What are the key clinical features to consider when assessing a patient with sudden sensorineural hearing loss?

When assessing a patient with sudden sensorineural hearing loss, key clinical features to consider include the timeframe of onset, the presence of specific associated symptoms, and the exclusion of external or middle ear causes NICE NG98.

Initially, it is important to exclude impacted wax and acute infections such as otitis externa NICE NG98.

Regarding the timeframe of hearing loss, the following should be considered:

• If the hearing loss developed suddenly (over 3 days or less) within the past 30 days, an immediate referral (to be seen within 24 hours) to an ear, nose and throat (ENT) service or an emergency department is warranted NICE NG98.
• If the hearing loss developed suddenly more than 30 days ago, an urgent referral (to be seen within 2 weeks) to an ENT or audiovestibular medicine service is needed NICE NG98.
• If the hearing loss worsened rapidly (over a period of 4 to 90 days), an urgent referral (to be seen within 2 weeks) to an ENT or audiovestibular medicine service is also required NICE NG98.

Specific additional symptoms or signs that necessitate immediate referral (within 24 hours) include acquired unilateral hearing loss accompanied by altered sensation or facial droop on the same side NICE NG98. If stroke is suspected, a local stroke referral pathway should be followed NICE NG98.

Other important features for referral consideration include unilateral or asymmetric hearing loss as a primary concern NICE NG98. Persistent unilateral or pulsatile tinnitus associated with hearing loss also warrants consideration for referral NICE NG98,NICE NG155.