Clinically, the success rate of Intratympanic steroid therapy in patients with SHL is variable in the literature and the available studies are limited to retrospective and non-controlled prospective ones. In those studies steroids were used in various concentrations, regimens and delivery methods and their effectiveness have not been established due to the lack of randomized controlled trials. There have been some studies in the literature that discussed the effectiveness of Intratympanic steroid therapy as a salvage mode of therapy in patients who failed to respond to oral steroids (Herr & Marzo 2005, Slattery et al 2005).
Other physical examination tests include the Romberg test and observation of gait. Swaying toward one side with the Romberg test is indicative of vestibular dysfunction in the ipsilateral side. Also, a patient's gait will lean toward the side of a vestibular lesion. Ataxia is indicative of cerebellar dysfunction, and the patient's gait is usually slow, wide-based, and irregular. 9 , 20 Observation of gait is also important to detect symptoms suggestive of parkinsonism in patients presenting with disequilibrium. 4 In early Parkinson disease, gait is usually slower with smaller steps and reduced arm swing, and progresses to freezing and hesitation in later stages of the disease. 20 Screening for peripheral neuropathy is also important in patients presenting with disequilibrium. 4