Introduction Sudden sensorineural hearing loss can be debilitating, and often, the aetiology remains idiopathic. Cochlear haemorrhage is a rare finding to explain sudden sensorineural hearing loss and acute vertigo, usually seen in patients taking oral anticoagulants, with a typically less favourable audiological outcome. This case describes a previously well 58-year-old male who presented with acute labyrinthitis with MRI findings suggestive of cochlear haemorrhage. Case Presentation 58-year-old male presented to Townsville University Hospital Audiology Department with a history of 6 days of rotatory vertigo, 4 days of left hearing loss and pulsatile tinnitus with a preceding viral illness. He was commenced on high dose steroids within 48 hours of the hearing loss. Pure tone audiogram confirmed a left profound sensorineural hearing loss across all frequencies. An urgent MRI was undertaken within 10 days of initial symptoms which confirmed haemorrhage in the scala tympani of the basal and middle turn of the cochlear, lack of contrast enhancement excluded schwannoma. The patient was a professional athlete and reported significant improvement in balance over the course of a month. He continued to rotate on Fukuda testing despite the vestibular physiotherapy assessment showing resolution of vestibular-ocular reflex asymmetry. He was commenced on intra-tympanic 24mg/mL dexamethasone injections 4 weeks post presentation which showed some improvement in audiological outcome. However, he remained a candidate for cochlear implantation which he undertook within 4 months of symptom onset. Conclusion Cochlear haemorrhage is a rare cause of sudden sensorineural hearing loss and ENT surgeons should be aware of worse hearing recovery. It may be underdiagnosed as patients do not receive early MRIs for sudden sensorineural hearing loss, unless presenting with acute vertigo due to risk of stroke. Consideration of early cochlear implantation prior to cochlear fibrosis is advisable.