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Objectives: To evaluate the pathological changes in the blood-perilymph, blood-endolymph, and blood-nerve barriers of a patient with idiopathic sudden sensorineural hearing loss (SSNHL). Methods: Potential ossification or fibrosis in the inner ear was evaluated using temporal bone CT and MRI acquired using the 3-dimensional T2-weighted sampling perfection with application-optimized contrasts using a flip angle evolution sequence. Pathological changes in the barriers were analyzed by MRI obtained 4 h after a single-dose intravenous injection of gadolinium chelate using a medium inversion-time inversion recovery imaging with magnitude reconstruction sequence. Results: The perilymph was absent, while significant enhancements of the vestibulocochlear nerve and the endolymphatic compartments were detected. Conclusion: Significant injuries in the blood-endolymph and blood-vestibulocochlear nerve barriers and disabled perilymph production may contribute to the development of SSNHL with poor response to treatments.