BACKGROUND AND OBJECTIVES: Intratympanic dexamethasone injection (ITDI) offers the potential for directed delivery of high concentrations of steroids to the inner ear while mitigating the risks involved with high doses of systemic steroids. We investigated the effectiveness of combination therapy, sequential early ITDI accompanied with systemic therapy on sudden sensorineural hearing loss (SSNHL). MATERIALS AND METHODS: We gathered 151 SSNHL patient's data, who were refractory to systemic treatment for 5 days. Injection group (n=47) were administered systemic therapy and 4 times of ITDI within 2 weeks after break of SSNHL. Control group (n= 104) only received traditional treatment. We compared last concreted hearing level and recovery rate according to initial hearing level and frequency. RESULTS: Overall hearing improvement was observed in 47 of 104 (45.2%) control patients and in 30 of 47 (63.8%) ITDI patients (p= 0.034). Depending on the degree of initial hearing loss, the patients with severe hearing loss who treated with ITDI showed significant higher recovery rate than control group (83.8% vs. 50.0%)(p=0.049). When we analyzed hearing improvements according to the frequency, clinically significant hearing improvements were observed at lower and mid-frequencies (250, 500 and 1,000 Hz) in the ITDI group than in the control group. CONCLUSIONS: Early combination the-rapy of intratympanic dexamethasone injection within 2 weeks accompanied with initial systemic treatment is effective for patients with refractory SSNHL, especially for patients with severe hearing loss.