Sudden Hearing Loss

Publication Date: August 1, 2019
Last Updated: December 15, 2022

Summary of Key Action Statements (KAS)

Exclusion of CHL

Clinicians should distinguish SNHL from CHL when a patient first presents with sudden hearing loss. (S)

Modifying factors

Clinicians should assess patients with presumptive SSNHL through history and physical examination for bilateral sudden hearing loss, recurrent episodes of sudden hearing loss, and/or focal neurologic findings. (R)

Computed tomography (CT)

Clinicians should NOT order routine CT of the head in the initial evaluation of a patient with presumptive SSNHL. (S)

Audiometric confirmation of SSNHL

In patients with sudden hearing loss clinicians should obtain, or refer to a clinician who can obtain, audiometry as soon as possible (within 14 days of symptom onset) to confirm the diagnosis of SSNHL. (R)

Laboratory testing

Clinicians should NOT obtain routine laboratory tests in patients with SSNHL. (S)

Retrocochlear pathology

Clinicians should evaluate patients with SSNHL for retrocochlear pathology by obtaining an MRI or Auditory Brainstem Response (ABR). (R)

Patient education

Clinicians should educate patients with SSNHL about the natural history of the condition, the benefits and risks of medical interventions, and the limitations of existing evidence regarding efficacy. (S)

Initial corticosteroids

Clinicians may offer corticosteroids as initial therapy to patients with SSNHL within 2 weeks of symptom onset. (O)

Initial therapy with hyperbaric oxygen therapy (HBOT)

Clinicians may offer, or refer to a clinician who can offer, HBOT combined with steroid therapy within two weeks of onset of SSNHL. (O)

Salvage therapy with HBOT

Clinicians may offer, or refer to a clinician who can offer, HBOT combined with steroid therapy as salvage within one month of onset of SSNHL. (O)

Intratympanic steroids for salvage therapy

Clinicians should offer, or refer to a clinician who can offer, intratympanic (IT) steroid therapy when patients have incomplete recovery from SSNHL 2–6 weeks after onset of symptoms. (R)

Other pharmacologic therapy

Clinicians should NOT routinely prescribe antivirals, thrombolytics, vasodilators, or vasoactive substances to patients with SSNHL. (S)

Outcomes assessment

Clinicians should obtain follow-up audiometric evaluation for patients with SSNHL at the conclusion of treatment and within six months of completion of treatment. (R)


Clinicians should counsel patients with SSNHL who have residual hearing loss and/or tinnitus about the possible benefits of audiological rehabilitation and other supportive measures. (R)

Recommendation Grading



Sudden Hearing Loss

Authoring Organization

Endorsing Organizations

Publication Month/Year

August 1, 2019

Last Updated Month/Year

February 22, 2024

Document Type


External Publication Status


Country of Publication


Document Objectives

This guideline update provides evidence-based recommendations for the diagnosis, management, and follow-up of patients who present with sudden hearing loss. It focuses on sudden sensorineural hearing loss in adult patients aged ≥18 years and primarily on those with idiopathic sudden sensorineural hearing loss.

Target Patient Population

Adults aged ≥18 years with sudden hearing loss

Target Provider Population

All clinicians who are likely to diagnose and manage adults aged ≥18 years with sudden hearing loss

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Ambulatory, Emergency care, Hospital, Long term care, Medical transportation

Intended Users

Audiologist, nurse, nurse practitioner, physician, physician assistant, speech language pathologist


Diagnosis, Management

Diseases/Conditions (MeSH)

D003639 - Hearing Loss, Sudden


sensorineural hearing loss, sudden hearing loss, hyperbaric oxygen, intratympanic steroids, SHL

Source Citation

Chandrasekhar SS, Tsai Do BS, Schwartz SR, et al. Clinical Practice Guideline: Sudden Hearing Loss (Update). Otolaryngol Head Neck Surg. 2019;161 (1_Suppl):[S1-S45].

Supplemental Methodology Resources

Data Supplement


Number of Source Documents
Literature Search Start Date
April 1, 2011
Literature Search End Date
July 31, 2017
Specialties Involved
Emergency Medicine, Family Medicine, Neurology, Otolaryngology