A patient who wakes with a blocked, deaf ear is often told it is wax or fluid. Look in the ear, then use a 512 Hz tuning fork. In sensorineural loss, the Weber test lateralises to the good ear and the Rinne test is positive on the affected side. If the canal and drum are normal and the Weber goes to the better ear, treat it as sudden sensorineural hearing loss: arrange urgent audiometry and ENT review, and start corticosteroids early, because benefit falls with delay. Unilateral sudden loss also needs MRI of the internal auditory meatus to exclude a vestibular schwannoma.
- Examine the ear canal and drum before attributing sudden deafness to wax or fluid.
- Use Weber and Rinne with a 512 Hz fork: Weber to the good ear suggests sensorineural loss.
- Arrange same-week audiometry and ENT review, and start steroids early.
- Request MRI of the internal auditory meatus for unilateral sudden sensorineural loss.
Why it matters
Delay is the main modifiable predictor of poor recovery, and it usually happens in primary care.
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