Sudden Hearing Loss in One Ear: Causes & What to Do

What is sudden sensorineural hearing loss (SSHL)?

SSHL is defined as a rapid loss of hearing — typically more than 30 decibels across three consecutive frequencies — occurring over 72 hours or less. Most people notice it when they wake up, or it happens so quickly they can pinpoint the moment.

It affects one ear in the vast majority of cases. Along with the hearing drop, many people experience:

• A sensation of fullness or pressure in the affected ear
• Tinnitus (a ringing, buzzing, or rushing sound)
• Dizziness or balance disturbance in some cases

SSHL is a diagnosis of exclusion — meaning a clinician must rule out blockage (earwax, fluid) and other structural causes before confirming it. An audiogram (hearing test) is essential 1Ref 1Chandrasekhar SS, Tsai Do BS, Schwartz SR, Bontempo LJ, Faucett EA, Finestone SA, et al. (2019).Clinical Practice Guideline: Sudden Hearing Loss (Update).Definition of SSHL, urgency of prompt evaluation within 24–72 hours, first-line oral corticosteroid treatment, intratympanic steroids as salvage, recommendation against routine antivirals, and follow-up audiogram.

Why does sudden hearing loss happen?

In the majority of cases, the underlying cause is never identified. Proposed mechanisms include:

• Viral infection — certain viruses can affect the inner ear or the auditory nerve 2Ref 2Stachler RJ, Chandrasekhar SS, Archer SM, Rosenfeld RM, Schwartz SR, Barrs DM, et al. (2012).Clinical Practice Guideline: Sudden Hearing Loss.Original AAO-HNS SSHL guideline describing viral, vascular, and immune-mediated etiologic hypotheses for idiopathic sudden sensorineural hearing loss
• Vascular disruption — reduced blood flow to the cochlea (the inner ear structure responsible for sound processing)
• Autoimmune inner ear disease — the immune system mistakenly attacks inner ear structures
• Acoustic trauma — sudden exposure to very loud sound

Less commonly, SSHL can be a sign of something that requires its own evaluation: an acoustic neuroma (a benign tumor on the hearing nerve), Meniere's disease, or — rarely — a neurological event affecting the auditory pathway. This is one reason prompt evaluation matters 1Ref 1Chandrasekhar SS, Tsai Do BS, Schwartz SR, Bontempo LJ, Faucett EA, Finestone SA, et al. (2019).Clinical Practice Guideline: Sudden Hearing Loss (Update).Definition of SSHL, urgency of prompt evaluation within 24–72 hours, first-line oral corticosteroid treatment, intratympanic steroids as salvage, recommendation against routine antivirals, and follow-up audiogram.

Is sudden hearing loss an emergency?

It is a medical urgency — not a wait-and-see situation. The clinical practice guideline from the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) recommends that patients with SSHL be evaluated promptly, ideally within 24 to 72 hours of onset 1Ref 1Chandrasekhar SS, Tsai Do BS, Schwartz SR, Bontempo LJ, Faucett EA, Finestone SA, et al. (2019).Clinical Practice Guideline: Sudden Hearing Loss (Update).Definition of SSHL, urgency of prompt evaluation within 24–72 hours, first-line oral corticosteroid treatment, intratympanic steroids as salvage, recommendation against routine antivirals, and follow-up audiogram.

Treatment effectiveness declines with delay. Most clinicians consider the window for first-line treatment to close at roughly four weeks from onset, with better outcomes earlier in that window.

If sudden hearing loss is accompanied by facial weakness, numbness, slurred speech, or significant difficulty with balance, go to an emergency department — these can signal a stroke affecting the brainstem or auditory cortex.

How is SSHL treated?

The first-line treatment is oral corticosteroids (typically prednisone), which reduce inflammation in the inner ear. For patients who cannot take oral steroids or who have not responded adequately, intratympanic steroid injections — delivered directly through the eardrum — are an option 1Ref 1Chandrasekhar SS, Tsai Do BS, Schwartz SR, Bontempo LJ, Faucett EA, Finestone SA, et al. (2019).Clinical Practice Guideline: Sudden Hearing Loss (Update).Definition of SSHL, urgency of prompt evaluation within 24–72 hours, first-line oral corticosteroid treatment, intratympanic steroids as salvage, recommendation against routine antivirals, and follow-up audiogram.

The guideline specifically recommends against routinely using antiviral medications as initial standalone treatment, since evidence for their benefit has not been established 1Ref 1Chandrasekhar SS, Tsai Do BS, Schwartz SR, Bontempo LJ, Faucett EA, Finestone SA, et al. (2019).Clinical Practice Guideline: Sudden Hearing Loss (Update).Definition of SSHL, urgency of prompt evaluation within 24–72 hours, first-line oral corticosteroid treatment, intratympanic steroids as salvage, recommendation against routine antivirals, and follow-up audiogram.

An MRI of the internal auditory canals is often ordered to rule out a structural cause such as an acoustic neuroma, especially if hearing does not recover.

Some people experience full or near-full recovery; others recover partially or not at all. Recovery tends to occur within the first two weeks if it is going to happen. A follow-up audiogram at the end of the treatment course is standard.

What kind of doctor should I see?

An ENT (otolaryngologist) is the right specialist for sudden hearing loss. They can perform or order an audiogram, examine the ear canal and eardrum to rule out mechanical causes, initiate corticosteroid treatment, and arrange imaging if needed.

If same-day ENT access is not available, urgent care or your primary care clinician can begin the evaluation, check for obvious blockage, and initiate corticosteroid treatment while you await an ENT appointment.

Gale can help you prepare for that specialist visit — gathering your symptom timeline, current medications, and relevant medical history — so you arrive ready for a productive conversation.

What should I do right now?

1. Do not wait to see if it resolves on its own. Some people delay, thinking it is earwax or congestion — but earwax does not cause sudden, complete hearing loss in one ear. 2. Check whether earwax or fluid is the cause. A clinician can look in your ear canal in minutes. If there is a blockage, the fix is different from SSHL treatment. 3. Contact an ENT or urgent care today. Explain that you had sudden hearing loss in one ear and need to be seen promptly. 4. Note the exact time symptoms started. The treating clinician will ask.