Figure 6: In addition to direct, mechanical damage of the inner ear structures, an excessive acoustic stimulation also leads to metabolic stress via a long term high-level increase in activity. This process induces signal cascades that lead to cell death, the survival of the cell with cell damage, or recovery and repair. The interplay of a multitude of factors determines the end-point of the possible signal pathways for the sensory and extrasensory cells of the cochlea. Opportunities for pharmacological protective (before or during noise exposure) or therapeutic (after noise exposure) intervention can be derived from these processes. It needs to be remembered when investigating new intervention strategies that the signal cascades do not so much run parallel with one another, but are instead interwoven in a network like manner.