Auditory Function Following Sport-Related Concussion And Repetitive Head Impacts: A Scoping Review

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Sport-related head impacts are common in contact sports, and resulting auditory symptoms, such as difficulty understanding speech-in-noise, are frequently reported. Yet auditory function remains absent from concussion assessment protocols. Repetitive head impacts are linked to neurodegenerative diseases, highlighting the need for sensitive, accessible biomarkers. Auditory processing relies on precisely timed subcortical and cortical neural transmission, making it vulnerable to diffuse axonal injury and the neurometabolic cascade of concussion. Further, the auditory cortex lies within the lateral sulcus, a region highly vulnerable to concussive impacts. This vulnerability suggests auditory measures may provide a window into concussion-related neuropathology. To explore how sports-related head impacts affect auditory function, a JBI and PRISMA-ScR-compliant scoping review was conducted. MEDLINE, PsycINFO, Embase, SPORTDiscus and grey literature were searched from inception to March 2026. Eligible studies assessed auditory function in athletes following concussive, sub-concussive, or repetitive head impacts in sport. Thirty-one studies met criteria. Peripheral hearing remained within clinically normal limits (across frequencies 0.25-8 kHz), yet central auditory processing deficits emerged within hours to years’ post-concussion. Subcortically, speech-evoked frequency following responses showed reduced fundamental frequency amplitude. Cortically, N100 amplitude reductions suggest early disruption of auditory processing. Higher-order auditory function, measured with auditory oddball paradigms, demonstrated reduced P300 amplitude, even after symptoms had resolved. Contact sport participation was also associated with poorer speech-in-noise performance and elevated rates of tinnitus and noise sensitivity. Despite converging electrophysiological evidence and a physiologically motivated rationale, auditory assessment remains absent from concussion management. While gaps remain, including limited data on female, elite, and retired athletes, the auditory system represents an underutilised biomarker of concussion-related neuropathology with implications for monitoring brain health and protecting athletes’ perceptual and communication abilities.

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