Objective: To investigate the factors influencing changes in vestibular function and treatment effects before and after virtual reality (VR) vestibular rehabilitation in patients with total sudden deafness or call Sudden Sensorineural Hearing Loss, (SSNHL)with vertigo. Methods: Patients with? unilateral tatal sudden deafness with vertigo who were initially diagnosed in our hospital and treated with immersive VR vestibular rehabilitation from August 2019 to August 2023 were selected as the VR experimental group (n=75), and patients with totally deaf? with vertigo who did not undergo vestibular rehabilitation during the same period were taken as the control group (n=41). The patients" clinical data and the results of dual temperature test and head pulse test (vHIT) were collected. All patients in the VR experimental group and the control group were divided into three groups according to hearing efficacy based on the retested 250-8 kHz air-conducted hearing thresholds after 14 days of treatment. The patients with an average hearing improvement of 30 dB or more at the impaired frequency were included in the effective group (n=39). 15 dB to 30 dB was included in the efficient group (n=35). Below 15 dB was included in the ineffective group (n=42). Multifactorial logistic regression was used to analyze the factors influencing efficacy. The predictive value of vestibular function parameters on patient outcome was calculated and assessed using R software.Results: Compared with the control group, the patients in the VR experimental group had significantly lower vertigo duration, vHIIT sweep wave abnormality rate, asymmetry ratio abnormality rate, UW value abnormality rate of dual temperature test, and DP value abnormality rate of dual temperature test, while the vHIIT gain value was significantly higher after treatment (P<0.05). Except for DHI-E, the reduction of DHI and HADS scores after treatment was more significant in the VR group than in the control group. The apparent efficiency of the VR experimental group was significantly higher than that of the control group (P<0.05). Patients in the effective group had a lower rate of receiving VR vestibular rehabilitation and a higher rate of vHIT sweep wave abnormality compared with the effective group. Compared with the apparent effect group, patients in the ineffective group had a lower rate of receiving VR vestibular rehabilitation treatment, a higher proportion of age≥50 years, time of initial diagnosis≥14 days, hearing loss≥100 dB, a lower number of RBCs, a higher level of Fib, a higher rate of abnormality in the calorie test, a higher rate of abnormality in the vHIT swept wave, and lower values of the horizontal semicircular canal gain and posterior semicircular canal gain. The results of multifactorial logistic regression showed that patients with ≥14 days of initial consultation, hearing loss ≥100 dB, abnormal calorie test (UW value and DP value), and vHIT sweep wave abnormality were independent risk factors for treatment ineffectiveness in patients, whereas receipt of VR vestibular rehabilitation was a protective factor for treatment efficacy (P<0.05). vHIT gain value, vHIT sweep wave abnormality rate, calorie test UW, and DP values predicting the effect of receiving VR vestibular rehabilitation therapy were consistent with the C-Statistics, NRI, and IDI results, and the joint predictive ability was optimal. Conclusion: VR vestibular rehabilitation can effectively improve the clinical efficacy of patients with total sudden deafness with vertigo by reducing the duration of vertigo, improving the rate of abnormal vestibular function, and relieving vertigo symptoms and anxiety. The combined vHIT gain value, sweep wave, calorie test UW and DP values were more predictive of efficacy.