When many people think of post-combat injuries among veterans, they think of missing limbs, post-traumatic stress, and brain trauma. What many often don’t consider is hearing loss as a severe combat injury. These 5 facts about veterans and hearing loss may surprise you.

The most common post-service malady happens to be hearing damage or loss. – Hearing loss is even more common than PTSD (post-traumatic stress disorder). IEDs (improvised explosive devices) can cause hearing damage just as much as commonplace military noise can. Tinnitus and hearing loss, both short- and long-term, are also often caused by loud engines of war such as planes, warships, and combat tanks as well as loud weapons and bombs. Veterans of the post-9/11 conflicts are the most affected population in terms of hearing loss. In fact, 414,000 post 9/11 soldiers have come home with some form of tinnitus or hearing loss.

More veterans have hearing loss than non-veterans. – According to the Center for Disease Control, post-combat soldiers are 30 percent more likely to have severe hearing impairment than nonveterans. Additionally, post-911 soldiers were actually four times more likely to lose their hearing than civilians.

Hearing loss may be more prevalent now than it was for soldiers in the past. – Since IEDs (improvised explosive devices) have become more commonplace and weapons become bigger and louder, more soldiers are losing their hearing. Field generators, “bunker buster” bombs, and loud transportation such as helicopters can be deafening.

Only a small number of soldiers returning home with damaged hearing actually get medical attention right away. – Experts say that too few returning soldiers who suffer tinnitus or hearing loss go to a hearing specialist or audiologist upon returning home – they often live simply live with the problem. Incredibly, the average time between someone noticing hearing damage and getting help for it is 7 years.

Neuroscience innovations may be a way to alleviate severe tinnitus. – Some scientists assert that low serotonin levels may be linked to how severe a person’s tinnitus can be. Low serotonin can cause insomnia, depression, and anxiety. Tinnitus therapies combined with antidepressants have aided some veterans who are chronic sufferers of tinnitus.