Neurotologic and MRI Correlates of Idiopathic Acute Unilateral Audiovestibulopathy

ABSTRACT Objective Although MRI can aid in detecting idiopathic acute unilateral audiovestibulopathy (iAUAV), the relationship between imaging and neurotologic findings remains unclear. Methods We retrospectively reviewed the medical records of patients diagnosed with iAUAV at a tertiary hospital in South Korea between March 2018 and September 2025. Neurotologic and imaging data on heavily T2‐weighted 3D fluid‐attenuated inversion recovery (FLAIR) sequences were included for analysis. Results Eighty‐four patients with iAUAV were included in the analysis. MRI‐positivity was found in 44 patients (52%), with high signal intensities in the vestibule ( n  = 31), horizontal (HC, n  = 27), posterior (PC, n  = 24), and anterior canals (AC, n  = 22), as well as basal ( n  = 15), apical ( n  = 13), and middle turns of the cochlea ( n  = 10). Multivariable logistic regression analysis showed that MRI positivity was negatively associated with vestibulo‐ocular reflex (VOR) gain for the PC ( p  = 0.028). The VOR gains for the HC and PC were negatively correlated with the normalized signal intensity ratios of the vestibule ( q  = 0.021) and each semicircular canal ( q  = 0.025). Conclusion 52% of patients with iAUAV showed positivity on precontrast 3D‐FLAIR images, showing a strong association with vestibular deficits in the PC. The observed correlation between MRI and neurotologic findings may facilitate the diagnosis and differentiation of iAUAV and provide insight into its underlying pathophysiology as a frequent cause of acute audiovestibulopathy. Level of Evidence 4.