Objectives: To evaluate the safety of intratympanic and intravenous dexamethasone administration for the treatment of sudden sensorineural hearing loss(SSNHL) and hearing improvement at low, mid and high frequencies. Methods: SSNHL patients were randomly divided into two groups within 72 hours after onset and received 24 days of dexamethasone therapy.The group A patients only received intravenous dexamethasone once every other day.Patients in group B received 12 days intravenous dexamethasome and six injection of intratympanic dexamethasome from the 13th day to 24th day like in Group A.Side effects and hearing recovery were compared. Results: The discomfort of intratympanic injection were mild and transient, no tympanic membrane perforation and otitis media, whereas the systemic adverse effects increased cumulatively over the course of intratympanic dexamethasone treatment in group A.The systemic side effects were more serious in group B than in group A. On day 7 (D7),the average 3-frequency PTA (250, 500, and 1000 Hz) was 34.10±9.14 dBHL in group A and 25.70±6.88 dBHL in group B(P<0.05). Hearing recovery was better in group A than group B,but there are the same long-term efficacy at the 90-day follow-up.Group A had slightly better high-frequency hearing recovery than group B, but this difference was not statistically significant. There were no significant differences in the total effective rate of hearing improvement. Conclusions: Early intratympanic dexamethasone intervention led to the rapid recovery of hearing loss, with a good remedial effect on hearing at low-mid frequencies. Intratympanic dexamethasone was safer than intravenous dexamethasone for SSNHL, and high-frequency hearing recovery may have been better with intratympanic dexamethasone, but the difference was not statistically significant. Therefore, it is necessary to make individualized treatment decisions according to the patient’s condition.