Sudden hearing loss assessment (Assessment of sudden sensorineural hearing loss (SSNHL))
An urgent check to find the cause of a sudden drop in hearing and decide whether early treatment, such as steroids, might help.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Sudden hearing loss in one or both ears is a possible medical emergency — it should be assessed urgently, not booked as a routine appointment.
- There is a short treatment window: steroids are usually given as soon as possible, and the chance of recovery is better when treatment starts early (within about a week).
- A normal-looking ear does not rule it out — sudden loss is easily mistaken for wax or a cold, which can delay the right care.
- Not everyone recovers fully, even with prompt treatment, but early assessment gives the best chance and rules out serious causes.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Finds treatable causes quickly, while there may still be time to act
If the cause is clearly wax, infection or a cold, urgent sensorineural assessment may not be the first step — but the ear must be examined to be sure.
You usually have your ears examined and a hearing test. If steroids are appropriate, they are often started straight away.
A named contact and clear instructions on what to do if hearing worsens or severe dizziness develops.
You usually have your ears examined and a hearing test. If steroids are appropriate, they are often started...
This is the key treatment window. Take steroids exactly as prescribed and report any side effects. Some people...
A repeat hearing test checks for recovery. If there has been little improvement, salvage treatment such as steroid...
If a scan was arranged, results are discussed and any further action explained.
What is a sudden hearing loss assessment?
A sudden hearing loss assessment is an urgent check carried out when your hearing drops quickly — usually in one ear, over a few hours to about three days — without a clear cause like wax or a cold. It is done by an ear, nose and throat (ENT) specialist or an audiovestibular medicine specialist, often working with an audiologist.
The purpose is twofold: to confirm whether the loss is coming from the inner ear or hearing nerve (sensorineural), and to look for any cause that needs treating in its own right. Sudden sensorineural hearing loss is treated as a medical emergency because there is a short window in which steroids may help recovery, and because rare but serious causes need to be ruled out.
The assessment usually includes looking in your ears, a hearing test (audiogram), and tuning-fork tests to tell sensorineural loss from a blocked or middle-ear problem. If sensorineural loss is confirmed, a scan (usually an MRI) is often arranged to check the hearing nerve.
It is important to understand what this assessment cannot do: it cannot guarantee your hearing will return, and not everyone recovers fully even with prompt treatment. Its value is in finding treatable causes quickly and giving you the best chance.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
Hearing test (pure-tone audiogram)
Headphones play tones at different pitches and volumes to map how much hearing has been lost and at which frequencies. This confirms the loss and how severe it is.
Tuning-fork tests (Weber and Rinne)
Simple bedside tests using a tuning fork that help tell sensorineural loss (inner ear or nerve) apart from a conductive problem (wax, fluid or middle-ear issue).
Ear examination (otoscopy)
The specialist looks in the ear canal and at the eardrum to rule out wax, infection, fluid or a perforation as the cause.
MRI scan of the hearing nerve
Often arranged after confirmed sensorineural loss to check for causes such as a vestibular schwannoma (a benign nerve growth) or, rarely, other problems.
Preparing for your test
- Do not wait. If your hearing drops suddenly, contact your GP the same day, or use NHS 111 in England, Scotland or Wales (in Northern Ireland, contact your GP out-of-hours service or your HSC Trust's Phone First service), or go to A&E if you cannot reach them — early treatment matters.
- Make a note of exactly when it started, whether it was one or both ears, and any dizziness, ringing (tinnitus) or ear fullness.
- List any recent illness, ear infection, head injury, loud-noise exposure or new medicines.
- Bring a list of all your medicines and any known allergies, as steroids may be discussed.
- Mention diabetes, high blood pressure, stomach ulcers, glaucoma or any condition affecting steroid use.
- If you can, bring someone with you, as you may be anxious and there may be a lot to take in.
What happens
The specialist will ask when and how your hearing changed and check for other symptoms such as dizziness, tinnitus or ear pain. They will look in your ears and carry out tuning-fork tests.
You will usually have a hearing test (audiogram) the same day, often with an audiologist, to confirm the loss and measure it. If the loss is sensorineural and no other cause is found, it is called idiopathic sudden sensorineural hearing loss.
If treatment is appropriate, oral steroids are usually started as soon as possible. Some people are offered steroid injections through the eardrum (intratympanic steroids), either as the main treatment or if tablets have not worked. An MRI of the hearing nerve is commonly arranged, and blood tests may be taken.
Is this test right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- If the cause is clearly wax, infection or a cold, urgent sensorineural assessment may not be the first step — but the ear must be examined to be sure.
- If hearing loss has been gradual over months or years, this is an age-related or other assessment rather than an emergency one.
- If symptoms point to a stroke (facial droop, arm weakness, slurred speech), this needs 999 emergency care, not an outpatient hearing assessment.
