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PubMed This is a summary of 16 peer-reviewed journal articles Updated
Otolaryngology

Diagnosing Sudden Hearing Loss and Ruling Out Other Causes

At a Glance

Sudden sensorineural hearing loss (SSNHL) is diagnosed through a combination of physical exams, tuning fork tests, and formal audiograms. An MRI of the internal auditory canal is also a standard and necessary precaution to rule out rare nerve growths like vestibular schwannomas.

The journey to a Sudden Sensorineural Hearing Loss (SSNHL) diagnosis often starts with a sense of urgency. Because the inner ear is hidden deep within the skull, doctors must use a series of physical exams, bedside tests, and advanced imaging to “look” inside and rule out other causes [1][2].

The Physical Exam: Ruling Out the Obvious

The first step is usually an otoscopy, where a doctor uses a handheld light to look into your ear canal. This is essential to rule out conductive hearing loss—a mechanical blockage that prevents sound from reaching the inner ear [3].

  • What they look for: Earwax buildup (cerumen impaction), fluid behind the eardrum (often from a cold), a ruptured eardrum, or an active ear infection [3][4].
  • The Goal: If your ear canal is clear but you still cannot hear, the problem likely lies deeper in the nerves or the inner ear (the cochlea) [5].

Tuning Fork Tests: Weber and Rinne

Doctors use a metal tuning fork (usually 512 Hz) to quickly distinguish between conductive and sensorineural loss at the bedside [6][7].

  • The Weber Test: The doctor strikes the fork and places the base on the bridge of your nose or the center of your forehead [8].
    • In SSNHL, the sound “lateralizes” (sounds louder) in your better-hearing ear because the damaged ear cannot process the vibration [8][9].
  • The Rinne Test: The doctor compares how you hear sound through the air (next to your ear) versus through the bone (pressed against the bone behind your ear) [8].
    • A “Positive Rinne” means you hear the sound better through the air. In the context of sudden hearing loss, this proves that the mechanical parts of your ear (eardrum and middle ear bones) are working perfectly. Therefore, your doctor knows the hearing loss must be coming from a deeper nerve or inner ear issue [8][6].

The Formal Audiogram

An audiogram is a detailed hearing test performed in a soundproof booth. It is the “gold standard” for confirming SSNHL [1]. Your report will likely include two key numbers:

  1. Pure-Tone Average (PTA): This measures the quietest sounds you can hear at different pitches. SSNHL is defined as a loss of at least 30 decibels (dB) at three neighboring pitches [1][10].
  2. Word Recognition Score (WRS): This measures how clearly you understand speech when it is played loudly enough for you to hear. A low score can sometimes indicate more significant nerve involvement [11].

Why You Need an MRI

Even if your hearing loss seems “simple,” guidelines recommend an MRI of the internal auditory canal (IAC) [1][2].

  • The Goal: To rule out retrocochlear pathology—a term for any problem located “beyond the cochlea” (the inner ear) along the auditory nerve [12][13].
  • Vestibular Schwannoma (Acoustic Neuroma): This is a rare, non-cancerous growth on the hearing and balance nerve. While only about 1% to 4.7% of people with one-sided hearing loss have this, an MRI is the only way to be sure [14][15].

What to Expect: An MRI is a standard, routine precaution for SSNHL, so do not panic that your doctor thinks you have a tumor just because they ordered the scan. The scan usually takes 30-45 minutes. The machine is loud and enclosed, so if you are claustrophobic, let your doctor know beforehand so they can help keep you comfortable [2].

Diagnostic Checklist

To ensure your workup is complete, verify that your care team has performed the following:

  • [ ] Visual Exam: Looking in the ear to rule out wax or fluid.
  • [ ] Tuning Fork Test: To differentiate between sensorineural and conductive loss.
  • [ ] Comprehensive Audiogram: Including both air and bone conduction testing.
  • [ ] Speech Testing: To measure your word recognition scores.
  • [ ] MRI Scan: Specifically looking at the internal auditory canals and brainstem.
  • [ ] Medical History Review: Checking for cardiovascular risks, recent viruses, or autoimmune conditions [1][16].

Return to the Home Page

Common questions in this guide

How does a doctor know my sudden hearing loss isn't just earwax?
A doctor will first perform an otoscopy, looking into your ear canal with a handheld light. This quick exam rules out a physical blockage like earwax buildup, fluid, or an active infection before moving on to check for nerve damage.
What do tuning fork tests tell my doctor about my hearing loss?
Tuning fork tests, like the Weber and Rinne tests, help doctors rapidly distinguish between a mechanical ear blockage and nerve damage. By comparing how you hear sound through the air versus bone vibration, doctors can pinpoint if the issue is in the inner ear.
Why do I need an MRI for sudden hearing loss?
An MRI of the internal auditory canal is a standard precaution to rule out issues located beyond the inner ear along the auditory nerve. It specifically checks for rare, non-cancerous growths on the hearing nerve, such as a vestibular schwannoma.
What is a pure-tone average (PTA) on an audiogram?
A pure-tone average measures the quietest sounds you can hear at different pitches inside a soundproof booth. Sudden sensorineural hearing loss is officially diagnosed when this test shows a loss of at least 30 decibels across three neighboring pitches.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Can you show me my audiogram and explain how it confirms my hearing loss is sensorineural and not conductive?
  2. 2.Was my Weber test lateralizing to my good ear or my bad ear, and what does that tell you?
  3. 3.Is an MRI of my internal auditory canal (IAC) being ordered to rule out a vestibular schwannoma?
  4. 4.What was my word recognition score on the audiogram, and how does that affect my prognosis?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (16)
  1. 1

    Clinical Practice Guideline: Sudden Hearing Loss (Update) Executive Summary.

