A woman holding her hand behind her ear, as if to hear better.

Nine years ago, Richard Einhorn woke up in a hotel room at 5 a.m., "my head buzzing with a strange loud noise,” the 67-year-old New York City music composer recalled.

Startled, he jumped out of bed, and promptly fell over. “I couldn’t stand up, I was so dizzy,” he says.

He then realized that he'd lost all hearing on his right side. “I’d gone to bed with the A/C blaring," Einhorn recalls. "But I couldn’t hear it at all on my right side.”

Einhorn took a taxi to the nearest emergency room, where he was told that his symptoms pointed to a condition called sudden sensorineural hearing loss, or SSNHL.

This condition, sometimes also called sudden deafness, is an unexplained or rapid loss of hearing (one that's not due to a "noise trauma," such as an exploding firecracker or a gunshot right next to the ear).

Marked by inflammation of the inner ear, SSNHL traditionally affects only one ear. (Sudden hearing loss in both ears can occur, but it’s rare and usually due to a condition such as an autoimmune disease or a stroke.) As it was in Einhorn's experience, SSNHL may be accompanied by tinnitus (ringing of the ears) and vertigo.

More on Hearing Health

SSNHL strikes about 66,000 people in the U.S. every year, according to an American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNSF) clinical practice guideline published in August in the journal Otolaryngology—Head and Neck Surgery. 

Though it can develop at any age, SSNHL is most often seen in adults in their late 40s or early 50s. “It can be very scary for patients—it’s not only disorienting to not be able to hear, but with these symptoms, people worry they’re experiencing a life-threatening emergency such as a stroke,” explains Seth Schwartz, M.D., M.Ph., an otolaryngologist at the Virginia Mason Medical Center in Seattle and a co-author of the guideline.

Here’s what you need to know—and do—if you experience sudden hearing loss.

See Your Doctor Right Away

If you’re suddenly having trouble hearing out of one ear, it may be tempting to chalk it up to clogged ears from a respiratory infection or allergies, and assume it will get better on its own.

And about half of people with SSNHL regain at least some of the hearing in the affected ear spontaneously, according to the AAO-HNSF. This usually occurs within one to two weeks.

But prompt diagnosis and treatment can improve those odds, says Schwartz. “You always want to see your primary care physician within 24 to 48 hours,” he advises.

The first thing your doctor should do is check your ears to make sure there’s no physical reason for your sudden hearing loss, such as earwax blocking your ear canal, fluid in your ear, or a punctured eardrum.

He or she will also consider possible causes such as head trauma, exposure to certain chemotherapy drugs, or neurological diseases like multiple sclerosis. 

For about 90 percent of people, however, doctors aren’t able to pinpoint the trigger. “We have a lot of theories, including viral infections that attack the inner ear, or even mini strokes that temporarily cut off blood flow to the inner ear,” says Schwartz. “But right now, most of the time it’s still a mystery.” 

Some research suggests a link with metabolic syndrome—a cluster of conditions that include elevated blood pressure, blood sugar, and cholesterol, as well as a larger than normal waist circumference.

For instance, a 2015 study published in Otolaryngology—Head and Neck Surgery found that people with metabolic syndrome had a higher risk of developing sudden hearing loss than those who didn’t have it. And a 2018 study published in JAMA Otolaryngology Head and Neck Surgery found that people treated for SSNHL who also had metabolic syndrome had a lower recovery rate compared with those without the condition.

You May Need to See More Than One Doctor

If a physical exam reveals no obvious reason for your sudden hearing loss, your next step should be to see an audiologist, ideally within the next several days.

The audiologist will perform what's called pure-tone testing, where you listen for beeps while wearing earphones and raise your hand whenever you hear one. 

If the pure-tone test—a measure of how loud different pitches of sound need to be before you hear them—finds that you’ve lost at least 30 decibels of hearing in one ear in three consecutive frequencies, you'll be diagnosed with SSNHL.

“This drop would make it hard for you to hear conversational speech,” says Deborah Berndtson, Au.D., CCC-A, associate director of audiology practices at the American Speech-Language-Hearing Association (ASHA). 

And if you're also experiencing symptoms like dizziness—as do up to 60 percent of all people with sudden hearing loss, according to the AAO-HNSF review—your audiologist can perform tests such as electronystagmography (ENG).

