Mild traumatic brain injury recovery: a qualitative study of noise sensitivity, vestibular issues and anxiety interactions

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BACKGROUND: Mild traumatic brain injury (mTBI) is a common public health issue, and a substantial minority of individuals experience persistent symptoms that disrupt everyday functioning. Although vestibular symptoms, noise sensitivity and anxiety are each recognised following mTBI, little is known about how people make sense of these symptom experiences or perceive their interaction during recovery. METHODS: This qualitative study explored the lived experiences of 14 adults recovering from mTBI, purposively sampled from a larger longitudinal cohort. Equal numbers had short (<6 months) or prolonged recovery. Semi-structured interviews were conducted 8-12 months post-injury and analysed using inductive thematic analysis informed by a critical realist framework. RESULTS: Three themes were identified. 'Noise really hurts' described distressing sensitivity to layered or unexpected noise and strategies to seek quiet. 'Broken spirit level' captured vestibular disturbance, including balance, spatial orientation and visual difficulty. 'Amplified apprehension' reflected heightened anxiety, and avoidance of symptom-provoking activities. Although most participants reported one or more symptoms, a minority explicitly described perceived relationships between them. Noise sensitivity was particularly prominent among those with prolonged recovery. CONCLUSION: Symptom experiences following mTBI are context dependent and can meaningfully constrain participation. Greater clinical attention to vestibular symptoms, noise sensitivity, and anxiety/fear-avoidance may support more responsive assessment and rehabilitation following mTBI.