    Chandrasekhar SS, Tsai Do BS, Schwartz SR, et al.

    Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2019; (161(2)):195-210 doi:10.1177/0194599819859883.

    PMID: 31369349
  2. 2

    The prevalence of vestibular schwannoma among patients treated as sudden sensorineural hearing loss.

    Fujita T, Saito K, Kashiwagi N, et al.

    Auris, nasus, larynx 2019; (46(1)):78-82 doi:10.1016/j.anl.2018.06.008.

    PMID: 30042019
  3. 3

    Non-Syndromic Sensorineural Hearing Loss in Children.

    Robson CD, Lewis M, D'Arco F

    Neuroimaging clinics of North America 2023; (33(4)):531-542 doi:10.1016/j.nic.2023.05.005.

    PMID: 37741656
  4. 4

    Two Cases of Multiple Ossicular Chain Disruption After Penetrating Injury and Tympanic Membrane Healing.

    Han S, Yeo CD, Lee EJ

    Journal of audiology & otology 2023; (27(4)):246-250 doi:10.7874/jao.2022.00556.

    PMID: 37533348
  5. 5

    Evaluation of Hearing Loss: Understanding Audiologic Testing to Refine Image Interpretation.

    Malouf WT, Bachmann MP, Meegalla NT, et al.

    Radiographics : a review publication of the Radiological Society of North America, Inc 2024; (44(10)):e240018 doi:10.1148/rg.240018.

    PMID: 39264839
  6. 6

    Contralateral Occlusion Test (COT): the effect of external ear canal occlusion with aging.

    Reis LR, Castelhano L, Correia F, Escada P

    CoDAS 2019; (31(3)):e20180058 doi:10.1590/2317-1782/20192018058.

    PMID: 31017175
  7. 7

    A Smartphone-Based Weber Test May Discriminate between a Conductive and a Sensorineural Hearing Loss.

    Ungar OJ, Handzel O, Cavel O, Oron Y

    Audiology & neuro-otology 2019; (24(4)):191-196 doi:10.1159/000502274.

    PMID: 31480043
  8. 8

    Sudden deafness and tuning fork tests: towards optimal utilisation.

    Bayoumy AB, de Ru JA

    Practical neurology 2020; (20(1)):66-68 doi:10.1136/practneurol-2019-002350.

    PMID: 31444233
  9. 9

    Validity of the Hum Test, a Simple and Reliable Alternative to the Weber Test.

    Ahmed OH, Gallant SC, Ruiz R, et al.

    The Annals of otology, rhinology, and laryngology 2018; (127(6)):402-405 doi:10.1177/0003489418772860.

    PMID: 29776326
  10. 10

    Early identification of idiopathic sudden sensorineural hearing loss.

    Jensen EAH, Harmon ED, Smith W

    The Nurse practitioner 2017; (42(9)):10-16 doi:10.1097/01.NPR.0000521990.15440.ee.

    PMID: 28787350
  11. 11

    Intratympanic Corticosteroid Administration as a Primary Treatment for Idiopathic Sudden Sensorineural Hearing Loss.

    Roshan R, Bagla RK, Srivastava A

    Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India 2022; (74(Suppl 1)):72-73 doi:10.1007/s12070-020-01831-y.

    PMID: 36032892
  12. 12

    [Comparison and analysis of ASSR test in sensorineural hearing loss children with cochlear lesion and retrocochlear lesion].

    Luo R, Wang X, Wen R, et al.

    Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology head and neck surgery 2015; (29(10)):885-8.

    PMID: 26596000
  13. 13

    Neurosarcoidosis Presenting as Isolated Bilateral Cerebellopontine Angle Tumors: Case Report and Review of the Literature.

    Crawford F, Alvi SA, Brahimaj B, et al.

    Ear, nose, & throat journal 2019; (98(8)):NP120-NP124 doi:10.1177/0145561319860528.

    PMID: 31522556
  14. 14

    The diagnostic accuracy of non-imaging screening protocols for vestibular schwannoma in patients with asymmetrical hearing loss and/or unilateral audiovestibular dysfunction: a diagnostic review and meta-analysis.

    Hentschel M, Scholte M, Steens S, et al.

    Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery 2017; (42(4)):815-823 doi:10.1111/coa.12788.

    PMID: 27905190
  15. 15

    Correlation of Clinical Factors and Audiometric Characteristics with MRI Findings in Patients with Asymmetric Sensorineural Hearing Loss.

    Vu QN, Ko E, Wisniewski SJ, et al.

    Spartan medical research journal 2018; (3(2)):7005.

    PMID: 33655146
  16. 16

    The association between auditory nerve neurovascular conflict and sudden unilateral sensorineural hearing loss.

    Ungar OJ, Brenner-Ullman A, Cavel O, et al.

    Laryngoscope investigative otolaryngology 2018; (3(5)):384-387 doi:10.1002/lio2.209.

    PMID: 30410992

This page provides educational information about diagnostic tests for sudden sensorineural hearing loss. Always consult an audiologist or ENT doctor to evaluate your hearing and determine the exact cause of your symptoms.

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