Audiovestibular Dysfunction in Alcohol Use Disorder: A Systematic Review of Human Primary Clinical Evidence

Alcohol use disorder is associated with substantial neurologic and systemic morbidity, but its relationship with audiovestibular dysfunction has not been clearly synthesized. This systematic review summarized human primary clinical evidence on auditory and vestibular manifestations, diagnostic findings, treatment, and prognosis in alcohol use disorder. PubMed, Embase, ClinicalKey, Web of Science, and ScienceDirect were searched from inception to 4 February 2026; the review followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD420261301021). Because study designs, clinical contexts, and outcome measures were highly heterogeneous, a structured qualitative synthesis was performed. Twelve human primary clinical studies were included. The available evidence supported objective auditory dysfunction, most commonly sensorineural hearing impairment with frequent high-frequency involvement. Vestibular involvement was also reported, but the evidence was smaller and less phenotypically specific, consisting mainly of syndromic reports, broad peripheral/central classifications, and historical nystagmographic findings. Direct treatment evidence was very limited; improvement after thiamine replacement was reported in alcohol-related Wernicke-spectrum presentations, but no established disease-specific therapy was identified. Overall, current human clinical evidence supports heightened clinical awareness but not disease-specific screening algorithms or targeted therapeutic recommendations. Better prospective studies using contemporary phenotype-based audiovestibular assessment are needed.