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Health condition · Clinically reviewed

Hearing loss after head injury, what caused it, what to check - and what can be done.

A blow to the head can injure the eardrum, the hearing bones, the inner ear or the bone around them. Some causes settle on their own; others need prompt specialist care.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, British Society of Audiology and peer-reviewed otology sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice, from early ENT review and repeat audiometry to bone-conduction devices and cochlear implants.

Key facts

Hearing loss after head injury at a glance.

The essentials, in plain English - the main causes, the two types of loss, and why timing matters.

  • What it is

    Loss of hearing caused by injury to the outer, middle or inner ear - or the skull bone that protects them - after a blow to the head.

  • Conductive loss

    Sound is blocked on its way in - blood behind the eardrum, a perforation or a disrupted ossicular chain. Often improves or can be repaired.

  • Sensorineural loss

    The cochlea or hearing nerve is injured - through inner-ear concussion or a fracture involving the inner ear. Recovery is less predictable.

  • Temporal bone

    Longitudinal fractures more often cause conductive loss; transverse fractures more often cause sensorineural loss and facial nerve injury.

  • Time matters

    Sudden sensorineural loss is treated on an urgent ENT pathway, and a clear fluid leak needs same-day assessment.

  • Follow-up

    Hearing is retested over weeks and months, because early results after injury can change as the ear heals.

Why this guide matters

A hearing problem that is easy to overlook.

After a head injury the headache, bruising and worry take centre stage. Hearing is easily left until later - yet some causes are time-critical. The three points below shape everything else on this page.

  • The type of loss guides the plan

    Conductive loss is often improved or repaired; sensorineural loss follows a different path. Knowing which you have comes first.

  • Some causes cannot wait

    Sudden sensorineural loss, a clear fluid leak and facial weakness all need urgent specialist assessment.

  • Recovery is tracked over time

    Hearing tests are repeated across weeks and months, so decisions about surgery or devices rest on how the ear actually heals.

How the diagnosis is made

From the injury to a clear picture of the ear.

The steps an emergency team, ENT specialist and audiologist will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Head injury first

    Life-threatening brain, spine and skull injuries are assessed and treated before any hearing problem is worked up.

  2. 02

    Assessing

    History of the injury

    How the injury happened, whether hearing, tinnitus or balance changed at once, and any blood or fluid from the ear or nose.

  3. 03

    Assessing

    Otoscopy and facial nerve check

    A look at the ear canal and eardrum for blood, tears or fluid, plus a check of facial movement on both sides.

  4. 04

    Confirming

    Tuning fork tests

    Simple bedside Rinne and Weber tests give an early hint of whether the loss is conductive or sensorineural.

  5. 05

    Confirming

    Audiometry and tympanometry

    Pure-tone audiometry measures how quietly you can hear each pitch; tympanometry tests how the eardrum and middle ear move.

  6. 06

    Planning

    CT of the temporal bones

    High-resolution CT is used when a fracture, ossicular injury, fluid leak or facial weakness is suspected - not for everyone.

  7. 07

    Planning

    ENT and audiology review

    A specialist plan, with hearing tests repeated over time to track recovery and decide if surgery or devices are needed.

Typical timeline: first tests within days, with repeat hearing checks over the following weeks and months.

Symptoms

What to look and listen for.

Hearing change after a head injury rarely comes alone. These are the signs that point to the ear - and the ones that mean it is time to act quickly.

  • Muffled hearing

    Sounds seem dull or distant in one ear - a typical sign of blood behind the drum, a perforation or an ossicular problem.

  • Tinnitus

    Ringing, buzzing or hissing that starts after the injury - common and often settles, but worth reporting.

  • Ear fullness

    A blocked or pressured feeling in the ear, often from fluid or blood in the middle ear.

  • Vertigo or imbalance

    Spinning or unsteadiness can point to inner-ear injury, or to a perilymph fistula or concussion.

  • Bleeding or fluid from the ear

    Blood is common with a torn eardrum. Clear, watery fluid may be cerebrospinal fluid and needs urgent care.

  • Facial weakness

    A drooping face or difficulty closing the eye on one side suggests injury to the facial nerve inside the temporal bone.

  • Bruising behind the ear

    Discolouration over the bone behind the ear can appear a day or two after injury and may signal a skull base fracture.

  • Sudden severe or worsening loss

    Abrupt, profound deafness in one ear is a time-critical sign and needs an urgent ENT opinion.

Treatment

How hearing loss after head injury is managed.

Watchful care for what will heal, urgent treatment for what will not wait, and surgery or devices for hearing that does not return.

  • Observation and a dry ear

    Many eardrum perforations and pockets of blood behind the drum settle over weeks. The ear is kept dry and left alone while hearing is monitored.

  • Urgent steroids

    For sudden sensorineural loss, ENT may start a course of steroids quickly under the local urgent pathway - the sooner the better for the best chance of recovery.

  • Tympanoplasty

    Surgical repair of an eardrum that has not healed by itself, closing the hole and protecting the middle ear from infection.

