Aims Intratympanic steroids (ITS) result in superior peri-lymph concentration within the inner ear and avoid adverse systemic side effects. Current evidence is uncertain and controversy exists over dosage, however higher concentrations have been associated with superior outcomes. Previous studies have shown a 40-53% improvement in pure-tone audiometry (PTA) using 24mg/ml dexamethasone in sudden sensorineural hearing loss (SSNHL) (Alexander 2015), as well as reduced vertigo in refractory Meniere’s disease (MD) (Cates & Winter 2023). The objective of this study was to examine outcomes of 24mg/ml ITS in SSNHL and MD. Methodology A retrospective cohort analysis was performed on patients who received 24mg/ml intratympanic dexamethasone by a single surgeon. Symptoms and PTA were recorded pre- and post-administration of ITS, as well as any complications. Results For MD, 84 injections were performed in 30 people, spaced approximately 99 days apart, with an average improvement of 10dB in PTA and 75% reporting improved vertigo. One experienced no attacks for 31 months after a single injection. For SSNHL, 47 injections in 30 people were performed with repeats spaced out 14 days. Those who received systemic steroids prior had a 19dB gain and a further 56% had greater than 15dB improvement in PTA. In the ITS only cohort, a 12dB PTA gain with a further 60% patients showing greater than 15dB improvement. Hearing gain was seen with ITS administered up to 90 days after initial onset of hearing loss with a gain of 50dB. There were no long-term complications. Conclusion In MD refractory to medical management, using 24mg/ml ITS can help to control vertigo attacks with most requiring repeat injections every three months. More than half (57.5%) with SSNHL experienced PTA recovery greater than 15dB with 24mg/ml ITS with an average gain of 18.6dB. This is compatible with previous data on systemic steroids improving recovery in a further 50% compared to controls.