<p>Menière’s disease (MD) is classically understood as a pressure-related disease of the inner ear; however, new histopathologic and imaging findings call for reassessment of this model. The current article focuses on new aspects of MD pathophysiology and derives innovative causal treatment approaches for the future based on cell and gene therapy. The recent differentiation between two biologically distinct endotypes (hypoplastic vs. degenerative) shifts the therapeutic focus from purely symptomic pressure reduction toward targeted modulation of epithelial function and regeneration. Building upon this, the article discusses new target structures beyond sensory hair cells, including epithelial cells of the endolymphatic sac and the stria vascularis as well as the ion and water transport mechanisms that are vital for pH regulation and endolymph homeostasis. Focus is also laid on novel, more precise application techniques for cell and gene therapies in the vestibular system that enable tissue-sparing deposition of therapeutic substances in the cochlea, vestibular organs, and stria vascularis. At the molecular level, modern gene therapy strategies are highlighted, complemented by a&#xa0;discussion of new preclinical studies on vestibular hair cell regeneration. Overall, the present article positions MD—for the first time—as an explicit candidate for precision medicine-based combined treatment concepts integrating gene modulation, epithelial repair, and sensory regeneration to offer realistic perspectives for disease-modifying or potentially causal therapy.</p>