(A860) Reduced Endolymphatic Hydrops Grading and Increased Vertigo Severity in Ménière's Disease with Concomitant Migraine

Introduction: Migraine has long been noticed to associate with Ménière’s disease, an inner-ear homeostatic failure characterized by endolymphatic hydrops (EH). Recent advances in hydrops magnetic resonance imaging (MRI) have enabled the visualization of EH in vivo. This study aims to investigate the EH grading trends in Ménière’s disease patients with and without concomitant migraine, to explore the influence of migraines on Ménière’s disease.

Methods: This prospective study was conducted at a tertiary hospital from August 2023 to January 2025. Subjects with unilateral definite Ménière’s disease, as per the 2015 criteria, were enrolled. All enrolled 43 subjects were newly diagnosed and stratified by the presence of migraine into migrainous MD (MMD) and MD cohorts. Each subject underwent pure-tone audiometry, cervical vestibular-evoked myogenic potentials tests using air-conducted stimulation, and hydrops MRI. Vertigo severity was documented based on the duration of attacks. Another 25 age-matched healthy subjects were enrolled to establish cVEMP normal data. Statistical analyses included non-paired t-tests, Chi-square tests (Fisher’s exact test), and Cochran-Armitage tests for trend.

Results: 37% of the enrolled patients belonged to the MMD cohort. The female-to-male ratios were 4 in the MMD cohort and 0.8 in the MD cohort, showing a significant difference (p < .05, Chi-square test). The mean age of disease onset was 50 years in the MMD cohort, slightly younger than 56 years in the MD cohort. EH grading analysis revealed a milder EH grading trend in the MMD cohort than the MD cohort (p < .05, Cochran-Armitage test for trend). Compared to the MD cohort, the MMD cohort clinically exhibited relatively increased vertigo severity as well as cVMEP amplitudes closer to the normal control data.

Conclusions: In comparison with MD patients, MMD patients exhibited reduced EH grading and milder saccular dysfunction yet experienced increased vertigo severity. Hence, migraine might be an important factor impacting the inner-ear homeostasis, warranting clinical attention of it in the management of Ménière’s disease.