J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Review

Volume 9, Number 9, September 2017, pages 733-744

Meniere’s Disease and Vestibular Migraine: Updates and Review of the Literature

**Table 1.** Diagnostic Criteria for Vestibular Migraine Proposed by Neuhauser, 2001
Vestibular migraine, defined
1) Vestibular symptoms at least of moderate intensity
2) Current or past history of migraine, according to International Headache Society criteria
3) One of the following migraine symptoms during at least two attacks of vertigo: migraine, photophobia, phonophobia, visual or other auras
4) Other causes ruled out by an appropriate research
Probable vestibular migraine
1) Vestibular symptoms of at least moderate intensity
2) One of the following:
a) Current or past history of migraine according to 2004 criteria
b) Migraine symptoms during vestibular symptoms
c) Migraine precipitants of vertigo in more than 50% of attacks: food triggers, sleep problems, hormonal changes
d) Response to anti-migraine drugs in more than 50% of attacks
3) Other causes ruled out by appropriate research

Table 1. Diagnostic Criteria for Vestibular Migraine Proposed by Neuhauser, 2001

Vestibular migraine, defined

1) Vestibular symptoms at least of moderate intensity

2) Current or past history of migraine, according to International Headache Society criteria

3) One of the following migraine symptoms during at least two attacks of vertigo: migraine, photophobia, phonophobia, visual or other auras

4) Other causes ruled out by an appropriate research

Probable vestibular migraine

1) Vestibular symptoms of at least moderate intensity

2) One of the following:

a) Current or past history of migraine according to 2004 criteria

b) Migraine symptoms during vestibular symptoms

c) Migraine precipitants of vertigo in more than 50% of attacks: food triggers, sleep problems, hormonal changes

d) Response to anti-migraine drugs in more than 50% of attacks

3) Other causes ruled out by appropriate research

**Table 2.** Diagnostic Criteria for Vestibular Migraine Proposed by Barany Society and the Third International Classification of Headache Disorders (ICHD-3), 2012
^aUsually interfere with daily activities. ^bUsually prohibit daily activities.
Vestibular migraine
1) At least five episodes with vestibular symptoms of moderate^a or severe^b intensity, lasting 5 min to 72 h
2) Current or previous history of migraine with or without aura according to the International Classification of Headache Disorders (ICHD)
3) One or more migraine features with at least 50% of the vestibular episodes: a) headache with at least two of the following characteristics: one sided location, pulsating quality, moderate^a or severe^b pain intensity, aggravation of routine physical activity; b) photophobia and phonophobia; c) visual aura
4) Not better accounted for by another vestibular or ICHD diagnosis
Probable vestibular migraine
1) At least five episodes with vestibular symptoms of moderate or severe intensity, lasting 5 min to 72 h
2) Only one of the criteria B and C for vestibular migraine is fulfilled (migraine history or migraine features during the episode)
3) Not better accounted for by another vestibular or ICHD diagnosis

Table 2. Diagnostic Criteria for Vestibular Migraine Proposed by Barany Society and the Third International Classification of Headache Disorders (ICHD-3), 2012

^aUsually interfere with daily activities. ^bUsually prohibit daily activities.

Vestibular migraine

1) At least five episodes with vestibular symptoms of moderate^a or severe^b intensity, lasting 5 min to 72 h

2) Current or previous history of migraine with or without aura according to the International Classification of Headache Disorders (ICHD)

3) One or more migraine features with at least 50% of the vestibular episodes: a) headache with at least two of the following characteristics: one sided location, pulsating quality, moderate^a or severe^b pain intensity, aggravation of routine physical activity; b) photophobia and phonophobia; c) visual aura

4) Not better accounted for by another vestibular or ICHD diagnosis

Probable vestibular migraine

1) At least five episodes with vestibular symptoms of moderate or severe intensity, lasting 5 min to 72 h

2) Only one of the criteria B and C for vestibular migraine is fulfilled (migraine history or migraine features during the episode)

