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

<b>Objectives</b>: 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). <b>Methods</b>: 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. <b>Results</b>: 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 (<i>p</i> = 0.005) and dizziness (<i>p</i> = 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; <i>p</i> = 0.002) and aggravated hearing levels on final audiometry (30.8 ± 23.0 dB vs. 12.6 ± 7.1 dB, <i>p</i> = 0.027). <b>Conclusions</b>: 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.