Sudden deafness with vertigo and Ménière’s disease are common diseases in otolaryngology. The symptoms of both diseases are similar at the time of onset, especially Ménière’s disease is not easily distinguished from the former at the first attack, and misdiagnosis and mistreatment often occur. Sudden deafness with vertigo is a sudden onset of sensorineural hearing loss of unknown origin. The onset of the disease is usually in middle age, unilateral, and the patient suddenly loses his or her hearing to the lowest point within minutes or hours or 72 hours, presenting moderate or severe hearing loss with tinnitus and vertigo; Ménière’s disease is an idiopathic inner ear disease, clinically manifested by recurrent episodes of vertigo, fluctuating hearing loss, tinnitus and fullness of the ear, with no vertigo between episodes and unknown etiology. It can be seen that the two clinical manifestations are very similar, both presenting with the main symptoms of deafness tinnitus vertigo, so it is crucial to differentiate the two effectively, which is related to the treatment plan and the prognosis of the disease. Patients with sudden deafness with vertigo usually have only one onset, and secondary onset is rare. The cause is mostly related to viral infection, impaired blood supply to the inner ear, and autoimmune function. It is easy to develop in winter and spring, mostly in middle age, and there is not much difference between men and women. The onset of deafness is usually in the early morning or in the morning, without aura, and is sometimes related to overexertion, cold and fever, emotional stress or excessive alcohol consumption. The heavier the hearing loss, the heavier the tinnitus. The tinnitus will decrease or disappear during the process of hearing recovery. If hearing is not restored, the tinnitus will persist for a long time. The vertigo associated with sudden deafness varies in severity, but most of it is severe and lasts for a long time, but does not recur after decreasing. Patients with Meniere’s disease mainly present with recurrent episodes of vertigo of unknown etiology, the pathogenesis of which is mainly based on excessive production or (and) impaired absorption of endolymphatic fluid. The incidence is predominantly middle-aged, with a similar incidence in men and women. The four main symptoms of Ménière’s disease are episodic vertigo, fluctuating hearing loss, tinnitus and a feeling of fullness in the ears, often with sudden onset and accompanied by nausea and vomiting and sweating. Deafness is characterized by predominantly low-frequency hearing loss, which will manifest itself as multi-frequency hearing loss after repeated episodes. Tinnitus will gradually improve as the symptoms of vertigo decrease, and there are also cases where tinnitus cannot disappear. The tone of tinnitus is low-frequency and blowing-like in the early stage, and high-frequency and cicada-like in the later stage. The fullness of the ear in Meniere’s disease is similar to that caused by changes in air pressure, but the latter can disappear after a swallowing motion. The diagnosis of typical Ménière’s disease is not difficult, but in patients with the first onset of the disease, it is difficult to distinguish them from patients with sudden deafness with vertigo, because they both present with symptoms of deafness, tinnitus and vertigo, which are not easily distinguished by clinical manifestations alone. In this case, we will differentiate them based on some auxiliary tests. For example, in the case of pure tone hearing, the first onset of Ménière’s disease is mainly in the low frequency part of the hearing loss, and the degree of hearing loss will be less than that of sudden deafness. In patients with sudden deafness, the hearing loss is usually more severe and is dominated by high-frequency or full-frequency loss. However, there are some patients with sudden deafness who present with predominantly low-frequency hearing loss without vertigo, and these patients should be closely monitored because they may be early manifestations of Ménière’s disease, and we will revise the diagnosis based on later changes. We can also give the patient a high and low stimulation ABR examination according to the different pathogenesis of the two, and if there is a prolongation of I-V in the affected ear, the possibility of sudden deafness with vertigo is more likely to be considered. If we can’t distinguish the two by these examinations, we should start with the diagnosis of sudden deafness with vertigo, because it is more important to save the hearing than to control the symptoms of vertigo, because once the deafness is missed the best treatment time, it will be more difficult to recover the hearing.