Sudden hearing loss can be ischemic

Mort DJ, Bronstein AM. Sudden deafness; editorial review. Current Opinion in Neurology 19:1:February 2006 pp.1-3(My summary)The two major causes of sudden deafness are postviral and ischemic. If accompanied by vertigo, sudden hearing loss may be the first sign of AICA stroke-- others appear later. If you are lucky, you will see MRI changes in the AICA part of the cerebellum or the pons, but not if the ischemia is purely cochlear. The cochlear supply usually lacks collaterals. Lee and Baloh found that ten percent of patients with vertebrobasilar stroke had unilateral hearing loss, almost always with vertigo. Treatment with steroids has class I evidence for being a beneficial treatment--even if the cause turns out to be vascular. Usually tapering oral steroids are given, sometimes with pentoxifylline, and occassionally acyclovir or valacyclovir. LDL apheresis also has been tried but lacks convincing evidence.