Sensorineural hearing loss comes from damage to the cochlea or the hearing nerve, so sound reaches the inner ear but is not turned into clear signals. Aging and noise are the most common causes, and sudden loss in one ear is an emergency.
Key symptoms
- Trouble understanding speech, especially in noise
- High-pitched sounds lost first
- Tinnitus
- Feeling of fullness in the ear
- Onset over hours to 3 days in sudden hearing loss
What you find on exam
- Normal ear canal and eardrum on otoscopy
- Weber test louder in the better ear
- Rinne test positive in both ears: air conduction louder than bone
- Whisper test
- Cranial nerve exam and balance testing
Tests
- Audiogram: air and bone thresholds equally reduced, no air-bone gap
- Speech discrimination scores
- MRI of the internal auditory canals if hearing is asymmetric, to rule out vestibular schwannoma
- Blood tests guided by history: syphilis, glucose, autoimmune markers
Treatment basics
- Hearing aids; cochlear implant for severe loss
- Sudden loss: oral prednisone started within 2 weeks, or intratympanic steroids
- Noise protection and stopping ototoxic drugs when possible
- Hearing rehabilitation and communication strategies
Red flags
- Sudden hearing loss in one ear
- Hearing loss with vertigo, facial weakness or other neurologic signs
- Asymmetric hearing loss or tinnitus in one ear
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.