Neurological complications of blast injury. Acoustic and barometric trauma with a focus on sensorineural hearing loss (a narrative review of international literature, 2021–2026) | Ukrainian Medical Journal

Litovchenko T.A.,Stepanchenko K.A.,Zavalna O.P.,Chernenko A.H.

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Neurological complications of blast injury. Acoustic and barometric trauma with a focus on sensorineural hearing loss (a narrative review of international literature, 2021–2026)

Neurological complications of blast injury. Acoustic and barometric trauma with a focus on sensorineural hearing loss (a narrative review of international literature, 2021–2026)

October 30, 2026

УДК: УДК 616.833.18:616.28-008.14]-02-001.3-08-036.838(048.8)

DOI: DOI:10.32471/umj.1680-3051.282085

Keywords :

acustic trauma,

blast injury,

cognitive impairment,

rehabilitation,

sensorineural hearing loss,

treatment,

vestibular dysfunction

Resume

Objective: to summarize neurological and audiovestibular consequences of blast injury, emphasizing sensorineural hearing loss and interdisciplinary clinical management.

Materials and methods. A structured narrative review covered international publications dated 2021, through April 2026. Accessible PubMed/MEDLINE, PubMed Central, Europe PMC and Cochrane Library records, alongside official publisher materials, were examined. Blast-specific and acoustic-trauma studies were distinguished from indirect evidence on idiopathic sudden sensorineural hearing loss and preclinical research.

Results. Blast exposure may affect sound-conducting structures, the cochlea, vestibular organs and central auditory networks simultaneously. Normal conventional audiometry or structural neuroimaging does not exclude functional impairment. Early differentiation of hearing-loss type, speech understanding assessment and neurological and vestibular examination are essential. Evidence supporting systemic corticosteroids after acute acoustic trauma remains inconsistent. Recovery proportions from observational cohorts do not establish treatment efficacy. Intratympanic corticosteroid and hyperbaric oxygen findings in idiopathic sudden hearing loss cannot be directly generalized to blast injury. Rehabilitation should address communication, balance, tinnitus-related distress and associated post-traumatic symptoms.

Conclusions. Early interdisciplinary assessment and repeated functional evaluation are warranted. Treatment decisions require individualized benefit-risk assessment and explicit separation of direct clinical evidence, extrapolation and experimental interventions.

