About This Page
This is a clinician-written, evidence-based summary aligned to the 2026 MLA Content Map. It is intended for medical students and junior doctors preparing for the UKMLA. Always cross-reference with NICE guidance, local protocols, and clinical judgement.
Key points
- CHL: outer/middle ear. Rinne negative on affected side, Weber lateralises TO affected ear
- SNHL: cochlea/CN VIII. Rinne positive bilaterally, Weber lateralises AWAY from affected ear
- Presbyacusis: most common SNHL — age-related, bilateral, high-frequency
- Sudden SNHL: ENT emergency — same-day referral, oral steroids, MRI to exclude vestibular schwannoma
- NICE NG98: hearing aids mainstay for SNHL
- Unilateral SNHL: MRI IAM to exclude vestibular schwannoma
Overview
Hearing loss is classified as conductive, sensorineural, or mixed. CHL arises from external canal or middle ear pathology (wax, OME, perforation, otosclerosis). SNHL results from cochlear or auditory nerve damage (presbyacusis, noise, ototoxicity, schwannoma). Accurate classification using Rinne and Weber tuning fork tests is fundamental.
Epidemiology
Approximately 12 million UK adults have hearing loss. Presbyacusis affects >70% aged >70. In children, OME is most common cause. 1–2 per 1,000 newborns have permanent hearing loss (NHSP screening).
Clinical Features
Symptoms
Difficulty hearing conversation
Tinnitus — especially SNHL causes
Aural fullness
Sudden onset SNHL
Unilateral hearing loss + tinnitus ± vertigo — suspect vestibular schwannoma
Signs
Weber lateralises TO affected ear in CHL, AWAY in SNHL
Rinne negative (BC > AC) in CHL; positive bilaterally in SNHL
Otoscopy may reveal wax, perforation, effusion, cholesteatoma (CHL causes)
Normal otoscopy with SNHL — presbyacusis, noise, schwannoma
Investigations
First-line
Rinne and Weber (512 Hz tuning fork)Essential bedside tests differentiating CHL from SNHL
OtoscopyExternal/middle ear pathology
Pure tone audiometryGold-standard — quantifies degree and type
Second-line
TympanometryType B = effusion; As = otosclerosis; C = ET dysfunction
Specialist
MRI IAMUnilateral/asymmetric SNHL — exclude schwannoma
CT temporal boneCholesteatoma, otosclerosis, fracture
Management
NICE NG98 (Hearing loss in adults), 20181
Reversible CHL causes
- Wax: drops ± microsuction
- OME: 3-month watch then grommets
- Otosclerosis: hearing aid or stapedectomy
2
Hearing aids for SNHL
- NHS digital BTE aids — free
- Bilateral fitting for bilateral loss
3
Sudden SNHL emergency
- Same-day ENT referral
- Prednisolone 1 mg/kg (max 60 mg) 7–14 days
- MRI IAM within 4 weeks
4
Severe-profound SNHL
- Cochlear implant (NICE TA566)
- BAHA for CHL or single-sided deafness
Complications
- Social isolation and depression
- Cognitive decline and dementia: Largest modifiable risk factor
- Speech delay in children
- Falls in elderly
UKMLA Exam Tips
- 1Rinne/Weber interpretation is VERY commonly tested
- 2Unilateral SNHL → vestibular schwannoma → MRI IAM
- 3Presbyacusis: bilateral high-frequency SNHL in elderly
- 4Otosclerosis: young female, CHL, normal otoscopy, family history, type As tympanogram
- 5Sudden SNHL = emergency: same-day ENT + steroids
- 6Newborn screening: OAE at birth
practicetest your knowledge on Hearing LossApply what you've learnt with UKMLA-style questions from the iatroX Q-Bank — ENT and beyond.
open q-bank