Intended for healthcare professionals

Practice Rational Testing

Investigating sudden hearing loss in adults

BMJ 2018; 363 doi: (Published 12 November 2018) Cite this as: BMJ 2018;363:k4347

Re: Investigating sudden hearing loss in adults

Many thanks to the authors for this concise and informative guide to the management of sudden hearing loss in adults.

Delay in addressing sudden sensori-neural, rather than conductive, hearing loss could have medico-legal implications, as it is generally considered that early intervention may be the only chance of a possible improvement in hearing loss of undetermined cause. Although there is no evidence that any early intervention, such as a week’s course of oral steroids, is effective, patients would perceive a delay as a missed potential benefit.

One cause for a delay is when a patient with hard wax impaction and hearing loss is given wax softening ear drops and asked to return a couple of weeks later. When the wax is removed, at this point, the patient may still report no improvement in hearing and may be found to have sensori-neural hearing loss. This scenario highlights the importance of documenting the use of tuning fork tests to confirm the conductive type of the hearing loss at initial presentation.

Another reason for a delay is waiting for an “urgent” ENT appointment. Air and bone conduction hearing assessment is now provided by some high street outlets, even at weekends. Guiding patients to these additional services provides speed and patients’ involvement in their own self-care. Additionally, a hospital “Audiology” department prompt service could be used if necessary.

Tablets used in malaria prophylaxis, cytotoxic medications for malignancies, auto-immune suppression and tuberculosis and repeated blood transfusions for thalassaemia major, could all cause sensori-neural hearing loss. A baseline hearing assessment is therefore advisable.

If and when a sudden sensori-neural hearing loss improves, low frequencies are observed to do so more than high frequencies.

Abdel-Majeed Zedan, ENT Associate Specialist,
Royal National Throat, Nose & Ear Hospital, UCLH, London

Competing interests: No competing interests

18 November 2018
Abdel-Majeed Zedan
ENT Associate Specialist
Royal National Throat, Nose & Ear Hospital, UCLH, London
Royal National Throat, Nose & Ear Hospital, 330 Grays Inn Road, London WC1X 8DA