Which investigations should be performed in primary care to rule out underlying causes of sudden sensorineural hearing loss?

In primary care, the initial investigations for sudden sensorineural hearing loss primarily involve ruling out common external and middle ear causes and then prompt referral to specialist services ¹.

• Exclude impacted earwax and acute infections such as otitis externa ¹.
• If earwax is contributing to the hearing loss, it should be removed in primary care using methods like an electronic irrigator, microsuction, or manual removal ¹.
• For adults with sudden onset or rapid worsening of hearing loss (developed over 3 days or less) that is not explained by external or middle ear causes, the following referrals are crucial:
  • If the hearing loss developed 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 ¹.
  • If the hearing loss developed more than 30 days ago, refer urgently (to be seen within 2 weeks) to an ENT or audiovestibular medicine service ¹.
• Refer immediately (to be seen within 24 hours) adults with acquired unilateral hearing loss and altered sensation or facial droop on the same side to an ENT service, or follow a local stroke referral pathway if stroke is suspected ¹.
• Consider referring adults to an ENT service if, after initial treatment of any earwax or acute infection, they have persistent issues such as pain affecting either ear for 1 week or more, unresolved or recurrent discharge, or an abnormal appearance of the outer ear or eardrum ¹.