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

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.

Following PRISMA guidelines, comprehensive searches were conducted in PubMed, Embase, and Medline up to December 2024.

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.

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).

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.