# Sudden sensorineural hearing loss (emergency ENT referral) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: AAO-HNS Sudden Hearing Loss Clinical Practice Guideline 2019 - Verified date: 2026-08 ## Verified against - AAO-HNS Sudden Hearing Loss Clinical Practice Guideline 2019 ## Treatment metadata - Prednisolone — 5 mg — oral.solid ## Complete treatment card ```text SUDDEN SENSORINEURAL HEARING LOSS (EMERGENCY ENT REFERRAL) Sources: AAO-HNS Sudden Hearing Loss Clinical Practice Guideline 2019 Review status: REVIEWED against the source listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - Important history covers onset, which ear or both, how quickly it worsened, whether it fluctuates, and accompanying tinnitus, ear fullness, unsteadiness, or vertigo [tinnitus · unsteadiness · vertigo] - Prior ear surgery, noise exposure, head injury, barotrauma, or aminoglycoside exposure should be asked about - Sudden sensorineural hearing loss is defined as more than 30 dB of loss across at least 3 consecutive frequencies within 72 hours [hearing loss] - Most cases of sudden hearing loss have no identifiable cause and are labeled idiopathic [hearing loss] SIGNS - what you find (1) - A full head, neck, and cranial nerve exam is done alongside the ear exam, though it is usually normal TESTS (10) - Sudden sensorineural hearing loss is treated as an emergency requiring prompt work-up and management - A pure tone audiogram should be done as soon as possible as part of the work-up - Bedside tuning-fork testing needs at least a 20 dB gap between ears, or between conductive and sensorineural thresholds, to pick up a difference - On the Weber test, sound lateralizes to the good ear in one-sided sensorineural loss, to the worse ear in a conductive loss, and does not lateralize if the loss is on both sides - A positive Rinne test - air conduction heard better than bone conduction - is expected in sensorineural loss since there is no conductive component - On a pure tone audiogram, sensorineural loss shows both air and bone conduction worsening together with no air-bone gap - Tympanometry checks middle-ear function and can pick up otitis media with effusion or eustachian tube dysfunction - Otoacoustic emissions are absent when the outer hair cells are damaged - Auditory brainstem testing can be affected by a cerebellopontine angle tumor compressing the cochlear nerve - CT of the temporal bone and brain MRI look for cochlear ossification, a cerebellopontine angle tumor, or active mastoiditis IF NOT THIS - what else fits (11) - Noise-induced hearing loss classically shows a notch at 4 kHz that starts to recover at 8 kHz on the audiogram - the Carhart notch - though it needs a history of noise exposure to be meaningful - Meniere disease shows the triad of episodic vertigo, hearing loss, and tinnitus, often with ear fullness and a low-frequency upsloping curve on audiogram - Autoimmune sensorineural hearing loss is rapidly progressive, usually starts in one ear before turning bilateral, and favors young women - A temporal bone fracture from head injury can cause conductive or mixed sensorineural hearing loss - Aminoglycosides like gentamicin cause hair-cell death with permanent hearing loss and balance trouble, starting in the higher frequencies - Loop diuretics can cause an acute but fully reversible hearing loss by affecting the stria vascularis - Waardenburg syndrome is the most common syndromic cause, marked by pigment abnormalities of