Sudden hearing loss is an emergency: what to do in the first 72 hours

This page is general information, not medical advice. If you have sudden hearing loss right now, stop reading and contact a doctor today. If you have any stroke signs, call 911. See our medical disclaimer.

What to do right now

Sudden hearing loss is time-sensitive. NIDCD says to consider it a medical emergency and see a doctor immediately ^[2]. Here is the order of operations.

1. Check for stroke signs first. Call 911 right away for sudden face drooping, arm or leg weakness on one side, slurred speech, trouble understanding others, sudden vision problems, sudden trouble walking or balancing, or a sudden severe headache with no known cause ^[3]. MedlinePlus also says to contact a provider right away for hearing loss that comes with headache, vision changes or dizziness ^[4].
2. No stroke signs? Call an ENT (otolaryngologist) office today. Say the words "sudden hearing loss" and ask for a same-day or next-day visit with a hearing test.
3. Can't get in? Go to urgent care or an emergency department. Ask them to check whether the loss is from a blockage or from the inner ear, and ask for an ENT referral and a hearing test (audiogram).
4. Don't write it off as wax or a cold. NIDCD warns that people delay care by blaming allergies, a sinus infection or earwax, and that the delay can make treatment less effective ^[2].
5. Don't buy an over-the-counter hearing aid for this. FDA lists a sudden hearing change, or worse hearing in one ear, as a reason to see a doctor before using an OTC device ^[5].
6. Write down the details. When it started, which ear, whether both ears are affected, any ringing, fullness or dizziness, recent illness, loud noise, head injury and your current medicines. The guideline asks clinicians to check for hearing loss in both ears, repeat episodes and nerve-related symptoms ^[1].

What sudden hearing loss is

Sudden sensorineural hearing loss (SSHL) is an unexplained, rapid loss of hearing from the inner ear or hearing nerve. It happens all at once or over a few days, and it usually affects one ear ^[2]. NIDCD's diagnostic marker is a loss of at least 30 decibels in three connected frequencies within 72 hours, which it says would make conversational speech sound like a whisper ^[2].

People often notice it in one of three ways: waking up with it, holding a phone to the affected ear, or hearing a loud "pop" right before the hearing goes ^[2]. Ear fullness, dizziness and ringing (tinnitus) can come with it ^[2].

How common is it? The AAO-HNS guideline puts it at 5 to 27 people per 100,000 each year, or about 66,000 new cases a year in the United States ^[1]. NIDCD says it most often affects adults in their late 40s and early 50s, though it can happen at any age ^[2].

Most cases have no clear cause. The guideline notes that more than 90% of SSHL is idiopathic, meaning no cause is found ^[1]. NIDCD lists possible causes when one is found, including infections, head trauma, autoimmune disease, some drugs, circulation problems, neurological disorders and inner ear disorders such as Ménière's disease ^[2].

Sudden hearing loss or a blocked ear?

You can't reliably tell the difference at home. A plugged-feeling ear can come from earwax or fluid, which is conductive hearing loss, or from the inner ear, which is sensorineural. The guideline's first strong recommendation is that clinicians tell these two apart at the first visit ^[1]. That's why you need an exam, not a guess. If wax turns out to be the cause, our guide to earwax buildup covers safe removal.

What you notice	What it could mean	What to do
Muffled or missing hearing in one ear, over hours to days, no clear cause	Possible sudden sensorineural hearing loss	Same-day ENT, urgent care or ER visit
Hearing loss plus face droop, weakness, slurred speech, vision loss or severe headache	Possible stroke [3]	Call 911
Hearing loss plus dizziness, headache or vision changes	Needs prompt evaluation [4]	Contact a provider right away
Sudden hearing loss in both ears, or a repeat episode	Flagged in the guideline for further evaluation [1]	Same-day visit; mention it is both ears or a repeat
Plugged ear after swimming, a cold or using swabs	Could be wax or fluid, but could still be inner-ear loss [2]	Get examined before assuming

Why the clock matters

Every major source on this condition stresses speed. NIDCD says treatment should start as soon as possible and that delays beyond two to four weeks make it less likely that permanent hearing loss will be reversed or reduced ^[2]. The 2019 guideline update specifically highlights "the urgency of evaluation and initiation of treatment" ^[1].

