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Sudden sensorineural hearing loss (SSNHL)
Sudden hearing loss is urgent: first exclude conductive loss, then confirm on audiogram a loss of at least 30 dB in 3 consecutive frequencies developing within 72 hours, offer steroids as early as possible, and look for a retrocochlear cause on MRI.
Why it matters in the exam
The exam shows a healthy person who woke with a "blocked" ear and tinnitus. The first step is to separate conductive loss (wax, fluid) from sensorineural: in the Weber test the sound moves to the healthy ear in sensorineural loss. Under AAO-HNS 2019, routine CT and routine blood tests are not needed. MRI with gadolinium (or ABR when MRI is unavailable) is performed to exclude vestibular schwannoma and other retrocochlear pathology.
Treatment: systemic steroids are offered within two weeks of onset — for example prednisone 1 mg/kg per day up to 60 mg for 7 to 14 days and then a taper. Intratympanic steroid injection is offered as salvage when recovery is partial, within 2 to 6 weeks, or as first treatment when systemic steroids are contraindicated (uncontrolled diabetes, for example). Hyperbaric oxygen may be offered together with steroids within two weeks, or as salvage within one month.
Antivirals, vasodilators, anticoagulants and thrombolytics should not be used routinely. A large share of patients — about 32% to 65% — improve even without treatment; prognosis is worse with severe loss, older age, vertigo, and a downsloping high-frequency curve. A follow-up audiogram is performed within 6 months, and hearing rehabilitation (hearing aid, CROS or cochlear implant) is offered when there is no recovery. Sudden bilateral loss raises suspicion of systemic disease.
Key points
- 30 dB in 3 consecutive frequencies within 72 hours.
- Exclude conductive loss first.
- Steroids within two weeks.
- Intratympanic salvage.
- MRI to exclude schwannoma.
Summary table
| Stage | What is done | Detail |
|---|---|---|
| Diagnosis | Weber, otoscopy, audiogram | 30 dB in 3 consecutive frequencies within 72 hours |
| Work-up | MRI with gadolinium or ABR | Exclude schwannoma; no routine CT or blood tests |
| First treatment | Systemic steroids within two weeks | Prednisone 1 mg/kg up to 60 mg, 7 to 14 days |
| Salvage treatment | Intratympanic steroid | Within 2 to 6 weeks |
| Hyperbaric oxygen | With steroids or as salvage | Within two weeks or within one month |
| Follow-up | Audiogram and rehabilitation | Within 6 months |
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Sources
- AAO-HNS Clinical Practice Guideline: Sudden Hearing Loss (Update), 2019 — Diagnosis, steroids, hyperbaric oxygen and follow-up
- Cummings Otolaryngology: Head and Neck Surgery, 7th edition (2021) — Sudden sensorineural hearing loss
- Cochrane Review: Corticosteroids for idiopathic sudden sensorineural hearing loss, 2022 — Main results
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.