How do you manage a patient with SLE with acute bilateral sensorineural hearing loss refractory to high dose systemic and intratympanic steroids, normal MRI brain and APL labs?   

Interesting, as I just saw a case almost exactly like this one (except my patient was unilateral)! I question whether systemic lupus erythematosus is truly the cause of the hearing loss. If immunologically induced (ie, autoimmune hearing loss), I'd expect to see at least some objective improvement ...