A young patient suffers from hearing loss in both ears following a traumatic head injury sustained in a skateboarding accident. What is the diagnosis? Sudden hearing loss after trauma can be caused by several problems—one is simple: blood in the ear canals. Lacerations around the ear and scalp cause blood to run into the ear canal and coagulate, blocking sound and leading to conductive hearing loss. Another cause is a temporal bone fracture, which may lead to a leakage of cerebrospinal fluid in the ear canal or a destruction of the cochlea and nerves of hearing. Most often sudden hearing loss is not described as a hearing loss but a feeling of fullness or pressure. Many times this leads to a misdiagnosis of the cause of the hearing loss and the assumption of middle ear fluid or infection. This is often treated with antibiotics which are ineffective for cochlear damage. Sudden hearing loss needs to be evaluated and treated aggressively during the first two weeks of the onset of symptoms and immediately if following a traumatic injury.