A patient reporting sudden loss of hearing in one ear, often on waking, needs to be seen the same or next day. First separate conductive from sensorineural loss: look for wax or effusion, and use a 512 Hz tuning fork. In sudden sensorineural loss, the Weber test lateralises to the better ear and Rinne is positive in the affected ear.
Arrange audiometry promptly to confirm sensorineural loss. Corticosteroids, oral or intratympanic, are most likely to help when started within two weeks, so do not wait for an outpatient slot. Unilateral sensorineural loss should be imaged, usually MRI of the internal auditory meati, to exclude a vestibular schwannoma or other retrocochlear cause.
- See sudden unilateral hearing loss the same or next day.
- Exclude wax and middle ear effusion first.
- Use Weber and Rinne: Weber lateralises away from a sensorineural loss.
- Start steroids early, ideally within two weeks, after discussing risks.
- Arrange MRI of the internal auditory meati for unilateral sensorineural loss.
Why it matters
Treatment works best early, and a missed sudden sensorineural loss is often mislabelled as wax or a cold.
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