Meniere’s disease is a progressive hearing–disabling condition. Patients can benefit from strict clinical management, including lifestyle and dietary counseling, and medical treatment. A prospective cohort study was carried out with 154 patients with definite Meniere’s disease, with an average age of 43.53 ± 11.40, and a male to female ratio of 0.97:1. The pure-tone thresholds of all 165 affected ears, over a one-year clinical management period, were analyzed. After one year, 87.27% of patients had improved or preserved their hearing at a low frequency, and 71.51% at a high frequency. The hearing threshold at frequencies from 250 Hz to 2000 Hz had improved significantly (p < 0.001, p < 0.001, p < 0.001, p < 0.01), and deteriorated slightly at 8000 Hz (p < 0.05). Of all the patients, 40.00% had a hearing average threshold that reached ≤ 25 dB HL after the clinical management period, among whom 27.27% were patients in stage 3. The restoration time was 2.5 (1.0, 4.125) months, with a range of 0.5–11.0 months, and the restoration time was longer for stage 3 than for stages 1 and 2 (u = −2.542, p < 0.05). The rising curves improved the most (p < 0.05), with most becoming peaks, whereas most peaks and flats remained the same. Patients who were initially in the earlier stages (95% CI 1.710~4.717, OR 2.840, p < 0.001), have an increased odds ratio of hearing by an average of ≤25 dB HL. Age (95% CI 1.003~1.074, OR 1.038, p = 0.031), peak curve (95% CI 1.038~5.945, OR = 2.484, p = 0.041), and flat curve (95% CI 1.056~19.590, OR = 4.549, p = 0.042), compared with the rising curve, increase the odds ratio of hearing on average by > 25 dB HL. Most patients can have their hearing preserved or improved through strict clinical management, and sufficient follow-up is also essential. Stage 3 patients also have the potential for hearing improvement, although the restoration time is longer than in the early stages. The initial hearing stage, age, and audiogram pattern are related to the hearing benefits.
