Sudden Hearing Loss - A Medical Emergency

Sudden hearing loss is an emergency and the ear should be checked immediately.. Getty Images/Huntstock

Most people would immediately call the doctor or even go to the emergency room if they woke up one morning and could not see out of one eye. Unfortunately, that same urgency is not always the case when one loses hearing suddenly. Approximately 4,000 cases of sudden sensorineural hearing loss occur in the United States yearly. This condition is a true emergency; the longer treatment is delayed, the worse the chance for recovery.

There is a window of two to four weeks to get treated. If treatment is first started after four weeks, there is little chance of any benefit.

What symptoms are present?

It is important to note that most people do not feel any pain with a sudden sensorineural hearing loss. 

What is the cause of sudden sensorineural hearing loss?

Most of the time (approximately 99%) no cause is found. This is referred to as, "idiopathic". It is believed that the most common causes are a viral infection of the inner ear or problems with blood flow or fluid balance in the inner ear. 

The remaining 1% are thought to be caused by “retro-cochlear” disease, such as an acoustic neuroma (a noncancerous tumor on the auditory nerve), demyelinating disease (such as multiple sclerosis), or stroke.

Medical evaluation

If you suspect a sudden sensorineural hearing loss a medical evaluation by an ear specialist - such as an otologist or otolaryngologist - is essential. The ear specialist will work with the audiologist to measure and monitor hearing, order imaging or blood tests, and prescribe treatment.


Hearing evaluation

A complete hearing evaluation is mandatory in all patients with suspected hearing loss.  Sudden sensorineural hearing loss can affect all frequencies (pitches) of hearing equally or it can affect just the high or low frequencies. In some cases, the hearing loss is mild and in other cases it is severe. The worse the hearing loss, the poorer the prognosis for recovery. The audiologist should monitor hearing regularly during treatment and communicate with the ear specialist regarding the effectiveness of treatment.

Brain MRI

The ear specialist may order imaging studies to check for tumor, stroke, or demyelination (MS). In patients who cannot have brain MRI, there are alternatives such as CT scanning and/or Auditory Brainstem Response (ABR) testing. Since only 1% of sudden sensorineural hearing losses are due to these type of conditions, treatment should be started immediately even if there is a delay in obtaining imaging studies.


The standard treatment for sudden sensorineural hearing loss is a tapering course of oral corticosteroids (prednisone or methylprednisolone).

Some ear specialists will choose to inject the medication directly through the ear drum in an effort to provide a more concentrated dose to the ear while decreasing the exposure to the rest of the body. A large multicenter clinical trial showed that both methods of treatment are equally effective. It is important to discuss the pros and cons of using each (or both) of these treatments with your ear specialist.

A number of other treatments have been proposed for sudden sensorineural hearing loss. These include antiviral drugs, drugs to reduce blood clotting or increase circulation, hyperbaric oxygen treatments, or inhalation of gasses to increase circulation.

Since there is only a two to four week window of opportunity for treating sudden sensorineural hearing loss, it is essential to start therapy as soon as possible, even if a complete diagnostic work-up has not been completed. Treatment should never be postponed for days or weeks to wait on results from MRI or CT studies. 

Follow Up

After completion of treatment, your hearing should continue to be monitored for at least one year. Retesting hearing at two months, six months, and one year after the onset of sensorineural hearing loss is important to make sure hearing is stable, monitor for signs of relapse, and watch for any hearing loss developing in the opposite ear.

If the hearing loss does not get better, your audiologist can discuss amplification options to help you hear better, such as a CROS or BAHA aid for single sided deafness, or a traditional hearing aid. 


Updated November 2, 2015

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