Sudden Sensorineural Hearing Loss as the Presenting Symptom of Varicella Zoster Virus Rhombencephalitis: A Case Report

Sudden sensorineural hearing loss (SNHL) is an ENT emergency that requires prompt diagnosis and treatment. Most cases are thought to be idiopathic, and early oral steroid initiation is thought to increase the likelihood of recovery. MRI of the internal auditory meatus (IAM) is the imaging modality of choice, as retrocochlear pathology needs to be excluded. We report the case of a 54-year-old man who presented with left-sided sudden SNHL in the absence of any other symptoms. MRI IAM demonstrated inflammation in the posterior fossa (rhombencephalitis), prompting an urgent neurology referral. Lumbar puncture detected varicella zoster virus (VZV) encephalitis, and the patient was treated with intravenous acyclovir. He subsequently developed a vesicular rash weeks later. Follow-up MRI showed near-complete lesion resolution, and his hearing showed minor improvement. This case demonstrates how expedient MRI can detect unusual causes of sudden SNHL, enabling timely management and increasing the likelihood of resolution.