Acute acoustic trauma (AAT) injuries include noise-induced damage to inner and middle ear presenting as hearing loss, tinnitus and vertigo. Classic presentation is sensorineural hearing loss with an intact tympanic membrane. The authors carried out a case-control study in military personnel. Subjects presented within a week for otomicroscopy, tuning fork testing and audiometry. Patients with normal hearing, perforated tympanic membrane, presenting >3 weeks post injury or with history of chronic ear disease were excluded. Pure tone audiometry was conducted within seven days following AAT and one month later. They evaluated the treatment of 263 subjects that presented with AAT between January 2016 and January 2020. Of these, 126 patients had no steroid treatment and 137 had varying oral steroid regimes (Either <7 days or >7 days). The best outcome (audiometrically) was in subjects who were treated early (<24 hours) with high-dose steroid (prednisolone 1mg/kg up to 60mg maximal daily dose) and for >7 days (tapering). Subjects in the steroid group demonstrated 13-14dB average improvement in bone conduction (BC) thresholds at 3 and 4 kHz (p=0.001) and additional 7-8dB average improvement in air conduction (AC) thresholds at 6 and 8 kHz (p<0.0001). The observations were more compelling in patients who presented with a more severe hearing loss (>35dB). It is of note that no statistically significant differences were observed in AC/BC pure tone average between the two groups. In addition, from looking at the authors’ data, ear specific results indicate 452 (86%) normal hearing ears out of 526 (defined as pure tone average AC <25dB) at presentation. With 60 (11%) mild hearing loss (defined as pure tone average AC >25dB and <40dB). AAT may not be a common presentation to UK non-military ENT units, however, it can present from varying causes. This article indicates that in healthy patients with symptoms, examination and audiometry in keeping with AAT, steroids may be of benefit and worth consideration if given in a timely fashion.