Many treatments have been proposed to manage sudden sensorineural hearing loss. The University of Iowa has used a protocol of intravenous radiopaque contrast and volume expander for the last 10 years in the treatment of sudden sensorineural hearing loss. A retrospective analysis of these cases was performed to review the efficacy of this treatment with respect to the natural history of the disease, as reported in previous studies. Sixty-four percent of 39 cases showed audiometric improvement in their pure-tone averages, speech reception thresholds, and speech discriminations while receiving treatment. Forty-eight percent of these showed improvement after their first treatment doses. Eighty percent of patients who presented more than 7 days after the onset of their hearing loss showed audiometric improvement with treatment, whereas 71 percent of patients presenting before 7 days showed audiometric improvement. However, the patients who presented earlier showed more marked improvement. Speech discrimination with the W-22 word list was a predictor of early recovery. Patients with measurable speech discrimination scores on presentation uniformly improved with treatment, even if their pure-tone average was profound. Our findings were suggestive of a pathophysiologic mechanism for some cases of sensorineural hearing loss for which intravenous contrast is efficacious. Although our findings were far from conclusive in this uncontrolled study, these initial results support the use of these agents in a rigorous clinical trial.