Delay or rearrange if…
- Do not delay the assessment itself — delay is the main danger with sudden hearing loss.
- Steroid treatment may need to be adjusted or delayed if you have poorly controlled diabetes, active infection or a stomach ulcer — your clinician will weigh this up.
- An MRI may be delayed if you have certain metal implants or are unable to lie still, in which case an alternative is discussed.
Alternatives to discuss
- Watchful waiting is not advised for confirmed sudden sensorineural loss within the treatment window because of the time-sensitive benefit of steroids.
- If steroids are unsuitable, steroid injections through the eardrum may be considered.
- If hearing does not recover, alternatives shift to hearing aids, tinnitus support and balance rehabilitation rather than further attempts to restore hearing.
- An NHS urgent pathway is a valid alternative to private care and is often just as fast for a true emergency.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- Finds treatable causes quickly, while there may still be time to act
- Allows steroids to be started early, when they are most likely to help
- Rules out rare but serious causes such as a nerve growth or stroke
- Gives you a clear picture of how much hearing has been affected
- Sets up the right follow-up, including repeat hearing tests to track recovery
Risks & complications
- The assessment itself is low-risk — the main risk is delay in getting it
- A hearing test can be tiring but is not painful
- Steroid tablets, if prescribed, can cause raised blood sugar, mood changes, sleep problems and stomach upset
- Steroid injections through the eardrum can cause brief pain, dizziness or a temporary hole in the eardrum
- The cause is not always found despite tests (idiopathic loss)
- An MRI may pick up an unrelated, incidental finding that needs explaining
- A serious underlying cause is found that needs urgent treatment in its own right
- Hearing does not recover despite prompt, correct treatment
The biggest risk with sudden hearing loss is not the assessment but waiting too long to have it. It is easily mistaken for wax or a cold. If your hearing drops suddenly, especially in one ear, ask to be seen urgently and say clearly that it came on quickly — ask whether you should be assessed for sudden sensorineural hearing loss.
Published figures to discuss
Recovery from sudden sensorineural hearing loss varies widely and depends on how severe the loss is, how soon treatment starts and the underlying cause. Some people recover spontaneously, which makes treatment effects hard to measure precisely. The figures below are from UK and research sources and should be treated as broad indicators, not promises.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Recovery when steroids are given early | Reported as around five times more likely to fully recover when steroids are given within seven days, in one UK hospital analysis | This reflects an association, not a guarantee; some people recover without treatment and some do not recover despite it. | Guide sourcesClinical context |
| Treatment within the seven-day window | Only about 60% of patients received steroids within seven days in one UK report | This highlights how often delay happens — often because the loss is mistaken for wax or a cold. | SeaSHeL national cohort study protocol — PMCncbi.nlm.nih.govPublished figure |
| Permanent hearing loss despite treatment | Possible | Some people recover fully, some partially and some not at all; early assessment improves the chance but does not guarantee recovery. | Guide sourcesClinical context |
| Serious underlying cause | Uncommon but important | Asymmetric sudden loss may need MRI or ENT review to exclude retrocochlear, inflammatory, vascular or other causes. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no physical recovery from the assessment itself. What matters afterwards is starting any treatment promptly and tracking whether your hearing improves over the following days and weeks.
- Feeling anxious while you wait to see whether hearing returns
- Tinnitus (ringing or buzzing) that may settle as hearing improves, or persist
- A blocked or full feeling in the ear
- Some short-term side effects from steroid tablets, such as restlessness or a raised appetite
- Hearing that improves gradually over days to weeks, partly, fully or not at all
Aftercare
- Take steroids exactly as prescribed and do not stop suddenly without advice.
- Report new dizziness, severe headache, facial weakness or visual changes urgently.
- Attend your repeat hearing test so recovery can be measured and next steps decided.
- Avoid loud noise exposure while your ear is recovering.
- Ask about salvage treatment (such as steroid injections) if there has been little improvement.
- Keep a note of your symptoms and how they change, to share at follow-up.
- Ask who to contact if symptoms worsen between appointments.
- Date and details of when the hearing loss started
- List of medicines and allergies
- Note of other symptoms (dizziness, tinnitus, ear fullness)
- Recent illnesses, infections or noise exposure noted
- Someone to come with you if you are anxious
- Pen and paper or phone to record advice
- The clinic's contact number for worsening symptoms
⚠ Get urgent help if…
- A sudden drop in hearing, especially in one ear — seek same-day assessment
- Hearing loss with sudden severe dizziness or being unable to stand
- Hearing loss with facial drooping, arm weakness or slurred speech — call 999 (possible stroke)
- A sudden severe headache or any change in vision
- Ear pain, discharge or fever alongside the hearing loss
- Hearing that keeps getting worse despite starting treatment
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A confirmed sudden sensorineural hearing loss means the problem is in the inner ear or hearing nerve rather than a blockage. The hearing test shows how severe it is, and repeat tests show whether it is recovering. Early treatment with steroids is associated with a better chance of recovery, and treatment started within about a week appears most likely to help.
