Sudden sensorineural hearing loss - Revision history

Danbot: Add MedicationDose entries for prednisone, dexamethasone

2026-03-20T21:14:39Z

Add MedicationDose entries for prednisone, dexamethasone

@@ Línea 55: / Línea 55: @@
 *Worse prognosis in older patients
 *Worse in patients with vertigo
 ==See Also==

Rossdonaldson1: /* Background */

2025-10-22T22:03:49Z

Background

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	==Background==		==Background==
			[[File:Hearing mechanics cropped.jpg\|thumb\|Diagram showing signal processing in the auditory system.]]
	===Epidemiology===		===Epidemiology===
	*Mostly idiopathic		*Mostly idiopathic

Gpowellhb: /* Management */

2020-02-20T19:44:38Z

Management

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	*Glucocorticoids orally ([[prednisone]] 1mg/kg/day up to 60mg maximum for 10-14 days or [[dexamethasone]] 300mg daily for 3 days)		*Glucocorticoids orally ([[prednisone]] 1mg/kg/day up to 60mg maximum for 10-14 days or [[dexamethasone]] 300mg daily for 3 days)
	*Glucocorticoids locally (intratympanic instillation, [[dexamethasone]] 10 to 24mg/mL or [[methylprednisolone]] 30 to 40mg/mL) if refractory to oral GCs		*Glucocorticoids locally (intratympanic instillation, [[dexamethasone]] 10 to 24mg/mL or [[methylprednisolone]] 30 to 40mg/mL) if refractory to oral GCs
	*Antivirals for possible [[HSV-1]] infection ([[valacyclovir]] 1g TID or [[famciclovir]] 500mg TID)		*Antivirals for possible [[HSV-1]] infection ([[valacyclovir]] 1g TID or [[famciclovir]] 500mg TID) are not routinely indicated in the absence of exam findings<ref> Clinical practice guideline: sudden hearing loss (update) executive summary Chandrasekhar SS, Tsai Do BS, Schwartz SR, et al. Otolaryngol Head Neck Surg. 2019;161(2):195-210.</ref>

	==Disposition==		==Disposition==

Gpowellhb: /* Evaluation */

2020-02-20T19:43:22Z

Evaluation

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	==Evaluation==		==Evaluation==
	*[[Eponyms_(T-Z)#Weber_test\|Weber test]] and [[Eponyms_(Q-S)#Rinne_test\|Rinne test]]		*[[Eponyms_(T-Z)#Weber_test\|Weber test]] and [[Eponyms_(Q-S)#Rinne_test\|Rinne test]] to rule out conductive hearing loss (poor man's version is to have patient hum with mouth closed and ask which side they hear it louder on; ipsilateral for conductive and contralateral for sensorineural)
	*Otoscopic exam to rule out OM, OE, foreign bodies, perforated TM or cholesteatoma		*Otoscopic exam to rule out OM, OE, foreign bodies, perforated TM or cholesteatoma
	*Remove [[cerumen impaction\|impacted cerumen]] and re-examine		*Remove [[cerumen impaction\|impacted cerumen]] and re-examine
	*Complete [[neurologic exam]] to rule out [[stroke]]		*Complete [[neurologic exam]] to rule out [[stroke]]
	*Audiometric evaluation (typically as outpatient)		*Audiometric evaluation (typically as outpatient)
	*Consider [[brain MRI\|MRI]] to rule out [[acoustic neuroma]], perilymphatic fistula, [[Meniere's disease]], vascular insufficiency, [[MS]]		*Consider [[brain MRI\|MRI]] to rule out [[acoustic neuroma]], perilymphatic fistula, [[Meniere's disease]], vascular insufficiency, [[MS]]; usually can happen as outpatient
			*No role for routine laboratory testing or CT head imaging in absence of other findings

	==Management==		==Management==

ClaireLewis: /* Evaluation */

2019-10-26T15:30:12Z

Evaluation

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	*Complete [[neurologic exam]] to rule out [[stroke]]		*Complete [[neurologic exam]] to rule out [[stroke]]
	*Audiometric evaluation (typically as outpatient)		*Audiometric evaluation (typically as outpatient)
	*Consider [[brain MRI\|MRI]] to rule out acoustic neuroma, perilymphatic fistula, [[~~Meniere’s~~ disease]], vascular insufficiency, [[MS]]		*Consider [[brain MRI\|MRI]] to rule out [[acoustic neuroma]], perilymphatic fistula, [[Meniere's disease]], vascular insufficiency, [[MS]]

	==Management==		==Management==

ClaireLewis: /* Evaluation */

2019-10-02T00:56:50Z

Evaluation

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	*Complete [[neurologic exam]] to rule out [[stroke]]		*Complete [[neurologic exam]] to rule out [[stroke]]
	*Audiometric evaluation (typically as outpatient)		*Audiometric evaluation (typically as outpatient)
	*Consider [[brain MRI\|MRI]] to rule out acoustic neuroma, perilymphatic fistula, [[~~Ménière’s~~ disease]], [[vascular insufficiency]], [[MS]]		*Consider [[brain MRI\|MRI]] to rule out acoustic neuroma, perilymphatic fistula, [[Meniere’s disease]], vascular insufficiency, [[MS]]

