Translation and Tilt Perceptual Thresholds Are Elevated in Meniere’s Disease Compared With Vestibular Migraine

OBJECTIVES: The clinical differentiation of two common vestibular disorders, Meniere's disease (MD) and vestibular migraine (VM), remains challenging and is based on criteria provided by expert panels rather than the results of diagnostic tests. We therefore investigated the hypothesis that perceptual thresholds for passive motions that activate the inner ear vestibular sensors (canals, otolith organs) can be used to improve the clinical differentiation of MD and VM. DESIGN: Self-motion perceptual thresholds were measured in MD and VM patients using a multiaxis motion platform during movements that included linear translations (along the naso-occipital, interaural, and superior-inferior axes); angular rotations (in the yaw plane); and head tilts (about an earth-horizontal roll axis). Conventional vestibular testing (caloric, video head impulse testing, and cervical vestibular evoked myogenic potential) was also performed in MD and VM patients. RESULTS: MD patients demonstrated elevated superior-inferior thresholds compared with VM patients and healthy controls; and elevated roll tilt thresholds compared with VM patients, consistent with previously described changes in saccular function in MD and in central vestibular integration in VM. Standard clinical vestibular tests, in contrast, did not differ significantly between MD and VM patients, nor did they correlate with perceptual thresholds. CONCLUSIONS: Our results support the hypothesis that perceptual threshold testing could be helpful to differentiate MD from VM in clinical practice. More generally, our findings suggest that perceptual threshold testing may provide information that is not available in the standard clinical vestibular test battery, implying that perceptual threshold tests could increase the diagnostic utility of the clinical vestibular test battery.