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Acoustic Trauma

Hearing Trauma

Acoustic trauma (AT) is characterized by severe hearing loss in the after long-term exposure to elevated noise levels or after a singular traumatic acoustic event, for example an explosion. An episode of AT is often preceded and accompanied by tinnitus. AT caused hearing loss is irreversible but can be prevented entirely by proper acoustic protection measures and avoiding noisy environments. Treatment of AT must focus on the preservation of remaining hearing function mainly by avoiding further noise exposure and on the prescription of adequate hearing aids.


Presentation

The main symptom for an acoustic trauma (AT) is progressive hearing loss, oftentimes accompanied by tinnitus, which may also be chronic. Hearing loss due to AT typically starts at high-pitched frequencies and spreads to lower frequencies later. The following consensus criteria provide a both a qualitative and quantitative guideline for AT caused hearing loss symptoms [1]: high-frequency losses are typically smaller than 75 dB, whereas low-frequency losses are seldom greater than 40 dB. Hearing loss is always greater for sound frequencies greater than 3-5 kHz than for the frequency range between 0.5 and 2 kHz. AT often presents with a hearing loss notch in the sound spectrum located around 4 kHz. Hearing loss will always progress unless noise exposure is stopped. In stable noise exposure, AT caused hearing loss stabilizes after about a decade with a slower rate of progression in later stages, is irreversible, always sensorineural and almost always bilateral.

AT can also be acute, i.e. caused by singular traumatic events like explosions, gunshots or excessively loud music [2].

Patients will first present with tinnitus, have problems following nearby conversations and feel as if their ear was congested after noise exposure. Furthermore, patients will gradually find it increasingly challenging to engage in conversations. AT is often ignored in early stages. If left untreated, AT can have severe impacts on the mental health of patients and their social lives. In such cases, depressions, social isolation, anxiety, paranoia, and poor self-esteem have been reported [3] [4] [5] [6] as well as relationship problems [7] [8] and business-related angst [9].

