OBJECTIVES: Intratympanic dexamethasone (ITD) is a standard treatment for patients with sudden sensorineural hearing loss. The aim of this study was to evaluate the effectiveness of ITD vs. combination of ITD and diuretics for acute low frequency sensorineural hearing loss (LFHL) with vertigo. METHODS: A total 31 patients with LFHL that had developed within previous 2 weeks were enrolled and categorized into two groups: treated with ITD four times on 4 consecutive days (ITD group; 17 patients) and treated with ITD in the same way and diuretics orally for 2 weeks (combination group; 14 patients). After 6 months, we analyzed treatment outcomes using subjective improvement and audiometric change. RESULTS: Hearing thresholds at low frequencies ≤500 Hz were significantly improved in both ITD only and combination group (p<0.05). The cure rate of combination group was not significantly higher than that of ITD only group (57.1% vs. 52.9%, p>0.05). For subjective symptoms, there were no significant differences of improvement rate in both groups (combination 64.3% vs. ITD only 64.7%, p>0.05). In pure tone audiometry, the improvement rate of combination group was not significantly different from that of ITD only group (71.4% vs. 76.5%, p>0.05). There was a significant correlation between the complete recovery rate and duration of symptoms. CONCLUSION: ITD alone is an effective treatment modality for acute LFHL with vertigo within 2 weeks of development. Combined ITD and diuretics have no additive effect for the recovery of hearing in patients with LFHL.