Noise-Induced Hearing Loss Treatment & Management

Updated: Mar 11, 2016
  • Author: Neeraj N Mathur, MBBS, MS, DNB(ENT), MNAMS, FAMS; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Treatment

Medical Care

No well-recognized and scientifically validated treatments are specifically directed to noise-induced hearing loss (NIHL). The following treatable conditions have been alleged to exacerbate NIHL by some authors, and appropriate management of these considerations might influence the development or progression of NIHL.

If initiated early, medical treatment could have a role in acute acoustic trauma. Animal studies have shown that a combination of hyperbaric oxygenation and corticoid therapies lead to significant improvement in recovery; however, either of these if given alone may not be effective. [16]

In an interesting German study on patients with acoustic trauma, intratympanic administration of a cell-permeable JNK ligand was used because it had shown to prevent hearing loss after acute acoustic trauma in animal models.

For the first application of AM-111 in humans, a clinical phase I/II trial in patients was organized in patients with acute acoustic trauma after exposure to firecrackers in Berlin and Munich on New Year's Eve 2005/2006. Functional and morphological analysis of the treated ears revealed that AM-111 had an excellent otoprotective effect, even when administered hours after the noise exposure. Blocking the signal pathway with D-JNKI-1 is therefore a promising way to protect the morphological integrity and physiological function of the inner ear in various conditions involving acute sensorineural hearing loss.

This trial included 11 randomly selected patients on whom intratympanic treatment with AM-111 at a concentration of 0.4 mg/ml or 2 mg/ml within 24 h after noise exposure was performed. Pure-tone audiometry and otoacoustic emissions were assessed before treatment and on days 3 and 30 thereafter. Based on this clinical experience and on a calculation using an empirically derived exponential hearing recovery function, AM-111 seems to have had a therapeutic effect. A total of 13 adverse events were reported in 5 study participants. None of the adverse events were serious or severe. [17]

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Surgical Care

Future treatment options

An animal study found that when neural stem cells (cNSCs) were injected into the scala tympani of sound-damaged mice and guinea pigs, and the animals were allowed to recover for up to 6 weeks, some of the cNSCs migrated throughout the cochlea and demonstrated morphological, protein, and genetic characteristics of neural cochlear tissue (eg, spiral ganglion neurons, satellite cells, Schwann cells) and cells of the organ of Corti (pillar cells, supporting cells, and hair cells). [18] This suggests that neural stem cell line may derive some information needed from the microenvironment of the cochlea to differentiate into replacement cells in the cochlea. This could help in future treatment development and entirely change the management of hearing loss resulting from damage to these cells.

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