There is some good news. NIDCD says about half of people recover some or all of their hearing on their own, usually within one to two weeks of onset ^[2]. But nobody can tell you on day one whether you'll be in that half, and timely treatment greatly increases the chance of recovering at least some hearing ^[2].

Here is the timeline the guideline lays out ^[1]:

When	What the guideline says
First visit	Tell conductive loss (wax, fluid) apart from sensorineural loss (strong recommendation)
As soon as possible, within 14 days	Get audiometry (a formal hearing test) to confirm the diagnosis
Within 2 weeks of onset	Steroids may be offered as initial treatment (option); hyperbaric oxygen plus steroids is also an option
2 to 6 weeks, if recovery is incomplete	Clinicians should offer or refer for steroid injections through the eardrum (intratympanic)
Within 1 month	Hyperbaric oxygen plus steroids is an option as salvage therapy
End of treatment, and within 6 months after	Repeat hearing test

What to expect when you're seen

An ear exam and a hearing test. The clinician will look in the ear to rule out wax or fluid. NIDCD says pure-tone audiometry should be done within a few days of symptom onset ^[2]. Our guide to how to read an audiogram explains the chart you'll get.

Questions about the rest of your nervous system. Expect questions about both ears, prior episodes and symptoms like weakness or numbness ^[1].

Probably no head CT or bloodwork, and that's by design. The guideline makes strong recommendations against routine head CT in the first evaluation and against routine lab tests ^[1]. If an ER sends you home without a scan, that alone doesn't mean you were brushed off. What you do need is a hearing test and a treatment conversation.

An MRI or ABR test later. The guideline recommends checking for problems behind the inner ear, such as a benign growth on the hearing nerve, using MRI or an auditory brainstem response (ABR) test ^[1]. NIDCD also notes that auditory nerve tumors should be ruled out when the loss is in one ear ^[2].

A real conversation about options. The guideline makes a strong recommendation that clinicians explain the natural course of SSHL, the benefits and risks of treatment, and the limits of the evidence ^[1]. Ask questions. Not sure which kind of specialist handles what? See audiologist vs. ENT vs. hearing aid specialist.

Treatment options the guideline discusses

This guide does not give doses, and you shouldn't start leftover or borrowed medication. Steroid choice, dose and route depend on your health history and are your doctor's call.

Treatment	Guideline position [1]	Timing
Steroids (oral or injected through the eardrum) as first treatment	Option: may be offered	Within 2 weeks of onset
Hyperbaric oxygen combined with steroids	Option, only when combined with steroids	Within 2 weeks (initial) or within 1 month (salvage)
Intratympanic steroid injection for incomplete recovery	Recommendation: should offer or refer	2 to 6 weeks after onset
Antivirals, clot-dissolving drugs, vasodilators, vasoactive drugs	Recommendation against routine use	Not applicable
Hearing rehabilitation (hearing aids, tinnitus support)	Strong recommendation to counsel if hearing loss or tinnitus remains	After treatment

NIDCD says corticosteroids are the most common treatment when no cause is found, and that an NIDCD-supported trial in 2011 found steroid injections through the eardrum worked as well as oral steroids ^[2]. If a specific cause turns up, such as an infection or an autoimmune condition, treatment targets that cause instead ^[2].

After treatment

Get the follow-up hearing test. The guideline recommends a hearing test at the end of treatment and again within 6 months ^[1]. Your hearing can keep changing, and a new baseline helps with any next steps.

Ask about rehabilitation if hearing or ringing remains. The guideline makes a strong recommendation that clinicians counsel people with leftover hearing loss or tinnitus about audiologic rehabilitation and other support ^[1]. NIDCD notes that hearing aids or cochlear implants may be recommended when the loss is severe or doesn't respond to treatment ^[2]. If ringing stays, our guide to tinnitus treatments with real evidence covers what helps.

Find someone for the long haul. An audiologist can track your hearing over time and fit devices if you need them. Find a hearing provider near you.