Is there a relation between sudden sensorineural hearing loss and white matter lesions?

  • Massimo Fusconi
  • Giuseppe Attanasio
  • Flavia CapitaniEmail author
  • Edoardo Di Porto
  • Davide Diacinto
  • Isotta Musy
  • Massimo Ralli
  • Giovanni Ralli
  • Antonio Greco
  • Marco de Vincentiis
  • Claudio Colonnese



Sudden sensorineural hearing loss (SSNHL) has similarities to conditions with vascular etiologies such as myocardial infarction and cerebral stroke. Thus, it could be considered as an early sign of a vascular disease and not only a specific local condition. Chronic hypoperfusion in the brain districts leads to a chronic ischemic damage, called cerebral small vessel disease (CSVD), detectable with brain magnetic resonance imaging (MRI).


The authors used CSVD to establish the presence of vascular risk factors in individuals with SSNHL and used the Fazekas score scale to classify them.


Our study showed that individuals with SSNHL aged between 48 and 60 years have 26% more probability to have a Fazekas score higher than 1 compared to the general population. Individuals younger than 28 years showed a statistically significant negative correlation to have a Fazekas score higher than 0. The higher is the Fazekas score, the less is the probability of hearing recovery. The medium hearing-recovery probability is 46%. This decreases by 16% for every increase of score in the Fazekas scale. In the present study, the recovery probability decreased from 80% in individuals younger than 48 years with a score of 0 to 14% in individuals with a Fazekas scores of 3 and 4.


The authors assessed a higher prevalence of CSVD compared to the general population in patients aged between 48 and 60 years with SSNHL. Moreover, they assessed that the presence of CSVD is related to a decreased probability of recovery, as it has already been demonstrated for stroke.


Sudden sensorineural hearing loss Cerebral gliosis Brain MRI Vascular risk factors Recover probability 



This study was performed without funding.

