Extended high-frequency audiometry in battlefield acoustic trauma: diagnostic value and steroid treatment outcomes

To evaluate the diagnostic utility of extended high-frequency audiometry (EHFA) and the efficacy of steroid therapy in acute acoustic trauma (AAT) during armed conflict.

Retrospective cohort study at Rabin Medical Centre, Petach Tikva, Israel, October 2023-June 2024.

182 active-duty military personnel diagnosed with AAT, categorised into steroid-treated (n = 52) and non-treated (n = 130) groups. A paired cohort of 51 patients with complete baseline and follow-up audiometry was used for threshold change analyses.

EHFA detected high-frequency hearing loss not apparent on standard audiometry; 25% of steroid-treated patients had normal conventional audiograms but demonstrated deficits on EHFA. Both groups showed significant within-group improvement at standard and high frequencies. Between-group comparisons revealed no significant differences across all bands (all p > 0.05, BH adjusted). After covariate adjustment, the non-treated group showed significantly greater high-frequency recovery (9.8 dB, p = 0.042). No significant improvement was observed at EHF (10-18 kHz) in either group.

EHFA effectively detects high-frequency cochlear injury missed by conventional audiometry. While unadjusted recovery was comparable between groups, adjusted analyses suggest steroids may not confer additional benefit beyond natural recovery at high frequencies. Given the non-randomised design, these findings are hypothesis-generating and steroid therapy should be considered selectively.