Exploring Vestibular Test Battery for Differential Diagnosis of Meniere’s Disease and Vestibular Migraine

Introduction: Ménière’s disease (MD) and vestibular migraine (VM) are common causes of recurrent vertigo, often presenting with overlapping symptoms such as episodic vertigo, hearing disturbances, tinnitus, and migraine-associated features. Accurate differentiation between MD and VM remains clinically challenging. This study aims to evaluate the utility of an objective vestibular test battery in distinguishing these conditions. Methods: A prospective cross-sectional study was conducted on 45 ears who were diagnosed as, probable MD (pMD, n = 15), definite MD (dMD, n = 15), and VM ( n = 15). All participants underwent a comprehensive vestibular test battery, including cervical and ocular vestibular evoked myogenic potentials (cVEMPs, oVEMPs), video head impulse test (vHIT), and oculomotor test of video nystagmography (VNG). Results: Vestibular evoked myogenic potentials (VEMPs) showed no significant difference for frequency tuning parameter across three groups of disorders ( P > 0.05) while response rate was significantly lower among patients with dMD followed by VM and pMD for oVEMP test. Parameters of vHIT demonstrated no significant difference across these groups of patients ( P > 0.05) while VNG revealed a significant difference on saccade test among the groups of patients ( P < 0.05), with both saccades and smooth pursuit affected in MD patients, whereas VM primarily exhibited smooth pursuit abnormalities. Conclusion: The study highlights overlapping vestibular test results between MD and VM for VEMP and vHIT while significant difference in test findings were observed for saccade test of VNG.