The exact cause and underlying mechanism of sudden hearing loss are not yet fully understood. It is believed to be associated with a variety of factors and may involve different pathways. The most widely recognized possible causes and mechanisms include:

1. Vascular Disorders: This is one of the most common causes. Similar to how a heart attack results from blocked blood flow, conditions such as dysfunction of the stria vascularis, spasms, or blockages in the inner ear blood vessels can reduce blood supply to the inner ear. This leads to a lack of oxygen, damaging the delicate hair cells responsible for hearing and causing sudden hearing loss.

2. Viral Infections: Certain viruses, such as the herpes virus, can attack the inner ear's hair cells and auditory nerve, causing inflammation and disrupting their normal function—much like an "internal attack" on the auditory system.

3. Autoimmune Disorders: In some cases, the body's immune system may mistakenly target and damage healthy structures in the inner ear, leading to hearing impairment.

4. Other Factors: Rare causes may include infectious diseases or tumors such as acoustic neuroma.