How Does Impaired Hearing Impact Cognition?

Did you know that changes in hearing and auditory processing can occur after a concussion or other traumatic brain injury?

Many people are familiar with post-concussive symptoms such as headaches, dizziness, and difficulty with memory. Fewer people realize that a head injury can also affect the way a person hears, processes, and responds to sound.

Some people experience changes in hearing itself, while others may experience symptoms such as:

• Difficulty understanding speech, particularly in noisy environments

• Difficulty processing auditory information

• Ringing in the ears, or tinnitus

• Increased sensitivity to noise

• Difficulty following conversations

• Feeling overwhelmed in busy or noisy environments

Auditory symptoms following head injury are well documented but can be overlooked during concussion evaluation and treatment. Research has also found that auditory difficulties can affect everyday functioning, communication, cognition, and quality of life.

That makes hearing an important part of the bigger picture when evaluating someone who is struggling after a concussion.

Start With a Hearing Evaluation

If you have noticed a change in your hearing or auditory symptoms since your concussion, one of the first steps is to have your hearing evaluated by a licensed audiologist.

An audiological evaluation can help determine whether there is a measurable hearing impairment and whether additional evaluation or treatment may be appropriate.

Depending on the individual's needs, treatment may include amplification technology, auditory rehabilitation, counseling, or strategies for managing challenging listening environments.

It's also important to remember that a person's standard hearing thresholds may not tell the whole story. Research on traumatic brain injury has identified auditory processing difficulties even in some people whose basic hearing tests are within normal limits.

Once hearing and auditory function have been evaluated, cognitive strategies can help people manage the additional mental effort that listening may require.

Hearing Can Affect Attention and Concentration

When listening becomes more difficult, paying attention can require significantly more mental effort.

For someone with a hearing impairment or auditory processing difficulty, the brain may have to work harder to decode and understand incoming information. This can contribute to cognitive fatigue and make it harder to maintain attention—particularly when there is competing background noise. Auditory and sensory difficulties following TBI can affect communication, productivity, cognition, socialization, and other areas of daily functioning.

Strategies that may help

Try modifying your environment whenever possible:

• Reduce background noise.

• Move to a quieter or less distracting location.

• Sit or stand closer to the person speaking.

• Face the speaker so you can use both auditory and visual information.

• Consider appropriate amplification technology when recommended by an audiologist.

These changes may seem simple, but reducing the amount of effort required to listen can make a meaningful difference.

Hearing Difficulties Can Affect Memory

Attention is an important foundation for learning and remembering information.

If you are struggling to understand what someone is saying, some of your mental energy is already being spent trying to decode the information. That can make it harder to retain and recall what you heard.

This can be particularly challenging in situations such as:

• Meetings

• Classrooms

• Group conversations

• Restaurants

• Social gatherings

• Conversations with multiple people speaking

If you're having trouble remembering information that you hear, start by making the listening environment easier.

Strategies that may help

• Use the attention strategies above to reduce distractions.

• Ask someone to repeat information when necessary.

• Pause and briefly summarize what you heard in your own words.

• Take notes when appropriate.

• Ask for important information to be provided in writing.

You don't have to rely on memory alone. External strategies can reduce the cognitive load associated with remembering information.

Hearing Can Affect Communication

Communication becomes much more difficult when you're working harder to hear, understand, and remember what someone is saying.

You may feel like people are mumbling even when they're speaking normally. You may miss important details or find yourself asking people to repeat themselves frequently.

And after a long conversation or social interaction, you may feel completely mentally exhausted from the effort required to stay engaged.

Noise sensitivity can add another layer of difficulty. Busy environments can become particularly overwhelming when your brain is already working hard to process auditory information.

Strategies that may help

• Face the person you're talking to so you can use both auditory and visual cues.

• Let people know when you're having difficulty hearing.

• Ask people to speak clearly and, when appropriate, a little slower.

• Try to have one person speak at a time during group conversations.

• Ask questions to clarify information you may have missed.

• Choose quieter environments when possible.

Advocating for what you need is an important part of managing post-concussion symptoms.

Don't Overlook Auditory Symptoms After Concussion

Hearing difficulties aren't always the first thing people think about after a concussion. Headache, dizziness, fatigue, and brain fog tend to get much more attention.

But auditory symptoms—including hearing difficulties, tinnitus, and noise sensitivity—can have a significant impact on daily life and may be missed if they aren't specifically assessed.

If you have noticed a change in your hearing or how you process sound since your injury, don't assume you simply have to live with it.

A comprehensive evaluation can help determine what's contributing to your difficulties and what types of support may be appropriate.

And if hearing or auditory difficulties are making it harder to concentrate, remember information, communicate, or manage your daily responsibilities, cognitive rehabilitation may also be helpful.

At Colorado Concussion Clinic, our licensed cognitive therapists can work with you to develop practical strategies for managing these challenges and getting back to the activities that matter to you.

Learn more about Cognitive Rehabilitation After a Concussion.

References

1. Theodoroff SM, et al. Concussion Management Guidelines Neglect Auditory Symptoms. Clinical Journal of Sport Medicine. 2022;32(2):82–85.

2. Mild Traumatic Brain Injury and the Auditory System: An Overview of the Mechanisms, Clinical Presentations, and Current Diagnostic Modalities. 2023.

3. Peripheral auditory dysfunction secondary to traumatic brain injury: a systematic review of literature. 2018.

4. Prevalence of tinnitus following non-blast related traumatic brain injury: a systematic review of literature. 2024.

5. Patricios JS, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport—Amsterdam, October 2022. British Journal of Sports Medicine. 2023;57:695–711.

Originally published May 26, 2021. Updated August 2026.
This article has been updated to reflect current research and clinical guidance.

Medical Disclaimer: This article is provided for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a qualified healthcare professional. Concussion symptoms and recovery can vary from person to person. If you have experienced a head injury or are concerned about changes in your hearing, balance, cognition, or other symptoms, consult an appropriate healthcare professional for individualized evaluation and guidance.