The diagnostic puzzle of episodic vertigo: A case report on ménière’s–migraine overlap syndrome
Year: 2026
Type: article
Study design: Case Report
Abstract: Ménière’s disease is a chronic inner ear disorder characterised by recurrent episodic vertigo, fluctuating low -to mid-frequency sensorineural hearing loss, tinnitus and aural fullness, and is associated with endolymphatic hydrops. A substantial proportion of patients presenting with episodic vestibular symptoms also meet the diagnostic criteria for vestibular migraine, and the two conditions frequently overlap, sharing symptoms such as photophobia, phonophobia and osmophobia, which makes clinical diagnosis a challenge. A comprehensive audiovestibular test battery, including electrocochleography (EcochG) and vestibular evoked myogenic potential (VEMPs), can support the differential diagnosis by objectively assessing cochlear and otolith involvement. Case presentation: A 47-year-old female presented with a 2-year history of giddiness and left-sided tinnitus, recurrent episodes of presyncope, and a history of benign paroxysmal positional vertigo. She reported progressive left aural fullness, fluctuating hearing loss, and episodic headache-associated giddiness accompanied by photophobia and osmophobia, with stress and panic attacks acting as triggers. Pure tone audiometry revealed minimal hearing loss in both ears, with a mild high-frequency sensorineural hearing loss in the left ear. Speech audiometry showed SRT of 20 dBHL with 92% SIS in the right ear and 25 dBHL with 88% SIS in the left ear. Tympanometry revealed an ‘A’ type tympanogram bilaterally, indicating normal middle ear functioning. DPOAEs were present, indicating preserved normal outer hair cell function bilaterally. Auditory brainstem responses demonstrated reproducible Wave V at 90dB nHL bilaterally with fair morphology and showed no electrophysiological evidence suggestive of retrocochlear involvement. Cervical and ocular VEMPs were obtained bilaterally within normal latencies, indicating intact vestibular reflex pathways, although c-VEMP amplitude was noted to be reduced in the left ear. Electrocochleography demonstrated a normal SP/AP ratio (0.25) in the right ear. In contrast, the SP/AP ratio could not be obtained in the left ear at 90dB nHL, an abnormal finding suggestive of left-sided cochlear endolymphatic hydrops. Conclusion: This case illustrates the diagnostic value of a comprehensive audio vestibular battery, particularly electrocochleography, in a patient presenting with overlapping features of Ménière’s disease and vestibular migraine. Recognizing this overlap is essential for guiding appropriate multidisciplinary management, including dietary modification and referral for further otological and neurological evaluation.
Authors: Andal Kodilingam, Rohith Rajesh
Language: English
Subfield: Neurology
Field: Neuroscience
Domain: Life Sciences
Open Access status: bronze
OpenAlex ID: W7202339705