Meniere’s disease (MD) is a prevalent disabling inner ear disorder, characterized by recurrent vertigo, fluctuating hearing loss, tinnitus, and aural fullness, severely impairing quality of life. Despite over two centuries of study, it remains diagnostically and therapeutically challenging due to unclear etiology, heterogeneity, and lack of definitive biomarkers. This article addresses these gaps via systematic analysis. Diagnosis relies on clinical symptoms and pure-tone audiometry. China’s 2017 guidelines (referencing 2015 Barany standards) classify MD as “clinical” or “suspected,” discarding “definite diagnosis” due to impractical pathology and nonspecific endolymphatic hydrops. Hearing staging follows 1995 AAO-HNS criteria (Stages I–IV). 500/1 k/2 kHz is preferred over adding 3 kHz for primary care use, though frequency selection does not affect staging. Pathogenically, MD involves immunity (higher autoimmune incidence, inner ear immune activity) and genetics (≈10% familial in Europeans, six associated genes), with sporadic MD’s genetic role unclear. MD is heterogeneous, with five subtypes each for unilateral (UMD 1–5) and bilateral (BMD 1–5) cases, based on onset age, family history, migraine, and autoimmunity. Inner ear MRI gadolinium enhancement detects hydrops but is nondefinitive. Treatment prioritizes inner ear function, using sequential or stage-based strategies. Antimigraine therapy is recommended for comorbid cases (≈46.6% incidence).