3) Not better accounted for by another vestibular or ICHD diagnosis

**Table 3.** The 1995 American Academy of Otolaryngology-Head and Neck Surgery Diagnostic Criteria for Meniere’s Disease
Certain Meniere’s disease	Definite Meniere’s disease plus histopathologic confirmation
Definite Meniere’s disease	Two or more definitive spontaneous episodes of vertigo 20 minutes or longer
Audiometrically documented hearing loss on at least one occasion
Tinnitus or aural fullness in the treated ear
Other causes excluded
Probable Meniere’s disease	One definitive episode of vertigo
Audiometrically documented hearing loss on at least one occasion
Tinnitus or aural fullness in the treated ear
Other causes excluded
Possible Meniere’s disease	Episodic vertigo of the Meniere’s type without documented hearing loss or sensorineural hearing loss, fluctuating or fixed, with disequilibrium but without definitive episodes
Other causes excluded

Table 3. The 1995 American Academy of Otolaryngology-Head and Neck Surgery Diagnostic Criteria for Meniere’s Disease

Certain Meniere’s disease

Definite Meniere’s disease plus histopathologic confirmation

Definite Meniere’s disease

Two or more definitive spontaneous episodes of vertigo 20 minutes or longer

Audiometrically documented hearing loss on at least one occasion

Tinnitus or aural fullness in the treated ear

Other causes excluded

Probable Meniere’s disease

One definitive episode of vertigo

Audiometrically documented hearing loss on at least one occasion

Tinnitus or aural fullness in the treated ear

Other causes excluded

Possible Meniere’s disease

Episodic vertigo of the Meniere’s type without documented hearing loss or sensorineural hearing loss, fluctuating or fixed, with disequilibrium but without definitive episodes

Other causes excluded

**Table 4.** Comparisons in Historical Findings Between Meniere’s Disease (MD) and Vestibular Migraine (VM)
Findings	Article	Criteria	MD	VM	P-value
Nil: data not mentioned; ND: no difference noted but no P-value given; MSQ: motion sensitivity questionnaire; HL: hearing loss; HA: headache; Mod: moderate; Hx: history. Official: International Headache Society and Barany Society criteria (2012); Unofficial: Neuhauser criteria (2001).
Sex (female %)	Neff et al [16]	Unofficial	35	83	< 0.0001
Martin-Sanz et al [20]	Official	Nil	Nil	ND
Age (years)	Hong et al [19]	Unofficial	49	43	ND
Martin-Sanz et al [20]	Official	46	37	ND
Age of onset (years)	Neff et al [16]	Unofficial	51	41	0.0007
Lopez-Escamez et al [18]	Official	48	43	0.007
Evolution	Martin-Sanz et al [20]	Official	Nil	Nil	ND
Vertigo Duration (hours)	Neff et al [16]	Unofficial	47	19	< 0.0001
Illness duration (months)			12	6	< 0.0001
Non-vertiginous dizziness (%)			50	78	< 0.0001
Fluctuating HL (%)			78	14	< 0.0001
Progressive HL (%)			93	22	< 0.0001
HL related to vertigo (%)			43	44	0.91
Tinnitus (%)	Neff et al [16]	Unofficial	96	55	< 0.0001
Lopez-Escamez et al [18]	Official	83	46	< 0.001
Tinnitus related to vertigo (%)	Neff et al [16]	Unofficial	59	50	0.47
Aural Fullness (%)	Neff et al [16]	Unofficial	78	51	0.0026
Lopez-Escamez et al [18]	Official	80	34	< 0.001
Aural Fullness related to vertigo (%)	Neff et al [16]	Unofficial	65	70	0.71
Otalgia (%)			17	27	0.09
Palpitations (%)	Lopez-Escamez et al [18]	Official	34	50	0.008
Anxiety (%)			78	91	0.024
Headache (%)	Neff et al [16]	Unofficial	81	99	0.0026
Lopez-Escamez et al [18]	Official	41	95	< 0.001
Frequent headache (daily or weekly)	Neff et al [16]	Unofficial	19	67	< 0.0001
Headache duration (> day)			8	43	0.0012
Headache severity (mod/severe) (%)			26	96	< 0.0001
HA age of onset (years)			23	28	0.44
Migraine-type headache (%)	Lopez-Escamez et al [18]	Official	8	69	< 0.001
Phonophobia (%)	Neff et al [16]	Unofficial	63	82	0.1
Lopez-Escamez et al [18]	Official	62	80	< 0.001
Photophobia (%)	Neff et al [16]	Unofficial	40	86	< 0.0001
Lopez-Escamez et al [18]	Official	41	80	< 0.001
Nausea or vomiting with HA (%)	Neff et al [16]	Unofficial	20	72	< 0.0001
Vomiting (%)	Lopez-Escamez et al [18]	Official	84	69	0.002
Headache triggers (%)	Neff et al [16]	Unofficial	11	69	< 0.0001
Balance symptoms with HA			31	81	0.07
Frequency of balance symptoms with HA			29	80	< 0.0001
Aura (%)	Neff et al [16]	Unofficial	22	62	< 0.0001
Lopez-Escamez et al [18]	Official	11	32	< 0.001
Family Hx of vertigo or dizziness (%)	Neff et al [16]	Unofficial	17	30	0.16
Family Hx of HL (%)			33	25	0.74
Family Hx of Migraine (%)			26	61	0.0017
History of motion sickness (%)	Neff et al [16]	Unofficial	20	51	0.0023
MSQ score to riding in a car	Sharon et al [17]	Unofficial	0.5	1.07	0.048

