Sudden hearing loss with vertigo or vertigo with sudden hearing loss: are we talking about the same thing? A clinical case study
DOI:
https://doi.org/10.51445/sja.auditio.vol10.2026.126Keywords:
Hipoacusia súbita, Hipoacusia súbita idiopática, Sordera súbita, Vértigo agudo, Síndrome vestibular agudo, Vértigo vascular, Mareo vascular, Síndrome antifosfolípifoAbstract
The concomitant presence of sudden hearing loss and acute vertigo/dizziness creates a conflict of approaches. The audiological approach considers it a presentation that implies a worse auditory prognosis. From this perspective, specific blood tests, a single MRI, and corticosteroid therapy are recommended. The otoneurological approach considers it a sign of focal neurological deficit with a high suspicion of vascular origin, requiring close monitoring, HINTS examination, gait and balance testing, and serial MRIs. The audiological approach underestimates the severity of the condition without assessing the need for vestibular testing and possibly overestimates the prevalence of sudden idiopathic hearing loss (SSHL). The otoneurological approach underestimates the therapeutic value of the auditory sequelae and the underlying etiology. A clinical example involving a patient with Antiphospholipid Syndrome shows that the acute audiovestibular symptoms can be the initial manifestation of a thrombotic systemic disease and allows us to discuss the implications of this difference in perspective. This can lead to inconsistent management that must be resolved to avoid errors. The combination of sudden hearing loss and acute vertigo requires that we move beyond the diagnosis of SSHL and that it be considered, regardless of MRI findings, as a warning sign of a vascular event.
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