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Timely recognition of sudden sensorineural hearing loss by the initial evaluating physician affects the availability of treatment options as well as the treatment success rates.
Immediately see the patient complaining of sudden hearing loss or refer the patient to urgent care:
- Examine the ear to rule out common causes of conductive hearing loss:
- Fluid behind the tympanic membrane
- A tuning fork test can assess conductive versus sensorineural hearing loss.
If the ear canal and tympanic membrane are normal, assume a sensorineural hearing loss:
- Start high dose oral steroids (60 mg prednisone for two weeks, followed by a taper).
- If the patient cannot take oral steroids due to comorbidities, an otolaryngologist can perform a steroid injection into the ear.
- Order a brain MRI of the internal auditory canal with contrast.
- Make an urgent referral to otolaryngology and audiology for a hearing test and evaluation. State the reason for referral: sudden hearing loss.
Chandrasekhar SS, Tsai Do BS, Schwartz SR, Bontempo LJ, Faucett EA, Finestone SA, Hollingsworth DB, Kelley DM, Kmucha ST, Moonis G, Poling GL, Roberts JK, Stachler RJ, Zeitler DM, Corrigan MD, Nnacheta LC, Satterfield L, Monjur TM. “Clinical Practice Guideline: Sudden Hearing Loss (Update) Executive Summary” Otolaryngol Head Neck Surg. 2019 Aug.; 161(2):195–210. doi: 10.1177/0194599819859883. PMID: 31369349. Prince ADP, Stucken EZ. “Sudden Sensorineural Hearing Loss: A Diagnostic and Therapeutic Emergency” J Am Board Fam Med. 2021 Jan–Feb; 34(1):216–223. doi: 10.3122/jabfm.2021.01.200199. PMID: 33452100.