Sudden Sensorineural Hearing Loss

• Sudden sensorineural hearing loss (SSNHL)

  Hearing loss over less than 72 hours, unexplained by other causes
• SSNHL is considered an otological emergency and requires an immediate referral to the on-call ENT team
• The diagnosis of SSNHL is made when someone rapidly loses their hearing, and no conductive cause can be found
• SSNHL


  • Hearing loss is most often unilateral
  • Hearing loss may be permanent or resolve over days to weeks
• Conductive causes of rapid-onset hearing loss (not classed as SSNHL)

  • Ear wax (or something else blocking the canal)
  • Infection (e.g., otitis media or otitis externa)
  • Fluid in the middle ear (effusion)
  • Eustachian tube dysfunction
  • Perforated tympanic membrane
• Idiopathic

  (of a disease or condition) arising spontaneously or from an unknown cause
• Other causes of SSNHL

  • Infection (e.g., meningitis, HIV and mumps)
  • Ménière's disease
  • Ototoxic medications
  • Multiple sclerosis
  • Migraine
  • Stroke
  • Acoustic neuroma
  • Cogan's syndrome (a rare autoimmune condition causing inflammation of the eyes and inner ear)
• Audiometry

  • Required to establish the diagnosis of SSNHL
  • Diagnosis of SSNHL requires a loss of at least 30 decibels in three consecutive frequencies on an audiogram
• MRI or CT head

  May be used if a stroke or acoustic neuroma are being considered
• Management of SSNHL


  1. Immediate referral to ENT for assessment within 24 hours for patients presenting within 30 days of onset

  2. Where an underlying cause is found (e.g., infection), treatment can be directed at this

  3. Idiopathic SSNHL may be treated with steroids under the guidance of the ENT team

  4. Steroids may be oral or intra-tympanic (via an injection of steroids through the tympanic membrane)