Purpose <p>This study aimed to compare the efficacy and safety of different types of intratympanic corticosteroids for treating idiopathic sensorineural hearing loss (ISSNHL).</p> Methods <p>MEDLINE/PubMed, Cochrane Central Register of Controlled Trials, and the Web of Science databases were systematically searched for clinical trials and cohort studies published from inception until the 28th of October 2024. The outcomes included the change in mean hearing threshold with pure tone audiometry (PTA average) (primary) as well as the percentage of patients with improved hearing, the final hearing threshold with PTA, the change in hearing threshold with speech audiometry, and adverse events. (secondary). The results were pooled as standardized mean difference (SMD) and risk ratio (RR) for numerical and dichotomous outcomes, respectively.</p> Results <p>Eleven studies were included. The pooled results did not reveal a significant improvement in PTA average with methylprednisolone compared to dexamethasone (number of studies = 5; number of participants = 430; pooled SMD [95% CI] = 0.31 [-0.10, 0.72], <i>P</i> = 0.100). The results showed that methylprednisolone was significantly associated with achieving satisfactory response (complete or partial recovery) (number of studies = 6; number of participants = 498; pooled RR [95% CI] = 1.32 [1.11, 1.56], <i>P</i> = 0.002).</p> Conclusion <p>The current evidence suggests that methylprednisolone potentially possesses an efficacy advantage compared to dexamethasone in terms of higher recovery rates in patients with ISSNHL. The evidence quality is downgraded by the limitations of the included studies and the observed wide clinical heterogeneity. There is a need for the conduct of high-quality randomized clinical trials to investigate the superiority of intratympanic methylprednisolone compared to intratympanic dexamethasone in patients with ISSNHL.</p>