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You wake up one morning and one of your ears feels as if it were plugged with cotton. Don't always assume it is earwax, because sudden hearing loss sometimes feels exactly like this.
What is sudden hearing loss?
Sudden hearing loss is a clear drop in hearing, usually in one ear, that develops over hours or a few days. Some patients notice it when they wake up, others when voices on the phone sound muffled in that ear.
It doesn't always start with "I suddenly can't hear"
Patients don't always come in saying their hearing suddenly went. What they often describe is a feeling of blockage. These symptoms may be present:
- A feeling of fullness or pressure in the ear
- Blockage, with sounds seeming to come "from far away"
- Sometimes ringing or buzzing in the ear (tinnitus)
- Even dizziness and imbalance
These symptoms can be confused with earwax, a blocked ear after a flight, or blockage due to a cold. This is where the problem starts: the person waits, thinking it will pass.
The first step: finding the cause
We broadly divide hearing loss into two groups, and treatment depends entirely on which one it is:
- Conductive hearing lossSomething is preventing sound from travelling through the outer and middle ear to the inner ear. An earwax plug, fluid in the middle ear or a perforated eardrum are examples. Most can be seen during an examination.
- Sensorineural hearing lossThe problem lies in the inner ear or the hearing nerve. From the outside, the ear can look completely normal. This is the group we are most concerned about in sudden hearing loss, and here time matters.
What causes it?
In a large proportion of sudden sensorineural hearing loss cases, no clear cause is found. Viral infections and problems with blood flow to the inner ear are among the suspected causes. Rarely, a benign tumour on the hearing nerve can present in a similar way, which is why we arrange further assessment with an MRI scan when needed.
Why time matters
Current guidelines specifically stress that a hearing test should be done as early as possible and that, if treatment is considered, it should be started early. The first 72 hours are especially important.
What happens during the examination?
- Ear examination: to check for earwax, fluid in the middle ear or a problem with the eardrum.
- Tuning fork tests: give the first clue as to whether the loss is conductive or sensorineural.
- Audiometry (hearing test): shows the type and degree of hearing loss.
- Tympanometry: assesses the middle ear and the eardrum.
- Imaging if needed: an MRI may be requested to assess the hearing nerve and inner ear region.
Treatment
If the cause is conductive, such as an earwax plug, hearing usually improves as soon as it is removed. For sudden sensorineural hearing loss, one of the options in the guidelines is corticosteroid treatment, given by mouth or injected behind the eardrum. Which treatment is appropriate is decided according to the patient's general health and test results.
What not to do
- Poking around in the ear with a cotton swab, assuming it is earwax
- Putting drops in the ear without an examination
- Waiting a few days to see whether it clears up on its own
Frequently asked questions
Does sudden hearing loss go away on its own? In some patients hearing can recover on its own. But we cannot predict in advance who will recover. That is why early assessment is better than waiting.
Is it important if I only have ringing in the ear? New, one-sided ringing should always be assessed, especially if it comes with a feeling of reduced hearing.
Which doctor should I see? An ear, nose and throat specialist is the right choice. If you cannot reach one, go to an emergency department and explain that your hearing loss is new.
Can it happen in both ears? It can, but it is rarer. In that case, too, assessment should not be delayed.
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