Military Personnel
  • Methods A retrospective study was performed on military personnel diagnosed with AAT between November 2012 and December 2017.[doi.org]
  • OBJECTIVES: To follow up the auditory status of military personnel after an acute acoustic trauma and to identify the possible predictive value of hearing thresholds and otoacoustic emissions during the first 24 hours after the acoustic trauma.[ncbi.nlm.nih.gov]
Tinnitus
  • The frequency and intensity of tinnitus were established by the usual matching technique with a clinical audiometer. The most effective masking of the tinnitus due to acoustic trauma was by pure tones.[ncbi.nlm.nih.gov]
Hearing Impairment
  • Three main severity categories of hearing impairment were established. These are described and illustrated.[ncbi.nlm.nih.gov]
Progressive Hearing Loss
  • Abstract Progressive hearing loss after single episodes of acute acoustic trauma (Knalltrauma) has been reported in only a few cases. Many authors dispute such a progressive evolution.[ncbi.nlm.nih.gov]
  • Clinical findings Partial, generally slowly progressive hearing loss, especially for high-pitched sounds, accompanied by ringing or other noises. acoustic trauma Injury to hearing by noise, esp. loud noise. acoustic trauma The often damaging effect of[medical-dictionary.thefreedictionary.com]
  • Progressive hearing loss is the main complication of acoustic trauma. Tinnitus (ear ringing) can also occur.[nlm.nih.gov]
  • Possible Complications Progressive hearing loss is the main complication of acoustic trauma. Tinnitus (ear ringing) can also occur.[ufhealth.org]
Hearing Problem
  • This type of doctor can diagnose hearing problems and recommend the best way to manage them. While there is no cure for noise-induced hearing loss, there is some promising research being done.[medicinenet.com]
Dysacusis
  • The results of our studies show that hyperbaric oxygen therapy shortens the course of healing with respect to high-pitch perception dysacusis.[ncbi.nlm.nih.gov]
Impulsivity
  • Abstract This prospective study of acute acoustic trauma (AAT) from exposure to impulse noise during compulsory military service focused on three issues the number of shot or explosion impulses that the conscript was exposed to at the time of AAT, distance[ncbi.nlm.nih.gov]
Social Isolation
  • In such cases, depressions, social isolation, anxiety, paranoia, and poor self-esteem have been reported as well as relationship problems and business-related angst.[symptoma.com]
  • If his hearing loss is meant to suggest his social isolation, his self-alienation is suggested by a phantom sound of the body, the wordless signal of a short-circuiting neurological subject.[thecine-files.com]
Vertigo
  • Their symptoms included attacks of vertigo, lasting between half an hour and a few hours and no more than 24 hours; the sensation of aural fullness; and tinnitus accompanied by a fluctuating or permanent low-tone hearing loss.[ncbi.nlm.nih.gov]
  • Benign Paroxysmal Positional Vertigo (BPPV) Benign paroxysmal positional vertigo, or BPPV, is the most common inner ear problem and cause of vertigo, or false sense of spinning.[entnet.org]
  • For example, in a scene from the Comedy Central sitcom Broad City, a character momentarily develops tinnitus and vertigo upon realizing she has failed to sign for an eagerly anticipated package. [4] For more on POA sound, see Rick Altman “Sound Space”[thecine-files.com]
  • This trauma can result in hearing loss, ringing in the ears ( tinnitus ), and occasional dizziness ( vertigo ), as well as non-auditory effects, such as increases in heart rate and blood pressure.[medicinenet.com]
Dizziness
  • The body’s equilibrium is partially controlled by the vestibular system in the ears; high-level noise may cause disorientation, motion sickness, and dizziness.[britannica.com]
  • ENT specialists treat conditions such as ear infection, hearing loss, dizziness, ringing in the ears (called tinnitus), ear, face, or neck pain, and more.[entnet.org]
  • Dizziness and ringing in the ear are common. Sensitivity to loud sounds may also happen. The hearing loss comes and goes, but over time some loss becomes permanent. Autoimmune inner ear disease.[asha.org]
  • Sometimes, particularly if the sudden loss is total and occurs combined with dizziness, immediate surgical exploration of the ear may be necessary.[medicinenet.com]
  • […] clinical observations and experiments, stated that the symptoms of this chronic activity include a sense of fullness in the ear, otalgia (pain), tinnitus and/or other transient acoustic sensations, abnormalities of sound perception but normal audiometry, dizziness[audiologyonline.com]

Workup

The first step in building an AT diagnosis is a thorough understanding of the patient's lifestyle and history. Crucial factors are the patient's (former) professional occupation(s), which may involve permanent noise exposure in selected industry jobs or in the music industry [10] and the patient's pastime habits and hobbies, which may include listening to loud music or watching TV at a high volume. Weapon aficionados and soldiers as well as veterans may have developed AT during service [2]. If the patient has recently witnessed an exceptionally loud event in immediate proximity, the patient may suffer from acute AT.

The next step is a routine examination of the ear, in particular of the tympanic membrane and of the external auditory canals to rule out other aural conditions conducive to hearing loss. A neurologic examination may also be advisable in selected cases.

The only irrefutable way to diagnose AT is a detailed audiometric test. Pure-tone audiometry (PTA) in the standard octave intervals should be performed with a special focus on the interval around 3 kHz. Furthermore, speech reception thresholds should be measured for each ear. In order to rule out suspected pseudohypoacusis in selected patients, more objective tests like cortical evoked response audiometry (CERA) or brainstem electric response audiometry (BERA) should be taken into consideration [11] [12].

Treatment

AT cannot be cured. The earlier treatment starts, the better the odds to prevent further hearing loss [13].

Hearing loss can be compensated by fitting appropriate hearing aids. Further progression of AT can be efficiently tackled by protective earplugs and are usually provided by employers. In severe cases of hearing loss, a patient should be advised to learn sign language. Progression of AT should be carefully monitored with regular audiometric checks. Patients should be encouraged to monitor their daily noise exposure with appropriate devices and avoid sounds louder than 85 dB.

