In Response to: Secondary Causes of Dizziness in Patients With MÉniÈre's Disease

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In reply: We read the above-mentioned article with great interest (1). The authors have addressed a very important clinical challenge and aimed to investigate coexisting dizziness-inducing diagnoses in patients’ fulfilling the Ménière's disease (MD) criteria by the American Academy of Otolaryngology—Head and Neck Surgery. They have performed a single institutional chart review of the patients observed at their tertiary care referral center. The authors have stated that no previous study had quantified the prevalence of other causes of dizziness in the MD population. They continued to report that psychological distress (PD) and benign paroxysmal positional vertigo were present in 21.7% and 3.2% of the MD patients as the two most common coexisting diagnoses. They additionally reported a 1.1% prevalence of vestibular migraine (VM) in their patient population.
A number of points need to be considered with respect to the above statements and findings. Previous studies have delved into overlapping diagnoses with MD and this is not the first report of its kind (2–4). In addition, the authors count PD as a cause for dizziness but none of the provided references indicate PD to be the etiology of dizziness or vertigo but rather show an increased prevalence. Finally, the prevalence of vestibular migraine in the MD population has been reported as 38% (3) and 41% (4) in two previous studies. These rates seem far greater than the 1.1% reported in this article. Multiple other studies have also reported presence of migraine features in the MD population. This significant difference between the rates of VM in this study and the literature has not been addressed in the article. The authors did not discuss why they thought their rate was much lower than the reports in the literature. A growing body of the literature is reporting overlapping symptoms and signs between VM and MD. As such, evaluation for history of migrainous features in MD, especially in those with probable or possible MD, should be a part of the routine workup for these patients.

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