AKT · ENT/Ear & hearinglow yield

Sudden sensorineural hearing loss

Acute cochlear/retrocochlear injury (often idiopathic)

Overview

Rapid-onset (≤72 hours) sensorineural hearing loss of ≥30 dB over ≥3 contiguous frequencies — an ENT EMERGENCY. Usually idiopathic, but must exclude a retrocochlear lesion. Early high-dose corticosteroids improve the chance of recovery, so it needs same-day/urgent assessment.

Recognise

Sudden (over hours to ≤3 days) unilateral hearing loss, often noticed on waking, ± tinnitus and aural fullness
Weber lateralises AWAY from the affected ear and Rinne is positive (sensorineural pattern)
Usually idiopathic (?viral/vascular); a minority have a serious cause (vestibular schwannoma, stroke)

Red flags

Any sudden sensorineural loss is an emergency; accompanying neurology (ataxia, diplopia) → posterior-circulation stroke; vertigo

Differentials & how to tell them apart

Conductive causes (wax, effusion, perforation)Weber lateralises TO the affected ear — exclude these first by otoscopy/tuning forks

Vestibular schwannomaa minority present with sudden loss — MRI

Posterior-circulation strokeadditional brainstem/cerebellar signs — emergency

Ménière diseaseepisodic vertigo + fluctuating low-frequency loss + tinnitus/fullness

Investigations

Confirm sensorineural (tuning forks: Weber to the GOOD ear; audiometry urgently). MRI to exclude a vestibular schwannoma/retrocochlear cause. Treat without waiting for MRI.

Management

Urgent ENT + prompt high-dose corticosteroids (do not wait for MRI)

1Confirm it is sensorineural (Weber to the GOOD ear), refer urgently to ENT and start high-dose corticosteroids as early as possible.Gate: Sudden SENSORINEURAL hearing loss is a same-day EMERGENCY — steroids work best started early, so treat without waiting for the MRI; first exclude a simple conductive cause (wax/effusion), because that is not an emergency
2MRI to exclude a retrocochlear lesion; intratympanic steroids as salvage; audiological rehabilitation if loss persists.

High-dose oral corticosteroids — first-line; start as early as possible (within days) — the window matters

Intratympanic steroids — salvage/adjunct (ENT)

Key points

Treat first, image later. The bedside step is the tuning fork: Weber to the GOOD ear confirms sensorineural and triggers the emergency pathway. Conductive sudden loss (wax) is not an emergency.

Monitor & prognosis

Audiometry recovery; MRI result; rehabilitation.

Earlier steroids → better recovery; some permanent loss.

Source: ENT UK; BAO-HNS sudden SNHL guidance