Guideline sources The following summarized guidelines for the evaluation and management of sudden sensorineural hearing loss (SSNHL) are prepared by our editorial team based on guidelines from the American Cochlear Implant Alliance (ACI Alliance 2022) and the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF 2019). 1 2 Guidelines 1. Diagnostic investigations History and physical examination: Distinguish sensorineural hearing loss from conductive hearing loss when a patient first presents with sudden hearing loss. B Assess patients with presumptive SSNHL through history and physical examination for bilateral sudden hearing loss, recurrent episodes of sudden hearing loss, and/or focal neurologic findings. B Audiometry: obtain, or refer to a clinician who can obtain, audiometry as soon as possible (within 14 days of symptom onset) to confirm the diagnosis of SSNHL in patients with sudden hearing https://web.pathway.md/diseases/rec7qB8KkRzQtBtw9 1/4 6/24/23, 3:13 PM Sudden sensorineural hearing loss Pathway loss. B Laboratory testing: do not obtain routine laboratory tests in patients with SSNHL. D Computed tomography: do not obtain routine CT of the head in the initial evaluation of patients with presumptive SSNHL. D Magnetic resonance imaging and auditory brainstem response: obtain MRI or auditory brainstem response to evaluate patients with SSNHL for retrocochlear pathology. B 2. Medical management Systemic corticosteroids: consider systemic corticosteroids as first-line therapy for patients with SSNHL within 2 weeks of symptom onset. C Other medications: do not routinely prescribe antivirals, thrombolytics, vasodilators, or vasoactive substances to patients with SSNHL. D 3. Therapeutic procedures Hyperbaric oxygen therapy: Consider offering, or referring to a clinician who can offer, hyperbaric oxygen therapy combined with corticosteroid therapy within 2 weeks of onset of SSNHL. C Consider offering, or referring to a clinician who can offer, hyperbaric oxygen therapy combined with corticosteroid therapy as salvage within 1 month of onset of SSNHL. C Intratympanic corticosteroids: offer, or refer to a clinician who can offer, intratympanic corticosteroid therapy when patients have incomplete recovery from SSNHL 2 to 6 weeks after onset of symptoms. B Cochlear implants: obtain standard medical workup and monitoring in patients with sudden and/or rapid progression of single-sided deadness to determine if the hearing spontaneously improves or is recoverable with treatment. Offer cochlear implantation not earlier than 3-6 months after the sudden hearing loss to allow ample time for potential recovery of hearing. E Show 13 more 4. Patient education Patient education: 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. B 5. Follow-up and surveillance https://web.pathway.md/diseases/rec7qB8KkRzQtBtw9 2/4 6/24/23, 3:13 PM Sudden sensorineural hearing loss Pathway Follow-up: arrange follow-up audiometric evaluation for patients with SSNHL at the conclusion of treatment and within 6 months of completion of treatment. B Audiologic rehabilitation: counsel patients with SSNHL who have residual hearing loss and/or tinnitus about the possible benefits of audiologic rehabilitation and other supportive measures. B Likelihood Ratios Pertinent positives The following findings increase the probability of sudden sensorineural hearing loss in adults. 1 1 Finding LR+ Value Positive Rinne test* 13.8 Presence of weber test lateralizes to the unaffected ear 1.9 air conduction > bone conduction implies sensorineural hearing loss (or normal ear) Tuning fork (256Hz) in the middle of the head - conductive hearing loss will make that ear louder, whereas sensorineural hearing loss will make the ear quieter. Pertinent negatives The following findings decrease the probability of sudden sensorineural hearing loss in adults. 1 1 Finding LR- Value Negative Rinne test* 0.5 Absence of weber test lateralizes to the unaffected ear 0.6 air conduction > bone conduction implies sensorineural hearing loss (or normal ear) Tuning fork (256Hz) in the middle of the head - conductive hearing loss will make that ear louder, whereas sensorineural hearing loss will make the ear quieter. References 1. Chandrasekhar SS, Tsai Do BS, Schwartz SR et al. Clinical Practice Guideline: Sudden Hearing Loss Update). Otolaryngol Head Neck Surg. 2019 Aug;161 1_suppl):S1 S45. Open 2. Lisa R Park, Amanda M Griffin, Douglas P Sladen et al. American Cochlear Implant Alliance Task Force Guidelines for Clinical Assessment and Management of Cochlear Implantation in Children With Single- Sided Deafness. Ear Hear. 2022 Mar/Apr;43 2 255 267. Open 3. Stachler RJ, Chandrasekhar SS, Archer SM et al. Clinical practice guideline: sudden hearing loss. Otolaryngol Head Neck Surg. 2012 Mar;146 3 Suppl):S1 35. Open 4. Gerhard Hesse. Inner Ear Hearing Loss Part II Sudden Sensorineural Hearing Loss, Therapeutic Options]. Laryngorhinootologie. 2016 Jul;95 7 461 9. Open https://web.pathway.md/diseases/rec7qB8KkRzQtBtw9 3/4 6/24/23, 3:14 PM Sudden sensorineural hearing loss Pathway 5. Anand Padmanabhan, Laura Connelly-Smith, Nicole Aqui et al. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue. J Clin Apher. 2019 Jun;34 3 171 354. Open https://web.pathway.md/diseases/rec7qB8KkRzQtBtw9 4/4