What guidelines should I follow for managing patients with sudden sensorineural hearing loss?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 22 August 2025Updated: 22 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

For patients presenting with sudden sensorineural hearing loss, the following guidelines should be followed:

  • Initial Assessment:
    • First, exclude impacted earwax and acute infections such as otitis externa .
    • If earwax is contributing to hearing loss or other symptoms, or needs to be removed for examination, offer earwax removal using methods like electronic irrigation or microsuction, provided the practitioner is trained and aware of contraindications . Manual syringing should not be offered .
  • Referral Pathways for Sudden or Rapid Onset Hearing Loss:
    • If the hearing loss developed suddenly (over 3 days or less) within the past 30 days, refer immediately (to be seen within 24 hours) to an ear, nose and throat (ENT) service or an emergency department .
    • If the hearing loss developed suddenly more than 30 days ago, refer urgently (to be seen within 2 weeks) to an ENT or audiovestibular medicine service .
    • If the hearing loss worsened rapidly (over 4 to 90 days), refer urgently (to be seen within 2 weeks) to an ENT or audiovestibular medicine service .
  • Treatment for Idiopathic Sudden Sensorineural Hearing Loss:
    • Consider a steroid to treat idiopathic sudden sensorineural hearing loss in adults .
  • Further Investigations:
    • Consider MRI of the internal auditory meati for adults with sensorineural hearing loss and no localising signs if there is an asymmetry on pure tone audiometry of 15 dB or more at any two adjacent test frequencies (0.5, 1, 2, 4, and 8 kHz) .
    • Offer MRI of the internal auditory meati to adults with hearing loss and localising symptoms or signs (such as facial nerve weakness) that might indicate a vestibular schwannoma or CPA (cerebellopontine angle) lesion, irrespective of pure tone thresholds .
  • Audiological Assessment:
    • An audiological assessment should include a full history, the person's hearing and communication needs, psychosocial difficulties, expectations, restrictions on activity, otoscopy, pure tone audiometry, and tympanometry if indicated .

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What guidelines should I follow for managing patients with sudden sens