Neurological assessment may reveal balance issues (if the vestibular nerve or cerebellum are involved – e.g. vestibular schwannoma).
You should perform a broad assessment of the patient, looking for signs suggestive of possible underling systemic causes (e.g. infective, autoimmune).
Common findings on clinical examination include:
Abnormal Rinne’s and Weber’s tests in keeping with sensorineural hearing loss
Pure tone audiometry is the gold standard investigation and will confirm the type of hearing loss, conductive or sensorineural, and indicate the severity and pattern of hearing loss, providing a baseline for assessment of recovery and efficacy of treatment.
An MRI IAM (internal acoustic meatus) should be carried out on an outpatient basis to exclude vestibular schwannoma, even if the hearing loss improves spontaneously.
Routine blood testing is not recommended.4
Patients with SSNHL should be discussed with the local ENT on-call team to arrange urgent pure tone audiometry and plan review after initial primary care treatment.
SSNHL is typically managed acutely in primary care with a short course of high dose oral steroids, though there is no consensus on their effectiveness.5
Caution should be taken in elderly patients and those with relative contraindications to steroids, such as diabetes and immunosuppression. Gastric protection should also be considered.
If the initial course of oral steroids fails to produce any hearing improvement, a course of three intratympanic steroid injections (over three weeks) may be considered as salvage therapy in secondary care, either alone or in combination with oral steroids.7
There is no evidence of the use of other therapies, such as antivirals, thrombolytics, vasodilators or vasoactive substances for patients with SSNHL.6
Between 32% and 65% of cases of SSNHL recover spontaneously, usually within two weeks. 8
Prognosis is thought to be related to several factors including age, the severity of hearing loss, presence or absence of vertigo, and the delay between hearing loss onset and treatment. 9,10
Patients can be followed up in an ENT clinic with audiology support (after liaising with a local ENT team).
Hearing aids may be an option for patients with incomplete hearing recovery.
SSNHL is a medical emergency that requires early recognition and treatment.
A thorough history and examination is essential to confirm that the hearing loss is sensorineural and exclude other causes.
Early treatment with high dose steroids remains the mainstay of treatment (despite limited evidence).
An MRI IAM scan should be requested to exclude vestibular schwannoma.
ENT Registrar (ST8)
Schreiber BE et al. Sudden sensorineural hearing loss. The Lancet. 2010. Available from: [LINK]
Eisenman DJ, Arts HA. Effectiveness of treatment for sudden sensorineural hearing loss. Archives of Otolaryngology – Head and Neck Surgery. 2000. Available from: [LINK]
Daniels RL et al. Causes of unilateral sensorineural hearing loss screened by high- resolution fast spin echo magnetic resonance imaging: Review of 1,070 consecutive cases. Am J Otol. 2000. Available from: [LINK]
Hearing loss in adults – NICE CKS [Internet]. [cited 2020 Apr 8]. Available from: [LINK]
Wei BPC et al. Steroids for idiopathic sudden sensorineural hearing loss. Cochrane Database of Systematic Reviews. 2009. Available from: [LINK]
Chandrasekhar SS et al l. Clinical Practice Guideline: Sudden Hearing Loss (Update). Otolaryngol – Head Neck Surg (United States). 2019. Available from: [LINK]
Ahmadzai N et al l. A systematic review and network meta-analysis of existing pharmacologic therapies in patients with idiopathic sudden sensorineural hearing loss. PLoS ONE. 2019. Available from: [LINK]
Mattox DE, Simmons FB. Natural history of sudden sensorineural hearing loss. Ann Otol Rhinol Laryngol. 1977. Available from: [LINK]
Fetterman BL et al. Prognosis and treatment of sudden sensorineural hearing loss. Am J Otol. 1996. Available from: [LINK]
Byl FM. Sudden hearing loss: eight years’ experience and suggested prognostic table. Laryngoscope. 1984. Available from: [LINK]