Optimal Assessment of Vestibular Function for Predicting Clinical Outcomes in Patients Diagnosed with Sudden Deafness

Importance Sudden sensorineural hearing loss (SSNHL) is often accompanied by vestibular dysfunction, yet the relationship between patterns of peripheral vestibular organ involvement and hearing prognosis requires systematic evaluation. Clarifying this association is essential for guiding clinical assessment and prognosis. Objective To explore the prognostic value of vestibular function tests in patients with SSNHL by assessing the functional status of peripheral vestibular receptors. Design Retrospective cohort study. Setting Inpatient departments of Jiaxing Second Hospital and the Hospital of the China Coast Guard (September 2020 to September 2021). Participants A total of 76 inpatients with unilateral SSNHL were enrolled and divided into a vertigo group (n = 29) and a non-vertigo group (n = 47). Exposures or Interventions All patients underwent pure-tone audiometry (PTA), cervical vestibular-evoked myogenic potentials (cVEMP), ocular VEMP (oVEMP), video head impulse test, and caloric testing to assess peripheral vestibular involvement. Main Outcome Measures Hearing recovery, defined by improvement in PTA thresholds. Results Patients with vertigo had significantly-worse baseline PTA thresholds compared with those without vertigo [67.91 ± 31.67 degrees of hearing loss (dBHL) vs 54.98 ± 29.03 dBHL, P = .001]. Vestibular dysfunction was common, most frequently involving semicircular canal lesions (49/76), followed by abnormal cVEMP (41/76) and abnormal caloric testing (39/76). Univariate analysis showed that cVEMP, oVEMP, and caloric testing results were significantly associated with treatment outcomes (all P < .001), with the combined assessment of oVEMP and caloric testing demonstrating particular prognostic value ( P = .007). Multivariate logistic regression further identified vertigo (OR = 0.132), cVEMP abnormality (OR = 6.460), and oVEMP abnormality (OR = 0.147) as independent predictors of hearing prognosis (all P < .05). Conclusion Vestibular dysfunction reflects the extent of inner ear involvement in SSNHL, with semicircular canal impairment being the most common, followed by saccular and utricular lesions. Combined oVEMP and caloric testing appears to be an optimal approach for evaluating vestibular function and predicting hearing prognosis. Relevance This study supports the integration of multiple vestibular assessments to more comprehensively characterize inner ear involvement in SSNHL and to provide clinicians with reliable prognostic reference tools.