References

1. Maas A.I.R., Menon D.K., Manley G.T. et al. (2022) Traumatic brain injury: progress and challenges in prevention, clinical care, and research. Lancet Neurol., 21(11): 1004–1060. DOI: 10.1016/S1474-4422(22)00309-X.
2. Ravula A.R., Das T., Gosain A. et al. (2022) An update on repeated blast traumatic brain injury. Curr. Opin. Biomed. Eng., 24: 100409. DOI: 10.1016/j.cobme.2022.100409.
3. Harris M., Nguyen A., Brown N.J. et al. (2024) Mild Traumatic Brain Injury and the Auditory System: An Overview of the Mechanisms, Clinical Presentations, and Current Diagnostic Modalities. J. Neurotrauma, 41(13–14): 1524–1532. DOI: 10.1089/neu.2023.0059.
4. Pomponio M.K., Roehm P.C. (2024) Auditory Dysfunction After Head Trauma: Causes, Evaluation, and Treatment. Curr. Phys. Med. Rehabil. Rep., 12: 353–358. DOI: 10.1007/s40141-024-00460-8.
5. Silverberg N.D., Iverson G.L., Cogan A. et al. (2023) The American Congress of Rehabilitation Medicine Diagnostic Criteria for Mild Traumatic Brain Injury. Arch. Phys. Med. Rehabil., 104(8): 1343–1355. DOI: 10.1016/j.apmr.2023.03.036.
6. Ding D., Manohar S., Kador P.F., Salvi R. (2024) Multifunctional redox modulator prevents blast-induced loss of cochlear and vestibular hair cells and auditory spiral ganglion neurons. Sci. Rep., 14: 15296. DOI: 10.1038/s41598-024-66406-1.
7. Braun M., Sevao M., Keil S.A. et al. (2024) Macroscopic changes in aquaporin-4 underlie blast traumatic brain injury-related impairment in glymphatic function. Brain, 147(6): 2214–2229. DOI: 10.1093/brain/awae065.
8. Eapen B.C., Bowles A.O., Sall J. et al. (2022) The management and rehabilitation of post-acute mild traumatic brain injury. Brain Inj., 36(5): 693–702. DOI: 10.1080/02699052.2022.2033848.
9. Stone J.R., Avants B.B., Tustison N.J. et al. (2024) Neurological Effects of Repeated Blast Exposure in Special Operations Personnel. J. Neurotrauma, 41(7–8): 942–956. DOI: 10.1089/neu.2023.0309.
10. Gilmore N., Tseng C.E.J., Maffei C. et al. (2024) Impact of repeated blast exposure on active-duty United States Special Operations Forces. Proc. Natl. Acad. Sci. U. S. A., 121(19): e2313568121. DOI: 10.1073/pnas.2313568121.
11. De Giorgi S., Diociasi A., Khalid R.N. et al. (2026) Brain MRI Analysis of Cumulative Blast Exposure and Intracranial Aneurysms in Special Operations Forces. Radiology, 319(1): e252415. DOI: 10.1148/radiol.252415.
12. Cacace A.T., Woodard J.L. (2025) Audiological characteristics of blast-induced hearing loss and tinnitus: unique outcomes in select cases. Neuroscience, 583: 103–119. DOI: 10.1016/j.neuroscience.2025.06.030.
13. Poliva O., Herrera C., Sugai K. et al. (2025) Functional hearing difficulties in Veterans with blast and blunt head trauma are associated with reduced fractional anisotropy in putative auditory radiations. Hear. Res., 466: 109387. DOI: 10.1016/j.heares.2025.109387.
14. Tsur N., Lotan T., Arbel I. et al. (2026) Extended high-frequency audiometry in battlefield acoustic trauma: diagnostic value and steroid treatment outcomes. Int. J. Audiol., Online ahead of print, 1 May 2026. DOI: 10.1080/14992027.2026.2666356.
15. Gianoli G.J. (2022) Post-concussive Dizziness: A Review and Clinical Approach to the Patient. Front. Neurol., 12: 718318. DOI: 10.3389/fneur.2021.718318.
16. Zloczower E., Tsur N., Hershkovich S., Fink N., Marom T. (2022) Efficacy of Oral Steroids for Acute Acoustic Trauma. Audiol. Neurootol., 27(4): 312–320. DOI: 10.1159/000522051.
17. Welber S., Oron Y., Handzel O. et al. (2024) Recovery rate after acute acoustic trauma: a case series and meta-analysis. Eur. Arch. Otorhinolaryngol., 281(12): 6303–6316. DOI: 10.1007/s00405-024-08847-y.
18. Plontke S.K., Meisner C., Agrawal S. et al. (2022) Intratympanic corticosteroids for sudden sensorineural hearing loss. Cochrane Database Syst. Rev., 7(7): CD008080. DOI: 10.1002/14651858.CD008080.pub2.
19. Joshua T.G., Ayub A., Wijesinghe P., Nunez D.A. (2022) Hyperbaric Oxygen Therapy for Patients With Sudden Sensorineural Hearing Loss: A Systematic Review and Meta-analysis. JAMA Otolaryngol. Head Neck Surg., 148(1): 5–11. DOI: 10.1001/jamaoto.2021.2685.
20. Skarzynski P.H., Kolodziejak A., Gos E. et al. (2023) Hyperbaric oxygen therapy as an adjunct to corticosteroid treatment in sudden sensorineural hearing loss: a retrospective study. Front. Neurol., 14: 1225135. DOI: 10.3389/fneur.2023.1225135.
21. Kim S.K., Bae H.G., Kim J.H. (2026) Therapeutic Assessment of TrkB Agonist in a Unilateral Blast-Induced Hearing Loss Mouse Model. Audiol. Res., 16(2): 36. DOI: 10.3390/audiolres16020036.
22. Sherlock L.P., Ballard-Hernandez J., Boudin-George A. et al. (2025) Clinical Practice Guideline for Management of Tinnitus: Recommendations From the US VA/DOD Clinical Practice Guideline Work Group. JAMA Otolaryngol. Head Neck Surg., 151(5): 513–520. DOI: 10.1001/jamaoto.2025.0052.
23. Langguth B., Kleinjung T., Schlee W., Vanneste S., De Ridder D. (2023) Tinnitus Guidelines and Their Evidence Base. J. Clin. Med., 12(9): 3087. DOI: 10.3390/jcm12093087.
24. Hall C.D., Herdman S.J., Whitney S.L. et al. (2022) Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Updated Clinical Practice Guideline From the Academy of Neurologic Physical Therapy of the American Physical Therapy Association. J. Neurol. Phys. Ther., 46(2): 118–177. DOI: 10.1097/NPT.0000000000000382.
25. Rytter H.M., Graff H.J., Henriksen H.K. et al. (2021) Nonpharmacological Treatment of Persistent Postconcussion Symptoms in Adults: A Systematic Review and Meta-analysis and Guideline Recommendation. JAMA Netw. Open, 4(11): e2132221. DOI: 10.1001/jamanetworkopen.2021.32221.
26. Toivonen M., Pääkkönen R., Niemensivu R., Aarnisalo A., Mäkitie A.A. (2023) Acute Acoustic Trauma after Exposure to Assault Rifle Noise among Conscripts in the Finnish Defence Forces—A Population-Based Survey. Int. J. Environ. Res. Public Health, 20(4): 3366. DOI: 10.3390/ijerph20043366.