aid use in a quiet environment. Increase duration by 15-30 minutes per day as tolerated. Add progressively noisier environments only after tolerating quiet environments at full duration. This graduated approach mirrors the return-to-activity protocol used for other concussion symptoms. Adjust hearing aid settings with your audiologist. Request reduced gain (volume) during recovery. Lower compression ratios to reduce the amplification of sudden loud sounds. Increase noise reduction aggressiveness. Some hearing aids allow custom "concussion recovery" programs with reduced overall output. The audiologist should know about the concussion to optimize settings for the recovering brain. Use hearing aids strategically rather than continuously. Prioritize hearing aid use for essential communication (classes, meetings, appointments) and remove them during solo activities (studying alone, walking, resting). This strategy maximizes the communication benefit while minimizing the processing burden. Autonomic Regulation and Global Support JME 3 Lateral cervical flexion during hearing aid breaks releases the tension that accumulates from effortful listening. The concentration required for hearing aid use in the concussed brain produces neck and shoulder tension that compounds headache. Performing cervical stretches during hearing aid breaks prevents tension accumulation. 8 repetitions per side. JME 42 Shoulder circles release the upper body tension from sustained auditory concentration. The effort of listening with a concussion produces the same shoulder elevation and tension pattern as other sustained cognitive tasks. 10 repetitions each direction during breaks. JME 15 Cervical extension improves posterior brain blood flow to the brainstem structures involved in auditory and vestibular processing. The inferior colliculus (auditory processing) and vestibular nuclei in the brainstem receive blood through the vertebral arteries. Cervical extension optimizes this blood flow. 8 repetitions. JME 151 Lateral side bends with breathing provide a complete reset exercise during hearing aid breaks. The breathing component manages autonomic reactivity while the trunk mobility counters sustained posture. Use this as a 2-minute reset between hearing aid sessions. 8 repetitions per side. Manage sensory symptoms with simplmobility's targeted concussion recovery programming. When to Discuss with Your Care Team Your audiologist and concussion provider should communicate. The audiologist adjusts hearing aid settings based on symptom response. The concussion provider adjusts the overall recovery plan to account for the additional cognitive load of hearing aid use. Neither provider alone has the full picture. Consider a central auditory processing evaluation. If auditory symptoms persist despite hearing aid adjustments and concussion recovery, a central auditory processing evaluation identifies specific auditory processing deficits. Auditory processing therapy addresses these deficits directly. Should I stop using hearing aids during concussion recovery? Do not stop completely. Hearing loss without amplification increases social isolation, communication difficulty, and cognitive strain from lip-reading and guessing. Instead, use a graduated approach: reduced duration, quieter environments, and adjusted settings. The goal is modified use, not cessation. Will my hearing aid tolerance return to normal? Yes. As concussion recovery progresses and auditory processing capacity improves, hearing aid tolerance returns to pre-concussion levels. Most patients return to full hearing aid use within the same timeline as overall concussion recovery (4-12 weeks with active rehabilitation). Are some hearing aid types better for concussion recovery? Hearing aids with advanced noise reduction, directional microphone systems, and adjustable programs offer more flexibility during recovery. Behind-the-ear models with open domes produce less occlusion and are often better tolerated. Discuss recovery-specific programming options with your audiologist. References Turgeon, C., et al. (2020). Central auditory processing after mild traumatic brain injury. Journal of Clinical and Experimental Neuropsychology, 42(8), 804-818. PubMed Patricios, J. S., et al. (2023). Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport, Amsterdam, October 2022. British Journal of Sports Medicine, 57(11), 695-711. PubMed