Objective. Sudden hearing loss is a frightening symptom that often prompts an urgent or emergent visit to a health care provider. It is frequently, but not universally, accompanied by tinnitus and/or vertigo. Sudden sensorineural hearing loss affects 5 to 27 per 100,000 people annually, with about 66,000 new cases per year in the United States. This guideline update provides evidence-based recommendations for the diagnosis, management, and follow-up of patients who present with sudden hearing loss. It focuses on sudden sensorineural hearing loss in adult patients aged 18 and over and primarily on those with idiopathic sudden sensorineural hearing loss. Prompt recognition and management of sudden sensorineural hearing loss may improve hearing recovery and patient quality of life. The guideline update is intended for all clinicians who diagnose or manage adult patients who present with sudden hearing loss.

Purpose. The purpose of this guideline update is to provide clinicians with evidence-based recommendations in evaluating patients with sudden hearing loss and sudden sensorineural hearing loss, with particular emphasis on managing idiopathic sudden sensorineural hearing loss. The guideline update group recognized that patients enter the health care system with sudden hearing loss as a nonspecific primary complaint. Therefore, the initial recommendations of this guideline update address distinguishing sensorineural hearing loss from conductive hearing loss at the time of presentation with hearing loss. They also clarify the need to identify rare, nonidiopathic sudden sensorineural hearing loss to help separate those patients from those with idiopathic sudden sensorineural hearing loss, who are the target population for the therapeutic interventions that make up the bulk of the guideline update. By focusing on opportunities for quality improvement, this guideline should improve diagnostic accuracy, facilitate prompt intervention, decrease variations in management, reduce unnecessary tests and imaging procedures, and improve hearing and rehabilitative outcomes for affected patients.

Methods. Consistent with the American Academy of Otolaryngology–Head and Neck Surgery Foundation’s Clinical Practice Guideline Development Manual, Third Edition, the guideline update group was convened with representation from the disciplines of otolaryngology–head and neck surgery, otology, neurotology, family medicine, audiology, emergency medicine, neurology, radiology, advanced practice nursing, and consumer advocacy. A systematic review of the literature was performed, and the prior clinical practice guideline on sudden hearing loss was reviewed in detail. Key action statements (KASs) were updated with new literature, and evidence profiles were brought up to the current standard. Research needs identified in the original clinical practice guideline and data addressing them were reviewed. Current research needs were identified and delineated.

Results. The guideline update group made strong recommendations for the following: clinicians should distinguish sensorineural hearing loss from conductive hearing loss when a patient first presents with sudden hearing loss (KAS 1); clinicians should educate patients with sudden sensorineural hearing loss about the natural history of the condition, the benefits and risks of medical interventions, and the limitations of existing evidence regarding efficacy (KAS 7); and clinicians should counsel patients with sudden sensorineural hearing loss who have residual hearing loss and/or tinnitus about the possible benefits of audiological rehabilitation and other supportive measures (KAS 13). These strong recommendations were modified from the initial clinical practice guideline for clarity and timing of intervention.

目的。突发性听力丧失是一种可怕的症状，通常会促使紧急或紧急就诊于医疗保健提供者。经常（但不是普遍）伴有耳鸣和（或）眩晕。突发性感音神经性聋每年每10万人中有5～27人受累，在美国每年约有6.6万新发病例。本指南更新为突发性听力损失患者的诊断、处理和随访提供了循证建议。其重点关注18岁及以上成人患者的突发性感音神经性聋，主要关注特发性突发性感音神经性聋患者。及时识别和处理突发性感音神经性聋可能会改善听力恢复和患者生活质量。本指南更新适用于诊断或管理突发听力丧失成人患者的所有临床医生。

目的。本指南更新的目的是为临床医生在评估突发性听力丧失和突发性感音神经性听力丧失患者时提供循证建议，特别强调管理特发性突发性感音神经性听力丧失。指南更新组认识到，患者以突发性听力丧失为非特异性主诉进入医疗保健系统。因此，本指南更新的初步建议阐述了在出现听力损失时区分感音神经性听力损失和传导性听力损失。他们还阐明了识别罕见的非特发性突发性感音神经性聋的必要性，以帮助将这些患者与特发性突发性感音神经性聋患者区分开来，这些患者是大部分指南更新的治疗干预的目标人群。通过关注质量改进的机会，本指南应提高诊断准确性，促进及时干预，减少管理的变化，减少不必要的检查和成像程序，并改善受累患者的听力和康复结局。

方法。与美国耳鼻喉科学会-头颈外科基金会的临床实践指南开发手册第三版相一致，指南更新小组由来自耳鼻喉科-头颈外科、耳科、神经耳科、家庭医学、听力学、急救医学、神经学、放射学、高级实践护理和消费者倡导等学科的代表召集。对文献进行系统综述，并对以往关于突发性听力损失的临床实践指南进行了详细综述。使用新文献更新了关键行动声明 (KAS)，并使证据概况符合现行标准。对原始临床实践指南中确定的研究需求和解决这些需求的数据进行了审查。确定并描述了当前的研究需求。

结果。指南更新小组对以下内容提出了强烈建议：当患者首次出现突发性听力丧失 (KAS 1) 时，临床医生应区分感音神经性听力损失和传导性听力损失；临床医生应教育突发性感音神经性听力损失患者了解疾病的自然史、医疗干预的获益和风险以及关于疗效的现有证据的局限性 (KAS 7)；临床医生应向存在残余性听力损失和/或耳鸣的突发性感音神经性听力损失患者咨询听力学康复和其他支持性措施的可能获益 (KAS 13)。这些强烈建议是根据最初的临床实践指南修改的，以明确和确定干预时间。