Otol Neurotol. 2026 Jul 15. doi: 10.1097/MAO.0000000000005003. Online ahead of print.
ABSTRACT
OBJECTIVES: The advancement of high-resolution magnetic resonance imaging (MRI) has enabled clinicians to detect endolymphatic hydrops, thereby prompting interest in distinguishing between Ménière disease (MD) and vestibular migraine (VM) in patients presenting with vertigo, headache, hearing loss, ear fullness, and tinnitus. The aim of this study is to compare cochlear and vestibular endolymphatic hydrops in diagnosing VM, MD, and vestibular migraine with Ménière disease (VMMD).
METHOD: A prospective clinical study evaluating patients with episodic vertigo meeting criteria for either MD, VM, or both was conducted between July 2019 and December 2021. All patients underwent an MRI to assess hydrops in both ears. Treatment response was evaluated and considered the gold standard for diagnosis.
RESULTS: A total of 231 patients were included. The gold standard diagnosis was determined based on treatment response over at least 2 years. For MD, regardless of definite or probable diagnosis, grade I hydrops was most common for the cochlea (59.6%) and grade II for the vestibule (50.6%). No cochlear or vestibular hydrops were identified in 58.0% and 50.7% of VM cases, respectively. Grade I hydrops predominated in VM (cochlear: 39.1%; vestibular: 39.1%). Our study revealed statistically significant differences between the final diagnoses of MD, VM, and VMMD and the severity grading of vestibular and cochlear hydrops.
CONCLUSION: Endolymphatic hydrops and its severity grading are associated with MD. More than 50% of VM patients demonstrated no evidence of hydrops. However, it is important to recognize that when hydrops is present in VM patients, it is most often mild.
PMID:42456062 | DOI:10.1097/MAO.0000000000005003
