Pharmacological Prevention of Noise-induced Hearing Loss: A Systematic Review

Otol Neurotol. 2021 Jan;42(1):2-9. doi: 10.1097/MAO.0000000000002858.


Objective: This study aims to explore and determine the effectiveness of current pharmacologic agents for the prevention of noise-induced hearing loss (NIHL) via a systematic review.

Databases reviewed: The PubMed, Scopus,, and Cochrane Library databases were searched from inception through February 6, 2020.

Methods: Full-text, English-language articles detailing prospective randomized and nonrandomized clinical trials with pharmacological interventions administered to prevent NIHL were included in accordance with PRISMA guidelines. The detailed search terms are included in the Appendix,

Results: Eleven articles were included in this review with 701 patients receiving a pharmacologic prevention for various noise exposures. Various regimens included administration of alpha-lipoic acid, ambient oxygen, beta-carotene, carbogen, ebselen, Mg-aspartate, N-acetylcysteine, and vitamins C, E, and B12. A number of studies demonstrated statistically significant amelioration of NIHL with pharmacologic intervention. Two studies demonstrated significantly better hearing outcomes for pharmacological prophylaxis with carbogen or ebselen as compared with placebo for the 4 kHz frequency, where the noise-notch is most likely to be encountered. Given the considerable heterogeneity in agents and methodologies, however, it was not possible to conduct a meta-analysis.

Conclusions: While several heterogenous articles demonstrated promising results for Mg-aspartate, carbogen, vitamin B12, and alpha-lipoic acid, the clinical significance of these pharmaceuticals remains unclear. Initial data from this study alongside future clinical trials might potentially contribute to the generation of clinical practice guidelines to prevent NIHL.

Level of evidence: 2.

Publication types

  • Research Support, N.I.H., Extramural
  • Systematic Review

MeSH terms

  • Hearing
  • Hearing Loss, Noise-Induced* / prevention & control
  • Humans
  • Noise
  • Prospective Studies