Sudden sensorineural hearing loss: when is it idiopathic?

Objective: To highlight the importance of assessing the certainty of a diagnosis of idiopathic sudden sensorineural hearing loss, and of modifying patient management accordingly. Case report: A patient presented with sudden sensorineural hearing loss in the right ear. Following assessment and preliminary investigation, a diagnosis of idiopathic sudden sensorineural hearing loss was made. Steroid treatment was commenced. Two weeks later, the patient experienced sudden sensorineural hearing loss in the left ear, and scalp tenderness. Subsequent biopsy confirmed giant cell arteritis. Conclusions: Management of idiopathic sudden sensorineural hearing loss should be guided by the level of certainty of diagnosis. If there is relative uncertainty, risk factors for specific diagnoses should be sought, the patient should be followed more closely, and investigation should be tailored appropriately. Giant cell arteritis should be considered in patients older than 50 years, those exhibiting suggestive signs or symptoms, and those with elevated inflammatory markers or deranged liver function tests.