Association of Systemic Hemodynamics and Endothelial Dysfunction With Clinical Phenotypes in Sensorineural Hearing Loss With Vertigo: A Cross-Sectional Analysis

Importance: Sensorineural hearing loss (SNHL) accompanied by vertigo is a condition with clinical heterogeneity. Understanding vascular underpinnings is crucial for management. Objective: To investigate the association of systemic hemodynamics and endothelial dysfunction with the distinct clinical manifestations of SNHL with vertigo. Design: A descriptive, hospital-based cross-sectional study. Setting: Department of Otolaryngology Head and Neck Surgery at a tertiary academic hospital. Participants: One hundred forty-two consecutive patients with SNHL and vertigo (disease duration ≤30 days) enrolled between January 2023 and October 2025. Intervention: Observational study; no intervention was performed. Main Outcome Measures: Pure-tone audiometry (PTA) including high-frequency thresholds (6-8 kHz), Dizziness Handicap Inventory (DHI), Tinnitus Evaluation Questionnaire, transcranial Doppler for mean flow velocity (Vm), and serum endothelin-1 (ET-1)/nitric oxide (NO). Linear regression analyzed associations. Results: Linear regression showed PTA was significantly predicted by higher ET-1 ( R 2 = .37, P < .001) and lower NO. DHI was predicted by lower Vm ( R 2 = .40, P < .001). High-frequency PTA (6-8 kHz) was significantly worse in the Hearing Loss-Dominant (HLD) group ( P < .001). The HLD group (n = 75) exhibited significantly higher ET-1 levels compared to the Vertigo-Dominant (VD) group (n = 67) (85.4 vs 73.1 pg/mL, P < .001). Conversely, the VD group showed a more pronounced reduction in Vm (33.2 vs 38.5 cm/s, P < .001). Multiple linear regression identified ET-1 as the strongest predictor for PTA and Vm for DHI score. Conclusions: Systemic hemodynamic compromise and endothelial dysfunction differentially associate with hearing and vestibular phenotypes. Cochlear symptoms may be driven by endothelial-mediated vasoconstriction, while vestibular symptoms are more sensitive to macrovascular flow reduction. Relevance: Vascular profiling could inform targeted therapeutic strategies.