Compliance with ethical standards

Conflict of interest

All the authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Chau JK, Lin JR, Atashband S, Irvine RA, Westerberg BD (2010) Systematic review of the evidence for the etiology of adult sudden sensorineural hearing loss. Laryngoscope 120(5):1011–1021. Google Scholar
  2. 2.
    Fusconi M, Chistolini A, de Virgilio A, Greco A, Massaro F, Turchetta R, Benincasa AT, Tombolini M, de Vincentiis M (2012) Sudden sensorineural hearing loss: a vascular cause? Analysis of prothrombotic risk factors in head and neck. Int J Audiol 51(11):800–805. CrossRefGoogle Scholar
  3. 3.
    Lin RJ, Krall R, Westerberg BD, Chadha NK, Chau JK (2012) Systematic review and meta-analysis of the risk factors for sudden sensorineural hearing loss in adults. Laryngoscope 122(3):624–635. CrossRefGoogle Scholar
  4. 4.
    Koo M, Hwang JH (2015) Risk of sudden sensorineural hearing loss in patients with common preexisting sensorineural hearing impairment: a population-based study in Taiwan. PLoS One 10(3):e0121190. CrossRefGoogle Scholar
  5. 5.
    Suckfull M, Wimmer C, Reichel O, Mees K, Schorn K (2002) Hyperfibrinogenemia as a risk factor for sudden hearing loss. Otol Neurotol 23(3):309–311CrossRefGoogle Scholar
  6. 6.
    Ralli M, Altissimi G, Di Stadio A, Mazzei F, Turchetta R, Cianfrone G (2017) Relationship between hearing function and myasthenia gravis: a contemporary review. J Int Med Res 45(5):1459–1465. CrossRefGoogle Scholar
  7. 7.
    Di Stadio A, Dipietro L, Ralli M, Meneghello F, Minni A, Greco A, Stabile MR, Bernitsas E (2018) Sudden hearing loss as an early detector of multiple sclerosis: a systematic review. Eur Rev Med Pharmacol Sci 22(14):4611–4624. Google Scholar
  8. 8.
    Mancini P, Atturo F, Di Mario A, Portanova G, Ralli M, De Virgilio A, de Vincentiis M, Greco A (2018) Hearing loss in autoimmune disorders: prevalence and therapeutic options. Autoimmun Rev 17(7):644–652. CrossRefGoogle Scholar
  9. 9.
    Ciorba A, Hatzopoulos S, Bianchini C, Iannini V, Rosignoli M, Skarzynski H, Aimoni C (2015) Idiopathic sudden sensorineural hearing loss: cardiovascular risk factors do not influence hearing threshold recovery. Acta Otorhinolaryngol Ital 35(2):103–109Google Scholar
  10. 10.
    Alford BR, Shaver EF, Rosenberg JJ, Guilford FR (1965) Physiologic and histopathologic effects of microembolism of the internal auditory artery. Ann Otol Rhinol Laryngol 74(3):728–748. CrossRefGoogle Scholar
  11. 11.
    Jaffe BF (1975) Hypercoagulation and other causes of sudden hearing loss. Otolaryngol Clin N Am 8(2):395–403Google Scholar
  12. 12.
    Gussen R (1976) Sudden deafnfess of vascular origin: a human temporal bone study. Ann Otol Rhinol Laryngol 85(1 Pt 1):94–100. CrossRefGoogle Scholar
  13. 13.
    Ullrich H, Kleinjung T, Steffens T, Jacob P, Schmitz G, Strutz J (2004) Improved treatment of sudden hearing loss by specific fibrinogen aphaeresis. J Clin Apher 19(2):71–78. CrossRefGoogle Scholar
  14. 14.
    Lin HC, Chao PZ, Lee HC (2008) Sudden sensorineural hearing loss increases the risk of stroke: a 5-year follow-up study. Stroke 39(10):2744–2748. CrossRefGoogle Scholar
  15. 15.
    Kuo CL, Shiao AS, Wang SJ, Chang WP, Lin YY (2016) Risk of sudden sensorineural hearing loss in stroke patients: a 5-year nationwide investigation of 44,460 patients. Med (Baltimore) 95(36):e4841. CrossRefGoogle Scholar
  16. 16.
    Redleaf MI, Bauer CA, Gantz BJ, Hoffman HT, McCabe BF (1995) Diatrizoate and dextran treatment of sudden sensorineural hearing loss. Am J Otol 16(3):295–303Google Scholar
  17. 17.
    Rajati M, Azarpajooh MR, Mouhebati M, Nasrollahi M, Salehi M, Khadivi E, Nourizadeh N, Hashemi F, Bakhshaee M (2016) Is sudden hearing loss associated with atherosclerosis? Iran J Otorhinolaryngol 28(86):189–195Google Scholar
  18. 18.
    Kano K, Tono T, Ushisako Y, Morimitsu T, Suzuki Y, Kodama T (1994) Magnetic resonance imaging in patients with sudden deafness. Acta Otolaryngol Suppl 514:32–36CrossRefGoogle Scholar
  19. 19.
    Oron Y, Elgart K, Marom T, Roth Y (2014) Cardiovascular risk factors as causes for hearing impairment. Audiol Neurootol 19(4):256–260. CrossRefGoogle Scholar
  20. 20.
    Aimoni C, Bianchini C, Borin M, Ciorba A, Fellin R, Martini A, Scanelli G, Volpato S (2010) Diabetes, cardiovascular risk factors and idiopathic sudden sensorineural hearing loss: a case–control study. Audiol Neurootol 15(2):111–115. CrossRefGoogle Scholar
  21. 21.
    Agrawal Y, Platz EA, Niparko JK (2009) Risk factors for hearing loss in US adults: data from the National Health and Nutrition Examination Survey, 1999 to 2002. Otol Neurotol 30(2):139–145. CrossRefGoogle Scholar
  22. 22.
    Fisch U, Dobozi M, Greig D (1972) Degenerative changes of the arterial vessels of the internal auditory meatus during the process of aging. A histological study. Acta Otolaryngol 73(2):259–266CrossRefGoogle Scholar
  23. 23.
    Kidwell CS, Rosand J, Norato G, Dixon S, Worrall BB, James ML, Elkind MS, Flaherty ML, Osborne J, Vashkevich A, Langefeld CD, Moomaw CJ, Woo D (2017) Ischemic lesions, blood pressure dysregulation, and poor outcomes in intracerebral hemorrhage. Neurology 88(8):782–788. CrossRefGoogle Scholar
  24. 24.
    Wardlaw JM, Smith C, Dichgans M (2019) Small vessel disease: mechanisms and clinical implications. Lancet Neurol 18(7):684–696. CrossRefGoogle Scholar