A normal MRI is reassuring, but it does not by itself restore hearing or guarantee full recovery. Recovery varies widely between people — some recover fully, some partly, and some not at all. The assessment cannot promise an outcome; its job is to find treatable causes and give you the best chance.
How long the result remains useful depends on what happens to your hearing. If it recovers, you may not need further tests unless symptoms return. If it does not fully recover, your hearing level may be re-checked over time and you may be offered hearing aids or other support. A sudden change at any point in the future should again be treated as urgent.
Related tests, treatments or support
Assessment often goes hand in hand with treatment, because the priority is to start steroids quickly where appropriate. It may be combined with an MRI of the hearing nerve, blood tests, and balance assessment if you are also dizzy.
Follow-up & long-term care
You should have at least one repeat hearing test, usually within a few weeks, to measure recovery. If a scan was done, the result is reviewed with you. If hearing does not return, follow-up moves on to support such as hearing aids, tinnitus management or balance rehabilitation, and any onward referral is arranged.
Repeat, follow-on and what comes next
- If first-line steroid tablets do not help, salvage treatment with steroid injections may be offered, often up to about six weeks after onset.
- Repeat hearing tests are normal practice to confirm whether the loss is recovering, stable or worsening.
- If the cause was not found at first, further tests or a scan may be arranged.
- If hearing does not return, the plan moves from trying to restore hearing to supporting it with aids and rehabilitation.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A named contact and clear instructions on what to do if hearing worsens or severe dizziness develops.
- A booked repeat hearing test to measure recovery, not just a one-off appointment.
- Discussion of salvage treatment (such as steroid injections) if there is little improvement.
- A clear plan for the MRI result and any onward referral.
- Honest discussion of support options if hearing does not fully return.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether you are seen urgently through the NHS (no charge to you) or pay for a private specialist appointment
- Whether a hearing test (audiogram) is included on the day
- Whether an MRI scan of the hearing nerve is needed, and same-day reporting
- Whether steroid injections through the eardrum are offered as well as tablets
- Number of follow-up appointments and repeat hearing tests
- Any blood tests to look for treatable causes
- The specialist's fee and whether a hearing test is included on the day
- Whether an MRI scan and its reporting are included or charged separately
- Cost of any steroid injection procedure if recommended
- Cost of follow-up appointments and repeat hearing tests
- What happens, and what it costs, if the cause is not found and more tests are needed
- How quickly you can be seen — speed is the key consideration here
On the NHS? Urgent assessment of sudden hearing loss is available on the NHS and should be sought the same day. If the situation is life-threatening, call 999 or go to A&E. For urgent advice, contact your GP, or NHS 111 in England, Scotland or Wales; in Northern Ireland, contact your GP out-of-hours service or your HSC Trust's Phone First service. Private care may be faster, but the priority is to be seen quickly by whichever route is fastest.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Being reassured it is 'just wax' without an examination or hearing test, causing critical delay.
- Not being told that the chance of recovery is time-sensitive and that steroids work best started early.
- Steroid tablets prescribed without discussing side effects or your other health conditions.
- No clear plan for a repeat hearing test or for what to do if there is no improvement.
Marketing red flags
- Any service that books sudden hearing loss as a routine, non-urgent appointment.
- Claims that a particular treatment or supplement will guarantee hearing recovery.
- Selling expensive hearing aids before the cause has been assessed and treatment tried.
- Downplaying the need for an MRI or specialist review when loss is in one ear.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Could this be sudden sensorineural hearing loss, and how urgently should I be assessed?
- Is steroid treatment suitable for me, and how soon can it start?
- If tablets do not help, would steroid injections through the eardrum be an option?
- Do I need an MRI of the hearing nerve, and when will I get the result?
- When will my hearing be re-tested, and what counts as a good response?
- What should I do if my hearing gets worse or I become very dizzy?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my test, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this test not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is sudden hearing loss really an emergency?
Can I get this assessment on the NHS?
Will my hearing come back?
What treatment might I be offered?
Why do I need an MRI scan?
Could it just be wax?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NICE — Hearing loss in adults: sudden onset (QS185) RNID — Treat sudden hearing loss within seven days NHS — Hearing loss ENT UK — Patient information UCLH — Doctors urged to treat sudden hearing loss within seven days SeaSHeL national cohort study protocol — PMC nidirect — urgent and emergency care services (Northern Ireland) nidirect — GP out-of-hours service (Northern Ireland)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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