Intravenous infusions of Sermion or Cavinton after an acute AT have been reported to relieve acute tinnitus symptoms [14]. Administration of magnesium has been implicated to have a preserving effect on remaining hearing functions and also provides an efficient relief of tinnitus symptoms in humans [15]. Combinations of hyperbaric oxygenation therapies with administration of corticoids have also provided promising treatment results in acute AT [16]. Experimental treatments with the cell-permeable c-Jun N-terminal kinases (JNK) ligand AM-111 and stem cells may also be viable method of choice in the future [17] [18].

Prognosis

AT related hearing loss is irreversible. The only way to prevent further hearing loss is to avoid further noise exposure. If protective measures are insufficient or omitted by the patient, further hearing loss may lead to the compulsive use of hearing aids or the necessity to learn sign language.

Etiology

AT is caused by either long-term noise exposure both in professional and in private life over 85 dB or by excessively loud blasts. Continuous exposure to 100 dB can lead to a hearing loss of up to 19 dB on the timescale of four decades.

Unprotected use of everyday devices, for instance e.g. leaf blowers, lawn mowers, chain saws and motorcycles, may also lead to slowly progressive AT, rock concerts have been shown to be able to cause AT both in musicians and concert attendees [10].

Epidemiology

AT is on the decline in industrialized countries, since working people at risk are getting increasingly aware of the fact that noise protection is imperative in their jobs [19]. AT is most prevalent in developing countries. Males are more prone to suffer from AT than females. It is not clear, if this observation is due to increased noise sensitivity or to increased noise exposure for men in their daily lives. AT susceptibility is independent of age [20]. In the US, 5-10 million people are estimated to be at an increased risk of acquiring AT because of their lifestyle [21].

Sex distribution
Age distribution

Pathophysiology

Pathological changes in AT can be inferred from experiments with animals, which get exposed to loud noises. Anatomic changes typically involve distortions of the stereocilia of the inner and outer hair cells and the rupture of the Reissner membane. In the immediate aftermath of the noise pulse, edema of the stria vascularis may develop. AT can also invoke an immune reaction in the form of a cochlear inflammation and substantial recruitment of leukocytes to the inner ear [22].

High amplitude sound waves have a destructive effect on the stereocilia of hair cells that can lead to a partial to complete loss of the hair cell mechanoexcitability and also to stereocilia loss conducive to hair cell apoptosis [23] and hair cell phagocytosis by epithelial supporting cells [24].

Prevention

AT is entirely preventable. Raising awareness in the general public about detrimental side effects of loud noise in pastime activities and providing adequate sound protection for workers at risk are paramount to achieve declining statistics in new AT cases. Quantitative noise measurements can be carried out to reliably assess noise levels everywhere and at any time.

Summary

Acoustic trauma is a condition of irreversible hearing loss mainly caused by lifestyle factors. It often presents with tinnitus symptoms and could be entirely prevented with adequate noise protection. Acute tinnitus symptoms can be efficiently tackled but hearing loss typically persists. Treatment efficiency in acute acoustic trauma is highest if patients seek professional help immediately. Patients should be strongly advised to protect their ears from noises louder than 85 dB at all times. Hearing aids may be necessary to ease symptoms. In extreme cases, sign language classes should be advised.

Patient Information

Acoustic trauma occurs either after prolonged exposure to loud sounds or after traumatic events like explosions or gunshots. If you hear a permanent ringing in your ear or find it increasingly harder to understand conversations, you should seek professional help. You should avoid loud noises at all times to prevent further hearing loss. Doctors may advise you to wear hearing aids or learn sign language.

