Sudden Hearing loss

If the hearing loss developed suddenly (over 3 days or less) within the past 30 days this needs to be assessed urgently in primary care to establish if the cause is conductive or sudden sensorineural hearing loss (SSNHL). SSNHL is a medical emergency and needs urgent referral and input from ENT.

GPs should try to look for reversible conductive causes;

• Obstruction
  • Wax
  • Foreign body
  • Infection
  • Trauma
  • Chronic otitis media with effusion (glue ear)
    • If this is identified then enquire about red flag head and neck symptoms
    • If unilateral glue ear is suspected then enquire about a recent URTI, hayfever or nasal symptoms. Trial the patient on (Xylometazoline hydrochloride 1 spray or 2-3 drops TDS) for 7 days as well as describing the Valsalva manoeuvre to be performed daily. If the glue ear persists this needs a referral described below.

To aid in this Rinne’s and Weber’s tests are very useful to help to identify those with a SSNHL.

The SSNHL criteria for Ninewells in terms of emergency referral is a sudden hearing loss (occurring within 3 days) without an obvious conductive cause and with the onset of symptoms starting less than 14 days ago. If these criteria are met then refer as per guidance below but also discuss with the patient and identify any contraindications to high dose steroids as this will likely be the guidance from the oncall ENT team.

The management in secondary care is to establish the diagnosis and then try to identify the cause. We have the option for salvage intratympanic steroid injections if there is no improvement up to two weeks later

Emergency referral

• If suspected SSNHL refer to the ENT on-call team (01382 660111) (bleep 4496) (see SSNHL guidance)

Urgent referral

• Unilateral SSNHL but over 14 days ago since onset
• Unilateral otitis media with effusion (OME) in adult not resolved by above management to rule out post nasal space pathology).

Patient information leaflet in progress

NICE guidance