chronic

Sudden sensorineural hearing loss (emergency ENT referral)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources1 source

AAO-HNS Sudden Hearing Loss Clinical Practice Guideline 2019

Verified against1 document

Verified date2026-08

Presentation reference

Reference only, to read alongside your own examination.

Important history covers onset, which ear or both, how quickly it worsened, whether it fluctuates, and accompanying tinnitus, ear fullness, unsteadiness, or vertigo [tinnitus · unsteadiness · vertigo]
Prior ear surgery, noise exposure, head injury, barotrauma, or aminoglycoside exposure should be asked about
Sudden sensorineural hearing loss is defined as more than 30 dB of loss across at least 3 consecutive frequencies within 72 hours [hearing loss]
Most cases of sudden hearing loss have no identifiable cause and are labeled idiopathic [hearing loss]

A full head, neck, and cranial nerve exam is done alongside the ear exam, though it is usually normal

Sudden sensorineural hearing loss is treated as an emergency requiring prompt work-up and management
A pure tone audiogram should be done as soon as possible as part of the work-up
Bedside tuning-fork testing needs at least a 20 dB gap between ears, or between conductive and sensorineural thresholds, to pick up a difference
On the Weber test, sound lateralizes to the good ear in one-sided sensorineural loss, to the worse ear in a conductive loss, and does not lateralize if the loss is on both sides
A positive Rinne test - air conduction heard better than bone conduction - is expected in sensorineural loss since there is no conductive component
On a pure tone audiogram, sensorineural loss shows both air and bone conduction worsening together with no air-bone gap
Tympanometry checks middle-ear function and can pick up otitis media with effusion or eustachian tube dysfunction
Otoacoustic emissions are absent when the outer hair cells are damaged
Auditory brainstem testing can be affected by a cerebellopontine angle tumor compressing the cochlear nerve
CT of the temporal bone and brain MRI look for cochlear ossification, a cerebellopontine angle tumor, or active mastoiditis

Noise-induced hearing loss classically shows a notch at 4 kHz that starts to recover at 8 kHz on the audiogram - the Carhart notch - though it needs a history of noise exposure to be meaningful
Meniere disease shows the triad of episodic vertigo, hearing loss, and tinnitus, often with ear fullness and a low-frequency upsloping curve on audiogram
Autoimmune sensorineural hearing loss is rapidly progressive, usually starts in one ear before turning bilateral, and favors young women
A temporal bone fracture from head injury can cause conductive or mixed sensorineural hearing loss
Aminoglycosides like gentamicin cause hair-cell death with permanent hearing loss and balance trouble, starting in the higher frequencies
Loop diuretics can cause an acute but fully reversible hearing loss by affecting the stria vascularis
Waardenburg syndrome is the most common syndromic cause, marked by pigment abnormalities of the eyes, skin, and cochlea alongside the hearing loss
Usher syndrome pairs progressive sensorineural hearing loss with visual loss from retinitis pigmentosa
Pendred syndrome combines hearing loss with vestibular dysfunction and a thyroid goiter
Jervell and Lange-Nielsen syndrome pairs hearing loss with a prolonged QT interval and a risk of syncope or sudden death
Alport syndrome combines bilateral high-frequency hearing loss with glomerulonephritis, kidney failure, and eye abnormalities, with blood and protein in the urine as it advances

SourceStatPearls "Sensorineural Hearing Loss" - disease-level clinical article

Presentation findings are traced to the source above.

1st line

Strength5 mg

Formoral.solid

Adult dose and duration

60 mg once daily in the morning with breakfast for 7-14 days, followed by a 5-day taper (e.g. 50, 40, 30, 20, 10 mg daily) x 12-19 days total

Paediatric dose

1-2 mg/kg/day [child max 60 mg]

(Child: 1-2 mg/kg once daily in morning (max 60 mg daily); urgent pediatric ENT emergency referral mandatory)

Dose source

AAO-HNS Sudden Hearing Loss Clinical Practice Guideline 2019

Why

OTOLOGIC EMERGENCY: high-dose oral corticosteroids must be initiated within 72 hours of symptom onset for maximum hearing recovery potential

Cautions

REQUIRES URGENT SAME-DAY ENT REFERRAL for audiometry and consideration of intratympanic steroid injection.
Monitor blood glucose closely (high risk of acute steroid-induced hyperglycemia).
Co-prescribe PPI gastroprotection during high-dose steroid therapy.
Contraindicated in active systemic fungal infections.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
HOSTACORTIN H 5MG 30 TAB.	SANOFI	12.00 EGP (0.40/unit)
PREDNISOLONE 5 MG 20 TABS.	ARAB DRUG COMPANY (ADCO)	24.00 EGP (1.20/unit)
PREDILONE 5MG 10 TAB. (25 STRIPS PACK)	KAHIRA	250.00 EGP (25.00/unit)
EPICOPRED 5 MG 30 ORODISPERSIBLE TABS.	EIPICO	69.00 EGP
PREDNISOLONE-EVA 5 MG 30 ORODISPERSIBLE TABS.	EVA PHARMA	79.50 EGP
DISPRELONE-OD 5 MG 30 ORODISPERSABLE TABS.	ANDALOUS PHARMA	84.00 EGP
SOLUPRED ORO 5 MG 30 ORODISPERSIBLE TABS.	SANOFI WINTHROP > SANOFI	84.00 EGP
ACETASEE 1% EYE DROPS (SUSP.) 5 ML? strength differs? different route - not oral solid	RAMEDA	7.50 EGP
PREDNIS 5MG/5ML SYRUP 100 ML? strength differs? different route - not oral solid	PHAROPHARMA	9.50 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.