A patient reporting sudden hearing loss in one ear over less than three days needs to be distinguished quickly between conductive causes, such as wax or effusion, and sudden sensorineural hearing loss. Otoscopy and tuning-fork tests help: in sensorineural loss the ear canal and drum look normal and the Weber test lateralises to the better ear. Sudden sensorineural loss needs same-day or next-day ENT assessment and audiometry, because treatment with corticosteroids is most likely to help when started early, and an MRI is usually arranged to exclude a vestibular schwannoma.
- Examine the ear canal and drum to exclude wax, effusion or perforation.
- Use the Weber test: lateralisation to the better ear suggests sensorineural loss.
- Refer suspected sudden sensorineural hearing loss to ENT the same or next day.
- Do not reassure and review in weeks; early treatment matters.
Why it matters
Sudden sensorineural hearing loss is often mistaken for wax or a cold, and the window for treatment is short.
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