QuestionSBA
QuestionChoice
While imaging is required to exclude a more sinister cause of sensorineural hearing loss, the most appropriate modality would be an MRI. In the first instance, however, steroids should be prescribed, and this is therefore the most appropriate first step to take.
10035989
c
Arrange a CT scan of the brain
QuestionChoice
This gentleman's clinical presentation and examination findings are consistent with sudden idiopathic sensorineural hearing loss. Imaging (an MRI of the cerebellopontine angle/acoustic meatus) should be undertaken to exclude a more serious pathology e.g. a space-occupying mass, however, the most appropriate next step is to initiate high-dose oral steroids as arranging a scan can take some time.
10035990
d
Arrange an MRI scan of the cerebellopontine angle and auditory meatus
QuestionChoice
This is inappropriate; the patient requires further work-up and management of his sensorineural hearing loss.
10035988
b
Discharge with reassurance and follow-up
QuestionChoice
This gentleman's clinical presentation and examination findings are consistent with sudden idiopathic sensorineural hearing loss. Imaging (an MRI of the cerebellopontine angle/acoustic meatus) should be undertaken to exclude a more serious pathology e.g. a mass, however the most appropriate next step is to initiate high-dose oral steroids.
10035987
a
Oral prednisolone
QuestionChoice
Pure tone audiometry would be more appropriate to assess this patient's hearing quantitatively; the otoacoustic emissions test is usually used in newborn hearing screening. In this scenario, the patient is likely suffering from idiopathic sudden-onset sensorineural hearing loss, for which steroids should be commenced.
10035991
e
Arrange an otoacoustic emissions test
Concept
Chapter
2693
4111
Sensorineural Hearing Loss
Topic
138
Ear, Nose & Throat
19601
First-line treatment options for idiopathic sudden idiopathic sensorineural hearing loss can include oral steroids, intra-tympanic steroid injections or a combination of both.
A 46-year-old man is referred to the emergency ENT clinic as he has been struggling to hear in his right ear for the past 3 days. He has no past medical history and takes no medications. He cannot think of any events that have precipitated this episode.

A full neurological examination and otoscopy are normal. He does not report any other symptoms.

The results of the initial screening are as follows:

Weber's test: Lateralises to the left ear
Rinne's test: Positive (air conduction > bone conduction) bilaterally.

What is the most appropriate next step in management?
a