BACKGROUND: Sudden Sensorineural Hearing Loss (SSNHL) is an otologic emergency characterized by a rapid decrease in hearing threshold. The etiology of SSNHL is often unclear, with potential links to vascular pathologies. This study investigates the association between white matter lesions (WMLs) observed in brain MRI and cardiovascular risk factors in SSNHL patients. METHODS: This case-control study involved 34 SSNHL patients and 34 matched controls, none of them had migraine. Both groups underwent pure tone audiometry and brain MRI. WMLs were assessed using the Fazekas scale. Cardiovascular risk factors, including hypertension, diabetes, dyslipidemia, BMI, and smoking, were documented. RESULTS: While none of the cardiovascular risk factors showed a significant difference between the two groups, the presence of WMLs was significantly higher in the SSNHL group compared to controls (79.4 % vs. 32.4 %
p <
0.001). More specifically, 24 patients (70.6 %) and 10 controls (29.4 %) had periventricular white matter (PVWM) lesions, while 20 patients (58.8 %) and 8 controls (23.5 %) had deep white matter (DWM) lesions. Logistic regression analysis revealed that increased grades of PVWM lesions were associated with a 5.7-fold higher likelihood of moderate or greater hearing loss (p = 0.033). The degree of DWM lesions, according to the Fazekas scale, demonstrated a significant correlation with hearing recovery rate. CONCLUSION: White matter lesions (WMLs) are significantly associated with sudden sensorineural hearing loss (SSNHL), with higher grades of PVWM lesions increasing the likelihood of severe hearing loss and DWM lesions correlating with hearing recovery. These associations seem to be independent of cardiovascular risk factors.