Hearing loss is important in the diagnosis and treatment of Meniere's disease (MD). However, little is known about the factors associated with hearing changes in MD.This study aimed to investigate the correlation between hearing prognosis and caloric test (CT) results in MD.Ninety consecutive patients diagnosed with unilateral definite MD underwent pure tone audiometry (PTA) and CT at initial visits, and were re-tested PTA at the 6-month follow-up.Fifty-three of ninety MD patients (58.89%) had abnormal CT results. The change of PTA (cPTA = initial PTA-last PTA) was negatively correlated with canal paresis (CP) values (overall association p = 0.032 and non-linear association p = 0.413). Multivariate linear model showed that as the CP value changed from 0 to 1, the cPTA decreased by -13.31 dB (95% CI: -24.03, -2.6) (p = 0.016). Stratified analysis found that the association was present in MD patients of Stage 1 and 2 (p < 0.05) but not in patients of Stage 3 and 4 (p > 0.05).Elevated CP values may be linked to worse hearing outcomes in MD, especially in Stage 1 and 2 patients. Conducting a caloric test at the initial consultation may aid in assessing hearing regression in MD.