Purpose <p>To summarize the clinical features, therapeutic effects, and related influencing factors of idiopathic sudden sensorineural hearing loss (ISSNHL) in children to optimize the clinical management plan for this disease.</p> Methods <p>A retrospective analysis was performed on the clinical data of 267 children with ISSNHL (318 ears) aged 5–18 years who were admitted to a single center between August 2015 and August 2025. An individualized comprehensive treatment regimen was adopted, and the primary efficacy endpoint was the hearing level 3 months after treatment. Correlation analysis was conducted to explore the associations between the therapeutic effect and different factors.</p> Results <p>Children aged 8–12 years old accounted for the highest proportion of cases (72.3%). Moderate-to-severe hearing loss was the main type of hearing impairment (85.3%), with total deafness accounting for 29.2% of cases. Tinnitus and vertigo were the most common accompanying symptoms. Patients aged 8–18 years old had better therapeutic outcomes than those aged 5–7 years old. Patients with accompanying tinnitus and vertigo had the best and worst therapeutic outcomes, respectively. A significant improvement in efficacy was observed when treatment was initiated within 7 days of onset. No significant correlations were found between the therapeutic effect and the time from onset to treatment or the affected ear.</p> Conclusion <p>Individualized comprehensive treatment can improve the prognosis of children with ISSNHL, and stratified treatment strategies should be formulated for different patient populations.</p>