I have had unilateral hearing loss for about one month, with the affected ear worse than the other; what evaluation and management steps are recommended?

Urgent Evaluation for Sudden Sensorineural Hearing Loss

You need urgent audiometry within 14 days of symptom onset to confirm sudden sensorineural hearing loss (SSNHL), and if confirmed, start corticosteroids immediately—ideally within 2 weeks of onset—as this is the only evidence-based treatment that may improve your hearing outcomes. 1

Immediate Diagnostic Steps

Distinguish Type of Hearing Loss

First, determine whether this is sensorineural versus conductive hearing loss through:

• Weber tuning fork test or Rauch hum test at the bedside 2
• Otoscopy to rule out cerumen impaction or middle ear pathology 1

Do not delay treatment waiting for audiometry or specialist referral if SSNHL is suspected. 2

Confirm with Audiometry

• Obtain formal audiometry as soon as possible, within 14 days of symptom onset 1
• SSNHL is defined as ≥30 dB hearing loss within 72 hours 3
• This confirms the diagnosis and establishes baseline for treatment response

History and Physical Examination

Specifically assess for:

• Bilateral hearing loss, recurrent episodes, or focal neurologic findings (these are red flags) 1
• Associated symptoms: tinnitus (present in 77.9% of cases), vertigo, ear fullness 4
• Timing: sudden onset over <72 hours 5

What NOT to Do

Avoid these unnecessary tests:

• No routine CT head imaging 1
• No routine laboratory tests (unless systemic illness suspected) 1, 3
• No antivirals, thrombolytics, vasodilators, or vasoactive substances (insufficient evidence) 1

Treatment Protocol

Initial Therapy (Within 2 Weeks)

Offer oral corticosteroids as initial therapy 1

• Most commonly given as oral prednisone
• Can use intratympanic steroid injection if oral steroids contraindicated 1
• Hyperbaric oxygen may be offered within 2 weeks when combined with steroids 1

Salvage Therapy (2-6 Weeks After Onset)

Offer intratympanic steroid injections for incomplete recovery at 2-6 weeks after symptom onset 1

Natural History Context

• One-third to two-thirds of patients may spontaneously recover some hearing within 2 weeks 1
• Those recovering half their hearing in first 2 weeks have better prognosis 1
• Patients with dizziness at onset have poorer prognosis 1

Essential Follow-Up Testing

Screen for Retrocochlear Pathology

Obtain MRI of brain and internal auditory canals to screen for vestibular schwannoma 1

• This is the most sensitive test
• Alternative: Auditory brainstem response (ABR) if MRI contraindicated, but less sensitive 1
• If ABR abnormal, MRI is mandatory 1
• Timing not specified in guidelines, but typically done after initial treatment initiated

Audiometric Follow-Up

Obtain repeat audiometry:

• At day 7 during treatment 5
• At conclusion of treatment 1
• Within 6 months of treatment completion 1

Rehabilitation for Residual Hearing Loss

Counsel about audiologic rehabilitation and hearing aids if residual hearing loss persists 1

• Despite treatment, most patients have persistent hearing loss 6
• Only 42.6% show objective audiometric improvement 6
• Hearing amplification is underutilized but important for quality of life 6

Critical Timing

The one-month duration since your symptom onset means you are still within the window for salvage intratympanic steroid therapy (2-6 weeks), though you have missed the optimal initial treatment window (within 2 weeks). Immediate audiometry and otolaryngology referral are essential to determine if salvage therapy is appropriate.