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Sudden Sensorineural Hearing Loss — RACP Adult Medicine MCQ

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ModerateGeneral Internal MedicineSudden Sensorineural Hearing LossRACP Adult Medicine

A 30-year-old man presents with sudden onset unilateral hearing loss and tinnitus in his right ear. He has no vertigo. There is no history of trauma or noise exposure. Pure tone audiometry confirms right-sided sensorineural hearing loss. What is the most important initial action?

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Correct answer: A — Oral prednisolone within 72 hours

Sudden sensorineural hearing loss (SSNHL – unilateral hearing loss ≥30 dB over 3 frequencies developing within 72 hours) is an otological emergency. Oral corticosteroids (prednisolone 1 mg/kg, max 60 mg, for 7–14 days) should be commenced within 72 hours of onset – earlier treatment is associated with better recovery. MRI should be arranged to exclude vestibular schwannoma (present in ~1% of SSNHL cases) but should NOT delay steroid initiation. Intratympanic dexamethasone is used as salvage therapy for steroid failures.

Reference: eTG – 2025 – Neurology; AAO-HNS – 2019 – SSNHL Guidelines