What are the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) clinical practice guidelines for sudden hearing loss?

Updated: Aug 28, 2019
  • Author: Neeraj N Mathur, MBBS, MS, DNB(ENT), MNAMS, FAMS; Chief Editor: Arlen D Meyers, MD, MBA  more...
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The American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF) issued clinical practice guidelines for sudden hearing loss on August 1, 2019. [28]


Sensorineural hearing loss (SNHL) should be differentiated from conductive hearing loss (CHL) in patients who present with sudden hearing loss (SHL).

Patients with suspected sudden sensorineural hearing loss (SSNHL) should undergo history and physical examination for bilateral SHL, recurrent SHL, and/or focal neurologic findings.


Patients with presumptive SSNHL should not undergo routine head CT scanning during the initial evaluation.

Audiometry should be performed as soon as possible to confirm a diagnosis of SSNHL, within 14 days of symptom onset.

Routine laboratory tests should not be performed in the workup of SSNHL.

Patients with SSNHL should undergo MRI or auditory brainstem response (ABR) to evaluate for retrocochlear pathology.

Patient education

Patients with SSNHL should be educated regarding the condition’s natural history and the potential benefits and risks of treatment.


Corticosteroids may be offered to patients with SSNHL as initial therapy within 2 weeks of onset.

Hyperbaric oxygen therapy (HBOT), in combination with steroid therapy, may be offered to patients with SSNHL within 2 weeks of onset.

HBOT, in combination with steroid therapy, may be offered as salvage therapy to patients with SSNHL within 1 month of onset.

Patients with an incomplete recovery from SSNHL should be offered intratympanic steroid therapy 2-6 weeks after symptom onset.

Antiviral therapy, thrombolytic therapy, vasodilator therapy, and vasoactive substances should not be routinely prescribed to patients with SSNHL.

Outcome assessment

At the conclusion of treatment and then 6 months thereafter, follow-up audiometric evaluation should be performed in patients with SSNHL.


Patients with SSNHL who have residual hearing loss and/or tinnitus should be educated about the potential benefits of audiologic rehabilitation and other supportive measures.

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