A patient reporting sudden hearing loss in one ear, often on waking, needs to be distinguished from wax or a middle ear effusion on the same day. Tuning fork tests help: in sensorineural loss, Weber lateralises to the better ear and Rinne is positive on the affected side.
Confirm with audiometry as soon as possible. Corticosteroids are most likely to help when started early, and an MRI is needed to exclude a vestibular schwannoma.
- Examine the ear and do Weber and Rinne tests the same day a patient reports sudden one-sided hearing loss.
- Arrange audiometry urgently, ideally within days.
- Discuss oral or intratympanic corticosteroids early, within two weeks of onset.
- Request an MRI of the internal auditory meatus to exclude a retrocochlear cause.
Why it matters
Primary care often sees these patients first, and the treatment window is short.
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