Synopsis
Recognise time-sensitive cochlear hearing loss, apply the correct NICE referral interval, discuss steroid treatment safely and arrange investigation, objective follow-up and support for persistent impairment.
- Ask when hearing was last normal, how many days deterioration took and how long the patient waited before presenting.
- NICE distinguishes sudden loss within the past 30 days from older sudden loss and progression over four to 90 days.
- Exclude a convincing conductive cause with history and otoscopy, but do not let incidental wax or fullness falsely explain the presentation.
Key red flags
New focal neurological signs with abrupt hearing loss require emergency assessment; activate the stroke pathway when stroke is suspected.
Investigation priorities
Recognise a sensory presentation and exclude emergencies without avoidable delay.
Management branches
Hearing deteriorated abruptly and examination gives no adequate conductive explanation.
- Apply the NICE immediate referral category when onset was within the previous 30 days and deterioration took three days or less, seeking assessment within 24 hours.
- Discuss oral steroid benefits, uncertainty and contraindications with ENT and the patient, ideally early in the first week, using a clearly documented selected regimen.
Key medicines
Prednisolone for an agreed idiopathic sudden-loss courseOrally 1 mg/kg once daily, maximum 60 mg daily, for seven days, followed by an agreed taper during the next week. For a starting dose of 60 mg, the ENT UK example is 50 mg on day 8, 40 mg on day 9, 30 mg on day 10, 20 mg on day 11 and 10 mg on day 12, then stop on day 13. Individualise the written taper for a lower starting dose or prior systemic steroid use.