In addition to the intratympanic application of gentamycin for the therapy of Menière's disease, therapy of sudden hearing loss with glucocorticoids has received steadily growing interest especially in the last 15 years. Various aspects favor local therapy of inner ear diseases, such as bypassing of the blood-labyrinth barrier and achieving higher inner ear drug levels. However, for local application special pharmacokinetic aspects must be taken into consideration in comparison to systemic application. Among the rapidly growing number of reports on local therapy of sudden hearing loss there are, however, only few which included control groups and an even fewer number of prospective randomized clinical studies. The case series and clinical studies differ in the glucocorticoid studied, the application system used and the mode of application as primary therapy or as secondary therapy following unsuccessful systemic application. Although both the number of clinical studies with sufficient quality as well as the total number of patients treated in the published studies are still low, intratympanic application of glucocorticosteroids seems in principal to be a good approach for secondary therapy of patients following unsuccessful systemic treatment.