ABSTRACT: Sensorineural hearing loss (SNHL) has many etiologies including vascular sources. Vascular causes of SNHL can occur at the microvascular level. Macrovascular level may be described as arising from vessels proximal to the labyrinthine artery or those vessels that can be visualized without the aid of a microscope. Otologic symptomatology and diagnostic evaluation of the SNHL may reveal a macroscopic vascular source. Representative cases of macrovascular sensorineural hearing loss due to aneurysm, arteriovenous malformation, and vertebrobasilar artery dolichoectasia are presented.