Hearing loss - emergency/acute approach
Focused guidance for adult patients in the emergency setting. Emphasis is on differentiating conductive and sensorineural loss, excluding reversible causes, recognising red flags that need immediate ENT/audiovestibular review, and arranging appropriate investigations and follow‑up (NICE NG98; NG155 where tinnitus co‑exists).
Classification and clinical importance
Hearing loss is commonly:
- Conductive - lesion of the external ear, tympanic membrane or middle ear impeding sound transmission to an intact cochlea.
- Sensorineural (SNHL) - dysfunction of the cochlea, auditory nerve or central pathways producing loss of perception and often poorer speech discrimination.
- Mixed - both elements present.
Distinguishing the type and time course matters: sudden or rapidly progressive SNHL, unilateral loss with facial signs, and certain infections require urgent assessment and treatment (NICE NG98).
Key history points
Ask about:
- Onset and time course: sudden (hours-days) versus gradual; progressive pattern (rapid over days-weeks).
- Laterality and symmetry.
- Associated symptoms: ear pain, discharge, tinnitus, vertigo, aural fullness, facial weakness or altered facial sensation.
- Recent upper respiratory infection, loud noise exposure, ototoxic drugs, head trauma.
- Medical risks: diabetes, immunosuppression (risk for malignant otitis externa).