1Objectives: Meniere's disease (MD) is a rare inner ear disorder characterized by 3 2 sensorineural hearing loss, episodic vertigo and tinnitus. Familial MD has been reported 3 3 in 6-9% of sporadic cases, and few genes including FAM136A, DTNA, PRKCB, 3 4 SEMA3D and DPT have been involved in single families, suggesting genetic 3 5 heterogeneity. In this study, the authors recruited 46 families with MD to search for 3 6 relevant candidate genes for hearing loss in familial MD. 3 7 Design: Exome sequencing data from MD patients were analyzed to search for rare 3 8 variants in hearing loss genes in a case-control study. A total of 109 patients with MD 3 9 (73 familial cases and 36 early-onset sporadic patients) diagnosed according to the 4 0 diagnostic criteria defined by the Barany Society were recruited in 11 hospitals. The 4 1 allelic frequencies of rare variants in hearing loss genes were calculated in individuals 4 2 with familial MD. A single rare variant analysis (SRVA) and a gene burden analysis 4 3 (GBA) were conducted in the dataset selecting one patient from each family. Allelic 4 4frequencies from European and Spanish reference datasets were used as controls. 4 5 Results: A total of 5136 single nucleotide variants in hearing loss genes were 4 6 considered for SRVA in familial MD cases, but only one heterozygous variant in the 4 7 OTOG gene (rs552304627) was found in two unrelated families. The GBA found an 4 8 enrichment of rare missense variants in the OTOG gene in familial MD. So, 15/46 4 9 * This novel variant was not included in the gene burden analysis. Abbreviations: MAF FMD, minor allele frequency in familial MD; MAF ALL MD, minor allele frequency in all familial and non-familial MD cases ; NFE, Minor allele frequency in non-Finnish European population; CSVS, Collaborative Spanish Variant Server; Abf, alpha-L-arabinofuranosidase B domain; CADD, Combined Annotation Dependent Depletion Score; CT: cysteine knot domain; vWD, von Willebrand factor type D domain.