Merck Manual

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Some Causes and Features of Sudden Hearing Loss

Some Causes and Features of Sudden Hearing Loss


Common Features*



Deafness in only one ear

No other symptoms

MRI using a contrast agent (gadolinium)

Obvious causes

Acute infection (such as bacterial meningitis, Lyme disease, mumps, or herpes simplex)

Deafness in one or both ears

In people with a serious, acute illness

Often headache and confusion

With Lyme disease, deafness preceded by a typical rash and flu-like symptoms

With mumps, pain in cheeks with swallowing

If not already done, blood tests and a spinal tap (lumbar puncture)

Deafness usually in only one ear

Sometimes fluid (bloody, blood-tinged, or clear) coming from the affected ear

CT and/or MRI

Pressure changes (as may occur during diving)

Deafness in one or both ears

Sudden onset during causative activity (for example, scuba diving, rapid descent in airplane) or after a blow to the ear

Sometimes accompanied by pain, an explosive sound, dizziness, or ringing in the ear

Tympanometry (placement of a device in the ear to measure how well sound passes through the ear)

Balance testing with electronystagmography (a test to record involuntary movements of the eye caused by a condition known as nystagmus)


Drugs that can damage the ear (ototoxic drugs), including

  • Aspirin

  • Aminoglycosides (such as gentamicin and tobramycin)

  • Vancomycin

  • Cisplatin

  • Furosemide

  • Ethacrynic acid

  • Quinine

Deafness in both ears

Sometimes dizziness and loss of balance

In people who recently started taking or have recently taken an ototoxic drug

A doctor's examination

Sometimes blood drug levels

Underlying disorders‡

Acoustic neuroma, a tumor of the auditory nerve

Deafness in only one ear

Often dizziness or a false sensation of spinning or moving (vertigo) and loss of balance

Sometimes drooping facial muscles and/or numbness of the face and taste abnormalities

MRI using a contrast agent (gadolinium)

Autoimmune disorders, such as some blood disorders, disorders that cause vasculitis, and Cogan syndrome

Deafness in one or both ears

Sometimes joint pains or a rash

Blood tests

Deafness in only one ear in about three fourths of people

Sometimes dizziness and/or ringing in the ear

MRI using a contrast agent (gadolinium)

Deafness in only one ear

Sometimes weakness or numbness that comes and goes and occurs in different parts of the body

MRI using a contrast agent (gadolinium)

Sometimes a spinal tap

Stroke (affecting the cerebellum)

Deafness in only one ear

Sometimes difficulty with balance or coordination

MRI using a contrast agent (gadolinium)

Reactivation of syphilis in people with HIV infection

Deafness in one or both ears

Sometimes risk factors for sexually transmitted diseases (such as unprotected sex, multiple partners)

Blood tests

Sometimes, spinal tap (lumbar puncture)

* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present. Features overlap between causes.

† Although a doctor's examination with an audiogram should always be done, it is only mentioned in this column if the diagnosis can sometimes be made only by the doctor's examination with an audiogram, without any additional testing. In other words, additional tests may not be needed.

‡ Rarely, sudden hearing loss is the first symptom of a disorder that usually has other symptoms first. Symptoms typical of these disorders may not be present at all. However, some people disregard mild symptoms that may be discovered by the doctor through careful questioning and examination.

CT = computed tomography; MRI = magnetic resonance imaging.