Abstract BACKGROUND: Meniere’s disease (MD) involves cochlear and vestibular symptoms, but the underlying cause remains unclear. Findings predominantly show a low-to-mid-tone hearing impairment, and it is not possible to predict hearing improvement after an attack. OBJECTIVE: To examine whether improvement in hearing in definite MD (DMD) patients could be predicted using inner ear contrast magnetic resonance imaging (IEC-MRI) and pure tone audiometry (PTA) at the time of an attack. METHODS: Between April 2020 and March 2022, seven DMD outpatients were enrolled based on the Bárány Society DMD criteria. Patients were divided into two groups: a low-tone hearing loss (LTL) group and a low-to-mid-tone hearing loss (LMTL) group. Hearing improvement rates were examined. We also examined whether endolymphatic hydrops and hearing improvement were related. RESULTS: Endolymphatic hydrops was found in two of four LTL cases. One of three LMTL cases had prominent lymphedema. All LTL patients showed hearing improvements. Only one LMTL patient showed hearing improvement. Endolymphatic hydrops did not correlate with hearing improvement. CONCLUSIONS: It is not possible to estimate hearing improvement using IEC-MRI. PTA showed that LTL had a better hearing prognosis than LMTL. Therefore, it is possible to estimate hearing improvement using PTA.