Differences Between Vestibular Migraine and Meniere's Disease Based on Cochlear-Vestibular Function Assessment: A 6-Year Retrospective Clinical Study

Summary

This article presents a protocol to differentiate vestibular migraine (VM) and Meniere's disease (MD) using cochlear-vestibular function assessments, including pure tone audiometry and videonystagmography (VNG), providing evidence for clinical differential diagnosis.

Abstract

Audiological and vestibular function tests are the most commonly used noninvasive evaluation methods for vertigo diseases. Preliminary studies have shown that detailed medical history, audiological, and vestibular function evaluation are effective methods to distinguish Meniere's disease and vestibular migraine diseases. This study retrospectively included 503 patients with vestibular migraine and 1,125 patients with Meniere's disease. Patients underwent pure tone audiometry and videonystagmography (VNG), including spontaneous nystagmus testing and the caloric test. In our study, we found that patients with Meniere's disease often exhibit abnormal unilateral weakness, while those with vestibular migraine show changes in vestibular function characterized by labyrinthine hyperactivity. Compared to vestibular migraine patients, Ménière's disease patients are more likely to experience unilateral full-frequency hearing loss. This study systematically compared the vestibular function and audiological characteristics of vestibular migraine and Ménière's disease, providing an evidence-based foundation for clinical differential diagnosis.

Introduction

Vestibular migraine (VM) and Ménière's disease (MD) are the two most common paroxysmal vertigo disorders encountered in clinical practice. Both conditions are classified as paroxysmal vestibular syndromes in the International Classification of Vestibular Disorders (ICVD)¹. Epidemiological surveys indicate that the global prevalence of VM ranges from 1% to 2.7%², which is significantly higher than that of MD, with a prevalence of 0.2% to 0.5%³. Although the Barany Society has developed diagnostic criteria for both VM and MD to facilitate standardized diagnosis worldwide

Protocol

The study was approved by the ethical review board of Sun Yat-sen Memorial Hospital of Sun Yat-sen University (No.SYSKY-2025-572-01). Written informed consent was waived because of this retrospective analysis.

A total of 1,628 patients diagnosed with VM and MD at the Vertigo Diagnosis and Treatment Center of Sun Yat-sen Memorial Hospital, Sun Yat-sen University, between August 1, 2018, and July 31, 2024, were included in this study. This cohort consisted of 1,125 cases of MD and 503 cases of VM.

1. Patient Selection

1. Inclusion criteria
   1. VM group: Include patients who meet th....

Results

Baseline characteristics
A total of 503 patients with VM and 1,125 patients with MD were included in the study. The average age of onset for the VM group was 45.89 ± 18.16 years, whereas the average age of onset for the MD group was 51.63 ± 14.29 years. A significant difference was observed between the two groups (P < 0.001). The proportion of women in the VM group was 76.1%, significantly higher than the 59.3% in the MD group (P < 0.001) (Table 1, Figure 1.......

Discussion

This study ensured result accuracy and reliability through key measures: pure tone audiometry in ISO 8253-1 compliant sound-insulated rooms (background noise ≤30 dB) with calibrated headphones; VNG using VertiGoggles-M to track eye movements in dimly lit Dix-Hallpike/supine roll tests. A notable modification was using air instead of water calorics, balancing accuracy with better operability, patient tolerance, and lower infection risk. Patient cooperation was ensured via instructions and training to avoid .......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Pure tone audiometer	Interacoustics	AC40
Sound-proof booth	Acoustic Systems	AS-2018
Video-nystagnography system	ZEHNIT Medical Technology	VertiGoggles-M system