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Objective To evaluate the effectiveness of nicergoline to prevent temporary threshold shift (TTS) in military personnel. Study Design A randomized control trial. Methods Two hundred and twenty‐four participants were enrolled. Nicergoline 30 mg twice daily intake was prescribed to the study group (n = 119) for 3 weeks. The placebo was prescribed to the control group (n = 105) for 3 weeks, as well. Audiometric thresholds were measured at baseline and within 24 h after the participants attended a 1‐day weapons firing practice. During the firing practice, all participants had to wear foam earplugs. The TTS was assessed by using a variety of published significant threshold shift (STS) definitions. Additionally, the effects of the treatment group on the magnitude of pre‐ to postexposure threshold shifts were estimated. Tinnitus and other adverse effects of the medication were recorded. Results The incidence of STS was 65.4% from the study group and 75% from the control group. The negative STS (thresholds improved) was 68.6% from the study group and 44.7% from the control group. The positive STS (thresholds worsened) from the study group and the control group was 31.4% and 55.3%, respectively. The effect of treatment in participants receiving nicergoline demonstrated significant coefficients (change in dB) in both ears (p = .001). The mean different threshold of participants receiving nicergoline showed negative STS in all tested frequencies without statistical significance. However, the mean different threshold of participants receiving a placebo showed positive STS with statistical significance. Additionally, there were 16 ears detecting a warning sign of permanent hearing loss. These participants from the control group presented a longer duration of tinnitus (p = .042). Moreover, the serious adverse effects of nicergoline were considerably low. Conclusion The study results suggest that nicergoline may attenuate noise‐related TTS and tinnitus, and justify further investigation on the effectiveness of this drug as an otoprotectant. Level of Evidence 2

Background: Currently, the instruction of 4th year medical students involves learning from general patients who walk in to OPD ENT but is limited by the number of patients. Therefore, a concept was created to study volunteers or standardized patients and assess the medical students' satisfaction level. Both methods comprised differing advantages and disadvantages without any previous study.

Background: In Thailand, military personnel attending the annual firing practice are at risk for noise-induced hearing loss (NIHL). Nowadays, hearing protection devices have been approved to prevent NIHL. Furthermore, N-acetyl-cysteine, Vitamin B12 or Magnesium were proved to be effective against temporary threshold shift (TTS). However, limited research regarding the effectiveness of nicergoline on preventing TTS has been reported. Methods: A randomized controlled trial was conducted. Two hundred twenty-four participants were evaluated for general physical status, hearing threshold levels and blood chemistry. After the inform consent form was explained and signed, the participants were divided into 2 groups. Nicergoline 30 mg twice daily intake was prescribed to the study group (n=119) for 3 weeks. The placebo was prescribed to the control group (n=105) for 3 weeks, as well. At the end of the second week, they had to attend the firing practice. All participants had to wear the silicone ear plugs. In addition, the audiometry was measured within 48 hours after the end of the firing practice. Moreover, aural symptoms (tinnitus and aural fullness) and the side effects of the medication were recorded. Results: TTS was detected in both groups 14 ears – 10 ears from the control group and 4 ears from the study group (p=0.075). The post-firing practice audiometry showed that the average hearing threshold levels of the study group significantly improved than that of the control group across all frequencies (p<0.05). Moreover, the audiometry from the control group worsened at 250 and 6K Hz (p<0.05). The duration of tinnitus and aural fullness in the study group occurred over a shorter period than that in the control group. Conclusion: The TTS was found in both groups without statistical significant differences. The effectiveness of nicergoline from the study demonstrated tinnitus reduction after the firing practice. Furthermore, the hearing threshold significantly improved in the study group.