Sudden onset sensorineural hearing loss (<72 hours) (Guidelines)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

Scope

GP Referral Protocol

Audience

  • North Highland only
  • Primary and Secondary Care
  • Adults only
Sudden onset SSNHL is an ENT emergency and should be referred to ENT urgently and managed promptly

Review referral and management guidance as below (Adapted from ENT UK SSNHL SSO and NICE guidelines)

Patient presenting with sudden onset hearing loss: unilateral versus bilateral

Clinical Assessment:

History

  • Onset <7 days versus >7 days
  • Focal neurological symptoms
  • Trauma
  • Dizzy? Tinnitus?
  • Medication history
  • Past medical history including autoimmune conditions
  • Systemic symptoms

Examination 

  • Examination of ears
  • Exclude impacted wax, acute ear infections, vesicles in ear/ palate
  • Neurological exam, including facial nerve examination
  • Tuning fork test (if available). Webers and Rinne. Conductive versus sensorineural hearing loss
  • Recovery calculator for patients presenting with unilateral sudden sensorineural hearing loss: suddenhearingloss.shinyapps.io/recovery/ (Note this calculator is recommended for use by the ENT Dept, however it is unvalidated, and is to be used with clinical judgement). 
Consider otological, neurological and systemic (infectious, inflammatory or neoplastic) or autoimmune causes of hearing loss
Presentation

Referral information

For ENT referrals: Refer to ENT on-call registrar via Raigmore Switchboard

If suspicious for trauma, acute stroke or neurological disorder

 Refer to appropriate specialty
If suspicious of idiopathic sudden onset sensorineural hearing loss

Urgent referral to ENT on call team.
To be reviewed in RAC (Rapid Access Clinic) with audiogram

Consider oral steroids, if no contraindications:

Oral prednisolone 1mg/kg/day (max 60mg/day) for 7 days tapered over next week (preferably in the first week of onset)

If >1 week or contraindication to systemic steroids please discuss with ENT as may consider intratympanic steroid injection

Adults with sudden hearing loss within 30 days or rapid worsening symptoms

 Immediate Referral (within 24 hours) to ENT

Adults with unilateral hearing loss + altered sensation/facial droop

 Immediate Referral (within 24 hours) to ENT

Adults with suspected stroke

 Immediate Referral to stroke team 

Immunocompromised adults with persistent ear ache and discharge

 Immediate Referral (within 24 hours) to ENT

Sudden hearing loss >30 days or gradual worsening >4 to 90 days

 Urgent Referral (2 weeks)

Adults of Chinese or South-East Asian descent with hearing loss and persistent middle ear effusion --> suspected cancer pathway referral.

 Urgent Referral (2 weeks)

Abbreviations

Abbreviation Meaning
ENT Ear, Nose and Throat
RAC Rapid Access Clinic
SSNHL Sudden sensorineural hearing loss

Editorial Information

Last reviewed: 30/06/2025

Next review date: 30/06/2028

Author(s): ENT.

Version: 1

Approved By: TAM Subgroup of the ADTC

Reviewer name(s): A Cain, ENT Consultant, S McKean, ENT Consultant, V Ganesh, ENT Registrar.

Document Id: TAM687

References
  1. Recommendations: Hearing loss in adults: Assessment and management: Guidance (2018) NICE. Available at: https://www.nice.org.uk/guidance/ng98/chapter/recommendations  (Accessed: 06 February 2025).
  2. ENT UK, Guidelines for Sudden Sensorineural Hearing Loss. Retrieved from https://www.entuk.org/_userfiles/pages/files/guidelines/SSNHL%20SSO.pdf
  3. Mandavia R, Hannink G, Ahmed MN, et al. Prognostic factors for outcomes of idiopathic sudden sensorineural hearing loss: protocol for the SeaSHeL national prospective cohort study. BMJ Open 2020;10:e038552. doi:10.1136/ bmjopen-2020-038552