A Demographic and Electrocochleographic Study of Ménière's Disease and Migraine Vertigo

Abstract

Ménière’s disease (MD) is an inner ear condition characterised by progressive hearing loss, tinnitus, aural fullness, and vertigo. Migraine is a common, chronic neurovascular disorder characterised by attacks of severe headaches, autonomic nervous system dysfunction, and, in some patients, visual disturbances. Patients with certain subclasses of migraine may also present with symptoms typically experienced by MD sufferers, such as vertigo, hearing loss, and tinnitus. Currently most MD cases are diagnosed through subjective criteria such as the guidelines provided by the American Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing Equilibrium (AAO-HNS CHE) and the Gibson score. Migraine is diagnosed subjectively according to the International Headache Society (IHS). The purpose of this study was to investigate whether tone burst Electrocochleography (ECochG) measures, which have been found to be effective in assisting with the diagnosis of MD, may be sensitive in differentiating between suspected MD patients with and without a history of migraine. A database of 395 patients, whose medical files included ECochG records, was analysed. The ECochG data and other patient characteristics were compared between three groups, including patients who had a history of migraine and attacks of vertigo (“Migraine”), patients who had no history of migraine but reported having had headaches and attacks of vertigo (“No migraine-with headache”), and patients who reported having had attacks of vertigo but neither a history of migraine nor headaches (“No migraine-without headache”). The “Migraine” group was found to have a significantly higher proportion of “negative” ECochG cases compared to the other two groups. The “Migraine” group also had the lowest occurrence of hearing loss and lowest mean Gibson scores amongst the three groups. These findings suggest that some patients who are subjectively diagnosed with MD may have vestibular migraine instead of MD. It is, therefore, concluded that utilisation of physiological test such as ECochG may improve the differential diagnosis of MD and vestibular migraine.