All patients with subjective hearing loss and tinnitus following blast exposure should have the exposure documented, and should be evaluated by hearing testing as soon as possible. Hearing loss (either subjective or through screening audiograms) that persists for more than 72 hours after an acoustic trauma or blast injury warrants formal comprehensive hearing test or audiogram (including tympanometry, bone conducted thresholds, speech discrimination, and acoustic reflexes not evaluated by screening audiograms). Patients with TTS greater than 25 dB losses in three consecutive frequencies should be considered candidates for high dose oral and/or transtympanic steroid injections when not otherwise contraindicated. An oral steroid regimen of prednisone 60mg daily for 10 days followed by a two week taper, and transtympanic dexamethasone 24mg/ml repeating at 1-2 week intervals for up to three injections are warranted. Hearing response to treatment should be followed by audiometry, and additional injections guided by response to steroid. Patients with threshold shift greater than 60 dB on three consecutive frequencies for ten or more days after noise exposure are not likely to resolve spontaneously and are likely PTS losses. Hearing loss is detrimental to the patient’s personal safety and effectiveness and may carry a comorbid vestibular deficit either clinically or sub clinically. Patients should be referred to ENT for evaluation and further testing. If ENT is not available in the specific Area of Operation (AOR), then patients should be evacuated to a higher level of care.