Using Video Head Impulse and Caloric Tests to Differentiate Meniere's Disease from Vestibular Migraine

Recent research highlights the clinical value of the video head impulse test (vHIT) and caloric testing in distinguishing Meniere's disease (MD) from vestibular migraine (VM). A study published online on August 6 in Frontiers in Neurology by Eleonora G.M. Vosbeek and colleagues from Gelre Hospitals in the Netherlands examined 295 patients—194 with MD and 101 with VM—at a specialized dizziness clinic. The investigation involved comprehensive assessments of sensorineural symptoms, auditory function via pure-tone audiometry, and vestibular function through caloric tests and vHIT.

The findings revealed that most patients with MD and a significant portion of VM patients experienced auditory symptoms such as tinnitus or hearing loss during vertigo episodes. Notably, MD patients more frequently exhibited abnormal caloric responses, abnormal horizontal vHIT results, and catch-up saccades, which are quick eye movements indicating vestibular deficits.

In terms of diagnostic accuracy, the vHIT showed a positive predictive value (PPV) of 81% and a negative predictive value (NPV) of 36% in identifying MD. When vHIT results were normal, the caloric test demonstrated a PPV of 82% and an NPV of 55%. These predictive values improved further to 90% PPV and 52% NPV when the unilateral caloric weakness threshold was increased to 34%. These metrics suggest that integrating vestibular testing can significantly aid clinicians in differentiating between MD and VM, especially in ambiguous cases.

The authors emphasized that while their study focused on patients already diagnosed with MD or VM, these tests may support more precise diagnosis and tailored treatment plans in patients with uncertain clinical presentations. This research underscores the importance of objective vestibular assessments in clinical practice to enhance diagnostic confidence and optimize management strategies for patients presenting with vertiginous symptoms.

Source: https://medicalxpress.com/news/2025-09-video-impulse-caloric-differentiate-meniere.html