### What you need to know A 55 year old woman presented with difficulty in hearing from the left ear. She first noticed this when she found it difficult to hear her husband over dinner yesterday. She also described a feeling of dizziness, where the room spins around, and ringing in the left ear. She was otherwise well. Clinical examination revealed a normal tympanic membrane. Hearing loss affects 1 in 6 adults and has an enormous personal, social, and economic impact.1 Patients may be frightened by the sudden loss of hearing, and tinnitus can cause anxiety. Prompt diagnosis and management may improve hearing recovery.2 In this article, we review the assessment of sudden hearing loss in adults and provide an overview on initial diagnostic tests. A lack of specialist diagnostic tests within the primary care setting makes the condition challenging to diagnose, and an awareness and high index of suspicion are required when non-specialists are faced with a patient with acute hearing loss. Box 1 lists common causes of conductive and sensorineural hearing loss. Box 1 ### Common causes of adult onset hearing loss #### Conductive hearing loss Caused by any pathology in the external ear, tympanic membrane, middle ear air space, or ossicles, ie, structures that “conduct” sound waves to the cochlea: #### Sensorineural hearing loss Caused by abnormalities of the cochlea, auditory nerve, or other structures that translate neural impulses to the brain:RETURN TO TEXT