In 1861, Prosper Ménière first reported Ménière’s disease, characterized by vertigo, tinnitus, and deafness, and in 1938, Hallpike suggested that the pathology of Ménière’s disease was characterized by an accumulation of fluid in the vagus of the inner ear membrane through histopathological studies of the temporal bone. The etiology and pathogenesis of Ménière’s disease have been widely discussed, and researchers have proposed numerous hypotheses such as excessive production of endolymphatic fluid, impaired absorption of the endolymphatic sac, ionic imbalance of the inner ear lymphatic fluid, congenital genetic defects, viral infections, autoimmune factors, allergic reactions, and vascular malformations of the inner ear in an attempt to explain the pathogenesis of Ménière’s disease, but no clear conclusion has been reached. According to the 1995 edition of AAO-HNS guidelines, the diagnosis of Ménière’s disease is based on the gold standard of four typical clinical symptoms: recurrent vertigo, fluctuating hearing loss, tinnitus, and a sense of ear congestion, with ancillary tests such as audiology and vestibular function as only supplementary evidence. Definitive diagnosis of Ménière’s disease still requires evidence of inner ear pathology, which is not clinically feasible. According to the relevant literature, the diagnostic positivity rate of commonly used tests reflecting cochlear function as well as vestibular function in patients with Ménière’s disease, such as EcochG, VEMP, and hot and cold tests, is about 56%-73%. Therefore, the clinical diagnosis of Ménière’s disease with greater accuracy has been the focus of research by otologists. In recent years, the development of imaging techniques has made it possible to distinguish between the exolymphatic and endolymphatic fluid in the inner ear, which provides a clinical basis for objective observation of the presence of endolymphatic fluid and definitive diagnosis of Ménière’s disease. Counter and Zou et al. successfully observed and distinguished the inner and outer lymphatic gaps by MRI after intra-dural injection of gadolinium contrast, and confirmed that the gadolinium contrast penetrated into the outer lymphatic fluid of the inner ear through the round window membrane. Based on these studies, Nakashima 2007 was the first to apply 3D-FLAIR sequence imaging 24 hours after intra-drum gadolinium contrast injection to observe the presence of endolymphatic fluid for the first time in patients with Ménière’s disease and patients with sudden deafness, and this study was revolutionary in the diagnostic method of Ménière’s disease. We believe that typical clinical symptoms coupled with enhanced MRI showing endolymphatic effusion after gadolinium contrast injection should confirm the diagnosis of Ménière’s disease. In other words, this imaging method has the potential to replace inner ear biopsy, making it possible to determine the diagnosis of Ménière’s disease in the 1995 edition of the AAO-HNS guidelines in the United States.