Early Biomarkers in Noise-Induced Hearing Loss: Clinical Screening and Diagnostic Approaches

Abstract

Aim: This narrative clinical review aimed to evaluate early biomarkers that may enable detection of noise-induced hearing loss (NIHL) before any change is observed on standard pure-tone audiometry, with a focus on clinical effectiveness and applicability. Method: A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and IEEE Xplore databases for studies published between 2009 and 2025. This review represents a narrative synthesis of selected literature and does not constitute a systematic review; PRISMA flow diagrams, bias assessment tables, or dual independent screening are outside its scope. Results: Evidence is growing that permanent damage to inner hair cell–spiral ganglion neuron synaptic connections (cochlear synaptopathy) may occur in individuals with normal audiometric thresholds following significant noise exposure. Among electrophysiological measures, reduction in ABR Wave-I amplitude, elevated electrocochleography SP/AP ratio, and extended high-frequency DPOAE changes are the most extensively investigated markers reflecting this damage. However, individual diagnostic reliability remains limited due to protocol heterogeneity and high inter-subject variability in human studies. Conclusion: Standard audiometry may be insufficient for early detection of NIHL. Based on current evidence, a multicomponent biomarker-based screening approach is recommended in clinical practice. Nevertheless, further research is needed for the standardization of clinical protocols.

Keywords

• noise-induced hearing loss
• cochlear synaptopaty
• hidden hearing loss
• otoacoustic emissions
• auditory brainstem response

Gürültüye Bağlı İşitme Kaybında Erken Biyobelirteçler: Klinik Tarama ve Tanı Yaklaşımları

Abstract

Amaç: Bu derleme, gürültüye bağlı işitme kaybının (GBİK) standart saf ses odyogramında herhangi bir değişiklik görülmeden önce saptanmasına olanak tanıyabilecek erken biyobelirteçleri klinik etkinlik ve uygulanabilirlik açısından değerlendirmeyi amaçlamaktadır. Yöntem: PubMed, Scopus, Web of Science ve IEEE Xplore veritabanlarında 2009–2025 yılları arasında yayımlanan çalışmalar kapsamlı biçimde taranmıştır. Koklear sineraptopati, gizli işitme kaybı, otoakustik emisyonlar, ABR ve elektrokleografi konularını kapsayan çalışmalar dahil edilmiştir. Bulgular: Normal işitme eşiklerine karşın yoğun gürültüye maruz kalan bireylerde iç tüylü hücre–spiral ganglion nöron sinaptik bağlantısının kalıcı olarak hasarlanabileceğine ilişkin kanıtlar giderek güçlenmektedir. ABR Dalga-I amplitüdündeki azalma, elektrokleografi SP/AP oranı ve genişletilmiş yüksek frekans DPOAE değişimleri, bu hasarı yansıtma potansiyeli taşıyan elektrofizyolojik belirteçler arasında öne çıkmaktadır. Bununla birlikte insan çalışmalarında protokol heterojenliği ve yüksek bireyler arası varyabilite nedeniyle bireysel tanısal güvenilirlik henüz sınırlı kalmaktadır. Sonuç: GBİK'in erken tespitinde standart odyometri yetersiz kalabilmekte; mevcut kanıtlar doğrultusunda çok bileşenli biyobelirteç temelli bir tarama yaklaşımının klinik pratikte uygulanması önerilmektedir. Ancak klinik protokollerin standardizasyonu için daha fazla araştırmaya ihtiyaç duyulmaktadır.

Keywords

• gürültüye bağlı işitme kaybı
• koklear sineraptopati
• gizli işitme kaybı
• işitsel beyinsapı cevabı
• otoakustik emisyon

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