Some Causes and Features of Sudden Hearing Loss
Cause | Common Features* | Diagnostic Approach† |
|---|---|---|
Unknown | ||
— | Deafness in only one ear No other symptoms | MRI using a contrast agent (gadolinium) |
Obvious causes | ||
Acute infection (such as bacterial meningitis, Lyme disease, mumps, or herpes simplex) | Deafness in one or both ears In people with a serious, acute illness Often headache and confusion With Lyme disease, deafness preceded by a typical rash and flu-like symptoms With mumps, pain in cheeks with swallowing | If not already done, blood tests and a spinal tap (lumbar puncture) |
Deafness usually in only one ear Sometimes fluid (bloody, blood-tinged, or clear) coming from the affected ear | CT and/or MRI | |
Pressure changes (as may occur during diving) | Deafness in one or both ears Sudden onset during causative activity (for example, scuba diving, rapid descent in airplane) or after a blow to the ear Sometimes accompanied by pain, an explosive sound, dizziness, or ringing in the ear | Tympanometry (placement of a device in the ear to measure how well sound passes through the ear) Balance testing with electronystagmography (a test to record involuntary movements of the eye caused by a condition known as nystagmus) CT or MRI |
Medications that can damage the ear (ototoxic medications), including | Deafness in both ears Sometimes dizziness and loss of balance In people who recently started taking or have recently taken an ototoxic medication | A doctor's examination Sometimes blood medication levels |
Underlying disorders‡ | ||
Vestibular schwannoma, a tumor of the auditory nerve | Deafness in only one ear Often dizziness or a false sensation of spinning or moving (vertigo) and loss of balance Sometimes drooping facial muscles and/or numbness of the face and taste abnormalities | MRI using a contrast agent (gadolinium) |
Autoimmune inner ear disease | Hearing loss in both ears that can come and go and may worsen over time | Blood tests |
Systemic rheumatic disorders and other autoimmune disorders, such as some blood disorders, disorders that cause vasculitis, and Cogan syndrome | Deafness in one or both ears Sometimes joint pains or a rash | Blood tests |
Meniere syndrome (including Meniere disease) | Deafness in only one ear in most affected people Sometimes dizziness and/or ringing in the ear | MRI using a contrast agent (gadolinium) |
Deafness in only one ear Sometimes weakness or numbness that comes and goes and occurs in different parts of the body | MRI using a contrast agent (gadolinium) Sometimes a spinal tap | |
Stroke (affecting the cerebellum) | Deafness in only one ear Sometimes difficulty with balance or coordination | MRI using a contrast agent (gadolinium) |
Reactivation of syphilis in people with HIV infection | Deafness in one or both ears Sometimes risk factors for sexually transmitted infections (such as unprotected sex, multiple partners) | Blood tests Sometimes, spinal tap (lumbar puncture) |
* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present. Features overlap between causes. | ||
† Although a doctor's examination with an audiogram should always be done, it is only mentioned in this column if the diagnosis can sometimes be made only by the doctor's examination with an audiogram, without any additional testing. In other words, additional tests may not be needed. | ||
‡ Rarely, sudden hearing loss is the first symptom of a disorder that usually has other symptoms first. Symptoms typical of these disorders may not be present at all. However, some people disregard mild symptoms that may be discovered by the doctor through careful questioning and examination. | ||
CT = computed tomography; MRI = magnetic resonance imaging. | ||