This paper from China compares the technique of widening the round window via a posterior tympanotomy approach and steroid-soaked gelatin sponge with intratympanic steroids alone for salvage therapy in severe idiopathic sensorineural hearing loss. Salvage therapy was defined as patients who failed to respond to intravenous and intratympanic steroids. All patients presented within three weeks onset of symptoms. The study involving 10 patients in the treatment and control arms showed statistically significant improvements in pure tone average, speech discrimination score, tinnitus handicap and tinnitus visual analogue scales one month after treatment. Both treatment and control groups also received daily intratympanic methylprednisolone for seven days post-treatment. A single case of dysgeusia was reported in the treatment group. The authors’ argument is that this method may represent an option for patients with unfavourable round window niche anatomy.