Table 2. Clinical recommendations for ITC Therapy in ISSNHL.

Clinical scenario	Recommended approach	Grade
Standard presentation	Systemic steroids OR combined therapy. Salvage ITC if incomplete recovery at 2 weeks.	B
Severe loss (≥70 dB)	Combined therapy strongly recommended. Aggressive early intervention.	B+
Contraindication to systemic steroids	ITC as primary monotherapy. Non-inferior to systemic.	B
Incomplete recovery after systemic	Salvage ITC (within 2-6 weeks). Strongest evidence.	A
Diabetes mellitus	ITC preferred. Eliminates glycemic perturbations.	C
High-frequency loss	Consider systemic steroids for better high-frequency recovery.	C

ITC: Intratympanic corticosteroids, OR: Odds ratio