Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 7 Sept 2026Clinical review pending
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Localise the loss without delaying referral
A blocked-ear sensation does not establish a conductive cause, and an abrupt cochlear loss may occur with a normal external and middle-ear examination.
Action: If hearing fell over three days or less in the last 30 days and visible external or middle-ear disease does not explain it, arrange assessment within 24 hours. Obtain a careful history and examination immediately; do not wait for a routine audiogram to initiate the referral.
Synopsis
Localise hearing impairment using history, examination and appropriately masked audiometry, while recognising mixed disease, urgent presentations and indications for investigation of asymmetric sensorineural loss.
Conductive loss reduces sound transfer through the outer or middle ear; sensorineural loss affects cochlear or neural function.
Air-conduction thresholds test the entire pathway, while bone conduction helps assess function beyond the outer and middle ear.
A conductive component creates an air-bone gap when reliable ear-specific thresholds have been established.
Key red flags
Recent sudden hearing loss without a convincing conductive explanation requires immediate referral for assessment within 24 hours.
Investigation priorities
01
History, otoscopy and communication assessmentFirst step
Identify obvious causes, urgent patterns and the person's functional priorities.
Management branches
Sudden or rapidly progressive lossApply the correct referral clock
The history suggests recent onset or progression without an adequate external or middle-ear cause.
Refer a loss developing within three days and occurring within the last 30 days immediately, aiming for assessment within 24 hours.
For sudden loss beginning more than 30 days ago, or worsening over four to 90 days, arrange urgent ENT or audiovestibular assessment within two weeks.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 7 Sept 2026; clinical approval remains outstanding.