The Differences in Caloric Test and vHIT Results Between Menière’s Disease and Vestibular Migraine: A Systematic Review and Meta-Analysis

Abstract

Objective: – To present an overview of differences in caloric test and video Head Impulse Test (vHIT) results between Menière's disease (MD) and vestibular migraine (VM) patients. Databases reviewed: – Following PRISMA guidelines, comprehensive searches were conducted in PubMed, Embase, and Medline up to December 2024. Methods: – Clinical studies comparing caloric and/or vHIT results in MD and VM patients were included. Exclusion criteria were non-English or non-Dutch papers, pediatric studies, and studies using non-standard caloric test protocols. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool for analytical cross-sectional studies. Certainty of evidence was assessed according to the Oxford Centre for Evidence-Based Medicine. Meta-analyses of caloric test and vHIT results were performed. Results: – Twenty-one studies, including 8 prospective cohort studies, with 3096 study subjects (1561 MD; 1535 VM), were included. Fourteen studies were assessed as low risk of bias. Results showed that patients with MD were significantly more likely than those with VM to show a canal paresis on caloric testing (OR=7.00, 95% CI: 5.69-8.61, P<0.00001). This indicates that a reduced vestibular response on caloric testing strongly favors a diagnosis of MD over VM. Similarly, MD patients had higher odds of having an abnormal horizontal vHIT (OR=3.38, 95% CI: 2.39-4.78, P<0.00001), and were also more likely to demonstrate corrective (catch-up) saccades during vHIT (OR=3.52, 95% CI: 2.11-5.88, P<0.00001). Conclusions: – These findings (level 3 evidence) suggest that in clinical practice, evidence of peripheral vestibular dysfunction—detected by either caloric testing or vHIT—can help distinguish MD from VM.