Loss of ≥30 dB across three contiguous frequencies developing within 72 hours — an otological emergency.
Examination
- • Weber lateralises to the unaffected ear; Rinne positive bilaterally
- • Otoscopy normal
- • Cranial nerve and neurological examination
Investigations
- • Urgent pure-tone audiometry
- • MRI internal auditory meatus to exclude vestibular schwannoma
- • Bloods for autoimmune/infective causes when indicated
Management
- • Oral prednisolone 1 mg/kg (max 60 mg) × 7 days with taper — start within 72 h
- • Intratympanic steroid as salvage or when oral steroids contraindicated
- • Audiology follow-up and hearing rehabilitation
Clinical pearls
- • Do not dismiss as wax or otitis — check tuning forks
- • Every day of delay reduces the chance of recovery
Related in WardRound
Educational — verify locally.
