Management of Sudden Sensorineural Hearing Loss

Diagnostic Steps

The American Academy of Otolaryngology-Head and Neck Surgery recommends performing Weber and Rinne tuning fork tests to differentiate the type of hearing loss, as this fundamentally changes management strategy 3
The American Academy of Otolaryngology-Head and Neck Surgery suggests obtaining formal audiometry urgently (within 24-48 hours) to confirm SSNHL and establish baseline 1, 2
Sudden sensorineural hearing loss is defined as ≥30 dB hearing loss over at least 3 contiguous frequencies occurring within 72 hours, according to the American Academy of Otolaryngology-Head and Neck Surgery 2

The American Academy of Otolaryngology-Head and Neck Surgery recommends initiating corticosteroid therapy as soon as possible for sensorineural hearing loss, as outcomes are time-dependent 1, 2
Oral corticosteroids are the first-line treatment option, with a typical regimen of Prednisone 1 mg/kg/day (max 60 mg) for 7-14 days with or without taper, as suggested by the American Academy of Otolaryngology-Head and Neck Surgery 2
Earlier treatment (within 2 weeks) is associated with better outcomes, according to the American Academy of Otolaryngology-Head and Neck Surgery 1

The American Academy of Otolaryngology-Head and Neck Surgery advises against using ototoxic drops until the tympanic membrane is confirmed to be completely intact 6, 4
The American Academy of Otolaryngology-Head and Neck Surgery recommends avoiding ear irrigation when the tympanic membrane status is uncertain or when blood suggests possible perforation 5, 6

Patients recovering ≥50% of hearing within the first 2 weeks have a better overall prognosis, according to the American Academy of Otolaryngology-Head and Neck Surgery 2
The presence of vertigo at onset indicates a poorer prognosis for hearing recovery, as suggested by the American Academy of Otolaryngology-Head and Neck Surgery 2