the eyes, skin, and cochlea alongside the hearing loss - Usher syndrome pairs progressive sensorineural hearing loss with visual loss from retinitis pigmentosa - Pendred syndrome combines hearing loss with vestibular dysfunction and a thyroid goiter - Jervell and Lange-Nielsen syndrome pairs hearing loss with a prolonged QT interval and a risk of syncope or sudden death - Alport syndrome combines bilateral high-frequency hearing loss with glomerulonephritis, kidney failure, and eye abnormalities, with blood and protein in the urine as it advances Source StatPearls "Sensorineural Hearing Loss" - disease-level clinical article Status traced to the source above 1. PREDNISOLONE [1st line] Adult 60 mg once daily in the morning with breakfast for 7-14 days, followed by a 5-day taper (e.g. 50, 40, 30, 20, 10 mg daily) x 12-19 days total Peds 1-2 mg/kg/day [child max 60 mg] (Child: 1-2 mg/kg once daily in morning (max 60 mg daily); urgent pediatric ENT emergency referral mandatory) 3kg -> 3-6 mg/day 4kg -> 4-8 mg/day 5kg -> 5-10 mg/day 6kg -> 6-12 mg/day 7kg -> 7-14 mg/day 8kg -> 8-16 mg/day 9kg -> 9-18 mg/day 10kg -> 10-20 mg/day 11kg -> 11-22 mg/day 12kg -> 12-24 mg/day 13kg -> 13-26 mg/day 14kg -> 14-28 mg/day 15kg -> 15-30 mg/day 16kg -> 16-32 mg/day 17kg -> 17-34 mg/day 18kg -> 18-36 mg/day 19kg -> 19-38 mg/day 20kg -> 20-40 mg/day 21kg -> 21-42 mg/day 22kg -> 22-44 mg/day 23kg -> 23-46 mg/day 24kg -> 24-48 mg/day 25kg -> 25-50 mg/day 26kg -> 26-52 mg/day 27kg -> 27-54 mg/day 28kg -> 28-56 mg/day 29kg -> 29-58 mg/day 30kg -> 30-60 mg/day 31kg -> 31-60 mg/day (upper capped) 32kg -> 32-60 mg/day (upper capped) 33kg -> 33-60 mg/day (upper capped) 34kg -> 34-60 mg/day (upper capped) 35kg -> 35-60 mg/day (upper capped) 36kg -> 36-60 mg/day (upper capped) 37kg -> 37-60 mg/day (upper capped) 38kg -> 38-60 mg/day (upper capped) 39kg -> 39-60 mg/day (upper capped) 40kg -> 40-60 mg/day (upper capped) 41kg -> 41-60 mg/day (upper capped) 42kg -> 42-60 mg/day (upper capped) 43kg -> 43-60 mg/day (upper capped) 44kg -> 44-60 mg/day (upper capped) 45kg -> 45-60 mg/day (upper capped) 46kg -> 46-60 mg/day (upper capped) 47kg -> 47-60 mg/day (upper capped) 48kg -> 48-60 mg/day (upper capped) 49kg -> 49-60 mg/day (upper capped) 50kg -> 50-60 mg/day (upper capped) Source AAO-HNS Sudden Hearing Loss Clinical Practice Guideline 2019 Why OTOLOGIC EMERGENCY: high-dose oral corticosteroids must be initiated within 72 hours of symptom onset for maximum hearing recovery potential Caution REQUIRES URGENT SAME-DAY ENT REFERRAL for audiometry and consideration of intratympanic steroid injection. Monitor blood glucose closely (high risk of acute steroid-induced hyperglycemia). Co-prescribe PPI gastroprotection during high-dose steroid therapy. Contraindicated in active systemic fungal infections. Egypt HOSTACORTIN H 5MG 30 TAB. SANOFI 12.00 EGP (0.40/unit) PREDNISOLONE 5 MG 20 TABS. ARAB DRUG COM... 24.00 EGP (1.20/unit) PREDILONE 5MG 10 TAB. (25 STRIPS PACK) KAHIRA 250.00 EGP (25.00/unit) EPICOPRED 5 MG 30 ORODISPERSIBLE TABS. EIPICO 69.00 EGP PREDNISOLONE-EVA 5 MG 30 ORODISPERSIBLE TABS. EVA PHARMA 79.50 EGP DISPRELONE-OD 5 MG 30 ORODISPERSABLE TABS. ANDALOUS PHARMA 84.00 EGP SOLUPRED ORO 5 MG 30 ORODISPERSIBLE TABS. SANOFI WINTHROP > SANOFI 84.00 EGP ACETASEE 1% EYE DROPS (SUSP.) 5 ML RAMEDA 7.50 EGP -> ? strength differs, ? different route - not oral solid PREDNIS 5MG/5ML SYRUP 100 ML PHAROPHARMA 9.50 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)