Chengk  
1 Shaare-Zedek Medical Center, Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 90938, Israel; [EMAIL_ADDRESS] (I.C. ); [EMAIL_ADDRESS] (R.P. ); [EMAIL_ADDRESS] (S.E. ); [EMAIL_ADDRESS] (O.M. ); [EMAIL_ADDRESS] (R.S. ); [EMAIL_ADDRESS] (J.-Y.S.) Chengk  
1 Shaare-Zedek Medical Center, Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 90938, Israel; [EMAIL_ADDRESS] (I.C. ); [EMAIL_ADDRESS] (R.P. ); [EMAIL_ADDRESS] (S.E. ); [EMAIL_ADDRESS] (O.M. ); [EMAIL_ADDRESS] (R.S. ); [EMAIL_ADDRESS] (J.-Y.S.) Chengk  
1 Shaare-Zedek Medical Center, Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 90938, Israel; [EMAIL_ADDRESS] (I.C. ); [EMAIL_ADDRESS] (R.P. ); [EMAIL_ADDRESS] (S.E. ); [EMAIL_ADDRESS] (O.M. ); [EMAIL_ADDRESS] (R.S. ); [EMAIL_ADDRESS] (J.-Y.S.) Chengk  
1 Shaare-Zedek Medical Center, Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 90938, Israel; [EMAIL_ADDRESS] (I.C. ); [EMAIL_ADDRESS] (R.P. ); [EMAIL_ADDRESS] (S.E. ); [EMAIL_ADDRESS] (O.M. ); [EMAIL_ADDRESS] (R.S. ); [EMAIL_ADDRESS] (J.-Y.S.) Chengk  
1 Shaare-Zedek Medical Center, Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 90938, Israel; [EMAIL_ADDRESS] (I.C. ); [EMAIL_ADDRESS] (R.P. ); [EMAIL_ADDRESS] (S.  
A short course of OCSs (oral corticosteroids) is the common standard treatment for SSNHL. This treatment gained validity in a randomized double-blind placebo control study by [PERSON] et al. in 1980, in which 61% of patients treated with OCSs experienced a significant improvement in hearing, compared to only 32% of patients in the placebo group [14]. However, this study had several biases, which raised many questions and doubts about its conclusions and implications [15; 16]. Compared with courses of treatment for chronic disease, SSNHL via steroids is very brief (only about two weeks). Currently, the prevalence of side effects from short courses of steroid use cannot be estimated due to insufficient clinical data. Compared to long-term use of steroids, short-term use is expected to generate fewer side effects. Still, some are already well known, particularly in patients suffering from hypertension or diabetes [17]. Over the last two decades, intradynamic corticosteroid injection (IT) treatment has become very popular because of its theoretical advantage in providing increased drug concentrations to the target organ and the possible avoidance of systemic adverse effects associated with reduced systemic corticosteroid exposure [18]. Treatment of SSNHL by OCSs is considered viable with a moderate level of evidence by the latest American Academy of Otolaryngology (AAO) guidelines; IT is recommended when patients have still not completely recovered from SSNHL after a period of two to six weeks from symptom onset [12]. It is still unclear whether treatment of SSNHL with steroids is advantageous since the outcomes reported from randomized controlled trials (RCTs) are inconsistent, in part due to the small sample sizes of these studies. Indeed, it is challenging to design an RCT with sufficient statistical power to detect a significant treatment effect due to the relatively low incidence of SSNHL [16; 19]. Moreover, in patients with moderate to severe hearing loss, the therapeutic outcomes for IT, OCS, and combined therapy (CB) are comparable [20]. In summary, SSNHL remains a poorly understood medical emergency that lacks a rational treatment approach. Furthermore, none of the RCTs evaluated the recent AAO recommendations, which would mean comparing the initial OCS and salvaging an IT with no treatment or placebo. In a previous study, we identified a correlation between the time from symptom onset to treatment initiation and hearing improvement in SSNHL [21].