A patient reporting sudden hearing loss in one ear over hours to three days needs same-day assessment. Look in the ear to exclude wax or effusion, then use a tuning fork: in sensorineural loss, Weber lateralises to the better ear and Rinne remains positive in the affected ear.
Arrange urgent audiometry and specialist review. Corticosteroids are most likely to help when started within two weeks, and every patient with unexplained unilateral sensorineural loss needs MRI to exclude a vestibular schwannoma.
- See sudden unilateral hearing loss the same day; do not label it wax without looking.
- Use Weber and Rinne to separate conductive from sensorineural loss.
- Refer urgently for audiometry and ENT review.
- Arrange MRI for unexplained unilateral sensorineural loss.
Why it matters
Delayed recognition loses the window in which steroids are most likely to help.
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