Clinical Prevalence of Vertigo in Vestibular Schwannoma Patients Presenting With Sudden Sensorineural Hearing Loss: A Systematic Review

Suwanee, GA

Introduction: Sudden sensorineural hearing loss (SNHL) can be an early presenting symptom of vestibular schwannoma (acoustic neuroma), but its coexistence with vertigo is not well defined. Understanding how frequently vertigo accompanies sudden SNHL in these patients is clinically important, as it may influence diagnostic suspicion and timely imaging. The primary objective of this study was to determine the proportion of patients with acoustic neuroma presenting with sudden or unilateral SNHL who also report vertigo.

Methods: A structured literature search was performed in PubMed using the keywords “Acoustic Neuroma with Vertigo Presentation.” The initial search yielded 224 articles. Sequential filters were applied for publications within the last 10 years (83), English language (76), human subjects (57), and reported patient ages 24–92 years (34). Studies were then screened for mention of vestibular schwannoma/acoustic neuroma (17). Articles were included if they reported both SNHL (sudden or unilateral) and vertigo at presentation, resulting in 16 studies for analysis. Studies lacking presentation data, focusing solely on non-vestibular tumors or intralabyrinthine schwannomas, or otherwise not meeting criteria were excluded. Extracted variables included sample size, demographics, prevalence of vertigo, SNHL, tinnitus, and tumor size. Findings were synthesized descriptively.

Results: The final dataset consisted primarily of retrospective cohort studies and case series, representing more than 6,000 patients overall. Mean patient ages generally ranged from the mid-40s to mid-60s, with an overall reported age span of 24–92 years. Across included cohorts, unilateral or sudden SNHL was the predominant presenting symptom, commonly reported in more than half of patients and reaching as high as 86–100% in several studies. In contrast, vertigo prevalence varied widely, ranging from approximately 1% in large database cohorts to greater than 60% in smaller selected series. Among the largest studies (n≥100), vertigo was typically reported in roughly 18–36% of patients. Multiple cohorts demonstrated that many patients presenting with SNHL did not report vertigo. Reported tumor sizes were heterogeneous but most commonly fell within the small-to-medium range.

Discussion: This review demonstrates that although SNHL remains the dominant presenting feature of vestibular schwannoma, vertigo is inconsistently present and often absent in a substantial proportion of patients. Larger cohort studies suggest vertigo occurs in only a minority of cases, whereas smaller series report higher rates, likely reflecting selection bias and heterogeneity in symptom definitions. Clinically, the absence of vertigo should not lower suspicion for vestibular schwannoma in patients presenting with sudden or unilateral SNHL. Reliance on vestibular symptoms alone may delay diagnosis. Clinicians should maintain a low threshold for appropriate imaging in patients with unexplained unilateral or sudden SNHL regardless of vertigo status. Prospective studies with standardized reporting are needed to better define the true coexistence of these symptoms.