References

Article

  1. Dobie RA. A method for allocation of hearing handicap. Otolaryngol Head Neck Surg. 1990; 103(5):733-739.
  2. Axelsson A, Hamernik RP. Acute acoustic trauma. Acta Otolaryngol. 1987; 104(3-4):225-233.
  3. Appollonio I, Carabellese C, Frattola L, Trabucchi M. Effects of sensory aids on the quality of life and mortality of elderly people: A multivariate analysis. Age Ageing. 1996; 25(2):89-96.
  4. Carabellese C, Appollonio I, Rozzini R, et al . Sensory impairment and quality of life in a community elderly population. J Am Geriatr Soc. 1993;41(4):401-417.
  5. Kochkin S, Rogin CM. Quantifying the obvious: The impact of hearing instruments on the quality of life. Hear Rev. 2000; 7:6-34.
  6. Mulrow CD, Aguilar C, Endicott JE, et al . Quality-of-life changes and hearing impairment: A randomized trial. Ann Intern Med. 1990; 113(3):188-194.
  7. Scarcini N, Worrall L, Hickson L. The effect of hearing impairment in older people on the spouse. Int J Audiol. 2008; 47(3):141-151.
  8. Hétu R, Jones L, Getty L. The impact of acquired hearing impairment on intimate relationships: Implications for rehabilitation. Audiology. 1993; 32(6):363-381.
  9. Morata TC, Themann CL, Randolph RF, Verbsky BL, Byrne DC, Reeves ER. Working in noise with a hearing loss: Perceptions from workers, supervisors, and hearing conservation program managers. Ear Hear. 2005; 26(6):529-545.
  10. Schink T, Kreutz G, Busch V, Pigeot I, Ahrens W. Incidence and relative risk of hearing disorders in professional musicians. Occup Environ Med. 2014; 71(7):472-476.
  11. Arlinger S. Manual of Practical Audiometry. London, UK: Whurr Publishers Ltd; 1991.
  12. Debruyne F, Hombergen G, Hoekstra M. Normal values in brain stem electric response audiometry (BERA). Acta Otorhinolaryngol Belg. 1980; 34(3):238-245.
  13. Harada H, Shiraishi K, Kato T. Prognosis of acute acoustic trauma: a retrospective study using multiple logistic regression analysis. Auris Nasus Larynx. 2001; 28(2):117-120.
  14. Konopka W, Zalewski P, Olszewski J, Olszewska-Ziaber A, Pietkiewicz P. Treatment results of acoustic trauma. Otolaryngol Pol. 1997; 51(25):281-284.
  15. Sendowski I. Magnesium therapy in acoustic trauma. Magnes Res. 2006;19(4):244-254.
  16. Fakhry N, Rostain JC, Cazals Y. Hyperbaric oxygenation with corticoid in experimental acoustic trauma. Hear Res. 2007; 230(1-2):88-92.
  17. Suckfuell M, Canis M, Strieth S, Scherer H, Haisch A. Intratympanic treatment of acute acoustic trauma with a cell-permeable JNK ligand: a prospective randomized phase I/II study. Acta Otolaryngol. 2007; 127(9):938-942.
  18. Parker MA, Corliss DA, Gray B, et al. Neural stem cells injected into the sound-damaged cochlea migrate throughout the cochlea and express markers of hair cells, supporting cells, and spiral ganglion cells. Hear Res. 2007; 232(1-2):29-43.
  19. Lie A, Skogstad M, Johannessen HA, et al. Occupational noise exposure and hearing: a systematic review. Int Arch Occup Environ Health. 2016; 89(3):351-372.
  20. Dell SM, Holmes AE. The effect of a hearing conservation program on adolescents' attitudes towards noise. Noise Health. 2012; 14(56):39-44.
  21. Mahboubi H, Zardouz S, Oliaei S, Pan D, Bazargan M, Djalilian HR. Noise-induced hearing threshold shift among US adults and implications for noise-induced hearing loss: National Health and Nutrition Examination Surveys. Eur Arch Otorhinolaryngol. 2013; 270(2):461-467.
  22. Tornabene SV, Sato K, Pham L, Billings P, Keithley EM. Immune cell recruitment following acoustic trauma. Hear Res. 2006; 222(1-2):115-124.
  23. Hu BH, Guo W, Wang PY, Henderson D, Jiang SC. Intense noise-induced apoptosis in hair cells of guinea pig cochleae. Acta Otolaryngol. 2000; 120(1):19-24.
  24. Abrashkin KA, Izumikawa M, Miyazawa T, et al. The fate of outer hair cells after acoustic or ototoxic insults. Hear Res. 2006; 218(1-2):20-29.

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Last updated: 2019-06-28 12:14