Table 4. Comparisons in Historical Findings Between Meniere’s Disease (MD) and Vestibular Migraine (VM)

Findings

Article

Criteria

P-value

Nil: data not mentioned; ND: no difference noted but no P-value given; MSQ: motion sensitivity questionnaire; HL: hearing loss; HA: headache; Mod: moderate; Hx: history. Official: International Headache Society and Barany Society criteria (2012); Unofficial: Neuhauser criteria (2001).

Sex (female %)

Neff et al [16]

Unofficial

< 0.0001

Martin-Sanz et al [20]

Official

Nil

Age (years)

Hong et al [19]

Unofficial

Martin-Sanz et al [20]

Official

Age of onset (years)

Neff et al [16]

Unofficial

0.0007

Lopez-Escamez et al [18]

Official

0.007

Evolution

Martin-Sanz et al [20]

Official

Nil

Vertigo Duration (hours)

Neff et al [16]

Unofficial

< 0.0001

Illness duration (months)

< 0.0001

Non-vertiginous dizziness (%)

< 0.0001

Fluctuating HL (%)

< 0.0001

Progressive HL (%)

< 0.0001

HL related to vertigo (%)

0.91

Tinnitus (%)

Neff et al [16]

Unofficial

< 0.0001

Lopez-Escamez et al [18]

Official

< 0.001

Tinnitus related to vertigo (%)

Neff et al [16]

Unofficial

0.47

Aural Fullness (%)

Neff et al [16]

Unofficial

0.0026

Lopez-Escamez et al [18]

Official

< 0.001

Aural Fullness related to vertigo (%)

Neff et al [16]

Unofficial

0.71

Otalgia (%)

0.09

Palpitations (%)

Lopez-Escamez et al [18]

Official

0.008

Anxiety (%)

0.024

Headache (%)

Neff et al [16]

Unofficial

0.0026

Lopez-Escamez et al [18]

Official

< 0.001

Frequent headache (daily or weekly)

Neff et al [16]

Unofficial

< 0.0001

Headache duration (> day)

0.0012

Headache severity (mod/severe) (%)

< 0.0001

HA age of onset (years)

0.44

Migraine-type headache (%)

Lopez-Escamez et al [18]

Official

< 0.001

Phonophobia (%)

Neff et al [16]

Unofficial

0.1

Lopez-Escamez et al [18]

Official

< 0.001

Photophobia (%)

Neff et al [16]

Unofficial

< 0.0001

Lopez-Escamez et al [18]

Official

< 0.001

Nausea or vomiting with HA (%)

Neff et al [16]