  25. 25.
    Hainsworth AH (2019) White matter lesions in cerebral small vessel disease: underperfusion or leaky vessels? Neurology 92(15):687–688. CrossRefGoogle Scholar
  26. 26.
    Li Q, Yang Y, Reis C, Tao T, Li W, Li X, Zhang JH (2018) Cerebral small vessel disease. Cell Transplant 27(12):1711–1722. CrossRefGoogle Scholar
  27. 27.
    Abraham HM, Wolfson L, Moscufo N, Guttmann CR, Kaplan RF, White WB (2016) Cardiovascular risk factors and small vessel disease of the brain: blood pressure, white matter lesions, and functional decline in older persons. J Cereb Blood Flow Metab 36(1):132–142. CrossRefGoogle Scholar
  28. 28.
    Ciorba A, Bianchini C, Crema L, Ceruti S, Ermili F, Aimoni C, Pelucchi S (2019) White matter lesions and sudden sensorineural hearing loss. J Clin Neurosci 65:6–10. CrossRefGoogle Scholar
  29. 29.
    Fazekas F, Wardlaw JM (2013) The origin of white matter lesions: a further piece to the puzzle. Stroke 44(4):951–952. CrossRefGoogle Scholar
  30. 30.
    Schmidt R, Schmidt H, Haybaeck J, Loitfelder M, Weis S, Cavalieri M, Seiler S, Enzinger C, Ropele S, Erkinjuntti T, Pantoni L, Scheltens P, Fazekas F, Jellinger K (2011) Heterogeneity in age-related white matter changes. Acta Neuropathol 122(2):171–185. CrossRefGoogle Scholar
  31. 31.
    Attanasio G, Russo FY, Di Porto E, Cagnoni L, Masci E, Ralli M, Greco A, De Vincentiis M (2018) Prediction of hearing recovery in sudden deafness treated with intratympanic steroids. Acta Otorhinolaryngol Ital 38(5):453–459. Google Scholar
  32. 32.
    Fazekas F, Offenbacher H, Fuchs S, Schmidt R, Niederkorn K, Horner S, Lechner H (1988) Criteria for an increased specificity of MRI interpretation in elderly subjects with suspected multiple sclerosis. Neurology 38(12):1822–1825. CrossRefGoogle Scholar
  33. 33.
    Ohlemiller KK, Gagnon PM (2004) Cellular correlates of progressive hearing loss in 129S6/SvEv mice. J Comp Neurol 469(3):377–390. CrossRefGoogle Scholar
  34. 34.
    Russolo M, Bianchi M (1988) Prognosis and therapy of early acute idiopathic auditory failure. Audiology 27(4):215–226CrossRefGoogle Scholar
  35. 35.
    de Leeuw FE, de Groot JC, Oudkerk M, Witteman JC, Hofman A, van Gijn J, Breteler MM (2002) Hypertension and cerebral white matter lesions in a prospective cohort study. Brain 125(Pt 4):765–772. CrossRefGoogle Scholar
  36. 36.
    de Leeuw FE, de Groot JC, Achten E, Oudkerk M, Ramos LM, Heijboer R, Hofman A, Jolles J, van Gijn J, Breteler MM (2001) Prevalence of cerebral white matter lesions in elderly people: a population based magnetic resonance imaging study. The Rotterdam Scan Study. J Neurol Neurosurg Psychiatry 70 (1):9–14. doi:10.1136/jnnp.70.1.9Google Scholar
  37. 37.
    Liu Y, Zhang M, Chen Y, Gao P, Yun W, Zhou X (2018) The degree of leukoaraiosis predicts clinical outcomes and prognosis in patients with middle cerebral artery occlusion after intravenous thrombolysis. Brain Res 1681:28–33. CrossRefGoogle Scholar
  38. 38.
    Lucitti JL, Mackey JK, Morrison JC, Haigh JJ, Adams RH, Faber JE (2012) Formation of the collateral circulation is regulated by vascular endothelial growth factor-A and a disintegrin and metalloprotease family members 10 and 17. Circ Res 111(12):1539–1550. CrossRefGoogle Scholar
  39. 39.
    Chalothorn D, Faber JE (2010) Formation and maturation of the native cerebral collateral circulation. J Mol Cell Cardiol 49(2):251–259. CrossRefGoogle Scholar
  40. 40.
    Giurgiutiu DV, Yoo AJ, Fitzpatrick K, Chaudhry Z, Leslie-Mazwi T, Schwamm LH, Rost NS (2015) Severity of leukoaraiosis, leptomeningeal collaterals, and clinical outcomes after intra-arterial therapy in patients with acute ischemic stroke. J Neurointerv Surg 7(5):326–330. CrossRefGoogle Scholar
  41. 41.
    Chen YF, Kuo YS, Wu WC, Tang SC, Jiang SF (2018) Association between leukoaraiosis and cerebral blood flow territory alteration in asymptomatic internal carotid artery stenosis. Clin Radiol 73 (5):502 e509–e502, e514.
  42. 42.
    Pham M, Bendszus M (2016) Facing time in ischemic stroke: an alternative hypothesis for collateral failure. Clin Neuroradiol 26(2):141–151. CrossRefGoogle Scholar
  43. 43.
    Ciorba A, Aimoni C, Crema L, Maldotti F, Napoli N, Guerzoni F, Govoni V (2015) Sudden hearing loss and the risk of subsequent cerebral ischemic stroke. B-ENT 11(3):205–209Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Massimo Fusconi
    • 1
  • Giuseppe Attanasio
    • 1
  • Flavia Capitani
    • 2
    Email author
  • Edoardo Di Porto
    • 3
  • Davide Diacinto
    • 4
  • Isotta Musy
    • 1
  • Massimo Ralli
    • 1
  • Giovanni Ralli
    • 1
  • Antonio Greco
    • 1
  • Marco de Vincentiis
    • 5
  • Claudio Colonnese
    • 6
    • 7
  1. 1.Department of Sense OrgansSapienza University of RomeRomeItaly
  2. 2.Clinic for Ear, Nose and Throat MedicineUniklinik of TuebingenStuttgartGermany
  3. 3.Department of Economics and StatisticsUniversity of Naples Federico II, Complesso Universitario di Monte Sant’AngeloNaplesItaly
  4. 4.Department of Radiological Sciences, Oncology and Anatomo-PathologyUniversity SapienzaRomeItaly
  5. 5.Department of Oral and Maxillofacial SciencesSapienza University of RomeRomeItaly
  6. 6.Department of Neurology and Psichiatry, Neuroradiology SectionUniversity SapienzaRomeItaly
  7. 7.IRCCS NeuromedPozzilliItaly

Personalised recommendations