Sudden hearing loss

Sudden hearing loss: urgent information

Sudden sensorineural hearing loss is a rapid reduction in hearing, usually in one ear, developing at once or over no more than a few days. It may be partial or profound. The ear can feel blocked even though there is no wax or middle-ear fluid. Tinnitus is common, and some people also have dizziness or vertigo.

Contact a GP, out-of-hours service or ENT department immediately if hearing suddenly becomes much worse in one ear. Early assessment matters because treatment is time-sensitive. Do not assume the blockage is wax and do not wait several days for it to clear.

Possible causes

In many cases no definite cause is found. Identifiable causes can include head injury, rapid pressure change, severe infection such as meningitis, autoimmune disease, inner-ear disorders and, rarely, a vestibular schwannoma or another neurological problem. A sudden conductive loss from wax or middle-ear disease can feel similar, which is why examination and a hearing test are needed.

Assessment

The clinician examines the ear and arranges urgent audiometry. The pattern of hearing loss, tinnitus, vertigo and neurological symptoms guides further tests. MRI is often considered for unexplained one-sided sensorineural loss to assess the auditory nerve and surrounding structures. Blood tests are used selectively rather than routinely for every patient.

Treatment and outlook

When no contraindication exists, corticosteroid treatment may be offered promptly, by mouth or by injection through the eardrum, according to the timing, severity and specialist assessment. The ENT specialist explains expected benefit and possible side effects. Treatment is also directed at any identified cause.

Recovery varies. Some people improve spontaneously, some recover partly and others retain a significant loss. Most improvement occurs during the first weeks, though later change is possible. Tinnitus can persist even when hearing improves.

If hearing remains reduced, rehabilitation may include hearing aids, a CROS system, assistive devices or, for selected severe cases, cochlear implantation. Emotional and communication support are important because sudden loss can be distressing.

Call emergency services for sudden hearing loss accompanied by facial weakness, difficulty speaking, limb weakness, severe new headache, loss of coordination or other signs of stroke.