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].

• Overeating

  Of this group, 26 patients had undergone a unilateral over-under tympanoplasty only (tympanoplasty group) and 25 had undergone a unilateral tympanoplasty plus additional mastoid surgery (mastoidectomy group). [ncbi.nlm.nih.gov]

  I have several friends with tinnitus, is unfortunately all have deteriorated over time. I'm terrified of doing the same end and do not know what to do to avoid it. [tinnitustalk.com]

• Flushing

  As detailed in a Twitter thread posted by Metzger last Friday, he was trying to fix the fill and flush valves in his toilet’s rear tank when he dropped its ceramic lid. [motherboard.vice.com]

• Tinnitus

  Yet, in 6.2% of the subjects tinnitus was the only symptom. These results strongly suggest that tinnitus is as important a symptom of AAT as is hearing loss. [ncbi.nlm.nih.gov]

  Seabra JC: The medical audiological evaluation of tinnitus patients. Int Tinnitus J 1999;5:53–56. Stouffer JL, Tyler RS: Characterization of tinnitus by tinnitus patients. J Speech Hear Disord 1990;55:439–453. [karger.com]

• Hearing Impairment

  If the hearing impairment does not worsen, it may be possible to continue with checks every three years. [evidence.unboundmedicine.com]

  Permanent acoustic trauma If the acoustic trauma continues, it will typically lead to hearing impairment within a relatively narrow frequency around 4 kHz. [hear-it.org]

  EBM Guidelines Dec 2, 2019 • Latest change Aug 26, 2019 Table of contents Extract A sudden exposure to an intense sound (e.g. a gunshot, fireworks, music) may cause hearing impairment or ringing in the ears. [ebm-guidelines.com]

  Three main severity categories of hearing impairment were established. These are described and illustrated. [ncbi.nlm.nih.gov]

• Hearing Problem

  It’s when you knew or ought to have known you were suffering from significant hearing problems and that it was as a result of your service. Quite often it is when you were first diagnosed – but not always! [militarylawyers4u.com]

  Every time we see more teenagers with hearing problems related to exposure to intense noises for a long time. [otorrinolaringologiamalaga.com]

  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]

• Benign Paroxysmal Positional Vertigo

  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]

  Article The most commonly cited demonstrative cause of benign paroxysmal positioning vertigo (BPPV) is trauma1. “Primary” or “idiopathic” BPPV accounts for about 50%–70% of cases. [vestibular.org]

  following a blast injury can be a result of traumatic brain injury, but is also often caused by injury to the inner ear, specifically benign paroxysmal positional vertigo, damage to sensitive neuroepithelial rests within the inner ear, perilymphatic [academic.oup.com]

• Vertigo

  Do NOT irrigate the ear as it may provoke pain and vertigo, move debris medially in the canal and middle ear, and promote infection. [academic.oup.com]

  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]

  As a result of this movement of otoconia in BPPV, this condition has three general characteristics: 1) it takes a change in position to initiate any vertigo; 2) it is typically one-sided causing short-lived vertigo with a movement of the head in a particular [vestibular.org]

  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]

• Dizziness

  Examination of a young service member or veteran with vague complaints of “dizziness” and “trouble with balance” in the past typically resulted in normal findings. [vestibular.org]

  Immediate symptoms can include: a feeling of fullness in the ear burning sensations or sharp pain around or in the ear numbness, tingling or soreness down the side of face, neck or shoulder nausea or vomiting dizziness tinnitus and other head noises, [safework.nsw.gov.au]

  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]

  Please refer to the Veteran Affairs/DoD vestibular clinical recommendations for a detailed review of traumatic dizziness (http://hearing.health.mil/files/vestibclinpractrecs.pdf). [academic.oup.com]

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].

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].

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.

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].

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].

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].

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.

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.

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.

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.