Unofficial

< 0.0001

Vomiting (%)

Lopez-Escamez et al [18]

Official

0.002

Headache triggers (%)

Neff et al [16]

Unofficial

< 0.0001

Balance symptoms with HA

0.07

Frequency of balance symptoms with HA

< 0.0001

Aura (%)

Neff et al [16]

Unofficial

< 0.0001

Lopez-Escamez et al [18]

Official

< 0.001

Family Hx of vertigo or dizziness (%)

Neff et al [16]

Unofficial

0.16

Family Hx of HL (%)

0.74

Family Hx of Migraine (%)

0.0017

History of motion sickness (%)

Neff et al [16]

Unofficial

0.0023

MSQ score to riding in a car

Sharon et al [17]

Unofficial

0.5

1.07

0.048

**Table 5.** Comparisons in Physical Exam Findings, Auditory Tests Results and Endolymphatic Hydrops Between MD and VM
Findings (unit)	Article	Criteria	MD	VM	P-value
MD: Meniere’s disease; VM: vestibular Migraine; dMD: definite Meniere’s disease; dVM: definite vestibular migraine; pMD: probable Meniere’s disease; pVM: probable vestibular migraine; PTA: pure tone average; ELH: endolymphatic hydrops; ECOG: electrocochleography; dB: decibels; Nil: data not mentioned; D: difference noted but no P-value given; official: International Headache Society and Barany Society criteria (2012); unofficial: Neuhauser criteria (2001). Hearing class according to AAO-HNS hearing preservation reporting guidelines (view Table 7). SP: summating potential; AP: action potential.
Abnormal head-shaking nystagmus (%)	Neff et al [16]	Unofficial	62	15	< 0.0001
Shin et al [21]		71	50	< 0.05
Abnormal head-thrust (%)	Neff et al [16]		37	3	< 0.0001
Abnormal vibration induced nystagmus (%)	Neff et al [16]		60	12	< 0.0001
Shin et al [21]		42	32	< 0.05
Abnormal smooth pursuit (%)	Neff et al [16]		5	8	0.09
Abnormal saccades (%)			5	0	0.46
Initial PTA ≥ 25 dB (%)	Neff et al [16]	Unofficial	83	7	0.0011
Worst PTA ≥ 25 dB (%)			100	9	< 0.0001
Initial discrimination ≥ 25 dB (%)			68	2	< 0.0001
Change in discrimination (%/month)			86	2	< 0.0001
Initial hearing class B-D (%)			71	5	< 0.0001
Worst hearing class B-D (%)			95	6	< 0.0001
Low tone hearing loss pattern (%)			40	0	< 0.0001
PTA for dMD vs. dVM (dB)	Martin-Sanz et al [20]	Official	Nil	Nil	> 0.05
PTA for pMD vs. pVM (dB)			35	16	D
Significant vestibular ELH (%)	Nakada et al [22]	Official	79	14	< 0.01
Significant Cochlear ELH (%)			30	0	< 0.05
ELH on ECOG (%) (SP/AP amplitude ratio)	Martin-Sanz et al [20]		82	24	< 0.05

Table 5. Comparisons in Physical Exam Findings, Auditory Tests Results and Endolymphatic Hydrops Between MD and VM

Findings (unit)

Article

Criteria

P-value

MD: Meniere’s disease; VM: vestibular Migraine; dMD: definite Meniere’s disease; dVM: definite vestibular migraine; pMD: probable Meniere’s disease; pVM: probable vestibular migraine; PTA: pure tone average; ELH: endolymphatic hydrops; ECOG: electrocochleography; dB: decibels; Nil: data not mentioned; D: difference noted but no P-value given; official: International Headache Society and Barany Society criteria (2012); unofficial: Neuhauser criteria (2001). Hearing class according to AAO-HNS hearing preservation reporting guidelines (view Table 7). SP: summating potential; AP: action potential.

