Meniere’s disease (MD) presents a complex clinical picture marked by vertigo, hearing loss, tinnitus, and aural pressure, challenging both diagnosis and treatment. This chapter provides a comprehensive overview of MD, addressing its multifactorial nature encompassing genetic, immunological, and environmental factors. Initially, this chapter delves into MD’s definition and epidemiology, highlighting its rarity and varied prevalence rates globally. Despite diagnostic criteria, MD’s heterogeneity complicates accurate prevalence estimations. Genetic predisposition, abnormal immune responses, and environmental triggers contribute to its etiology. Immunological and genetic aspects are explored extensively. While familial aggregation underscores genetic influences, immune dysregulation, and allergy associations shed light on immunological mechanisms. Recent advancements identify distinct allergic and autoinflammatory cytokine profiles and genetic markers, offering potential for targeted interventions. Furthermore, clinical subgroups within MD are delineated based on genetic, immunological, and clinical characteristics, aiding in personalized management strategies. Additionally, novel diagnostic techniques such as electrocochleography are discussed, alongside current pharmacological and surgical interventions. This chapter concludes with genetic insights into promising therapeutic avenues, emphasizing ongoing research aimed at unraveling MD’s intricacies for improved patient outcomes. As understanding evolves, innovative treatments targeting specific molecular pathways offer hope for more effective MD management in the future.