Background: idiopathic sudden sensorineural hearing loss (ISSHL) is one of the most controversial issues in otology. There have been countless publications and debates concerning ISSHL over the last decades. ISSHL can be defined as a sensorineural hearing loss of sudden onset or one that happens in minutes, hours or even in a few days. The hearing impairment varies as far as intensity and sound frequency are concerned, some specifically say it is a 30dB hearing loss minimum, in at least three continuous frequencies with all known causes have to be ruled out previously. Aim of the Work: the aim of this study was to evaluate the treatment outcomes of ITS treatment and SST based on meta-analysis, and to provide an alternative modality for clinical practice. Materials and Methods: the current meta-analysis assessed the therapeutic effectiveness of intra-tympanic (IT) steroid protocol as first and single drug method compared to a systemic steroid protocol. In the current meta-analysis study we applied 2 parameters to compare between ITS group and SST group which were : recovery rate and hearing improvement.  Results: the results of this study showed that regarding both; recovery rate and hearing improvement, there was no significant difference between intra-tympanic steroid (ITS) and systemic steroid therapy (SST). Second both SST and ITS alone were an effective treatment in ISSNHL patients as they significantly improved PTA and also the recovery rate. Third, if patient has any systemic condition that make the use of systemic steroid risky or lead to side effect, then the option of intra-tympanic steroid was, not only justified but mandatory. Conclusion: the conclusion from our meta-analysis was shown as follows: first, according to the current study, ITS treatment produced no significant difference in both aspects PTA improvements and recovery rate than SST in ISSHL patients. Second both SST and ITS alone were an effective treatments in ISSNHL patients as they significantly improved PTA and also the recovery rate.