  • Ossiculoplasty

    Surgery to repair or replace the small hearing bones when a persistent conductive loss is caused by a broken or dislocated chain. Usually considered once the ear has settled.

  • Hearing aids and bone conduction

    Conventional aids help many people; bone-conduction devices bypass the middle ear when it cannot be reconstructed or an aid cannot be worn.

  • Cochlear implant

    Considered when the inner ear is too badly injured for aids to help. Assessment is specialist-led and looks at both ears and overall function.

  • Urgent CSF leak and nerve care

    A confirmed fluid leak or facial nerve injury is managed urgently by ENT and neurosurgical teams, with imaging and, sometimes, surgery.

  • Tinnitus and balance support

    Sound therapy, counselling and vestibular rehabilitation help many people adapt while the ear and brain recover.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, emergency team or ENT specialist knows your injury and history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE. Hearing loss in adults: assessment and management (NG98).

  • NICE. Head injury: assessment and early management (NG232).

  • British Society of Audiology. Recommended procedures for pure-tone audiometry and tympanometry.

  • ENT UK. Patient and clinician guidance on sudden sensorineural hearing loss and ear trauma.

  • Peer-reviewed otology and skull base literature on temporal bone fractures and traumatic ossicular injury.

Red flags

When to seek urgent help.

Most hearing change after injury can be worked up calmly. These signs cannot - call 999 or go to A&E for the most serious, and contact ENT or your GP urgently for the rest.

  • Clear watery fluid from the ear or nose

    This may be cerebrospinal fluid from a skull base fracture. Seek emergency care the same day.

  • Facial weakness

    A new droop, or being unable to close an eye or smile evenly, needs urgent ENT assessment.

  • Sudden severe deafness

    Profound hearing loss in one ear after injury is time-critical - do not wait to see if it improves.

  • Severe vertigo

    Intense spinning, with vomiting or inability to stand, can indicate serious inner-ear injury.

  • Worsening headache or drowsiness

    These can mean bleeding around the brain and need emergency assessment, not an ENT appointment.

  • Fever or neck stiffness

    With any fluid leak from the skull base, these raise concern for meningitis and need emergency care.

  • Bleeding that does not stop

    Persistent bleeding from the ear, or blood with fluid, needs prompt medical review.

  • Bruising behind the ear

    A possible sign of a skull base fracture - report it, particularly alongside any of the signs above.

  • No improvement over weeks

    Hearing that has not begun to recover, or is getting worse, deserves repeat testing and an ENT referral.

Living with it

Recovery takes time, and support helps along the way.

Four things that make the biggest difference day to day - protecting the ear, keeping up with retests, making listening easier and asking for help with tinnitus and balance.

A quiet reminder

Early results are a starting point, not a verdict.

Hearing after an injury often changes over the following weeks. Repeat testing gives a far better guide than the first day.

  1. 01 Protect

    Look after the ear

    Keep water out if the eardrum is torn, avoid cotton buds and do not use ear drops unless an ENT clinician has advised them.

  2. 02 Retest

    Keep every hearing check

    Early results can change, so repeat audiometry over the following weeks and months shows what recovery to expect.

  3. 03 Adapt

    Make listening easier

    Face people when they speak, reduce background noise and let colleagues know which ear is weaker. A hearing aid trial can help early.

  4. 04 Support

    Ask about tinnitus and balance

    Persistent tinnitus, dizziness or worry about them is a reason to ask for audiology or vestibular support, not something to simply put up with.

Frequently asked

Everything we get asked about hearing loss after head injury.

Quick answers on causes, recovery, keeping the ear dry, fluid leaks and scans.

  • Can a head injury cause hearing loss?

    Yes. A blow to the head can bruise or tear the eardrum, disrupt the tiny hearing bones, fracture the temporal bone, or concuss the inner ear. Blast and airbag noise can also injure the cochlea. The type of loss depends on which structure is hurt.

  • Will my hearing come back?

    It depends on the cause. Blood behind the eardrum and many small perforations settle over weeks, and conductive loss from a broken ossicular chain can often be repaired. Sensorineural loss is less predictable - some hearing returns, some does not. Repeated audiometry gives a clearer picture over time.

  • What is the difference between conductive and sensorineural loss?

    Conductive loss means sound is blocked in the outer or middle ear. Sensorineural loss means the cochlea or hearing nerve is damaged. Audiometry and tuning fork tests tell the two apart, and the difference largely decides whether surgery, a device or observation is best.

  • Why does my ear need to stay dry?

    If the eardrum is torn, water can carry bacteria into the middle ear and cause infection, which slows healing. Your ENT team will explain how to protect the ear while it recovers, and will advise if any drops or cleaning are appropriate.

  • What if clear fluid is running from my ear or nose?

    Treat it as an emergency. Clear, watery fluid after a head injury may be cerebrospinal fluid, which means the barrier around the brain has been breached. Go to A&E and do not plug the ear or nose.

  • Will I need a scan?

    Not everyone does. High-resolution CT of the temporal bones is usually reserved for a suspected fracture, fluid leak, facial weakness or a conductive loss that is not settling. Your ENT specialist will decide whether it is needed and when.

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