Sudden hearing loss is a medical emergency, and treatment works best when started within 72 hours of symptoms appearing. The standard first-line treatment is a course of oral corticosteroids, typically lasting about two weeks. About half of people with sudden sensorineural hearing loss recover some or all of their hearing on their own within one to two weeks, but delaying treatment significantly reduces the chances of full recovery for those who need it.
Why the First 72 Hours Matter
Sudden sensorineural hearing loss (SSHL) is clinically defined as a drop of 30 decibels or more across at least three connected sound frequencies, happening within three days. To put that in perspective, 30 decibels is roughly the difference between a normal conversation and a whisper. It usually affects only one ear.
The 72-hour window is critical. Starting treatment within that timeframe gives you the strongest chance of recovering your hearing. After that window closes, the likelihood of full recovery drops considerably. If you wake up with muffled hearing in one ear, or notice it disappear over the course of a few hours, don’t wait to see if it resolves on its own. Get to a doctor the same day if possible.
Many people initially assume the problem is earwax, allergies, or a cold, which delays treatment. One simple way to check: hold a phone to each ear separately. If one side sounds noticeably quieter or distorted, that points toward sensorineural loss rather than simple congestion.
Oral Steroids as First-Line Treatment
High-dose oral corticosteroids are the primary treatment. A typical course runs about 14 days: seven days at full dose, followed by a gradual taper over the next seven days. The goal is to reduce inflammation and swelling in the inner ear, which is thought to be a key driver of the hearing loss in many cases.
Current clinical guidelines from the American Academy of Otolaryngology recommend offering corticosteroids as initial therapy to patients within two weeks of symptom onset. The guidelines also explicitly recommend against routinely prescribing antivirals, blood thinners, or blood-vessel-dilating drugs, as none of these have shown reliable benefit for sudden hearing loss.
Steroids can cause short-term side effects like trouble sleeping, increased appetite, mood changes, and elevated blood sugar. For people with diabetes or other conditions where steroids are risky, there’s an alternative: injections delivered directly into the middle ear.
Steroid Injections Through the Eardrum
When oral steroids aren’t an option, or when a first round of oral steroids hasn’t worked, doctors can inject a steroid solution directly through the eardrum into the middle ear. This is called intratympanic injection, and it delivers medication right where it’s needed while minimizing effects on the rest of the body.
The procedure is done in an office setting. You lie on your back with your head turned to one side. The doctor numbs the eardrum with a local anesthetic, then uses a small needle to inject the medication through it. The whole process takes only a few minutes per session, and it’s typically repeated every two days for a total of about four sessions.
In one clinical study, about 35% of patients who received these injections saw meaningful hearing improvement, with gains ranging from 16 to 54 decibels. That’s a significant recovery for some patients, though it also means the majority didn’t respond. These injections are most commonly used as “salvage therapy,” meaning they’re tried after oral steroids have failed to produce results.
Hyperbaric Oxygen Therapy
Hyperbaric oxygen therapy, where you breathe pure oxygen in a pressurized chamber, is sometimes used alongside steroids. The idea is that flooding the body with oxygen helps heal the delicate structures of the inner ear, which have limited blood supply and are vulnerable to oxygen deprivation.
Clinical guidelines suggest considering hyperbaric oxygen for patients with moderate to severe hearing loss (greater than 40 decibels) when combined with steroid therapy. It works best when started within two weeks of symptom onset. Even patients who’ve failed an initial course of steroids can sometimes benefit from combining intratympanic injections with hyperbaric oxygen as late as ten weeks after symptoms began.
Hyperbaric oxygen isn’t available everywhere, typically requiring a specialized facility. Sessions usually run 60 to 90 minutes, and a full course may involve 10 to 20 sessions. It’s not a standalone treatment for sudden hearing loss but rather an add-on that may improve outcomes when paired with steroids.
Tests Your Doctor Will Order
The first step is a hearing test (audiogram) to confirm sensorineural loss and measure its severity across different frequencies. Your doctor also needs to distinguish sensorineural loss, which involves the inner ear or auditory nerve, from conductive loss, which involves blockages or problems in the outer or middle ear. The distinction matters because the treatments are completely different.
Routine blood tests and CT scans are not recommended for the initial workup. However, an MRI may be ordered to rule out an acoustic neuroma, a benign tumor on the nerve connecting the inner ear to the brain. These tumors are an uncommon but important cause of sudden hearing loss, and MRI is far more sensitive than CT for detecting them. Sudden hearing loss is sometimes the first sign that leads to an acoustic neuroma diagnosis.
What Recovery Looks Like
Recovery varies widely. About half of people regain some or all hearing spontaneously within one to two weeks, even without treatment. For the other half, medical intervention can make a meaningful difference, but there are no guarantees. Younger patients and those with less severe initial loss tend to have better outcomes. Hearing loss accompanied by severe dizziness or vertigo generally carries a worse prognosis.
Recovery doesn’t always mean a return to perfect hearing. Some people regain most of their hearing but are left with residual symptoms like tinnitus (ringing or buzzing) or a persistent feeling of fullness in the affected ear. Others recover hearing at some frequencies but not others, which can make speech sound distorted even when overall volume improves.
For those with lasting hearing loss, audiologic rehabilitation is an important next step. This can include hearing aids fitted to compensate for the specific frequencies affected, or in cases of profound loss in one ear, a device that routes sound from the affected side to the better ear. Counseling and support groups can also help with the psychological adjustment, particularly for people dealing with persistent tinnitus alongside their hearing loss.