<unk>  occurs when a continuous transient sounds transfers enough energy to a cochlea to result in necrosis of the outer hair cells (OHC), inner hair cells (IHC), and cause glutamate excitotoxicity of first-order afferent neurons of the spiral ganglion (cochlear synaptopathy). This can occur when an impact or impulse sound like an explosion occurs abruptly. When excessive, this force can lead to cellular metabolic overload, cell damage and cell death. The force of that transient sound exceeds the elastic limit of the tissues. The organ of Corti can be sheared off the basilar membrane when the sound coming through the ear canal, middle ear and cochlea exceeds 132 dB. If the sound is more intense than 184 dB, the eardrum is ruptured. 184 dB and above usually comes from military sound exposures, such as with the explosion of an IED (improvised explosive device). When a person has a shock wave, not only is the eardrum ruptured, but also has ossicular discontinuities. The explosion or blast if powerful can cause traumatic brain injury. As a result, a person could have an auditory processing disability. Lung injures can develop as well as some injuries to the viscera. Once exposure to damaging noise levels is discontinued, further significant progression of hearing loss stops. Individual susceptibility to noise-induced hearing loss varies greatly, but the reason that some people are more resistant to it while others are susceptible is not well understood.
Acoustic trauma
Facial trauma
Barotrauma
Penetrating trauma
Traumatic asphyxia
Closed-head injury
Trauma
Blast injury