Sudden sensorineural hearing loss is often idiopathic. Although the aetiology of idiopathic sudden sensorineural hearing loss (ISSNHL) is unclear, vascular compromise is one of the frequently proposed hypotheses to explain its pathophysiology. Existing studies have shown an association between ISSNHL and cardiovascular risk and also the prevalence of certain features of early-stage atherosclerosis in patients with ISSNHL. In this study, the authors aimed to determine the association of severity and prognosis of ISSNHL with cervical ultrasonographic findings suggestive of cardiovascular risk. Seventy-four patients with ISSNHL were included in this retrospective study. They were all treated with systemic steroids and/or intratympanic steroids. The mild and severe hearing loss (HL) groups included 15 and 59 patients respectively. Patients showing complete recovery and marked improvement were classified in the good prognosis group (44 patients) and those showing slight improvement and no change, in the poor prognosis group (30 patients). Cervical ultrasonography was performed during the patients’ hospital admission to evaluate the vascular system and measurements taken. Markers of atherosclerosis, namely pulsatility indices (PI) of the common and internal carotid arteries and resistance index (RI) of the internal carotid artery, were significantly related to the prognosis of ISSNHL. Higher markers of atherosclerosis were associated with poorer hearing prognosis. There was no association between ISSNHL severity and cervical ultrasonographic findings. These results suggest that cardiovascular risk may influence hearing outcome in ISSNHL. Although this is in line with some studies, this negative correlation between cardiovascular risk and hearing outcome is controversial in existing literature. The authors acknowledged their small study’s limitations and suggested further large-scale prospective studies. In clinical practice, clinicians should be aware of this potential cardiovascular risk correlation when counselling patients with ISSNHL about their hearing outcome. Hopefully, future robust studies will provide stronger evidence on the prognosis of ISSNHL.