WHEN A patient tells you that he lost his hearing last Wednesday at exactly 2:35 pm, the chances are that he did indeed have a truly sudden hearing loss. Further, if he is under 45, has never been dizzy or had hearing trouble before, the possibility that his hearing loss was caused by a break or tear in the membranous cochlea is reasonably good. The likelihood increases if, on that Wednesday, he first noticed the loss after hearing a loud "pop" or a marked roaring tinnitus, and if several weeks later the hearing loss disappears completely almost as suddenly as it began.
Other favorable but less secure diagnostic points should be given if (1) the patient's physical activity at the time could have caused an increase in intrathoracic or intracranial venous or cerebrospinal fluid (CSF) pressure, or (2) if more than a modest amount of alcohol was drunk beforehand.
Simmons FB. Theory of Membrane Breaks in Sudden Hearing Loss. Arch Otolaryngol. 1968;88(1):41–48. doi:10.1001/archotol.1968.00770010043009
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