Prevalence and Clinical Significance of Aural Symptoms in Vestibular Migraine with and Without Ménière’s Disease

TL;DR

This study finds that aural symptoms are common in vestibular migraine and are linked to poorer treatment outcomes, with those also having Ménière’s disease showing distinct hearing loss patterns.

Contribution

The study identifies a novel association between aural symptoms in vestibular migraine and reduced treatment response, along with distinct hearing patterns in co-occurring Ménière’s disease.

Findings

Aural symptoms like ear fullness and tinnitus are prevalent in vestibular migraine patients.

Aural symptoms predict lower likelihood of improvement in headache and dizziness after treatment.

Patients with vestibular migraine and Ménière’s disease show distinct low-frequency hearing loss patterns.

Abstract

Objectives: This study investigated the clinical characteristics of patients with vestibular migraine (VM) with a specific focus on aural symptoms. Additionally, we explored the distinct features of patients with VM who were also diagnosed with Ménière’s disease (MDVM). Methods: In this retrospective cohort study conducted in a tertiary center from 2016 to 2020, we analyzed clinical features, audiovestibular test results, and symptom improvement following medical therapy in 169 patients with VM. Logistic regression was used to identify factors linked to symptom improvement. Data collected from patients with VM and MDVM were compared. Results: Patients with VM commonly experienced aural symptoms, with 47.9% experiencing ear fullness, 40.2% reporting tinnitus, and 17.2% experiencing hearing fluctuations. Logistic regression analysis revealed that aural symptoms were predictive of a lower probability of symptom improvement for headache (p = 0.005) and dizziness (p = 0.007). Eleven (6.5%) patients with VM with aural symptoms were diagnosed with MD and exhibited distinct hearing patterns. The patients with MDVM showed a greater drop at low frequencies (mean hearing threshold of 33.6 ± 6.7 dB vs. 20.6 ± 11.1 dB in MDVM and VM, respectively; p = 0.002) and aggravated hearing levels on final audiometry (30.8 ± 23.0 dB vs. 12.6 ± 7.1 dB, p = 0.027). Conclusions: Aural symptoms are common among patients with VM and are associated with a lower probability of migraine symptoms responding to medication. Patients with MDVM exhibit a distinct pattern of hearing loss, leading to deterioration, whereas other patients with VM and aural symptoms show preserved hearing levels.

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