Multimodal biomarkers in idiopathic sudden sensorineural hearing loss: integrating immune, vascular, and metabolic perspectives for precision medicine.

Idiopathic Sudden Sensorineural Hearing Loss (ISSNHL) is a common otological emergency driven by intertwined microcirculatory disorders, immune-inflammatory activation and metabolic dysregulation.This narrative overview collates representative published evidence to summarize research advances on hematological, immunological and metabolomic biomarkers, with a focus on their investigational-not yet clinically validated- diagnostic and prognostic potential. Key observational findings from existing cohorts are outlined as follows: (i) inflammatory and coagulation markers display promising discriminatory performance in single-center exploratory analyses, yet consistent cut-off values across populations remain absent; (ii) multi-indicator combined nomograms yield favorable predictive metrics within isolated research groups, though external multi-center validation is still required; (iii) exosomal molecules, complement C3, and other novel metabolic markers provide new analytical angles to interpret disease mechanisms and guide tentative individualized intervention research. Despite these preliminary observational results, widespread clinical translation is hindered by limited sample scales, non-uniform detection protocols and confounding comorbidities. Future multi-omics combined modeling aided by artificial intelligence may only serve as auxiliary stratification tools after rigorous prospective verification, rather than supporting definitive clinical classification at the current stage.This narrative collation merely offers preliminary analytical references for auxiliary clinical assessment and personalized research design of ISSNHL, without claiming validated diagnostic utility for routine practice.