If one ear suddenly sounds like it’s under a pillow—or voices turned to muffled mumbling overnight—don’t wait and see. Some causes are harmless. Others need action now. This is your clear, supportive guide to what to do in the first hours and days, which treatments actually help, and how to protect your long-term hearing.

First, a friendly reality check: sudden hearing loss is urgent

Sudden sensorineural hearing loss (SSNHL) is a rapid drop in inner-ear hearing, usually in one ear, over hours to a couple of days. People often describe a “pop,” sudden fullness, ringing, or distortion, sometimes with dizziness. It’s a medical urgency because early treatment—especially steroids—can improve your chance of recovery.

Not every sudden change is SSNHL. Earwax, fluid behind the eardrum, or a head cold can also clog hearing. The catch? From the outside, they can feel the same. That’s why you want a same-day professional check to sort it out.

Why the clock matters

Think of inner-ear hair cells like delicate piano strings. When they’re shocked, inflamed, or starved of blood, they need help fast. Studies and clinical guidelines suggest the best treatment window is within about 48 hours, and still worthwhile up to two weeks. Beyond that, benefit declines, though “salvage” options may still help.

  • Best odds: Start steroids within 48 hours.
  • Still helpful: Up to 14 days, sometimes a bit longer.
  • Don’t self-diagnose or delay—getting an audiogram quickly is key.

What to do right now (the first 24–72 hours)

  • Seek urgent evaluation today. If you can’t see your primary care, call an ENT (ear, nose, and throat specialist) or go to urgent care or the ER, especially if you also have vertigo or new neurological symptoms.
  • Request a same-day hearing test. An audiologist can perform an audiogram and tympanometry to confirm whether the loss is sensorineural (inner ear) or conductive (outer/middle ear, like wax or fluid). This distinction drives treatment.
  • Skip DIY fixes. Don’t irrigate your ear, ear-candle, or push cotton swabs inside. You could worsen the problem or obscure the exam.
  • Bring your meds list and health history. Some treatments are adjusted if you have diabetes, stomach ulcers, or glaucoma.

Get emergency care immediately if you have sudden hearing loss with severe headache, facial weakness, double vision, confusion, or difficulty speaking. These can signal a neurological emergency.

How clinicians figure it out

Expect a quick but thorough workup:

  • Otoscopic exam: Checks for wax, infection, or eardrum issues.
  • Tuning fork tests: A rapid way to tell conductive vs sensorineural loss.
  • Audiogram and tympanometry: The gold standard to confirm degree and type of loss.
  • Blood tests or MRI: Sometimes ordered to look for rare causes (e.g., autoimmune issues or a vestibular schwannoma). These don’t delay starting treatment.

Proven treatments and when they’re used

Good news: We have therapies that can help many people, especially when started early.

Corticosteroids: the cornerstone

Steroids calm inflammation and swelling in the inner ear. They can be given two main ways:

  • Oral steroids (e.g., prednisone): Typically a high dose for several days, then a taper. Many clinicians start these same-day once SSNHL is confirmed or strongly suspected.
  • Intratympanic steroids (e.g., dexamethasone injected through the eardrum): Delivers medication directly to the inner ear. Useful if you can’t take oral steroids, if diabetes makes oral dosing tricky, or as an add-on when hearing doesn’t improve quickly.

Which is better? Head-to-head studies suggest both can work; some patients benefit most from a combination strategy. Your clinician will tailor the choice to your health profile and how quickly you present.

Common, usually temporary steroid side effects include jitteriness, sleep disturbance, increased appetite, and elevated blood sugar. Your care team can help manage these and weigh risks vs benefits.

Hyperbaric oxygen therapy (HBOT): an option for early or “salvage” care

HBOT involves breathing 100% oxygen in a pressurized chamber, which can boost oxygen delivery to the inner ear. Guidelines suggest HBOT may be offered within two weeks of onset, typically in combination with steroids, and as a salvage option up to about one month. Access varies by location; your ENT can advise whether it’s appropriate and available.

What usually doesn’t help

  • Decongestants and antihistamines: They can ease nasal symptoms but don’t fix SSNHL.
  • Routine antibiotics: Not helpful unless a bacterial infection is confirmed.
  • Antivirals alone: Evidence doesn’t support benefit for typical SSNHL.
  • Waiting it out: Some people recover spontaneously, but delaying proven treatment can reduce your odds.

What recovery looks like (and how to boost your odds)

Recovery is a spectrum. Many people regain some or even most of their hearing, especially with early treatment. Others are left with partial loss, distortion, or persistent tinnitus. Factors linked to better outcomes include milder initial loss, prompt steroid therapy, and younger age—but there are exceptions in both directions.

