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  • The Review Course in Family Medicine

Hearing Loss Guideline Alert: Navigating the Sudden Silence

Someone cupping their ear showing that their hearing is poor. There is also a red colour effect around the ear showing there is a problem.

Sudden hearing loss can be worrying for patients, often presenting to family practice, urgent care, or emergency departments. Here are the top 7 take-aways to approach sudden hearing loss!

1. Distinguish between sudden sensorineural hearing loss (SSNHL), conductive, and mixed hearing loss

with Weber and Rinne test. No tuning fork? The ‘hum test’ has similar sensitivity and specificity to the Weber test.

2. Refer for urgent audiometry within two weeks of symptom onset to confirm SSNHL.

3. With exception of Lyme serology, routine lab work is not indicated.

4. Routine computed tomography (CT) head is not needed in initial workup unless there are focal neurological findings.

5. Consider magnetic resonance imaging (MRI) if worried about cerebellar pontine angle lesions/masses.

6. There is some evidence for early steroids (oral or intratympanic steroids with ENT) and hyperbaric oxygen therapy within two weeks of symptom onset.

7. Obtain follow-up audiometric evaluation at 6 months and offer audiological rehabilitation to those with residual hearing loss and/or tinnitus.

In summary, effective management of sudden hearing loss hinges on prompt evaluation and intervention, including timely audiometry and consideration of early treatment options. Long-term follow-up and rehabilitation are essential to optimize patient outcomes in these challenging cases.


Chandrasekhar SS, Tsai Do BS, Schwartz SR, et al. Clinical Practice Guideline: Sudden Hearing Loss (Update). Otolaryngology–Head and Neck Surgery. 2019;161(1_suppl):S1-S45. doi:10.1177/0194599819859885



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