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. Here are 5 facts you may not know about hearing loss among veterans.

The number one injury soldiers suffer from combat is loss of hearing. – Hearing loss beats out PTSD (post-traumatic stress disorder) as the number one service-connected disability. Severe hearing loss is commonly caused by bomb detonations and general military and combat noise. Improvised explosive devices, loud weapons, and other sounds such as the engines of ships, planes, and tanks can cause tinnitus and temporary to permanent loss of hearing. 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.

Veterans have been found to be more susceptible to loss of hearing than those who haven’t served in the military. – According to the Center for Disease Control, post-combat soldiers are 30 percent more likely to have severe hearing impairment than nonveterans. Worse yet, those who served after 9/11 were found to be four times more likely to be afflicted with some sort of hearing impairment than nonveterans.

It may be that recent combat soldiers are likelier to lose their hearing than veterans of past conflicts. – Since IEDs (improvised explosive devices) have become more commonplace and weapons become bigger and louder, more soldiers are losing their hearing. Field generators and powerful “bunker buster” bombs are extremely loud and dangerous to the ears. Even helicopters can cause loss of hearing.

Many veterans suffering from hearing impairment don’t seek medical help 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.

Breakthroughs in neuroscience may help those who suffer 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.