Introduction: Blast wave exposure represents a primary cause of complex auditory and neurological injuries. The ear acts as a sensitive pressure transducer, making it exceptionally vulnerable to the intense mechanical forces of a blast. This review provides an overview of the multidimensional damage to the auditory system following blast events.

Materials and Methods: We conducted a systematic literature search across PubMed, Scopus, Web of Science, and Google Scholar (January 2000–January 2025) using comprehensive search terms. After screening 462 unique records, 36 original research studies (27 animal, 8 human, 1 computational) met the inclusion criteria and underwent quality assessment.

Results: Evidence suggests that blast exposure causes widespread auditory impairment, ranging from cochlear synaptopathy to central neurodegeneration. Blast-related injuries involve distinct biomechanical forces that differ from conventional noise trauma. Furthermore, cumulative damage from repeated exposures leads to chronic functional impairments, including tinnitus and difficulty understanding speech in noisy environments.

Conclusion: Effective management of blast-induced hearing loss requires a multidisciplinary approach. Future research needs to focus on validating sensitive biomarkers for early diagnosis and developing targeted neuroprotective therapies.