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Review Article Volume 18 Issue 2
Sudden sensorineural hearing loss as a vascular event: labyrinthine infarction, stroke risk, and the limits of the idiopathic label
Anirudda Deshpande, Supriya Khardenavis, Vikram Khardenavis, Gayatri Godse
Received: August 03, 2026 | Published: October 5, 2026
Citation: Deshpande A, Khardenavis S, Khardenavis V, et al. Sudden sensorineural hearing loss as a vascular event: labyrinthine infarction, stroke risk, and the limits of the idiopathic label. J Otolaryngol ENT. 2026;18(2):81‒87. DOI: 10.15406/joentr.2026.18.00592
Abstract
Most cases of sudden sensorineural hearing loss are classified as idiopathic, and the classification has consequences: it directs treatment towards corticosteroids, closes the diagnostic question, and returns the patient to primary care with a hearing problem rather than a vascular one. The anatomy invites scrutiny of that position. The labyrinthine artery is functionally an end artery, arising in most people from the anterior inferior cerebellar artery, supplying tissue with a high metabolic demand and limited collateral reserve, so a lesion below the resolution of routine imaging may produce permanent cochlear damage. Sudden deafness is a documented manifestation of anterior inferior cerebellar artery infarction, and in a minority of patients in small series it preceded the brainstem event by days to weeks. The epidemiological literature linking sudden hearing loss to subsequent stroke is more heterogeneous than it is sometimes presented to be: positive cohort studies derive largely from Asian administrative datasets restricted to hospitalised patients, whereas a Dutch primary care cohort found no significant excess risk overall. This narrative review examines the anatomical, clinical and epidemiological strands separately and argues that they support a modest and probably age-dependent association rather than a demonstrated causal relationship. We draw particular attention to a problem of reverse inference: evidence derived from patients with established infarction cannot be inverted into a diagnostic rule for the much larger and more heterogeneous population presenting with sudden hearing loss. We propose, explicitly as an expert-opinion framework rather than a validated prediction rule, a tiered set of features that may warrant emergency stroke assessment, vascular imaging, or routine vascular risk assessment. Current guidance does recognise focal neurological findings and non-idiopathic causes including stroke; the more specific gap we identify is the absence of a structured pathway for evaluating sudden hearing loss as a possible isolated manifestation or marker of posterior circulation ischaemia.
Keywords: sudden sensorineural hearing loss, labyrinthine infarction, anterior inferior cerebellar arter, posterior circulation stroke, internal auditory artery, sudden deafness
©2026 Deshpande, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.