Your follow-up plan typically includes:

  • Repeat audiograms: Often at 1–2 weeks, then again around 4–6 weeks to track improvement.
  • Medication adjustments: Your team may add intratympanic steroids if early improvement is limited.
  • Lifestyle support: Prioritize sleep, hydration, balanced nutrition, and stress reduction—your inner ear likes a calm, well-oxygenated environment.

It’s normal to feel anxious or down when hearing suddenly changes. Lean on your support network, and consider counseling if you’re feeling stuck. Mental health care is part of hearing health.

If hearing doesn’t fully return: smart, modern rehab

If you’re left with residual loss, the right tools can make conversations click again—and quiet the ring.

Hearing devices that help when one ear is weaker

  • Conventional hearing aids: If there’s usable hearing in the affected ear, a tailored fitting can improve clarity and reduce listening effort.
  • CROS/BiCROS systems: If one ear can’t be aided, these systems route sound from the poorer side to the better ear so you don’t miss voices on your “bad side.”
  • Bone-conduction options: Wearable or implanted devices can transmit sound via skull vibrations, bypassing a damaged inner ear.
  • Cochlear implant evaluation: If the loss is profound and stable, some adults are excellent candidates for a cochlear implant in the affected ear. Implants can also help suppress tinnitus for many users.

Pro tip: Bring someone with you to your hearing appointments. Two sets of ears catch more details, and a familiar voice helps during device fine-tuning.

Tinnitus after SSNHL

Ringing or hissing often accompanies sudden loss. Helpful options include:

  • Amplification: Hearing aids can reduce tinnitus perception by restoring ambient sound.
  • Sound therapy: Gentle background sound (nature, fans, apps) can lower the contrast with the tinnitus, making it less intrusive.
  • Cognitive behavioral therapy (CBT): Strong evidence supports CBT to reduce tinnitus distress, even if loudness doesn’t change.

An audiologist can tailor a tinnitus plan to your needs and lifestyle.

What about causes—and prevention?

In many cases, the cause is never found (that’s common). Sometimes, contributors like viral triggers, autoimmune inner-ear disease, tiny vascular events, or profound noise exposure are suspected. While you can’t control everything, you can stack the deck in your favor:

  • Protect your ears: Keep loud exposures short, use properly rated earplugs, and give your ears recovery time.
  • Mind your heart-health basics: Manage blood pressure, blood sugar, cholesterol, and don’t smoke. Healthy blood vessels help inner-ear resilience.
  • Review medications with your clinician: If you take drugs with known ear risks, ask about monitoring plans and alternatives.
  • Act fast if symptoms recur: If the other ear ever changes suddenly, you now know the drill—seek same-day care.

The bottom line

If your hearing drops suddenly, favor action over anxiety. Same-day assessment, an audiogram, and early steroid therapy can be difference-makers. If residual loss remains, today’s hearing tech and tinnitus care are remarkably effective. You deserve clear sound and less struggle—reach out to an audiologist or ENT and get momentum on your side.

HearingAcademy note: This article is educational and does not replace personalized medical care. If you suspect sudden hearing loss, seek urgent in-person evaluation.

Further Reading

- Sudden Hearing Loss: The 72-Hour Treatment Playbook (What to Do Now) (Treatment) - 72 Hours Matters: Treating Sudden Hearing Loss Without Losing Time (Treatment) - Sudden Hearing Loss Needs Speed: Treatments and the Critical Window (Treatment) - Wake Up With a Muffled Ear? Treat Sudden Hearing Loss Like an Emergency (Hearing Loss)

Frequently Asked Questions

How can I tell if it’s earwax or sudden sensorineural hearing loss?

Both can feel like a plugged ear. Clues for wax or middle-ear fluid include a hollow, echoey voice and improvement when you move your jaw or swallow. SSNHL often comes with ringing and sound distortion. The only reliable way to tell is a same-day ear exam and audiogram, which are quick and painless.

Am I too late to treat if it’s been more than two weeks?

Earlier is best, but don’t give up. Some people still improve with intratympanic steroids or, in select cases, hyperbaric oxygen within the first month. Get evaluated—your clinician can review options and monitor for recovery even if the initial window has passed.

Can flying or a cold cause sudden hearing loss?

Flying and colds commonly cause temporary conductive issues (ear pressure or fluid) that usually resolve. Less commonly, a viral trigger or pressure change can coincide with inner-ear injury. Because symptoms overlap, it’s wise to get examined rather than assume it’s just congestion.

If my hearing doesn’t return, what’s next?

You still have strong options. Depending on your audiogram, you may benefit from a hearing aid, CROS/BiCROS system, bone-conduction device, or cochlear implant. An audiologist can also help with tinnitus care and communication strategies so conversations feel easy again.

References