Sudden Hearing Loss-Guideline update by AAO/HNSF

The American Academy of Otolaryngology-Head and Neck Surgery Foundation has updated its guidelines on evaluating and managing adults with sudden sensorineural hearing loss. This guideline update provides evidence-based recommendations for the diagnosis, management, and follow-up of patients who present with sudden hearing loss. It focuses on sudden sensorineural hearing loss in adult patients aged ≥18 years and primarily on those with idiopathic sudden sensorineural hearing loss. Prompt recognition and management of sudden sensorineural hearing loss may improve hearing recovery and patient quality of life. The guideline update is intended for all clinicians who diagnose or manage adult patients who present with sudden hearing loss.

Sudden hearing loss is a frightening symptom that often prompts an urgent or emergent visit to a health care provider. Sudden sensorineural hearing loss affects 5 to 27 per 100,000 people annually, with about 66,000 new cases per year in the United States.

Among the key recommendations:

• Clinicians should distinguish conductive from sensorineural hearing loss when a patient initially presents with sudden hearing loss.


• Clinicians should assess patients with presumptive SSNHL through history and physical examination for bilateral SHL, recurrent episodes of SHL, and/or focal neurologic findings.


• Clinicians should not order routine computed tomography (CT) of the head in the initial evaluation of a patient with presumptive SSNHL.


• The guidelines emphasize that patients should have audiometric confirmation of hearing status as soon as possible (within 2 weeks of symptom onset).


• Clinicians should not obtain routine laboratory tests in patients with SSNHL.


• Clinicians should evaluate patients with SSNHL for retrocochlear pathology by obtaining an MRI or auditory brainstem response (ABR).


• Clinicians should educate patients with SSNHL about the natural history of the condition, the benefits and risks of medical interventions, and the limitations of existing evidence regarding efficacy.


• Corticosteroids are an option in the first 2 weeks after symptom onset.


• Clinicians may offer, or refer to a clinician who can offer, hyperbaric oxygen therapy (HBOT) combined with steroid therapy within 2 weeks of the onset of SSNHL. Clinicians may offer, or refer to a clinician who can offer, hyperbaric oxygen therapy (HBOT) combined with steroid therapy as salvage within 1 month of onset of SSNHL.


• Clinicians should not routinely prescribe antivirals, thrombolytics, vasodilators, or vasoactive substances to patients with SSNHL.


• The guideline no longer recommends against using antioxidants.


• Follow-up audiometry is now recommended at the end of treatment and within 6 months after that.


• Clinicians should counsel patients with SSNHL who have residual hearing loss and/or tinnitus about the possible benefits of audiologic rehabilitation and other supportive measures.