Idiopathic sudden sensorineural hearing loss remains one of the major unsolved otologic emergencies. In this paper the most important recent clinical literature is reviewed, a new method of clinical staging is presented, and unexplored potential treatrments are presented. The method of clinical staging presented here is based on four elements represented by the acronym HEAR. The individual elements of the staging are hearing threshold (H), elapsed time from onset (E.), audiogram shape (A), and related vestibular symptoms (R). Insufficiently explored potential treatments of sudden hearing loss include antiviral drugs, rheologic agents, and free radical scavengers.