Patient handout

Sudden sensorineural hearing loss (SSNHL — otologic emergency)

PRODUCTION

1. Your condition

This handout is for sudden sensorineural hearing loss (ssnhl — otologic emergency). Your care team identified this based on: sudden (≤72 h) unilateral hearing loss / aural fullness ± tinnitus — presumptive ssnhl until conductive loss excluded (aao-hns 2019 kas 1, chandrasekhar otolaryngol hns 2019 pmid 31369359).

Other reasons your team may use this plan: sudden hearing loss with vertigo / imbalance — combined audiovestibular loss; raises vascular (aica) and ménière priors (kim & lee j stroke 2016 pmid 28030893); sudden hearing loss with any focal neurologic sign (diplopia, dysarthria, ataxia, facial weakness, central hints) — posterior-circulation/aica stroke until proven otherwise (kas 2; kim & lee 2016 pmid 28030893); bilateral or recurrent episodes of sudden snhl — autoimmune inner-ear disease / ménière / systemic cause workup trigger (aao-hns 2019 kas 2).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
audiogram_confirmation_no_steroid_if_conductive_or_central	—	—	—	AAO-HNS 2019 KAS 1 (Chandrasekhar PMID 31369359) — distinguish SNHL from conductive FIRST; conductive loss → treat the ear (cerumen/effusion/ENT), do NOT enter the steroid pathway. Central HINTS / focal deficit → route to neuro.posterior-circulation-stroke.core.v1 (Kim & Lee 2016 PMID 28030893).

Plan: Idiopathic SSNHL — time-critical corticosteroid (systemic / intratympanic) ± HBOT salvage

3. When to call your provider

Contact your care team if any of the following happen:

Focal neuro deficit / central HINTS / high vascular-risk → route to neuro.posterior-circulation-stroke.core.v1 (Kim & Lee 2016 PMID 28030893)
Bilateral / rapidly progressive / recurrent → autoimmune inner-ear / systemic workup + neurotology
Profound loss not recovering after salvage → cochlear-implant candidacy referral (KAS 13)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Sudden hearing loss WITH focal neuro deficit (diplopia, dysarthria, ataxia, facial palsy), central HINTS (normal/abnormal-pattern head-impulse with spontaneous nystagmus, direction-changing nystagmus, skew deviation), or sudden deafness on a high vascular-risk substrate (Kim & Lee J Stroke 2016 PMID 28030893; AAO-HNS 2019 KAS 2)(life-threatening)
Bilateral simultaneous/sequential or recurrent sudden SNHL, especially rapidly progressive and steroid-responsive (AAO-HNS 2019 KAS 2 PMID 31369359)
Time from symptom onset approaching/exceeding 2 weeks (initial steroid window) or salvage approaching 6 weeks; treatment ≥14 days from onset is an independent poor-prognosis predictor (Perez Ferreira Neto Otolaryngol HNS 2021 PMID 33557702 — recovery OR 0.250)
Severe-to-profound presenting loss on the first audiogram (the strongest independent poor-prognosis predictor) ± accompanying vertigo ± down-sloping/flat/U-shaped curve (Perez Ferreira Neto 2021 PMID 33557702 — OR 6.6; Bogaz Braz J ORL 2015 PMID 26248967; Wen Eur Arch ORL 2013 PMID 23771280)

5. Follow-up

Counsel natural history and the limits of the evidence (KAS 7); for residual hearing loss and/or tinnitus, offer or refer for audiologic rehabilitation — hearing aids, CROS/BiCROS, cochlear implant for profound non-recovery, tinnitus management (KAS 13). Ensure the retrocochlear MRI/ABR result is closed-looped; recurrent/bilateral disease → autoimmune/systemic and neurotology follow-up. Headache/neuro re-presentation → re-screen for delayed posterior-circulation events.

6. Sources

Guideline: AAO-HNS Clinical Practice Guideline: Sudden Hearing Loss (Update) — Chandrasekhar et al, Otolaryngol Head Neck Surg 2019;161(1_suppl):S1-S45 (PMID 31369359) + Executive Summary (PMID 31369349) — verified 2026-05-17 as still the current AAO-HNS authority (no 2024/2025 replacement). Supplemented by Rauch JAMA 2011 oral-vs-intratympanic steroid RCT (PMID 21610239), Wei Cochrane 2013 steroid review (PMID 23818120), Rhee JAMA Otolaryngol HNS 2018 HBOT meta-analysis (PMID 30267033), and Kim & Lee J Stroke 2016 vascular audiovestibular loss / AICA infarction (PMID 28030893).