''Comparing the Effectiveness of the combination of Hyperbaric Oxygen Therapy and Systemic Glucocorticoids in the Treatment of Sensorineural Hearing Loss resulting from Shooting Noise versus Blast Injury''

• Hyperbaric oxygen therapy improves hearing in acute acoustic trauma and blast injuries. • All patient groups showed significant post-treatment improvement in high-frequency thresholds. • Blast injury patients responded less favorably to therapy compared to pure noise exposure cases. • Combined exposure (noise + blast) showed intermediate improvement similar to other groups. • Treatment was well-tolerated; ear pain was the only adverse event, affecting up to 7% of patients. A paucity of evidence exists as to the comparison of neurotologic injuries caused by explosive blast compared to the much more common gunshot-noise induced acute acoustic trauma (AAT). We aimed to compare the baseline characteristics and response to best available therapy (a combination of hyperbaric oxygen (HBO) and systemic glucocorticoids) between these two etiologies. We retrospectively collected 442 patients (695 ears) presenting during 2015-2025, where exposure history was clear and detailed enough to categorize into either pure blast (286 ears) or gunshot noise (409 ears) induced AAT. All patients were treated with a combination of HBO (2.5 ATA for 90 minutes, 5 days a week) and oral prednisone (60 mg daily for 7 days tapered down over 7 days). Included were patients with at least 30dB new worsening in at least one pure tone frequency presenting at most 30 days from exposure. Excluded were those missing 5 or more therapy sessions and those in whom a clear and single exposure could not be ascertained. Blast injured patients presented with significantly worse baseline low-frequency thresholds (pure tone average (PTA) of 16.7 vs 10.0 dB, p < 0.001) and speech reception thresholds (SRT) (15.8 vs 9.8, p < 0.001), as well as greater relative improvement in SRT (2.8dB vs 0.5dB, p < 0.001) and a significant twofold rate of improvement in subjective symptoms ( p < 0.036) following therapy. The noise group demonstrated superior recovery in the primary outcome of high-frequency pure-tone (3000–8000Hz) average (6.2 vs 3.8 dB, p =0.018). Blast induced hearing loss exhibits distinct characteristics as well as different responses to combination (HBO and steroids) therapy.