Vosbeek Eleonora G M, Seelen Meinie, Vingerhoed Aliede M, Schermer Tjard R, Cannegieter Suzanne C, Terwindt Gisela M, Bruintjes Tjasse D
Apeldoorn Dizziness Centre, Gelre Hospitals, Apeldoorn, Netherlands.
Department of Otorhinolaryngology - Head and Neck Surgery, Leiden University Medical Center (LUMC), Leiden, Netherlands.
Front Neurol. 2025 Aug 7;16:1569247. doi: 10.3389/fneur.2025.1569247. eCollection 2025.
Menière's disease (MD) presents with episodic vertigo and auditory symptoms. Vestibular migraine (VM) typically contains migraine features associated with the vertigo attacks. Distinguishing MD from VM can be challenging due to overlap in symptomatology. To assist in the differentiation between the two, this study aimed to compare auditory and vestibular symptoms and functions in MD and VM, and to assess the diagnostic value of the video head impulse test (vHIT) and caloric test.
A cohort study was performed at a tertiary dizziness clinic in the Netherlands in MD and VM patients seen in our clinic from January 2018 until September 2024. Patients were diagnosed based on the Bárány Society criteria. We collected demographic characteristics, symptoms at presentation, results of pure-tone audiometry (PTA), caloric testing, and vHIT. Positive predictive value (PPV) and negative predictive value (NPV) of the vHIT and caloric test were calculated and the optimal unilateral weakness cut-off value was determined.
The mean age of the MD patients ( = 194) was 60.2 ± 13.4 years, with 46.4% females. The VM patients ( = 101) had a mean age of 50.2 ± 14.6 years, with 86.1% females. Not only MD patients, but also 65.7% of VM patients experienced at least one aural symptom during vertigo attacks. An abnormal caloric test, abnormal horizontal vHIT, and catch-up saccades during the vHIT were observed more frequently in MD than in VM patients. The vHIT had a PPV of 81% and an NPV of 36% to distinguish MD from VM. Additionally, in patients with a normal vHIT, the caloric test had a PPV of 82% with an NPV of 55%. Increasing the unilateral caloric weakness threshold to 34%, increased the PPV to 90%, with an NPV of 52%.
While the diagnosis of MD and VM is based on history and audiometry findings, vHIT and caloric testing may aid in differentiating between the two diseases in ambiguous cases. If either the vHIT or caloric test is abnormal, a diagnosis of MD is more likely. The optimal PPV and NPV to differentiate between MD and VM was found with a unilateral caloric weakness threshold of 34%.
梅尼埃病（MD）表现为发作性眩晕和听觉症状。前庭性偏头痛（VM）通常包含与眩晕发作相关的偏头痛特征。由于症状重叠，区分MD和VM可能具有挑战性。为了辅助两者的鉴别诊断，本研究旨在比较MD和VM患者的听觉和前庭症状及功能，并评估视频头脉冲试验（vHIT）和冷热试验的诊断价值。
在荷兰一家三级眩晕诊所进行了一项队列研究，研究对象为2018年1月至2024年9月期间在我们诊所就诊的MD和VM患者。患者根据巴兰尼协会标准进行诊断。我们收集了人口统计学特征、就诊时的症状、纯音听力测定（PTA）结果、冷热试验和vHIT结果。计算vHIT和冷热试验的阳性预测值（PPV）和阴性预测值（NPV），并确定最佳单侧减弱阈值。
MD患者（n = 194）的平均年龄为60.2±13.4岁，女性占46.4%。VM患者（n = 101）的平均年龄为50.2±14.6岁，女性占86.1%。不仅MD患者，65.7%的VM患者在眩晕发作期间也经历过至少一种耳部症状。与VM患者相比，MD患者中冷热试验异常、水平vHIT异常以及vHIT期间出现追赶性扫视的情况更为常见。vHIT区分MD和VM的PPV为81%，NPV为36%。此外，在vHIT正常的患者中，冷热试验的PPV为82%，NPV为55%。将单侧冷热减弱阈值提高到34%，PPV提高到90%，NPV为52%。
虽然MD和VM的诊断基于病史和听力测定结果，但在疑难病例中，vHIT和冷热试验可能有助于区分这两种疾病。如果vHIT或冷热试验异常，则更有可能诊断为MD。发现单侧冷热减弱阈值为34%时，区分MD和VM的PPV和NPV最佳。
