What is the treatment for a hearing injury after shooting?

Treatment for Hearing Injury After Shooting

For hearing injuries after shooting, fluoroquinolone antibiotics (ciprofloxacin or levofloxacin) are the first-line treatment for auricular perichondritis, while corticosteroids are recommended for sudden sensorineural hearing loss, with prompt initiation within the first two weeks for optimal recovery.

Initial Assessment and Classification

• Hearing injuries after shooting can be classified into two main types:

  • Conductive hearing loss (damage to outer/middle ear) 1
  • Sensorineural hearing loss (damage to inner ear or nerve) 1

• Acoustic trauma from gunshots typically causes:

  • Tinnitus (ringing in ears) - present in 94.2% of cases 2
  • Hearing loss - most prominent at high frequencies 2
  • Possible auricular perichondritis if physical trauma to ear occurred 1

Treatment for Auricular Perichondritis (External Ear Injury)

• Auricular perichondritis presents as painful swelling, warmth, and redness of the auricle, often sparing the earlobe 1

• Treatment protocol:

  1. First-line antibiotic therapy: Fluoroquinolones (ciprofloxacin or levofloxacin) 1
  2. Alternative antibiotics for hospitalization: clindamycin, ceftazidime, or cefepime 1
  3. Surgical intervention: Incision and drainage if abscess is present 1

• Warning: Once an abscess develops, good cosmetic preservation of auricular cartilage becomes difficult 1

Treatment for Sensorineural Hearing Loss

• Corticosteroids are the primary treatment for sudden sensorineural hearing loss (SSNHL) 1

  • Can be administered orally or via intratympanic injection 1
  • Should be initiated as soon as possible, ideally within the first two weeks 1

• Salvage therapy with intratympanic steroids should be offered for incomplete recovery after initial therapy 1

• Hyperbaric oxygen therapy may be offered:

  • Within 2 weeks of initial diagnosis, or
  • Up to 1 month in conjunction with steroids 1

• Watchful waiting is an alternative to active treatment, as one-third to two-thirds of patients may recover hearing spontaneously 1

Follow-up Care and Rehabilitation

• Audiologic rehabilitation should be addressed as soon as hearing loss is identified 1
• Follow-up audiometry should be obtained within 6 months of initial diagnosis 1
• For incomplete recovery, counseling about amplification and hearing-assistive technology is recommended 1

Prevention of Future Injury

• Hearing protection (bilateral earplugs) is necessary during shooting activities 2
• Environmental modifications at shooting ranges can help reduce risk 2

Prognosis

• Approximately one-third to two-thirds of patients with SSNHL may recover some percentage of their hearing within 2 weeks 1
• Patients who recover half of their hearing in the first 2 weeks have a better prognosis 1
• Patients with minimal change within the first 2 weeks are unlikely to show significant recovery 1
• The presence of dizziness at onset indicates a poorer prognosis 1
• Even exposure to noise levels below permissible limits can lead to acoustic trauma 3

Common Pitfalls to Avoid

• Delaying treatment beyond the first two weeks significantly reduces effectiveness of interventions 1
• Failure to diagnose auricular perichondritis can lead to progression to abscess formation and necrosis 1
• Relying solely on pure-tone audiometry may miss early hearing loss; transiently evoked otoacoustic emission (TEOAE) is more sensitive for detecting early damage 3
• Neglecting psychological impacts of sudden hearing loss (anxiety, depression, social isolation) 1