Summary of Key Action Statements (KAS)

Document Overview

Design and created by Guideline Central in participation with the American Academy of Otolaryngology - Head and Neck Surgery Foundation.

Sudden Hearing Loss

American Academy of Otolaryngology - Head and Neck Surgery Foundation

Publication Date: Aug 1, 2019

Page Last Updated: May 5, 2026

Grading Table

Strength of Action Terms in Guideline Statements and Implied Levels of Obligation
Strength	Definition	Implied Obligation
Strong Recommendation (S)	A strong recommendation means that the benefits of the recommended approach clearly exceed the harms (or that the harms clearly exceed the benefits, in the case of a strong negative recommendation) and that the quality of the supporting evidence is excellent (grade A or B). In some clearly identified circumstances, strong recommendations may be made on the basis of lesser evidence, when high-quality evidence is impossible to obtain and the anticipated benefits strongly outweigh the harms.	Clinicians should follow a strong recommendation unless a clear and compelling rationale for an alternative approach is present.
Recommendation (R)	A recommendation means that the benefits exceed the harms (or that the harms exceed the benefits, in the case of a negative recommendation) but that the quality of evidence is not as strong (grade B or C). In some clearly identified circumstances, recommendations may be based on lesser evidence when high-quality evidence is impossible to obtain and the anticipated benefits outweigh the harms.	Clinicians should also generally follow a recommendation but should remain alert to new information and sensitive to patient preferences.
Option (O)	An option means that either the quality of evidence is suspect (grade D) or that well-done studies (grade A, B, or C) show little clear advantage to one approach versus another.	Clinicians should be flexible in their decision making regarding appropriate practice, although they may set bounds on alternatives. Patient preference should have a substantial influencing role.

Aggregate Grades of Evidence by Question Type
Grade	Treatment	Diagnosis	Prognosis
A	Systematic review^a of randomized trials	Systematic review^a of cross-sectional studies with consistently applied reference standard and blinding	Systematic review^a of inception cohort studies^b
B	Randomized trials, or observational studies with dramatic effects or highly consistent evidence	Cross-sectional studies with consistently applied reference standard and blinding	Inception cohort studies^b
C	Non-randomized or historically controlled studies, including case-control and observational studies	Non-consecutive studies, case-control studies, or studies with poor, non-independent, or inconsistently applied reference standards	Cohort study, control arm of a randomized trial, case series, or case-control studies; poor quality prognostic cohort study
D	Case reports, mechanism-based reasoning, or reasoning from first principles
X	Exceptional situations where validating studies cannot be performed and there is a clear preponderance of benefit over harm

^a A systematic review may be downgraded to level B because of study limitations, heterogeneity, or imprecision
^b A group of individuals identified for subsequent study at an early, uniform point in the course of the specified health condition, or before the condition develops.

Document Overview

Document Title: Sudden Hearing Loss

Authoring Society: American Academy of Otolaryngology - Head and Neck Surgery Foundation

Endorsing Societies

American Academy of Neurology

American College of Emergency Physicians

American College of Radiology

Society of Otorhinolaryngology and Head-Neck Nurses

American Speech-Language-Hearing Association

American Otological Society

American Neurotology Society

Document Publication Date: Aug 1, 2019

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: aao-hnsfjournals.onlinelibrary.wiley.com/doi/10.1177/0194599819859885

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 Implementation Resources

Document Scope, Criteria, and Use Cases

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.

Scope: Diagnosis, Management

Diseases/Conditions (MeSH)

D003639 - Hearing Loss, Sudden

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

Recommendation Development Processes & Methodology

Supplemental Methodology Resource: Data Supplement

Number of Source Documents: 273

Literature Search Start Date: Friday, April 1, 2011

Literature Search End Date: Monday, July 31, 2017

Includes peer/external review process?: Yes

Includes public comment process?: Yes

Methodologist involvement?: Yes

Patient involvement?: Yes

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: Yes

Identifies study selection process?: Yes

Identifies study selection criteria?: Yes

Identifies methods used to evaluate and analyze the evidence?: Yes

Identifies key questions addressed by the systematic review?: Yes

Identifies search strategy?: Yes

Sudden Hearing Loss

Summary of Key Action Statements (KAS)

Exclusion of CHL

Modifying factors

Computed tomography (CT)

Audiometric confirmation of SSNHL

Laboratory testing

Retrocochlear pathology

Patient education

Initial corticosteroids

Initial therapy with hyperbaric oxygen therapy (HBOT)

Salvage therapy with HBOT

Intratympanic steroids for salvage therapy

Other pharmacologic therapy

Outcomes assessment

Rehabilitation

Grading Table

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology