Evaluation of hearing loss

Last reviewed: 14 Apr 2025
Last updated: 16 Jul 2024

Summary

Differentials

Common

  • Cerumen impaction
  • Foreign body
  • Benign tumors (e.g., exostosis, osteoma, polyps)
  • Uncomplicated otitis externa
  • Acute otitis media
  • Otitis media with effusion
  • Cholesteatoma
  • Labyrinthitis
  • Noise-related hearing loss
  • External ear canal trauma
  • Complication of meningitis
  • Stroke
  • Presbycusis
Full details

Uncommon

  • External ear canal neoplasm
  • Necrotizing otitis externa
  • Tympanic membrane perforation
  • Temporal bone fracture
  • Isolated developmental abnormality
  • Congenital hearing loss
  • Alport syndrome
  • Jervell Lange-Nielsen syndrome
  • Craniofacial abnormalities (e.g., Pierre Robin, Crouzon, Apert syndromes)
  • Waardenburg syndrome
  • Acoustic neuroma (vestibular schwannoma)
  • Glomus tumor
  • Cytomegalovirus (CMV) infection
  • Toxoplasmosis infection
  • Syphilis infection
  • Paget disease
  • Systemic lupus erythematosus (SLE)
  • Granulomatosis with polyangiitis (formerly known as Wegener granulomatosis)
  • Diabetes mellitus
  • Osteogenesis imperfecta
  • Vertebral artery dissection
  • Multiple sclerosis (MS)
  • Arnold-Chiari malformation
  • Auditory neuropathy
  • Idiopathic sudden sensorineural hearing loss
  • Ototoxic drugs
  • Meniere disease
  • Neonatal hyperbilirubinemia
  • Otosclerosis
  • Autoimmune inner ear disease
  • Perilymphatic fistula
Full details

Contributors

Authors

Seth R. Schwartz, MD, MPH

Otolaryngologist (Otology/Neurotology)

Department of Otolaryngology

Virginia Mason Medical Center

Medical Director

The Listen for Life Center at Virginia Mason

Seattle

WA

Disclosures

SRS is an author of a reference cited in this topic.

Acknowledgements

Dr S.R. Schwartz would like to gratefully acknowledge Dr S.J. Marzo, Dr J.P. Leonetti, and Dr R.J. Buckingham, previous contributors to this topic. SJM, JPL, and RJB declare that they have no competing interests.

Peer reviewers

Alan Micco, MD, FACS

Assistant Professor

Department of Otolaryngology

Department of Neurosurgery

Northwestern University Feinberg School of Medicine

Chicago

IL

Disclosures

AM declares that he has no competing interests.

George Browning, MD ChB FRCS (Ed & Glasg)

Professor of Otorhinolaryngology

MRC Institute of Hearing Research

Glasgow

UK

Disclosures

GB is an author of several books that include discussion of evaluation of hearing loss.

References

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Key articles

Chandrasekhar SS, Tsai Do BS, Schwartz SR, et al. Clinical Practice Guideline: Sudden Hearing Loss (Update). Otolaryngol Head Neck Surg. 2019 Aug;161(1_suppl):S1-S45.Full text  Abstract

Schwartz SR, Magit AE, Rosenfeld RM, et al. Clinical practice guideline (update): earwax (cerumen impaction). Otolaryngol Head Neck Surg. 2017 Jan;156(1 Suppl):S1-29. Abstract

Tsai Do BS, Bush ML, Weinreich HM, et al. Clinical practice guideline: age-related hearing loss. Otolaryngol Head Neck Surg. 2024 May;170 Suppl 2:S1-54.Full text  Abstract

American College of Radiology. ACR Appropriateness Criteria: hearing loss and/or vertigo. 2018 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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