Sudden sensorineural hearing loss after rapid reduction of blood pressure in malignant hypertension

Although circulatory impairment of the cochlea would be intuitively a possible cause of sudden sensorineural hearing loss (SSHL), definite proof is lacking. A 46-year-old man developed bilateral SSHL immediately after rapid reduction of the blood pressure in malignant hypertension. Vertigo and left-sided hearing impairment and tinnitus resolved spontaneously a few hours after onset. The right-sided hearing loss and tinnitus persisted, and the hearing loss improved only 17 dB after 3 months of treatment. This case may provide an in vivo human model of SSHL caused by ischemia. Bilateral involvement is possible in SSHL if the circulatory disturbance is systemic. In addition, a poorer prognosis is anticipated on the side with the more severe initial attack.