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 on serial audiometry after so many steroids. I would feel uncomfortable using immunosuppressants without at least some evidence of it being autoimmune-related. I would employ my "first do no harm" in t...