A patient with sudden hearing loss in one ear needs to be seen urgently. Wax and middle ear effusion cause conductive loss and are common; sudden sensorineural loss is less common and time-sensitive.
Weber and Rinne tests with a 512 Hz fork help separate the two at the bedside: in sensorineural loss, Weber lateralises to the better ear and Rinne is positive in the affected ear. Arrange audiometry promptly, and where sensorineural loss is likely, discuss early corticosteroids. Unilateral sensorineural loss needs investigation for a retrocochlear cause.
- Examine the ear canal and drum to exclude wax and effusion.
- Use Weber and Rinne to separate conductive from sensorineural loss.
- Arrange audiometry promptly for suspected sensorineural loss.
- Discuss early corticosteroids; delay predicts poorer recovery.
- Investigate unilateral sensorineural loss for a retrocochlear cause.
Why it matters
Sudden sensorineural loss is often first labelled as wax or a cold, and the delay costs recovery.
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