Within the last decade, ELH imaging has greatly impacted the field of otology and has prompted an ongoing shift in the diagnostic paradigm for Menière's disease (MD) from a purely clinical-based diagnosis to one that also takes into account objective visualization of the chief histopathologic correlate known to occur in this condition - namely endolymphatic hydrops (MD)~ [[20]]. If one accepts MRI diagnosis as a "new test" and the symptom-based diagnosis as the "gold-standard" as seems to be implied by the authors' assertion that MD is a clinical diagnosis, then it is impossible to characterize the "added diagnostic value" of the MRI. 2 A. Bernaerts and B. De Foer, Imaging of Meniere Disease, Neuroimaging Clin N Am. 29 (2019), 19-28. 3 G. Bier, M.N. Bongers, C. Schabel, W. Heindel, U. Ernemann and J.M. Hempel, In vivo Assessment of an Endolymphatic Hydrops Gradient Along the Cochlea in Patients With Meniere's Disease by Magnetic Resonance Imaging-A Pilot Study, Otology & Neurotology. 5 F. Fiorino, F.B. Pizzini, A. Beltramello, B. Mattellini and F. Barbieri, Reliability of magnetic resonance imaging performed after intratympanic administration of gadolinium in the identification of endolymphatic hydrops in patients with Meniere's disease, Otology & Neurotology. [Extracted from the article]