Auditory and vestibular symptoms and chronic subjective dizziness in patients with Ménière's disease, vestibular migraine, and Ménière's disease with concomitant vestibular migraine

Brian A Neff, Jeffrey P Staab, Scott D Eggers, Matthew L Carlson, William R Schmitt, Kathryn M Van Abel, Douglas K Worthington, Charles W Beatty, Colin L Driscoll, Neil T Shepard
Otology & Neurotology 2012, 33 (7): 1235-44

OBJECTIVE: To compare presentations of Ménière's disease (MD), vestibular migraine (VM), and Ménière's disease plus vestibular migraine (MDVM), with and without comorbid chronic subjective dizziness (CSD).

STUDY DESIGN: Retrospective review with diagnosis confirmed by consensus conference of investigators using published criteria for MD, VM, and CSD.

SETTING: Ambulatory, tertiary dizziness clinic.

PATIENTS: Approximately 147 consecutive patients with diagnoses of MD, VM, or MDVM, with/without comorbid CSD.

INTERVENTIONS: Diagnostic consultation.

MAIN OUTCOME MEASURES: Similarities and differences between diagnostic groups in demographics; symptoms; and results of neurotologic, audiometric, and vestibular laboratory assessments.

RESULTS: Seventy-six patients had MD, 55 MD alone. Ninety-two patients had VM, 71 VM alone. Twenty-one patients had MDVM, representing about one-quarter of those diagnosed with MD or VM. Clinical features thought to differentiate VM from MD were found in all groups. Twenty-seven patients with VM (38%) had ear complaints (subjective hearing loss, aural pressure, and tinnitus) during episodes of vestibular symptoms and headache, including 10 (37%) with unilateral symptoms. Conversely, 27 patients with MD alone (49%) had headaches with migraine features that did not meet full IHS diagnostic criteria, migrainous symptoms (photophobia, headache with vomiting), or first-degree relative with migraine. Including MDVM patients, 59% (45/76) of all patients with MD had migrainous features. Thirty-two patients had CSD; most (29; 91%) were in the VM group.

CONCLUSION: Comorbidity was common between MD and VM, and their symptoms overlapped. More specific diagnostic criteria are needed to differentiate these diseases and address their coexistence. CSD co-occurred with VM but was rarely seen with MD.

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