Related Experiment Video
Updated: Jun 20, 2026
In Vivo Protocol of Controlled Subconcussive Head Impacts for the Validation of Field Study Data
Published on: April 18, 2019
Associations Between Football-Related Exposures, Head Injury, Tinnitus, and Neuropsychological Health Outcomes Among
Niki A Konstantinides1,2, Michael Leung3,4, Rachel Grashow3,4
1Harvard Medical School, Football Players Health Study at Harvard University, Boston, MA, USA. nkonstantinides@hsph.harvard.edu.
Objectives:
Auditory dysfunction such as tinnitus is a common sequelae of traumatic brain injury (TBI), and has been associated with neurobehavioral outcomes, including cognitive decline, depression, and anxiety. Few studies have examined associations between concussion history and tinnitus independent of confounding by blast injury or occupational noise exposure. This study investigated concussion history and tinnitus among former professional American-style football (ASF) players, and evaluated whether tinnitus mediates associations between concussion history and neurobehavioral outcomes.
Methods:
This cross-sectional study included former ASF players who contracted with a professional league after 1960 and completed self-administered questionnaires between 2019-2025. Surveys assessed football exposure, auditory dysfunction, and mental health. Cumulative head injury exposure was measured using self-reported concussion signs and symptoms during play. Tinnitus was self-reported and assessed concurrently with validated measures of perceived cognition, depression, and anxiety. Logistic regression evaluated associations between concussion symptom history and tinnitus, and linear regression models assessed mediation and interaction effects.
Results:
Among 1085 participants (mean age 57.9 ± 13.5 years; 32.4% Black; 6.1 ± 3.7 seasons), greater concussion symptom history was associated with increased odds of tinnitus (highest vs. lowest quintile: OR = 2.90; 95%CI 1.91-4.43; p < 0.0001). Tinnitus did not mediate associations between concussion symptom history and neurobehavioral outcomes. However, associations with perceived cognition (p-interaction = 0.1), depression (p-interaction < 0.01), and anxiety (p-interaction < 0.01) were larger among participants reporting tinnitus.
Conclusion:
Greater concussion symptom history was associated with increased reporting of tinnitus, and neurobehavioral associations were stronger among those with tinnitus. Clinicians should consider tinnitus when evaluating long-term cognitive and mental health outcomes following repeated head injury.
