Hearing Loss in Young Adults: Risk Factors, Mechanisms and Prevention Models

Hearing loss is increasingly recognized as a major public health concern among young adults, who are traditionally considered a low-risk group. This narrative review synthesizes recent evidence on risk and aggravating factors of early-onset hearing impairment, including recreational and occupational noise exposure, genetic susceptibility, infections, ototoxic medications, and lifestyle contributors. Pathophysiological mechanisms include cochlear synaptopathy, oxidative stress, excitotoxicity, vascular compromise, and immune-mediated injury. Global Burden of Disease data and World Health Organization reports indicate that more than one billion young people are at risk due to unsafe listening practices. Studies highlight emerging risk factors such as hidden hearing loss, extended high-frequency impairment and associations with COVID-19. Aggravating factors include delayed diagnosis, cumulative exposures and lack of preventive strategies. Early detection via advanced audiological assessments, such as extended high-frequency audiometry, otoacoustic emissions, speech-in-noise testing and auditory brainstem responses, is critical to prevent permanent damage. Public health interventions-particularly safe listening campaigns, early screening and monitoring in high-risk populations-are essential to reduce long-term disability.