CODEPEH Recommendations for the Prevention of Noise-Induced Hearing Loss in the Pediatric Age Group

Noise-induced hearing loss is preventable but may be permanent, cumulative, and clinically silent in its early stages. This consensus document from the Spanish Commission for the Early Detection of Hearing Loss (Comisión para la Detección Precoz de la Hipoacusia, CODEPEH) combines an evidence-based review with practical recommendations for the prevention of noise-related auditory injury from birth to 18 years of age. It reviews developmental vulnerability, mechanisms of injury, exposure settings, individual susceptibility, clinical manifestations, and audiological assessment. In children, ongoing maturation of the peripheral and central auditory systems, age-dependent middle-ear transmission, limited capacity to recognize and control hazardous exposure, and the consequences of hearing difficulty for language, learning, and psychosocial development justify a specific preventive approach. Noise may damage not only sensory hair cells and the basilar membrane but also the stria vascularis, spiral ligament, ribbon synapses, spiral ganglion neurons, and central auditory pathways. Mechanical disruption, oxidative and nitrosative stress, mitochondrial dysfunction, inflammation, glutamate excitotoxicity, altered autophagy, and apoptosis contribute to injury. CODEPEH recommends a hierarchy of controls: reduce sound at source; regulate products, venues, schools, healthcare environments, and recreational activities; promote age-appropriate hearing protection and safe listening; and implement risk-based surveillance using conventional and extended high-frequency audiometry, otoacoustic emissions, speech-in-noise testing, and other tests when indicated. No pharmacological agent is currently recommended for routine prophylaxis. Effective prevention requires coordinated action by families, educators, healthcare professionals, industry, event organizers, and public authorities.