What are the guidelines for managing patients with sudden sensorineural hearing loss in primary care?

In primary care, adults presenting with sudden sensorineural hearing loss (SSNHL) should first be assessed to exclude external or middle ear causes such as impacted wax or acute infections. If SSNHL is suspected, immediate referral is required depending on the timing and progression of hearing loss. Specifically, if the hearing loss developed suddenly within the past 30 days (over 3 days or less), the patient should be referred immediately to an ear, nose and throat (ENT) service or emergency department to be seen within 24 hours. If the hearing loss developed suddenly more than 30 days ago, or if it worsened rapidly over 4 to 90 days, an urgent referral to ENT or audiovestibular medicine service is recommended to be seen within 2 weeks. Consideration of steroid treatment for idiopathic SSNHL may be appropriate but typically occurs after specialist assessment. Additionally, if the patient has unilateral hearing loss with neurological signs such as facial droop or altered sensation, immediate referral within 24 hours is essential, and stroke pathways should be considered if stroke is suspected. Primary care should also ensure that earwax removal or treatment of infections is completed before referral if these are contributing factors. Audiological assessment and further diagnostic investigations, including MRI if indicated, are part of specialist management following referral from primary care.