Systemic steroids are the most common first-line therapy in sudden sensorineural hearing loss (SSNHL), with significant improvement in hearing outcomes in over 60 % of patients. Salvage treatment includes intratympanic steroids (ITS) and hyperbaric oxygenation therapy (HBOT), with inconsistent results reported. This study aimed to compare the results of ITS and HBOT in patients with SSNHL that previously failed systemic steroid therapy. This is a comparative retrospective nonrandomized interventional cohort study, enrolling 126 patients with SSNHL. Out of these, 35 patients received HBOT, 43 patients received ITS, and 48 patients did not receive any second-line therapy (control group). Puretone audiograms were performed before and after the salvage therapy in the ITS and HBOT groups and at the same time interval in the control group. Study variables included age, time until therapy initiation, tinnitus status, and hearing outcomes, with cutoff criteria of cumulative >30 dB improvement on all frequencies indicating recovery. ITS and HBOT were associated with statistically significant hearing recovery at all frequencies compared to systemic steroids. The results show an average hearing improvement of 13,6 dB overall frequencies (250 to 8000 Hz) after ITS therapy and 7,4 dB in HBOT in comparison to the control group. Presence of significant hearing improvement positively correlated with age, ITS therapy, and HBOT. Presence of tinnitus before therapy was negatively correlated with hearing improvement. Patients with tinnitus present at the start of therapy improve 4,67 dB less on average compared to those without tinnitus. ITS therapy significantly reduced tinnitus compared to the other two treatment options. Patients with tinnitus present before therapy significantly improve hearing at low frequencies, compared to the control group. ITS and HBOT show superior hearing results compared to observation alone after failed oral steroid therapy for SSNHL. ITS shows an additional positive impact on tinnitus reduction and shows superior hearing outcomes after salvage therapy.