Best of five
- A. Routine audiology in six weeks
- B. Immediate ENT assessment with consideration of steroid treatment
- C. Empirical antibiotics
- D. MRI before any clinical assessment
- E. Reassurance because tinnitus is absent
FRCS (ORL-HNS) · SECTION 1 SBA
Sudden sensorineural hearing loss
A 47-year-old develops unilateral sensorineural hearing loss over twelve hours, 8 days ago. Otoscopy is normal and there is no focal neurology. What is the best next step?
B. Immediate ENT assessment with consideration of steroid treatment
NICE treats sudden loss within the preceding 30 days as requiring assessment within 24 hours; steroids may be considered after excluding conductive and secondary causes.
Why every option is right or wrong
A. Routine audiology in six weeks: Delay may lose a time-sensitive therapeutic and diagnostic window.
B. Immediate ENT assessment with consideration of steroid treatment: NICE treats sudden loss within the preceding 30 days as requiring assessment within 24 hours; steroids may be considered after excluding conductive and secondary causes.
C. Empirical antibiotics: Normal otoscopy and a sensorineural pattern do not support bacterial middle-ear disease.
D. MRI before any clinical assessment: Retrocochlear investigation matters, but it should not delay urgent assessment and treatment discussion.
E. Reassurance because tinnitus is absent: Tinnitus is not required for the diagnosis or urgency.
What if the scenario changed?
If the onset were 45 days ago, NICE recommends urgent assessment within two weeks rather than the within-24-hour pathway.
Independent Clinora preparation material; not official JCIE content, an accredited programme or a substitute for local policy and specialist judgement.
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