Abnormal head-shaking nystagmus (%)

Neff et al [16]

Unofficial

< 0.0001

Shin et al [21]

< 0.05

Abnormal head-thrust (%)

Neff et al [16]

< 0.0001

Abnormal vibration induced nystagmus (%)

Neff et al [16]

< 0.0001

Shin et al [21]

< 0.05

Abnormal smooth pursuit (%)

Neff et al [16]

0.09

Abnormal saccades (%)

0.46

Initial PTA ≥ 25 dB (%)

Neff et al [16]

Unofficial

0.0011

Worst PTA ≥ 25 dB (%)

100

< 0.0001

Initial discrimination ≥ 25 dB (%)

< 0.0001

Change in discrimination (%/month)

< 0.0001

Initial hearing class B-D (%)

< 0.0001

Worst hearing class B-D (%)

< 0.0001

Low tone hearing loss pattern (%)

< 0.0001

PTA for dMD vs. dVM (dB)

Martin-Sanz et al [20]

Official

Nil

> 0.05

PTA for pMD vs. pVM (dB)

Significant vestibular ELH (%)

Nakada et al [22]

Official

< 0.01

Significant Cochlear ELH (%)

< 0.05

ELH on ECOG (%) (SP/AP amplitude ratio)

Martin-Sanz et al [20]

< 0.05

**Table 6.** Comparisons in Vestibular Tests Results Between MD and VM
Findings	Article	Criteria	MD	VM	P-value
Hz: Hertz; TB: tone burst; vHIT: video head impulse test; hVOR: horizontal vestibulo-ocular reflex; CAQEM: covert anti-compensatory quick eye movements; nil: data not mentioned; official: International Headache Society and Barany Society criteria (2012); unofficial: Neuhauser criteria (2001). oVEMP: ocular vestibular evoked myogenic potential; cVEMP: cervical vestibular evoked myogenic potential; µV: microvolt; ms: millisecond; mV: millivolt; ND: no difference noted but no P-value given.
Mean caloric asymmetry (%)	Neff et al [16]	Unofficial	33	13	< 0.0001
Blodow et al [23]	Official	38	16	0.005
Sharon et al [17]	Unofficial	40	24	0.0007
Abnormal caloric asymmetry (%)	Neff et al [16]	Unofficial	63	17	< 0.0001
Blodow et al [23]	Official	67	22	0.002
Hong et al [19]	Unofficial	48	23	< 0.05
Shin et al [21]	Unofficial	47	25	< 0.05
Taylor et al [24]	Unofficial	OR = 26.36 for MD vs. VM	< 0.001
		Sensitivity = 74.5%
Martin-Sanz et al [20]	Official	Nil	Nil	> 0.05
Mean directional preponderance (%)	Neff et al [16]	Unofficial	19	13	0.09
Abnormal directional preponderance (%)			29	15	0.15
Abnormal rotary chair phase (%)	Neff et al [16]	Unofficial	68	18	< 0.0001
Rotary chair gain towards affected ear (Hz)	Neff et al [16]	Unofficial	25	36	< 0.0001
Taylor et al [24]	Unofficial	16	25	0.014
Rotary chair gain towards unaffected ear (Hz)	Taylor et al [24]	Unofficial	18	23	0.165
Abnormal rotary chair TC towards affected ear (Hz)			16	25	0.009
Abnormal rotary chair TC towards un affected ear (Hz)			17	24	0.033
Abnormal rotary chair symmetry (%)	Neff et al [16]	Unofficial	35	29	0.02
Abnormal vHIT hVOR gain (%)	Blodow et al [23]	Official	37	9	0.025
Presence of vHIT CAQEM (%)	Heuberger et al [28]	Official	Nil	Nil	0.01
Abnormal VEMP (%)	Neff et al [16]	Unofficial	45	16	0.0068
cVEMP 250 Hz TB amplitude asymmetry ratios (%)	Taylor et al [24]	Unofficial	40	5	< 0.001 - 0.024
cVEMP 500 Hz TB amplitude asymmetry ratios (%)			60	10	< 0.001 - 0.024
cVEMP 1 kHz TB amplitude asymmetry ratios (%)			40	15	< 0.001 - 0.024
cVEMP 2 kHz TB amplitude asymmetry ratios (%)			30	15	< 0.001 - 0.024
cVEMP 500 Hz/1kHz TB amplitude ratio			0.89	1.11	0.007
cVEMP 500 Hz TB detection rate (%)	Murofushi et al [25]	Unofficial	63	100	0.0003
cVEMP mean corrected amplitudes			0.59	1.49	0.001
cVEMP click amplitudes (µV)	Zuniga et al [26]	Unofficial	Nil	Nil	ND
cVEMP click peak-to-peak amplitudes (µV)			29	38	0.625
cVEMP click latencies (ms)			Nil	Nil	ND
cVEMP click amplitudes for right side	Baier et al [27]	Unofficial	Nil	Nil	0.22
cVEMP click amplitudes for left side (ms)			Nil	Nil	0.744
cVEMP click latencies p13 right side (ms)			16	16	> 0.01
cVEMP click latencies p13 left side (ms)			16	16	> 0.01
cVEMP click latencies n23 right side (ms)			25	25	> 0.01
cVEMP click latencies n23 left side (ms)			26	25	> 0.01
oVEMP click reflex latencies (ms)	Zuniga et al [26]	Unofficial	11.1	9.8	0.028
oVEMP 500 Hz TB reflex latencies (ms)			11.1	10.4	0.041
oVEMP 500 Hz TB reflex amplitudes			0.98	3.4	0.007
oVEMP reflex hammer midline tap amplitudes (mV)			4.6	5.45	0.21
oVEMP mini-shaker tap amplitudes (mV)			3.9	5	0.217
oVEMP reflex hammer midline tap latencies (ms)			8	7.5	0.879
oVEMP reflex mini-shaker tap latencies (ms)			9.8	9.8	0.597

