Auditory and vestibular findings in patients with vestibular migraine

Abstract

Objective: We aimed to report audiological and vestibular test results in patients with vestibular migraine (VM). We used a retrospective analysis study design in the setting of a tertiary referral neuro-otology center. Patients and methods: Data from 55 patients with the diagnosis of vestibular migraine were enrolled into the study. Comprehensive audiometry, electronystagmography (ENG) and vestibular myogenic evoked potentials (VEMP) were the interventions and main outcome measures were the degree and profile of hearing loss, speech discrimination, oculomotor gaze, saccades and pursuit abnormalities, as well as the presence of spontaneous, post head-shake and positional nystagmus. We also measured the caloric response peak slow phase velocity, asymmetry, failure of fixation suppression, and VEMP p12-n23 latency response. Results: Sensorineural hearing loss was present in 71% (39/55) of patients; 53% (29/55) had bilateral symmetrical loss, 9% (5/55) had bilateral asymmetrical loss and 9% (5/55) had unilateral loss. The pattern of hearing loss was flat in 44% (24/55) of patients, low frequency in 3% (2/55) and high frequency in 24% (13/55). The degree of hearing loss was 10–25dB HL in 62% (34/55) of patients and >25dB HL in 9% (5/55). Word discrimination scores were ≥90% in 97% (53/55) of patients and <90% (84–88%) in only 3% (2/55) of patients. Abnormal vestibular findings were present in 87% (48/55). Oculomotor saccades, pursuit, and gaze tests were normal in all patients. Abnormal nystagmus was present in 58% (32/55) of patients; 15% (8/55) had spontaneous nystagmus, 31% (17/55) had post head-shake nystagmus, and 36% (20/55) had non-paroxysmal positional nystagmus. None of the patients had benign paroxysmal positional nystagmus. Caloric responses were normal and symmetrical in 57% (31/55) of patients and showed unilateral weakness in 33% (18/55) of patients. No bilateral weakness was present. Caloric hyperactivity (caloric response >40°/s) was present in 10% (6/55) of patients. All patients showed normal fixation suppression index. VEMP response (p13n23) was present in 66% (33/50) of patients with normal latency and absent in 34% (17/55) of patients. Conclusions: Sixty-two percent (34/55) of the vestibular migraine patients in this study had sensorineural hearing loss (>10–25dB HL), 58% (32/55) abnormal nystagmus, 10% (6/55) hyperactive caloric response, 33% (18/55) caloric asymmetry and 34% (17/55) absent VEMP. The patients in this study did not have central vestibular abnormalities.

Key words::

• vestibular
• migraine
• vestibular migraine
• hearing loss
• VEMP
• ENG

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.