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J Head Trauma Rehabil. 2019 Sep 27. doi: 10.1097/HTR.0000000000000513. [Epub ahead of print]

Association of Traumatic Brain Injury With Vestibular Dysfunction and Dizziness in Post-9/11 Veterans.

Author information

University of Texas at San Antonio (Dr Swan); Department of Defense Hearing Center of Excellence, Defense Health Agency, San Antonio, Texas (Dr Nelson); Ho-Chunk, Inc, Alexandria, Virginia (Dr Nelson); Department of Radiology and Imaging Sciences, School of Medicine, Indiana University, Indianapolis (Dr Nelson); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts (Dr Pogoda); Boston University School of Public Health, Boston, Massachusetts (Dr Pogoda); James H. Quillen VA Medical Center, Mountain Home, Tennessee (Drs Akin and Hall); Departments of Audiology and Speech Language Pathology (Dr Akin) and Physical Therapy (Dr Hall), East Tennessee State University, Johnson City; Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University, Durham, North Carolina (Dr Riska); Center for Health Care Organization and Implementation Research, Edith Nourse Rogers VA Medical Center, Bedford, Massachusetts (Ms Amuan); Departments of Psychiatry, Neurology and Epidemiology, School of Medicine, University of California San Francisco (Dr Yaffe); Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), VA Salt Lake City Health Care System, Salt Lake City, Utah (Dr Pugh); and Department of Internal Medicine, The University of Utah, Salt Lake City (Dr Pugh).



To describe the prevalence and impact of vestibular dysfunction and nonspecific dizziness diagnoses and explore their associations with traumatic brain injury (TBI) severity, mechanism, and postconcussive comorbidities among post-9/11 veterans.


Administrative medical record data from the US Departments of Defense and Veterans Affairs (VA).


Post-9/11 veterans with at least 3 years of VA care.


Cross-sectional, retrospective, observational study.


International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for TBI, vestibular dysfunction, dizziness, and other commonly associated postconcussive conditions; Neurobehavioral Symptom Inventory.


Of the 570 248 post-9/11 veterans in this sample, 0.45% had a diagnosis of vestibular dysfunction and 2.57% had nonspecific dizziness. Those with either condition were more likely to have evidence of TBI (57.11% vs 28.51%) and reported more disruption from neurobehavioral symptoms. Blast and nonblast injuries were associated with greater symptom disruption, particularly in combination.


There was a consistent, significant association between TBI and vestibular dysfunction or nonspecific dizziness, after controlling for sociodemographic factors, injury mechanism, and comorbid conditions. Given that most deployed post-9/11 veterans report blast and/or nonblast injuries, the need for prompt identification and management of these conditions and symptoms is clear.

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