Role of vestibular-evoked myogenic potentials and magnetic resonance imaging in diagnosis of vestibular migraine and Ménière’s disease

Abstract Introduction Differentiation between Meniere’s disease (MD) and vestibular migraine (VM) represents one of the most challenging audiological scenarios. This study aims to evaluate the role of using vestibular-evoked myogenic potentials and magnetic resonance imaging in better assessment of these two entities. Methods A retrospective case-control study was conducted at our tertiary referral center on cases diagnosed with MD and VM during the period from January 2023 to December 2024. Inclusion criteria included sure diagnosis with either definite VM or definite MD. Patients with peripheral hearing loss due to other causes and other neurological diseases causing headaches, and those with cervical vertebral problems were excluded. All cases had basic audiological evaluation, assessment of vestibular-evoked myogenic potentials (VEMPs) both cervical (cVEMPs) and ocular (oVEMPs), and magnetic resonance imaging of the inner ear. Results A total of 26 affected ears with MD, 26 unaffected ears, 52 ears with VM, and 40 ears as a control group were evaluated. Regarding the cVEMP test, a statistically significant delay in p13 latency was found in the affected ears in the MD group, unaffected ears in the MD group, and the VM group compared to the control group at 500 Hz ( p -value = 0.001). Regarding N23 latency, only affected MD had significantly prolonged latency compared to the control group at 500 Hz. Also, there was a delay in N23 latency in VM at this frequency compared to the control group. There was a significantly lower P13-N23 amplitude in the affected ears by MD in comparison to the control group. Radiological findings revealed a significantly larger distance between the posterior semicircular canal and posterior fossa in the VM group when compared to the control group. Receiver operating curve was done to detect the cutoff point between the VM and control groups regarding this distance and yielded a value of 1.99. Conclusion Abnormal c/oVEMP recordings, which appeared in MD patients more than in VM patients with positive frequency tuning, offer the possibility of using VEMP to differentiate MD from VM and for early detection and therapeutic monitoring of MD.