Auditory and Vestibular Symptoms and Chronic Subjective Dizziness in Patients With Meniere's Disease, Vestibular Migraine, and Meniere's Disease With Concomitant Vestibular Migraine

Objective: To compare presentations of Meniere's disease (MD), vestibular migraine (VM), and Meniere'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.