Sudden sensorineural hearing loss is often mistaken for wax, fluid or a blocked ear and sent away, yet it is a time-critical diagnosis where early treatment improves the chance of recovery.
Suspect it when hearing drops over three days or less, usually in one ear, often with tinnitus or aural fullness. The bedside discriminator is the tuning-fork examination: in sensorineural loss, Weber lateralises to the better ear and Rinne stays positive, unlike a conductive cause. Confirm with pure-tone audiometry urgently, defined as a drop of at least 30 dB across three contiguous frequencies.
Start systemic corticosteroids as soon as the diagnosis is made, ideally within days, and refer for ENT assessment and consideration of intratympanic steroid salvage if recovery is incomplete. Obtain MRI of the internal auditory meatus to exclude a retrocochlear lesion such as a vestibular schwannoma. The window for benefit is short, so the error to avoid is delay.
- Suspect sudden sensorineural hearing loss with a one-ear drop over three days or less, often with tinnitus or fullness.
- Use tuning forks: Weber to the better ear and a positive Rinne point to a sensorineural cause.
- Confirm urgently with audiometry (a drop of at least 30 dB over three contiguous frequencies) and start corticosteroids promptly.
- Refer to ENT for intratympanic steroid salvage if needed, and arrange MRI to exclude a retrocochlear lesion.
Why it matters
The chance of hearing recovery falls with delay, so mistaking it for wax or fluid and deferring treatment costs the patient hearing.
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