“My ear’s blocked — I think it’s just wax”

Sudden, unilateral hearing loss over hours to days — with tinnitus and aural fullness, and WITHOUT pain, discharge or a wax history — is possible sudden sensorineural hearing loss (SSNHL), an ENT EMERGENCY, not wax. It is time-critical: urgent corticosteroid treatment works best started early (ideally within days; ENT UK 2018: benefit is limited beyond about 2 weeks), so the action is immediate referral to be seen within 24 hours by ENT or the emergency department (NICE NG98) for audiometry and steroids — NOT routine syringing, drops, or an olive-oil-and-wait plan, and "no pain" does not make it benign. Use simple discriminators where possible (Weber lateralises to the GOOD ear in sensorineural loss), and screen central red flags (focal neurology, severe vertigo/ataxia, sudden severe headache) that raise concern for a posterior-circulation stroke or cerebellopontine lesion needing emergency assessment. The examinable hidden agenda is minimisation ("just wax, not worried") masking a buried fear of "something in the brain" (a father’s stroke); screen the central features, address the fear, convey urgency without alarmism, and safety-net stroke red flags. SSNHL is treated with urgent (high-dose) corticosteroids, started by the specialist after audiometry, and benefits from EARLY treatment — ideally within days (ENT UK 2018: benefit is greatest when started early and is limited beyond about 2 weeks). Misattributing it to wax and booking routine syringing wastes the treatment window and can mean permanent deafness in that ear.