Among patients caught between dizzying episodes of vertigo, tinnitus, and sensory overload, the line between Menière’s disease and vestibular migraine can blur. A new prospective study could offer a sharper image of the distinction between the conditions.
Menière’s disease (MD) and vestibular migraine (VM) can present with overlapping symptoms such as vertigo, tinnitus, and episodic attacks, often complicating diagnosis based on clinical and audiovestibular findings alone. Misdiagnosis may delay appropriate treatment.
In a prospective clinical study, researchers demonstrated that hydrops magnetic resonance imaging (MRI) using combined cochlear and vestibular biomarkers accurately differentiated MD from VM, addressing a long-standing diagnostic challenge in neurotology.
The researchers recruited 31 patients: 15 with MD and 16 with VM. All underwent delayed postgadolinium contrast three-dimensional SPACE FLAIR MRI to visualize inner ear fluid abnormalities, performed 4 hours following intravenous gadobutrol administration.
The researchers assessed three markers: cochlear endolymphatic hydrops (CEH), vestibular endolymphatic hydrops (VEH), and perilymphatic enhancement (PLE). None of the patients with VM showed CEH, VEH, or increased PLE. In contrast, all of the patients with MD exhibited at least one abnormality. CEH was present in 13 MD cases, VEH in 14, and increased PLE in 9.
Logistic regression analysis showed that the combination of CEH and VEH achieved 100% diagnostic accuracy in distinguishing MD from VM. In contrast, using CEH, VEH, or PLE alone led to misclassifications, underscoring the importance of combining biomarkers for optimal accuracy.
Patient classification followed diagnostic criteria from the Bárány Society and the International Headache Society. Among MD cases, 10 were definite and 5 probable; while among VM cases, 9 were definite and 7 probable. The mean age was 56 years in the MD group and 46 years in the VM group. The VM group had a higher female-to-male ratio (14:2) compared with the MD group (7:8).
MRI scans were performed using a 3-Tesla scanner. Radiologists blinded to clinical data evaluated CEH and VEH using standard grading scales; PLE was assessed qualitatively.
Current practices may involve empiric medication trials to differentiate MD from VM by observing treatment response. However, this approach is time-consuming and may yield inconclusive results. Hydrops MRI provided a noninvasive, objective alternative that can improve diagnostic clarity and reduce time to appropriate care.
Though the study was limited by its small sample size, the prospective design, strict case definitions, and standardized imaging protocol supported the validity of the findings. The researchers recommended larger studies to confirm diagnostic performance in broader populations.
The results supported the integration of hydrops MRI into diagnostic workflows among patients with vertigo and overlapping inner ear symptoms, offering a precise tool to distinguish MD from VM.
The authors reported no conflicts of interest.
Source: Frontiers in Neurology
