Short answer
Sudden hearing loss is treated as an emergency because one form, sudden sensorineural hearing loss (damage to the inner ear or hearing nerve rather than a blockage), may respond to treatment that works best when started early, usually within days. It can also occasionally be a sign of a stroke or another neurological problem. UK guidance is to be seen within 24 hours if hearing dropped over three days or less. How urgent it is depends on how fast the loss came on and whether there are other symptoms, such as facial weakness.
Key points
- The first step is telling a simple blockage, such as earwax, apart from inner-ear damage.
- Most sudden sensorineural hearing loss has no identifiable cause.
- Steroid treatment is usually offered early, ideally in the first week.
- The evidence for steroids is uncertain, but treatment windows are short, so delay closes options.
- Sudden hearing loss with facial weakness or other neurological symptoms needs immediate assessment.
Two very different kinds of sudden hearing loss
Hearing can drop suddenly for two broad reasons, and telling them apart is the first job of assessment.3
| Conductive hearing loss | Sensorineural hearing loss | |
|---|---|---|
| Where the problem is | Sound cannot reach the inner ear | The inner ear or hearing nerve is affected |
| Examples | Impacted earwax, an ear infection, a perforated eardrum12 | Usually no cause found; sometimes labyrinthitis, Ménière’s disease, stroke or other neurological conditions123 |
| How it is told apart | Ear examination, tuning fork tests and a hearing test (audiogram)23 | |
The American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF) guideline notes that more than 90% of sudden sensorineural hearing loss is idiopathic, meaning no cause is found.3
Why speed matters
There are two reasons. First, the treatments used for sudden sensorineural hearing loss have time limits. NHS Highland guidance describes it as “an ENT emergency” and advises oral steroids preferably in the first week after onset.2 The AAO-HNSF guideline says initial steroid treatment may be offered within two weeks of onset.3 After that window, options narrow.
Second, sudden hearing loss can occasionally be part of a more serious problem. The National Institute for Health and Care Excellence (NICE) recommends immediate referral when there are sudden, significant neurological symptoms or signs, such as facial weakness.4 NHS Highland lists suspected stroke, trauma and hearing loss in one ear with altered sensation or facial droop among its red flags.2
NICE’s tinnitus guideline sets the general timescale: people whose hearing loss developed suddenly, over three days or less, within the past 30 days should be seen within 24 hours.4
What assessment involves
A clinician examines the ear to exclude wax, infection and other visible causes, and may use tuning fork tests (the Weber and Rinne tests) to distinguish conductive from sensorineural loss.2 A formal hearing test confirms the type and degree of loss; the AAO-HNSF recommends audiometry within 14 days of onset.3
The same guideline advises against routine CT scans of the head and routine blood tests, but recommends checking for retrocochlear causes (problems behind the cochlea, such as a benign tumour on the hearing nerve), usually with an MRI scan or an auditory brainstem response test.3
How it is treated, and what the evidence shows
If no contraindication exists, NHS Highland guidance recommends oral prednisolone (a steroid tablet) for 7 days, then tapered over the following week.2 When tablets are unsuitable or the loss is more than a week old, an ENT specialist may consider intratympanic steroids, injected through the eardrum into the middle ear.2 The AAO-HNSF also lists hyperbaric oxygen (breathing pure oxygen in a pressurised chamber) with steroids as an option within two weeks, and advises against antivirals, clot-dissolving drugs and vasodilators.3
The evidence base is weaker than the urgency might suggest. A 2013 Cochrane review found only three small randomised trials of steroid tablets against placebo or no treatment, all at high risk of bias. One showed improvement in 61% of treated patients versus 32% of controls; the other two showed no benefit. The authors concluded that the value of steroids remains unclear.5 The evidence for oral steroids is therefore Mixed.
A 2022 Cochrane review of 30 studies found that, as a first treatment, steroids injected into the ear may make little or no difference compared with tablets. As a rescue treatment when hearing has not recovered, they may increase the proportion of people whose hearing improves, though the certainty is low. Injections can cause ear pain, dizziness and a hole in the eardrum, while tablets can affect blood sugar.6
Even with uncertain evidence, guidelines favour early assessment because treatment is only an option within a short window, and because serious causes need to be excluded.23
When to seek medical advice
If you notice sudden hearing loss in one or both ears, ask for an urgent GP appointment or contact NHS 111, as it may need to be treated quickly.1
Seek emergency help if hearing loss comes with facial weakness, other new neurological symptoms or signs of a stroke, or follows an injury such as a head injury.24
Common questions
Could it just be earwax?
It could, which is why examination comes first, but you cannot reliably tell the difference yourself.23
Is it too late if a week has passed?
Not necessarily; guidelines allow steroids within two weeks and rescue treatment later, so it is still worth seeking help.23
I also have ringing in the ear. Is that related?
Often, yes; sudden hearing loss with tinnitus or vertigo can point to inner-ear conditions such as labyrinthitis or Ménière’s disease.1 Our page on tinnitus causes and treatment explains more.
What if my hearing does not come back?
Hearing rehabilitation is available; the AAO-HNSF recommends counselling about options such as hearing aids for anyone left with hearing loss or tinnitus.3
Bottom line
Sudden hearing loss is urgent not because treatment reliably works, but because the window for it is short and occasionally the cause is serious. Same-day contact with a GP or NHS 111 keeps the options open.
Related reading
- Ear, nose and throat overview
- What causes tinnitus, and what helps?
- What does hearing with a cochlear implant sound like?
Sources
- NHS. Hearing loss. NHS website. https://www.nhs.uk/conditions/hearing-loss/. Accessed 5 November 2026.
- NHS Highland. Sudden onset sensorineural hearing loss (<72 hours): adult therapeutic guidelines (TAM687). Right Decisions, NHS Scotland; 2025. https://www.rightdecisions.scot.nhs.uk/tam-treatments-and-medicines-nhs-highland/adult-therapeutic-guidelines/ear-nose-and-oropharynx-ent/sudden-onset-sensorineural-hearing-loss-72-hours-guidelines/. Accessed 5 November 2026.
- American Academy of Otolaryngology–Head and Neck Surgery. Sudden hearing loss update (summary of the AAO-HNSF Clinical Practice Guideline: Sudden Hearing Loss (Update)). ENTtoday/AAO-HNS Bulletin; 2019. https://bulletin.entnet.org/home/article/21247640/sudden-hearing-loss-update. Accessed 5 November 2026.
- National Institute for Health and Care Excellence. Tinnitus: assessment and management (NG155). Recommendations 1.2. NICE. https://www.nice.org.uk/guidance/NG155/chapter/recommendations. Accessed 5 November 2026.
- Wei BPC, Stathopoulos D, O’Leary S. Steroids for idiopathic sudden sensorineural hearing loss. Cochrane Database of Systematic Reviews; 2013, Issue 7: CD003998. doi:10.1002/14651858.CD003998.pub3. https://www.cochrane.org/evidence/CD003998. Accessed 5 November 2026.
- Plontke et al. Intratympanic corticosteroids for sudden sensorineural hearing loss. Cochrane Database of Systematic Reviews; 2022, Issue 7: CD008080. https://www.cochrane.org/evidence/CD008080. Accessed 5 November 2026.
Article history
- — First published.