There is a lack of established objective tests in Ménière’s disease (MD) that can provide information about the disease process. The appearance of low-frequency air-bone gaps (LFABGs) in MD is a recognised but unexplored phenomenon. Two theories have been suggested to explain their aetiology: increased perilymphatic pressure resulting in either reduced stapedial mobility or dampened transmission of acoustic energy, and direct contact between the dilated saccule and the stapes footplate. The aim of this study was to compare delayed post-gadolinium MRI features of two groups of patients with unilateral definite MD, those with and without LFABGs. In the cohort of unilateral definite MD patients, the incidence of LFABGs was 28.6%, adding to existing evidence that they are a true audiological finding in MD. Analysis of delayed gadolinium-enhanced MRI suggests that direct contact between the distended saccule and the inner surface of the stapes footplate is the more likely underlying pathophysiological mechanism for this audiometric phenomenon.