Table 6. Comparisons in Vestibular Tests Results Between MD and VM

Findings

Article

Criteria

P-value

Hz: Hertz; TB: tone burst; vHIT: video head impulse test; hVOR: horizontal vestibulo-ocular reflex; CAQEM: covert anti-compensatory quick eye movements; nil: data not mentioned; official: International Headache Society and Barany Society criteria (2012); unofficial: Neuhauser criteria (2001). oVEMP: ocular vestibular evoked myogenic potential; cVEMP: cervical vestibular evoked myogenic potential; µV: microvolt; ms: millisecond; mV: millivolt; ND: no difference noted but no P-value given.

Mean caloric asymmetry (%)

Neff et al [16]

Unofficial

< 0.0001

Blodow et al [23]

Official

0.005

Sharon et al [17]

Unofficial

0.0007

Abnormal caloric asymmetry (%)

Neff et al [16]

Unofficial

< 0.0001

Blodow et al [23]

Official

0.002

Hong et al [19]

Unofficial

< 0.05

Shin et al [21]

Unofficial

< 0.05

Taylor et al [24]

Unofficial

OR = 26.36 for MD vs. VM

< 0.001

Sensitivity = 74.5%

Martin-Sanz et al [20]

Official

Nil

> 0.05

Mean directional preponderance (%)

Neff et al [16]

Unofficial

0.09

Abnormal directional preponderance (%)

0.15

Abnormal rotary chair phase (%)

Neff et al [16]

Unofficial

< 0.0001

Rotary chair gain towards affected ear (Hz)

Neff et al [16]

Unofficial

< 0.0001

Taylor et al [24]

Unofficial

0.014

Rotary chair gain towards unaffected ear (Hz)

Taylor et al [24]

Unofficial

0.165

Abnormal rotary chair TC towards affected ear (Hz)

0.009

Abnormal rotary chair TC towards un affected ear (Hz)

0.033

Abnormal rotary chair symmetry (%)

Neff et al [16]

Unofficial

0.02

Abnormal vHIT hVOR gain (%)

Blodow et al [23]

Official

0.025

Presence of vHIT CAQEM (%)

Heuberger et al [28]

Official

Nil

0.01

Abnormal VEMP (%)

Neff et al [16]

Unofficial

0.0068

cVEMP 250 Hz TB amplitude asymmetry ratios (%)

