American Academy of Otolaryngology-Head and Neck Surgery Foundation
Sudden Hearing Loss
This guideline holds 14 recommendations, 273 references, 13 tables and 1 figure.
Summary
Sudden hearing loss is a frightening symptom that often prompts an urgent medical visit. Sudden sensorineural hearing loss affects 5 to 27 per 100,000 people annually in the United States. This guideline update provides recommendations for diagnosing, managing, and following up on adult patients with sudden hearing loss to improve diagnostic accuracy, reduce unnecessary testing, and enhance patient outcomes.
Key takeaways
Distinguish sensorineural hearing loss from conductive hearing loss at presentation.
Do not order routine head CT scans or laboratory tests.
Perform audiometry to confirm diagnosis within 14 days of symptom onset.
Evaluate patients for retrocochlear pathology using MRI or ABR.
Educate patients on natural history, treatment risks/benefits, and shared decision making.
Consider initial corticosteroid therapy within 2 weeks of onset.
Intratympanic steroids are recommended for salvage therapy 2-6 weeks post-onset if initial treatments fail.
Hyperbaric oxygen therapy is an option alongside corticosteroids for both initial and salvage therapy.
Routinely prescribing antivirals or vasodilators is strongly discouraged.
Follow-up with audiometry 6 months post-treatment and refer for audiologic rehabilitation if hearing loss persists.
What is new in this version
Included 10 new guidelines, 29 systematic reviews, and 36 RCTs. Emphasized the urgency of evaluation and timeframes. Clarified terminology (using SSNHL to mean ISSNHL). Added specific time windows for audiometry (<14 days), initial steroids (<2 weeks), and salvage IT steroids (2-6 weeks). Removed antioxidants from KAS 11. Modified HBOT to be an option combined with steroids for initial or salvage therapy. Added KAS regarding 6-month follow-up audiometry.