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 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. The deafening sounds of tank, plane, and ship engines contributes to temporary to permanent hearing loss and tinnitus, as do explosive devices and other loud weapons. Soldiers who have served since September 2011 are especially afflicted with hearing damage. An astounding 414,000 veterans serving post-9/11 have returned home with mild to severe tinnitus or hearing loss.

Soldiers are more likely to suffer hearing damage than civilians. – 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.

Soldiers now may suffer more hearing damage than those who have served in past decades. – 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. – Most soldiers with hearing damage or tinnitus avoid seeking out help for their injury upon returning home, according to experts. They often let it go for long periods of time. In fact, most people will wait an average of 7 years from initially noticing hearing loss to actually seeking medical attention.

Breakthroughs in neuroscience may help those who suffer severe tinnitus. – Tinnitus cannot be cured completely at this time. However, it’s severity may be linked to maladies caused by serotonin loss, such as depression, sleeplessness, and anxiety. Some veterans with tinnitus have found that anti-depressants combined with other tinnitus therapies eased their chronic condition significantly.