A patient reporting sudden hearing loss in one ear, often noticed on waking or with a blocked feeling and tinnitus, may have sudden sensorineural hearing loss rather than wax or middle ear fluid. Tuning fork tests help at the first visit: with sensorineural loss, the Weber test lateralises to the better ear and the Rinne test stays positive in the affected ear. Arrange audiometry urgently, because corticosteroid treatment is most likely to help when started early, ideally within two weeks. MRI is needed to exclude a vestibular schwannoma.
- Examine the ear canal and drum, then do Weber and Rinne tests in anyone with sudden unilateral hearing loss.
- Treat a Weber lateralising to the good ear with a normal drum as possible sensorineural loss.
- Arrange audiometry and ENT review within days, not weeks.
- Expect ENT to consider early corticosteroids and an MRI of the internal auditory canals.
Why it matters
Misattributing it to wax or a cold wastes the window in which treatment is most likely to help.
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