The video head impulse test (vHIT) and caloric test can help differentiate Meniere disease (MD) from vestibular migraine (VM), according to a study published online Aug. 6 in Frontiers in Neurology.

Eleonora G.M. Vosbeek, from Gelre Hospitals in the Netherlands, and colleagues conducted a cohort study at a tertiary dizziness clinic in the Netherlands involving 194 MD and 101 VM patients. Demographic characteristics, symptoms at presentation, and results of pure-tone audiometry, caloric testing, and vHIT were obtained; auditory and vestibular symptoms and functions were compared in MD and VM.

The researchers found that all MD patients and 65.7% of VM patients experienced at least one aural symptom during vertigo attacks. Compared with VM patients, MD patients more often had an abnormal caloric test, abnormal horizontal vHIT, and catch-up saccades during the vHIT. For distinguishing MD from VM, the vHIT had a positive predictive value (PPV) of 81% and negative predictive value (NPV) of 36%. In patients with normal vHIT, the caloric test had PPV and NPV of 82% and 55%, respectively. The PPV and NPV were increased to 90% and 52%, respectively, by increasing the unilateral caloric weakness threshold to 34%.

“Although our study focused on patients with a diagnosis of VM or MD, our findings suggest that vestibular function tests may support diagnostic refinement and treatment planning in patients who do not (yet) completely fulfill the criteria for VM nor for MD,” the authors write.

One author disclosed ties to the pharmaceutical industry.

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