Modern day high-performance machines, weapons, aircrafts and locomotives are more powerful, more efficient, and unfortunately, frequently produce high noise levels resulting in Noise-induced Hearing Loss (NIHL). Mechanical hearing protection is essential and effective; however, inherent limitations allow a significant percentage of permanent hearing loss to occur despite protection. Hence, a pharmacological preventative or rescue agent for NIHL forms an important element of a comprehensive approach to maintaining inner ear functional integrity in individuals exposed to noise. The ideal pharmacologic agent would specifically address known mechanisms of acoustic injury, be orally administered, be exceptionally safe, be effective and affordable. Though currently such a pharmacological agent is not available, but the ongoing research is promising. In this article, we discuss various pharmacological agents for prevention and management of NIHL.