For most patients, we recommend an initial treatment with a combination of oral and transtympanic steroids for SSNHL. The transtympanic steroids result in a high dose of steroid within the inner ear, and we know a higher dosage of steroid leads to better results [ 31 ]. Because steroid within the inner ear persists for less than 24 hours, we recommend daily injections. We typically recommend a minimum of three injections, but do not have a set maximum of injections, instead we treat until the hearing improvement stabilizes. We do not place a tube or wick as the rates of persistent eardrum perforation has been reported to be as high as 29% [ 32 ].