TNF and infection: A few studies have shown that the main roles of steroids in the treatment of SHL are to protect the cochlea from the harmful effects of inflammatory mediators such as the tumor necrosis factor (TNF-a and NFK-b), which is elevated in infection and inflammation,29 to increase cochlear blood flow30 thereby avoiding cochlear ischemia,31 to avoid noise-induced hearing loss,32 and to regulate protein synthesis in the inner ear.33