Hearing loss, acute
Questionnaire/history:
Sudden-onset sensorineural hearing loss (SNHL)?
URTI?
Cause?
- Idiopathic (70%)?
- Infective - viral (eg measles, mumps, rubella), bacterial (eg syphilis, Lyme, meningitis, acute labyrinthitis)?
- Trauma (head injury, blast trauma, barotrauma)?
- Autoimmune (Wegener's granulomatosis)?
- Central (ischaemic (eg CVA), multiple sclerosis, cerebellopontine angle tumour)?
- Pharmacological (ototoxic medication (eg IV aminoglycosides))?
- Other (eg Meniere's)?
Past medical history?
Current medication?
Known drug allergies?
Examination:
Conductive hearing loss?
- Otoscopy?
--- Acute ear infection?
--- Wax?
--- Perforation?
--- Glue ear?
Sensory hearing loss?
- Weber’s test?
Otorrhoea?
Management:
Immediate referral ( < 24hrs):
Acquired unilateral hearing loss and altered sensation/facial droop on the same side
Otalgia + otorrhoea not responding to treatment in 72 h in immuno-compromised patients
Sudden SNHL (over a period of ≤3 days) within the past 30 days:
(Note: to gain maximal benefit from steroids they ought to be started within 48 hours, for patients with normal otoscopy, no current URTI and Weber's suggesting SNHL: steroids can be initiated in primary care immediately)
Prednisolone: 1mg/kg OD for 7 days, with a max. dose of 60mg/day
Sudden hearing loss more than 30 days ago or hearing rapidly worsens (over 4-90 days):
Urgent referral
(Note: adults of Chinese or South-Asian family origin with hearing loss and middle ear effusion not associated with URTI: naso-pharyngeal tumours are common in these populations, the risk is > 3% with these presenting features)
Resource(s):