Noise-Induced Hearing Loss

Noise-Induced Hearing Loss (NIHL) is a significant cause of hearing impairment and such patients frequently present to the ED. Oral corticosteroids are considered first-line therapy by otolaryngologists. Dosing varies, but a typical course is prednisone 60 mg/day for 10-14 days, followed by a brief taper.

It should be noted that the recommendation for steroids for NIHL is largely based on small trials and the efficacy of systemic steroid therapy appears to vary depending on the nature of the trauma (e.g. single gunshot vs hours-long concert; severity of cochlear damage).

Relevant to Emergency Medicine practice, response to steroid treatment is generally better the earlier steroids are initiated. Therefore, consider initiating therapy from the ED to avoid a typical delay before ENT follow-up.

Emerging evidence suggests that in addition to – or in lieu of – oral steroids, intratympanic steroid treatment results in better hearing outcomes.

References:
(1) Choi N. J Laryngol Otol. 2019 Jun 11:1-5. [Epub ahead of print]
(2) Trung N, et al. Otolaryngol Head Neck Surg. 2017;46: 41.
(3) Zhou Y, et al. Audiol Neurootol. 2013;18:89-94.
(4) Chang YS, et al. Acta Otolaryngol. 2017;26:1-7.
(5) Mutlu A, et al. Auris Nasus Larynx. 2018;45:929-935.
(6) Wada T, et al. Acta Otolaryngol. 2017;137(sup565): S48-S52.