Taylor et al [24]

Unofficial

< 0.001 - 0.024

cVEMP 500 Hz TB amplitude asymmetry ratios (%)

< 0.001 - 0.024

cVEMP 1 kHz TB amplitude asymmetry ratios (%)

< 0.001 - 0.024

cVEMP 2 kHz TB amplitude asymmetry ratios (%)

< 0.001 - 0.024

cVEMP 500 Hz/1kHz TB amplitude ratio

0.89

1.11

0.007

cVEMP 500 Hz TB detection rate (%)

Murofushi et al [25]

Unofficial

100

0.0003

cVEMP mean corrected amplitudes

0.59

1.49

0.001

cVEMP click amplitudes (µV)

Zuniga et al [26]

Unofficial

Nil

cVEMP click peak-to-peak amplitudes (µV)

0.625

cVEMP click latencies (ms)

Nil

cVEMP click amplitudes for right side

Baier et al [27]

Unofficial

Nil

0.22

cVEMP click amplitudes for left side (ms)

Nil

0.744

cVEMP click latencies p13 right side (ms)

> 0.01

cVEMP click latencies p13 left side (ms)

> 0.01

cVEMP click latencies n23 right side (ms)

> 0.01

cVEMP click latencies n23 left side (ms)

> 0.01

oVEMP click reflex latencies (ms)

Zuniga et al [26]

Unofficial

11.1

9.8

0.028

oVEMP 500 Hz TB reflex latencies (ms)

11.1

10.4

0.041

oVEMP 500 Hz TB reflex amplitudes

0.98

3.4

0.007

oVEMP reflex hammer midline tap amplitudes (mV)

4.6

5.45

0.21

oVEMP mini-shaker tap amplitudes (mV)

3.9

0.217

oVEMP reflex hammer midline tap latencies (ms)

7.5

0.879

oVEMP reflex mini-shaker tap latencies (ms)

9.8

0.597

**Table 7.** 1995 American Academy of Otolaryngology-Head and Neck Surgery Hearing Preservation Reporting Guidelines
Class	Pure-tone thresholds	Speech discrimination (%)
A	≤ 30 dB	≥ 70
B	> 30 dB, ≤ 50 dB	≥ 50
C	> 50 dB	≥ 50
D	Any level	< 50

Table 7. 1995 American Academy of Otolaryngology-Head and Neck Surgery Hearing Preservation Reporting Guidelines

Class

Pure-tone thresholds

Speech discrimination (%)

≤ 30 dB

≥ 70

> 30 dB, ≤ 50 dB

≥ 50

> 50 dB

≥ 50

Any level

< 50

**Table 8.** Amended 2015 Criteria for Diagnosis of MD by the European Academy of Otology and Neurotology
Definite	Two or more spontaneous episodes of vertigo, each lasting 20 min to 12h
Audiometrically documented low to midfrequency sensorineural hearing loss in one ear, defining the ear on one occasion before, during or after one episode of vertigo
Fluctuating aural symptoms (hearing, tinnitus, or fullness) in the affected ear
Not better accounted for by another vestibular diagnosis
Probable	Two or more episodes of vertigo or dizziness, each lasting 20 min to 24 h
Fluctuating aural symptoms (hearing, tinnitus, or fullness) in the affected ear
Not better accounted for by another vestibular diagnosis

Table 8. Amended 2015 Criteria for Diagnosis of MD by the European Academy of Otology and Neurotology

Definite

Two or more spontaneous episodes of vertigo, each lasting 20 min to 12h

Audiometrically documented low to midfrequency sensorineural hearing loss in one ear, defining the ear on one occasion before, during or after one episode of vertigo

Fluctuating aural symptoms (hearing, tinnitus, or fullness) in the affected ear

Not better accounted for by another vestibular diagnosis

Probable

Two or more episodes of vertigo or dizziness, each lasting 20 min to 24 h

Fluctuating aural symptoms (hearing, tinnitus, or fullness) in the affected ear

Not better accounted for by another vestibular diagnosis