A Comprehensive Evaluation of Hearing Loss due to Head Trauma: Pathophysiology, Diagnosis and Treatment

Abstract

Introduction.  The human capability to perceive and interpret sound is given by a set of structures such as the ear, the brainstem and the brain. Hearing loss following craniocerebral trauma, with the middle ear or cochlea being the most affected, often goes unnoticed; primary audiological deficit does not only appear as a result of direct trauma to the inner or middle ear, as occurs in skull base fractures or tears of the central neural pathways. In the case of early secondary injury, there is an increase in intracranial pressure in response to hematomas, hemorrhages or diffuse axonal degeneration. The incidence of post-traumatic hearing loss occurs in approximately 5-10% of cases of hearing loss, the age group most affected are young people, especially those who practice sports or participate in risky activities, in addition, workers exposed to very loud noises and physical injuries. Objective.  To analyze the impact of cranial trauma on the auditory system and its relationship with hearing loss determined by diagnostic tools and early intervention. Methodology. Original studies, clinical investigations, meta-analyses published during the five years (2020-2024) with emphasis on the diagnosis and management of hearing loss due to head trauma are included. Results.  Cranioencephalic trauma (TBI) has significant effects on hearing, which is evidenced in several studies. On one hand, in mice it shows that repetitive mild TBI can cause early neuronal damage although it does not directly affect hair cells, but causes degeneration of the spiral ganglion. An accurate evaluation of hearing loss and exposure history are essential for successful treatment of hearing loss after TBI. Studies agree that early intervention is vital to prevent progression to chronic deafness. As research progresses, the integration of objective diagnostic methods, such as DpOAE, along with an understanding of the context of trauma, may significantly improve treatment outcomes in patients with post-TBI hearing loss. Conclusion.  Cranioencephalic trauma (TBI) has significant effects on hearing, which is evidenced in several studies. On one hand, in mice it shows that repetitive mild TBI can cause early neuronal damage although it does not directly affect hair cells, but causes degeneration of the spiral ganglion. An accurate evaluation of hearing loss and exposure history are essential for successful treatment of hearing loss after TBI. Studies agree that early intervention is vital to prevent progression to chronic deafness. As research progresses, the integration of objective diagnostic methods, such as DpOAE, along with an understanding of the context of trauma, may significantly improve treatment outcomes in patients with post-TBI hearing loss.