The most common treatment for sudden deafness, especially in cases where the cause is unknown, is corticosteroids. Steroids are used to treat many different disorders and usually work by reducing inflammation, decreasing swelling, and helping the body fight illness. Steroids are usually prescribed in pill form. In recent years, direct injection of steroids behind the eardrum into the middle ear (from here the steroids travel into the inner ear), called intratympanic corticosteroid therapy, has grown in popularity. In 2011, a clinical trial supported by the NIDCD showed that intratympanic steroids were no less effective than oral steroids , but were less comfortable overall for patients. They remain an option for people who can’t take oral steroids.
The intratympanic steroid injection uses four 1-mL dose of 40mg/mL of methylprdnisolone or 10 mg/ml of dexamethasone (less painful) over 2 weeks with a dose given every 3 to 4 days through the tympanic membrane (ear drum) into the middle ear space where it can diffuse via the round window into the cochlea (organ of hearing). Anesthesia can be provided with phenol but many patients prefer no local because the injection is brief. Patients are positioned supine at the operating microscope with the affected ear slightly up and remain in this position for 30 minutes after the injection.