Emergency Department Sudden Deafness: Clinical Features and Predictors of Advanced Imaging

Background: Sudden sensorineural hearing loss (SSNHL) is an otologic emergency that requires immediate evaluation and treatment. Recognizing presentation patterns and the use of imaging in emergency settings can improve diagnostic efficiency. Objective: To describe the demographic characteristics, clinical features, comorbidities, and factors predicting advanced imaging in patients presenting to the emergency department with sudden hearing loss in Mersin, Turkey. Methods: This retrospective analysis reviewed 2462 consecutive patients who presented to the emergency department with sudden hearing loss between 2022 and 2025. Data collected included the affected side of hearing loss, associated symptoms (tinnitus, vestibular dysfunction, and nausea), comorbidities (diabetes, hypertension, and infection), laboratory abnormalities (hypercholesterolemia, hyperlipidemia, and polycythemia), imaging studies (MRI and CT), and treatment options. Results: The cohort included 2462 patients. Unilateral hearing loss was the most common (75.8%), with left-sided cases slightly more frequent (50.9%) than right-sided (24.9%). Bilateral cases occurred in 24.2% of patients. Tinnitus was the most common associated symptom (77.9%), followed by balance problems (32.0%) and nausea (18.0%). At least 1 comorbidity was present in 43.5% of patients, with hypertension being the most common (22.0%), followed by infection (20.0%) and diabetes (10.0%). Dyslipidemia affected 30.0% of patients. Advanced imaging with MRI was performed in 64.9%, while CT scans were used in 20.0%. Patients with any comorbidity had slightly higher MRI use rates (66.1%) compared with those without (64.1%). Medical treatment alone was given to 99.6% of patients, with only 0.4% receiving additional hyperbaric oxygen therapy. Conclusion: This large emergency department cohort shows that sudden hearing loss primarily affects 1 ear, with a slight leftward bias. The high rates of tinnitus, vestibular symptoms, and cardiovascular comorbidities highlight the multifactorial nature of this condition. MRI imaging was used in about two-thirds of patients, with slight variation based on the patients’ comorbidity burden. These findings offer insights into presentation patterns and help guide clinical decisions in the emergency management of sudden hearing loss in a Mediterranean population.