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OtolaryngologyEmergency

Sudden Sensorineural Hearing Loss (AAO-HNSF 2019)

Sudden Sensorineural Hearing Loss (AAO-HNSF 2019): Sudden Hearing Loss Presentation → Distinguish SNHL from Conductive → Urgent Audiometry → Identifiabl...

Pathway Overview

14 steps

Algorithm Steps

14 total

  1. 01Start

    Sudden Hearing Loss Presentation

    Patient reports acute onset hearing loss. Definition: ≥30dB hearing loss in ≥3 consecutive frequencies occurring within ≤72 hours.

  2. 02Action

    Distinguish SNHL from Conductive

    KAS 1 (Strong): Perform Weber/Rinne tests. SNHL: Weber lateralizes to GOOD ear, Rinne positive bilaterally. Conductive: Weber to affected ear, Rinne negative affected side.

    • 512 Hz tuning fork preferred
    • Examine ear canal and TM for obstruction/perforation
    • Confirm with audiometry ASAP
  3. 03Action

    Urgent Audiometry

    Obtain audiogram within 14 days of symptom onset (ideally immediately). Documents degree and configuration of hearing loss. Establishes baseline for monitoring.

  4. 04Decision

    Identifiable Cause?

    History and exam to exclude: Ototoxic drugs, Meniere's disease, acoustic neuroma, stroke, trauma, infection (otitis, meningitis), autoimmune disease.

  5. 05Action

    Treat Underlying Cause

    If identifiable cause found: treat accordingly. This algorithm focuses on IDIOPATHIC SSNHL. Stroke protocol if neurological signs.

  6. 06Decision

    MRI Indicated?

    Consider MRI with gadolinium to evaluate for retrocochlear pathology (acoustic neuroma). Especially if: asymmetric hearing, unilateral tinnitus, focal neurological signs.

  7. 07Action

    Initial Steroid Therapy

    Offer oral corticosteroids as initial therapy (Option, may offer). Typical: Prednisone 1mg/kg/day (max 60mg) x 10-14 days with taper. OR Dexamethasone 10mg x 7 days. Start within 2 weeks of onset.

    • Benefit decreases with delay
    • Discuss risks: hyperglycemia, insomnia, mood changes
    • No benefit from antivirals (strong against)
  8. 08Decision

    Response to Initial Therapy?

    Reassess hearing at 2-6 weeks. Complete recovery? Partial recovery? No recovery?

  9. 09Outcome

    Hearing Recovered

    If hearing recovers fully, routine follow-up with audiometry. Counsel on hearing protection. No specific restrictions.

  10. 10Action

    Salvage: Intratympanic Steroids

    KAS: Offer intratympanic steroids 2-6 weeks after symptom onset for incomplete recovery. Dexamethasone 10-24mg/mL or methylprednisolone 40mg/mL. 3-4 injections over 2 weeks.

  11. 11Outcome

    Residual Hearing Loss/Tinnitus

    KAS 13 (Strong): Counsel on audiologic rehabilitation: hearing aids, CROS/BiCROS, cochlear implant evaluation if profound. Tinnitus management. Support groups.

  12. 12Action

    Consider HBOT

    Hyperbaric oxygen therapy within 2 weeks of onset (in combination with steroids) OR as salvage within 1 month. 10-20 sessions at 2.0-2.5 ATA for 90 minutes.

  13. Path rejoins step 11Shared downstream outcome
  14. 13Action

    Education & Counseling

    KAS 7 (Strong): Educate on natural history (1/3 recover, 1/3 partial, 1/3 permanent). Discuss treatment limitations. Address tinnitus if present.

  15. Path rejoins step 11Shared downstream outcome
  16. 14Warning

    ⚠️ DO NOT Order Routinely

    KAS: Do NOT order routine CT head (strong against). Do NOT order routine labs (strong against). Do NOT prescribe antivirals, thrombolytics, vasodilators (strong against).

Guideline Source

AAO-HNSF Clinical Practice Guideline: Sudden Hearing Loss (Update)

DOI: 10.1177/0194599819859885View Guideline

Clinical Safety Information

Clinical Decision Support — Not a Substitute for Clinical Judgment

Individual patient factors may require deviation from these recommendations.

Known Limitations

  • Applies to adults ≥18 years only
  • Does not address pediatric SSNHL
  • Idiopathic SSNHL focus - excludes known causes
  • HBOT availability varies by region

Applicable Regions

USEU
Version 1Next review: 2027-01-11

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Frequently Asked Questions

What is the Sudden Sensorineural Hearing Loss (AAO-HNSF 2019)?

The Sudden Sensorineural Hearing Loss (AAO-HNSF 2019) is a emergency clinical algorithm for Otolaryngology. It provides a structured decision tree to guide clinical decision-making, based on AAO-HNSF Clinical Practice Guideline: Sudden Hearing Loss (Update).

What guideline is the Sudden Sensorineural Hearing Loss (AAO-HNSF 2019) based on?

This algorithm is based on AAO-HNSF Clinical Practice Guideline: Sudden Hearing Loss (Update) (DOI: 10.1177/0194599819859885).

What are the limitations of the Sudden Sensorineural Hearing Loss (AAO-HNSF 2019)?

Known limitations include: Applies to adults ≥18 years only; Does not address pediatric SSNHL; Idiopathic SSNHL focus - excludes known causes; HBOT availability varies by region. Individual patient factors may require deviation from these recommendations.

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