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 (R2 = .37, P < .001) and lower NO. DHI was predicted by lower Vm (R2 = .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.