July 14, 2009 Feature

Head-to-Head With Helmets and Hearing Aids

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The issue of concussions in high school and college athletes is having a profound effect on the long-term participation of student athletes in all contact sports, and it's raising questions for audiologists who treat these athletes. According to the Centers for Disease Control and Prevention (CDC), the age range of 15–19 years is one of the highest risk periods for significant head trauma (Langlois, Rutland-Brown, & Thomas, 2004).

What's more, recent CDC data also show that football has the highest rate of overall injury, with 12.09 injuries per 1,000 players (CDC, 2006).

Studies have shown that two of the more common forms of "contact" between professional football players is head-to-head at a velocity of 8–10 meters per second, and head-to-ground at a velocity of 6–8 meters per second (Viano, Pellman, Withnall, & Shewchenko, 2006).

And although high school football players' head-to-head contact is estimated to be less than that of professional players (approximately 2–5 meters per second), head-to-ground contact can easily equal what is seen in the NFL (6–8 meters per second).

Adding to the alarm, it appears that high school players are trying harder to emulate college and professional players through harder hitting. In a study published in 2001, for example, the incidence of concussions among Ohio high school football players was 47%, with 37% having multiple concussions. Although most of these players experienced mild concussions, about 12% had more severe concussions, causing some to miss games or stop playing completely (Langburt, Cohen, Akhthar, O'Neill, & Lee, 2001).

I recently had a patient, a 16-year-old high school student, who knows firsthand how hard high school players can hit. He came for an audiological evaluation after experiencing a grade III concussion, a crushed C3 vertebra, and a splintered C4 vertebra in a football game last September. He is now quadraparetic secondary to the head trauma.

Reducing Concussion Incidence

Fortunately a concerted effort to reduce the incidence of concussion among all athletes has begun, and this effort can be seen in the evolution of helmet design. Helmets are designed to attenuate both the linear and angular forces associated with helmet impact to reduce the force impinging on the skull. This design allows the head to "float" to allow the padding to absorb the impact force. The number of concussions has been reduced by using these new designs because they have thicker, more energy-absorbing padding on the side and back of the helmet and around the ears.

Because helmet designs have come a long way, audiologists are sometimes asked if helmets can be further modified to permit hearing aid use. The current research on helmet design, however, suggests the padding around the ears should not be modified in any way for two reasons: First, altering the energy-absorption characteristics of the helmet would decrease protection against physical head trauma; second, the plastic case of the hearing aid was not designed to be used in traumatic impact situations. Impact may not only cause damage to the hearing aid but it possibly increases the risk to the skin and skull in the immediate area of the hearing aid.

Robert Fifer, PhD, CCC-A,, is director of audiology and speech-language pathology at the Mailman Center for Child Development at the University of Miami. Contact him at rfifer@med.miami.edu.

cite as: Fifer, R. (2009, July 14). Head-to-Head With Helmets and Hearing Aids. The ASHA Leader.


Langlois, J.A., Rutland-Brown, W., & Thomas, K.E. (2004). Traumatic brain injury in the United States: Emergency department visits, hospitalizations, and deaths. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.

Centers for Disease Control and Prevention (2006). Sports-related injuries among high school athletes—United States, 2005–06 school year. MMWR Weekly, 55(38), 1037–1040 (www.cdc.gov/mmwr/preview/mmwrhtml/mm5538a1.htm#fig1, accessed June 10, 2009).

Langburt, W., Cohen, B., Akhthar, N., O'Neill, K., & Lee, J.C. (2001).I ncidence of concussion in high school football players in Ohio and Pennsylvania. Journal of Child Neurology, 16, 83–85.

Viano, D.C., Pellman, E.J., Withnall, C., & Shewchenko, N. (2006). Concussion in professional football: Performance of newer helmets in reconstructed game impacts. Neurosurgery, 59, 591–606.


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