## Clinical Interpretation The audiogram shows a **sensorineural hearing loss (SNHL)** pattern: - Air conduction elevated (50–60 dB HL across frequencies) - Bone conduction normal (10 dB HL) - No air-bone gap - **Unilateral** presentation with **3-month duration** = **Sudden Sensorineural Hearing Loss (SSNHL)** ### Audiometric Findings | Parameter | Finding | Significance | |-----------|---------|---------------| | Air conduction (AC) | 50–60 dB HL | Elevated across frequencies | | Bone conduction (BC) | 10 dB HL (normal) | Preserved | | Air-bone gap | Absent | Confirms sensorineural origin | | Lateralization (Weber) | Left (normal) ear | Sound lateralizes away from affected (right) ear | | Duration | 3 months | Within typical SSNHL window (usually <3 months) | **Key Point:** SSNHL is defined as ≥30 dB hearing loss over ≥3 consecutive frequencies within ≤72 hours. This patient meets criteria and requires **urgent medical intervention**. ### Management Algorithm for SSNHL ```mermaid flowchart TD A[Unilateral SNHL within 72 hours]:::outcome --> B[Initiate oral corticosteroids immediately]:::action B --> C[Repeat audiometry in 2 weeks to assess response]:::action C --> D{Improvement?}:::decision D -->|Yes| E[Continue steroids, taper, and monitor]:::action D -->|No| F[Consider intratympanic steroid injection]:::action A --> G[MRI IAC protocol to exclude retrocochlear cause]:::action G --> H{Retrocochlear pathology?}:::decision H -->|Yes - e.g., acoustic neuroma| I[Refer to neurosurgery/neuro-otology]:::urgent H -->|No| J[Medical management as above]:::action J --> K[Audiologic follow-up and hearing aid if needed]:::outcome ``` **High-Yield:** The **gold standard management** of SSNHL is: 1. **Oral corticosteroids** (e.g., prednisone 1 mg/kg/day × 7–14 days, then taper) — must be started within **2 weeks** of onset (ideally within 72 hours) 2. **MRI brain with IAC protocol** to exclude retrocochlear lesions (acoustic neuroma, MS, etc.) 3. **Repeat audiometry in 2 weeks** to assess steroid response 4. **Intratympanic steroid injection** if inadequate response to oral steroids **Clinical Pearl:** Unilateral SNHL is retrocochlear (i.e., due to 8th nerve or brainstem pathology) until proven otherwise. MRI is mandatory to exclude acoustic neuroma, which presents with unilateral hearing loss and tinnitus in 5–10% of SSNHL cases. **Warning:** ~~Hearing aids alone~~ without steroid therapy delay recovery and miss the window for medical intervention. ~~Caloric testing~~ is not indicated unless there is associated vertigo or vestibular symptoms. ~~Cochlear implants~~ are premature — most patients recover hearing with steroids; implants are reserved for profound bilateral SNHL after medical management failure. 
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