	==Management==		==Management==

ClaireLewis: /* Evaluation */

2019-10-02T00:56:23Z

Evaluation

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	*[[Eponyms_(T-Z)#Weber_test\|Weber test]] and [[Eponyms_(Q-S)#Rinne_test\|Rinne test]]		*[[Eponyms_(T-Z)#Weber_test\|Weber test]] and [[Eponyms_(Q-S)#Rinne_test\|Rinne test]]
	*Otoscopic exam to rule out OM, OE, foreign bodies, perforated TM or cholesteatoma		*Otoscopic exam to rule out OM, OE, foreign bodies, perforated TM or cholesteatoma
	*Remove impacted cerumen and re-examine		*Remove [[cerumen impaction\|impacted cerumen]] and re-examine
	*Complete [[neurologic exam]] to rule out [[stroke]]		*Complete [[neurologic exam]] to rule out [[stroke]]
	*Audiometric evaluation		*Audiometric evaluation (typically as outpatient)
	*MRI to rule out acoustic neuroma, perilymphatic fistula, Ménière’s disease, vascular insufficiency, [[MS]]		*Consider [[brain MRI\|MRI]] to rule out acoustic neuroma, perilymphatic fistula, [[Ménière’s disease]], [[vascular insufficiency]], [[MS]]

	==Management==		==Management==

ClaireLewis at 22:46, 30 September 2019

2019-09-30T22:46:01Z

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	==Clinical Features==		==Clinical Features==
	*Immediate/rapid hearing loss or hearing loss upon awakening		*Immediate/rapid [[hearing loss]] or hearing loss upon awakening
	*Mostly unilateral hearing loss		**Mostly unilateral hearing loss
	*Sensation of blocked or full ear, patient doesn’t recognize hearing is gone		*Sensation of blocked or full ear, patient doesn’t recognize hearing is gone
	*Difficulty in localizing sound		*Difficulty in localizing sound
	*Tinnitus is common		*[[Tinnitus]] is common
	*Some patients report vertigo		*Some patients report [[vertigo]]
	*Occasionally ear pain is present		*Occasionally [[otalgia\|ear pain]] is present
	*No sign of obstruction or OM on physical exam		*No sign of obstruction or [[otitis media]] on physical exam

	==Differential Diagnoses==		==Differential Diagnoses==
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	*[[Meningitis]]		*[[Meningitis]]
	*Vestibular schwannomas		*Vestibular schwannomas
	*Migrainous infarction		*[[migraine\|Migrainous]] [[CVA\|infarction]]
	*[[Acute otitis media]]		*[[Acute otitis media]]
	*Traumatic [[TM rupture]]		*Traumatic [[TM rupture]]

Rossdonaldson1: Text replacement - "r/o" to "rule out"

2016-07-30T13:38:56Z

Text replacement - "r/o" to "rule out"

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	==Evaluation==		==Evaluation==
	*[[Eponyms_(T-Z)#Weber_test\|Weber test]] and [[Eponyms_(Q-S)#Rinne_test\|Rinne test]]		*[[Eponyms_(T-Z)#Weber_test\|Weber test]] and [[Eponyms_(Q-S)#Rinne_test\|Rinne test]]
	*Otoscopic exam to ~~r/o~~ OM, OE, foreign bodies, perforated TM or cholesteatoma		*Otoscopic exam to rule out OM, OE, foreign bodies, perforated TM or cholesteatoma
	*Remove impacted cerumen and re-examine		*Remove impacted cerumen and re-examine
	*Complete [[neurologic exam]] to ~~r/o~~ [[stroke]]		*Complete [[neurologic exam]] to rule out [[stroke]]
	*Audiometric evaluation		*Audiometric evaluation
	*MRI to ~~r/o~~ acoustic neuroma, perilymphatic fistula, Ménière’s disease, vascular insufficiency, [[MS]]		*MRI to rule out acoustic neuroma, perilymphatic fistula, Ménière’s disease, vascular insufficiency, [[MS]]

	==Management==		==Management==

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-25T18:32:35Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

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	{{Ear DDX}}		{{Ear DDX}}

	==~~Diagnosis~~==		==Evaluation==
	*[[Eponyms_(T-Z)#Weber_test\|Weber test]] and [[Eponyms_(Q-S)#Rinne_test\|Rinne test]]		*[[Eponyms_(T-Z)#Weber_test\|Weber test]] and [[Eponyms_(Q-S)#Rinne_test\|Rinne test]]
	*Otoscopic exam to r/o OM, OE, foreign bodies, perforated TM or cholesteatoma		*Otoscopic exam to r/o OM, OE, foreign bodies, perforated TM or cholesteatoma