Abstract: Objective: This study aims to determine the percentage of patients with idiopathic sudden hearing loss later diagnosed with Ménière's disease. It also seeks to identify predictive factors for Ménière's diagnosis and compare treatment responses between first-time Ménière's patients and those with idiopathic sudden hearing loss. Study design: A prospective observational study. Setting: Tertiary referral center. Patients: Cohort of apparently idiopathic sudden hearing loss patients over a period of 30 years (1992-2022). Intervention: Identification of Ménière's disease cases during follow-up. Main outcome measure: Determining how many were subsequently diagnosed with definitive Ménière's disease. Results: From a cohort of 369 patients with apparently idiopathic sudden hearing loss treated over 30 years, 15 (4%) developed definite Ménière's disease.The predictive factors for developing Ménière's disease were mild to moderate hearing loss, vertigo, tinnitus at the initial episode, and a predominantly ascending audiometric curve.When comparing treatment responses, patients with Ménière's disease showed better outcomes than those with idiopathic sudden hearing loss. Conclusions: Cases of sudden sensorineural hearing loss that represent the first episode of definite Ménière's disease are rare. A moderate hearing loss at low frequencies, accompanied by tinnitus and vertigo during an episode of sudden hearing loss, should raise suspicion for Ménière's disease rather than idiopathic sudden hearing loss. Patients with sudden hearing loss secondary to an episode of Ménière's disease tend to show significantly greater hearing improvement compared with those with idiopathic sudden hearing loss.

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