Braz J Otorhinolaryngol. 2026 Nov 4;93(1):101903. doi: 10.1016/j.bjorl.2026.101903. Online ahead of print.

ABSTRACT

OBJECTIVE: To develop evidence-based Brazilian clinical practice recommendations for the evaluation and management of sudden hearing loss, with emphasis on idiopathic sudden sensorineural hearing loss.

METHODS: A multidisciplinary Brazilian taskforce composed of otolaryngologists, otologists, and neurotologists was convened by the Brazilian Association of Otorhinolaryngology and Cervico-Facial Surgery and the Brazilian Society of Otology. Each clinical statement was supported by a focused systematic literature review addressing a predefined clinical question. Reviews were conducted according to PRISMA methodology and structured using the PICOS framework. Evidence was synthesized by the panel, and recommendations were formulated considering aggregate evidence quality, benefits and harms, patient preferences, costs, availability of diagnostic and therapeutic resources, and applicability to the Brazilian healthcare context.

RESULTS: Fifteen clinical statements were developed. The guideline recommends early differentiation between conductive and sensorineural hearing loss, recognition of atypical presentations, prompt audiometric confirmation, selective use of computed tomography, magnetic resonance imaging for retrocochlear evaluation, and avoidance of routine laboratory and genetic testing in typical adult-onset idiopathic cases. Systemic corticosteroids, intratympanic corticosteroids, or a combination of both are recommended as initial treatment, while hyperbaric oxygen therapy may be considered in selected patients. Intratympanic corticosteroids are also recommended as salvage therapy. Routine use of antivirals, thrombolytics, vasodilators, vasoactive substances, immunosuppressive agents, immunobiological therapies, neurotrophic factors, stem cell therapies, and other biological agents is not recommended outside specific indications or research settings. Auditory rehabilitation counseling and structured audiometric follow-up are recommended.

CONCLUSION: This Brazilian guideline provides practical, evidence-based recommendations to standardize the diagnosis, treatment, rehabilitation, and follow-up of patients with sudden hearing loss, aiming to improve timely care and reduce unnecessary interventions.

PMID:42981831 | DOI:10.1016/j.bjorl.2026.101903