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# Sudden sensorineural hearing loss: an emergency

- Emergency

Hearing that drops suddenly in one ear, without wax or infection, is an inner-ear emergency: get a hearing test and treatment the same day.

Updated Nov 5, 2026

## Key points

- Definition: a sensorineural loss of at least 30 dB over three consecutive frequencies, developing within 72 hours.
- Tuning forks: Weber lateralises to the good ear and Rinne is positive (air conduction better than bone) in the affected ear.
- Treat as an emergency: audiogram and corticosteroids (oral or intratympanic) as early as possible; benefit falls after two to four weeks.
- One-sided sensorineural loss needs MRI of the internal auditory canals to exclude a vestibular schwannoma.
- About half of patients recover some or all of their hearing; vertigo, a severe loss and delay mean a worse outlook.

## What it is

Sudden sensorineural hearing loss is a rapid loss of hearing from the inner ear or the nerve, usually in one ear, developing at once or over up to three days. It is often mistaken for wax or a blocked ear, which delays treatment. Most cases have no cause found; about one in ten has an identifiable cause, such as a tumour of the vestibulocochlear nerve, infection, trauma, autoimmune disease or vascular events. Early corticosteroids give the best chance of recovery, so the key steps are to recognise it, confirm it with tuning forks and an audiogram, and refer the same day.

## How to recognise it

- Typical story: waking up with a deaf or «full» ear, often with tinnitus and sometimes vertigo.
- Otoscopy is normal: no wax, no fluid, no perforation.
- With a conductive loss (wax, middle ear fluid), Weber goes to the bad ear and Rinne is negative.
- Sudden deafness with vertigo and neurological signs can be a posterior circulation stroke.

## Step-by-step management

- Take the history: time of onset, one or both ears, tinnitus, vertigo, trauma, recent infection, ototoxic drugs.
- Examine the ear: normal otoscopy rules out wax, fluid and perforation as the cause.
- Use tuning forks (Weber and Rinne) to tell sensorineural from conductive loss at the bedside.
- Examine the cranial nerves and cerebellum; neurological signs mean the stroke pathway.
- Arrange a pure-tone audiogram the same day or as soon as possible to confirm and measure the loss.
- Start corticosteroids early, after discussing the benefits and risks (diabetes, hypertension); ENT may use intratympanic steroids.
- Request MRI of the internal auditory canals to look for a vestibular schwannoma or other retrocochlear cause.

## Sudden «blocked ear»: conductive or sensorineural?

| Test | Conductive loss (wax, fluid) | Sensorineural loss |
| --- | --- | --- |
| Otoscopy | Wax, fluid or perforation | Normal |
| Weber | Lateralises to the affected ear | Lateralises to the good ear |
| Rinne in the affected ear | Negative (bone better than air) | Positive (air better than bone) |
| Urgency | Treat the cause, routine | Emergency: audiogram and same-day referral |

## Red flags

- Any sudden one-sided hearing loss with a normal eardrum.
- Associated vertigo, which predicts a worse recovery.
- Neurological signs (ataxia, diplopia, facial weakness, limb weakness): possible stroke.
- Bilateral sudden loss, or loss after head trauma or barotrauma.
- Hearing loss in a patient receiving ototoxic drugs.

## Next step / Initial management

- Workup: pure-tone audiogram urgently; MRI of the internal auditory canals; blood tests guided by the history (no routine panel is needed).
- First-line: corticosteroids, oral or intratympanic, as early as possible; hearing aids and rehabilitation if hearing does not recover.
- Refer to ENT the same day (urgent) any suspected sudden sensorineural hearing loss; do not treat it as wax or a cold.
- Refer as an emergency to the stroke pathway when sudden deafness comes with vertigo and neurological signs.

## Test yourself

Think of the answer, then tap the question to see it.

## A 45-year-old woke up with a «blocked» left ear and tinnitus. Otoscopy is normal, Weber goes to the right and Rinne is positive on the left. What is it and what is the next step?

Left sudden sensorineural hearing loss. Same-day ENT referral, urgent audiogram, early corticosteroids and later MRI of the internal auditory canals.

## What audiometric definition is used for sudden sensorineural hearing loss?

A loss of at least 30 dB over three consecutive frequencies, developing within 72 hours.

## Why does one-sided sensorineural hearing loss need an MRI?

To exclude a retrocochlear cause, mainly a vestibular schwannoma of the internal auditory canal or cerebellopontine angle.

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## Connections

## Related 1

- [Approach to hearing loss](https://durgical.com/en/ent/approach-to-hearing-loss/)

## Related conditions 1

- [Hearing loss (conductive and sensorineural, including sudden hearing loss)](https://durgical.com/en/conditions/hearing-loss/)

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Educational content; it does not replace a medical assessment and is not a clinical instruction. For a real case, follow current guidelines and specialist advice.

Sources: [Sudden Deafness](https://www.nidcd.nih.gov/health/sudden-deafness) (National Institute on Deafness and Other Communication Disorders (NIDCD), NIH, 2018); [Sensorineural Hearing Loss (StatPearls)](https://www.ncbi.nlm.nih.gov/books/NBK565860/) (StatPearls Publishing, NCBI Bookshelf, 2026).

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