Vestibular Migraine versus Méniere’s Disease: Diagnostic Utility of Electrocochleography

Abstract

Objectives: The diagnostic criteria for vestibular migraine (VM) and Ménière’s disease (MD) present an important overlap, which leads to a difficult diagnosis in patients presenting with headache, vertigo, hearing loss, ear fullness, and tinnitus. The objective of our study is to determine whether the area-under-the-curve ratio of the summating potentials (SP) and action potentials (AP) curves on electrocochleography (ECoG) helps differentiate VM from MD with or without the use of the well-established clinical criteria. Method: A retrospective review of patients filling either VM or MD criteria was undertaken between September 2015 and December 2018. All patients underwent ECoG before the introduction of anti-migraine therapy. The prediction of symptom improvement between the clinical criteria and ECoG results was compared by using the Vertigo Symptom Scale. Results: In total, 119 patients were included. An overlap of 36% exists between patients filling VM and MD criteria. Clinical criteria alone did not demonstrate a significant prediction of symptom response to anti-migraine therapy (VM 83%, MD 51%; p = 0.10). However, ECoG results alone did demonstrate adequate prediction (VM 94%, MD 32%; p < 0.001). A negative ECoG result combined with the clinical criteria of VM (100% symptom improvement) was shown to be more predictive of treatment response when compared to clinical criteria alone (83% symptom improvement) (p = 0.017). Finally, when used in patients filling both the VM and MD criteria (VMMD), ECoG was able to predict symptom improvement, thus better differentiating both diseases (normal ECoG: 95%, abnormal ECoG 29%; p < 0.001). Conclusion: Combining VM criteria with normal ECoG using the AUC ratio seems superior in predicting adequate symptom improvement than VM criteria alone.

Click SP/AP Area Ratio Vesrus Tone Burst SP Amplitude to Diagnose Ménière's Disease Using Electrocochleography

“…Our team already demonstrated that around 38% of patients had fulfilled both clinical criteria simultaneously 25 . The association of clinical criteria and ECochG result together can improve the prediction of symptoms improvement with antimigraine treatment in patient presenting with both criteria of MD and MV but has a normal ECochG result 26 . Therefore, these patients will be considered as patients having VM.…”

“…25 The association of clinical criteria and ECochG result together can improve the prediction of symptoms improvement with antimigraine treatment in patient presenting with both criteria of MD and MV but has a normal ECochG result. 26 Therefore, these patients will be considered as patients having VM. Observable inner ear hydrops on MRI imaging with intratympanic or intravenous injection of gadolinium compelled a series of new MRI inner ear researchers in the possibility that an identifiable diagnosis of hydrops on MRI would serve as the gold standard for MD diagnosis.…”

Reply to Hornibrook, J. Comment on “Tabet et al. Vestibular Migraine versus Méniere’s Disease: Diagnostic Utility of Electrocochleography. Audiol. Res. 2023, 13, 12–22”

“…We appreciate the comments made by Hornibrook (2024) [ 1 ] on our paper reporting on the Vestibular Migraine (VM) versus Ménière’s Disease (MD): Diagnostic Utility of Electrocochleography (ECochG) [ 2 ].…”

“…Hornibrook unaware of this information, assumed in his comment that audiologists have not employed the tone burst stimulus ECochG because it requires specialty co-operation and customized equipment that cannot be achieved by the standard commercial systems used by audiologists. However we realized throughout the period where we included the TT-TBS in our protocol that these data of TT-TBS were not as helpful as Hornibrook reported; that’s why we didn’t included their analysis in our published article to report utility of ECochG in VM and MD [ 2 ].…”

Comment on Tabet et al. Vestibular Migraine versus Méniere’s Disease: Diagnostic Utility of Electrocochleography. Audiol. Res. 2023, 13, 12–22

“…I wish to comment on an aspect of the recently published article by Saliba I. et al, titled Vestibular Migraine versus Meniere’s Disease: Diagnostic Utility of Electrocochleograpy [ 1 ]. It is commendable that the authors would use the EcochG to make a distinction, even though the technique is becoming unfashionable with the increased use of MRI inner-ear imaging.…”