An interesting paper recently published in Journal of Stroke [
Although all statements can be shared, in our opinion a distinction should be made between cochlear and vestibular symptoms.
Studies carried on by our group in the last two decades point out the role of functional causes related to hemodynamics in “idiopathic” sudden hearing loss (SHL), thus permitting to hypothesize the possible absence of arterial occlusive mechanisms in such cases: our observations, recently supported by MRI [
On the contrary, vestibular system is more diffusely represented in central nervous system, due to its connections with reticular substance, cerebellum, neuromuscular fuses etc.: accordingly, the concept of vascular vertigo is widespread in the literature and demonstrates a larger dependence on macro-vascular conditions as compared to auditory system. This difference can be observed in common ENT clinical practice; we recently discussed this aspect in commenting our 26-year lasting observation of a subject who had a SHL at 37, and subsequently underwent an audiological and cardiovascular follow-up always demonstrating the absence of appreciable vestibular and vascular impairments [
In general terms, however, it can be concluded that the vestibular symptoms are more easily linked to a blood support derived from the middle arteries than to microcirculation, that in turn more strictly depends to local mechanisms and is less linked to atherosclerosis: even assuming all the reliability of the analysis made in the cited article, this difference must not be neglected when dealing with an isolated cochlear or vestibular disorder.
The authors have no financial conflicts of interest.