Sudden Sensorineural Hearing Loss and Stroke: A Narrative Review of Pathophysiological Links, Clinical Evidence, and Diagnostic Implications

Background Sudden sensorineural hearing loss (SSNHL) has long been hypothesized as a potential early warning sign of posterior circulation stroke, yet the causal association and clinical implications remain highly controversial. Summary This narrative review synthesizes current peer-reviewed evidence on the pathophysiological links, epidemiological associations, diagnostic strategies, and integrated management of SSNHL and stroke. Current findings demonstrate that anatomical and pathophysiological overlaps support the biological plausibility of this association, which is predominantly mediated by the vertebrobasilar circulatory system. Shared vascular and prothrombotic factors, including dyslipidemia, hyperhomocysteinemia, and MTHFR gene polymorphisms, may further contribute to the observed association. Clinically, SSNHL may present as an initial manifestation of posterior circulation infarction in a small subset of patients, particularly those with accompanying neurological symptoms or multiple vascular risk factors; however, existing epidemiological data are inconsistent, and there is insufficient evidence to define SSNHL as an independent predictor of stroke in the general population. Key Messages This review concludes that risk stratification and interdisciplinary collaboration between otolaryngologists and neurologists are critical in clinical practice: for high-risk SSNHL patients, timely neurovascular evaluation is warranted to enable early detection of cerebrovascular disease, and future large-scale prospective cohort studies and combined audiological–neurological assessment models are needed to clarify the causal relationship and optimize clinical pathways.