For this test, small electrodes are placed on the skin around your eyes to measure your eye movements. This helps determine how well your vestibular system—which is connected to your inner ear and helps with balance—is working.  

Once you've been told you have SSNHL, see an ENT as soon as possible. He or she may have you undergo imaging tests such as MRI to look further for a physical cause, like a tumor that may have initially been missed.

(In rare instances, vestibular schwannomas, benign growths on the nerve that connects the ear to the brain, may be the cause of SSNHL.) 

Some doctors may also order lab tests to look for markers of autoimmune disorders or viruses.

Most of the time, this is unnecessary. But in some cases, there may be a specific reason—if, for example, you also have a bull's-eye rash and your physician wants to rule out Lyme disease, which may cause sudden hearing loss. 

Get Treated Right

Although sudden hearing issues may resolve on their own in about half of those who experience one—usually in those with mild to moderate SSNHL—experts can't currently predict who will be among them, according to the AAO-HNSF. We do know that the up to 60 percent of people with SSNHL who also have vertigo may have a poorer prognosis, however.

So talk to your doctor about the benefits, potential risks, and possible effectiveness of treatment. 

The gold standard for sudden hearing loss has been corticosteroids, says Erika Woodson, M.D., an otolaryngologist at the Cleveland Clinic.

These medications work by reducing the inflammation and swelling thought to cause symptoms like hearing loss and dizziness. 

For SSNHL, steroids may be given in pill form or as an injection into the eardrum. Both ways are equally effective, according to a 2011 randomized trial published in the Journal of the American Medical Association.

There’s also some research to suggest combining both forms may be slightly more effective than one alone: A 2016 study published in the journal Otolaryngology-Head and Neck Surgery found that about 78 percent of people who received steroid injections into the eardrum along with "systemic" steroids (oral and IV) recovered their hearing, compared with only about 60 percent of those who received only systemic steroids.  

However, when it comes to steroids overall for SSNHL, "this guideline points out that they may not be that helpful," Schwartz says.

And like all medications, they have their side effects. “Oral steroids have more side effects, like weight gain, mood changes, and trouble sleeping,” explains Woodson. “Since oral steroids can also cause high blood pressure or blood sugar, I also tend to avoid it in people with heart disease or in diabetics.”

If you and your doctor determine that steroids are a good option for you, you'll need to begin treatment fairly quickly. “We know that treatment is most effective if it’s started within two weeks of the onset of symptoms,” Schwartz says.

You may also want to ask your ENT about hyperbaric oxygen therapy (HBOT). This involves breathing pure oxygen in a special chamber as a way to boost oxygen to your ear and brain.

Studies on HBOT have been mixed, but some research suggests that doing it within two weeks of the onset of symptoms in combination with steroids or within four weeks in people who don’t respond to steroids may help people with SSNHL regain some lost hearing. The higher levels of oxygen may help repair any damage that has occurred to the inner ear, Schwartz says.

Some doctors also prescribe antiviral medications, but the AAO-HSNF doesn’t recommend routine use of these drugs because there’s no evidence of their benefit. 

Hearing Aids and More

If your hearing doesn’t improve within three months, your ENT can refer you back to an audiologist to get fitted for a hearing aid, or if your hearing loss is very severe, discuss the possibility of a cochlear implant, Schwartz says.

A cochlear implant is a small electronic device that is surgically implanted, that bypasses the damaged portions of your ear and stimulates your auditory nerve directly. 

For a hearing problem or tinnitus that lingers, your doctor may also recommend audiological rehabilitation, a multifaceted approach to improve your quality of life.

This may include everything from behavioral strategies (such as meditation for relaxation) to the use of assistive listening devices to training to help you maintain focus in noisy situations, according to the Hearing Loss Association of America.

Richard Einhorn, whose SSNHL wasn’t resolved by steroid treatment, ultimately turned to hearing aids for help. “Those first few weeks after I lost my hearing, while I was waiting for my hearing aid, were horrible: I literally could not hear anything on my right side,” he says. “The only way I could follow a conversation was to have people stand right by my left side, or if I was on the phone, to use a headset.”

For the last nine years, he has worn aids full-time. “They don’t solve all my problems, but now I can listen and compose music again, which is the most important thing to me,” he says.