MAV vs. Meniere's

Here's a summary I made of a long article on MAV from the Tampa Bay Hearing & Balance Center. Hopefully it will give some clues to those who are trying to determine if their vertigo is MAV or purely Meniere's.

I've put it in a MAV vs. Meniere's type format, since they contrasted the two for much of the article. My summaries/interpretations are that of a laymen, and a very lay man at that. So you can reference the full article for yourself here:

http://www.tampabayhearing.com/vestibularmigraine


MAV vs. Meniere’s

Hearing:

“[Hearing is one of the bigger differences] between MAV and Ménière's. The hearing loss of migraine occurs simultaneous with the vertigo, whereas in Ménière's, it tends to occur hours to days ahead of the vertigo.”


Auditory issues - both ears vs. one ear:

MAV, auditory symptoms during episodes usually affect both ears at the same time.

Meniere’s: Auditory symptoms occur in just one ear at a time. (Excluding bilateral Meniere’s)


Nystagmus:

MAV: During vertigo episode there is seldom spontaneous nystagmus, and very little nystagmus.

Meniere’s: Nystagmus is easily observable.


Direction of Visual Spinning:

MAV: Usually vertical.

Meniere’s: Typically horizontal.

(In acute viral vertigo syndrome, nystagmus is more typically slightly rotary but can be horizontal.)


Duration of Vertigo

Not always a telling difference between the two. Both commonly last hours. Minor episodes of both MAV and Meniere's can be short lived.

In both, changing body/head positions can make it worse.

However there is an instructive difference:

MAV: Vertigo can last days. (And there is sometimes a rocking sensation that may last for many weeks to months.)

Meniere’s: Vertigo does not typically last more than 24 hours.


Timing of Associated Symptoms:

MAV: Ear issues (hearing loss or tinnitus) tend to occur at the onset of vertigo.

Meniere’s: Hearing loss usually worsens as tinnitus and pressure increases in the hours to days prior to onset of vertigo.


Head pain:

MAV: No headache required to be diagnosed with MAV. But almost all MAV patients have had a form of migraine history and a high percentage have a family history of migraine headache. “Consider that in migraine, the aura may occur without headache. It should then not seem strange that vertigo may occur without headache.”

Meniere's: The article does not discuss Meniere's headaches (unless I missed it).


Treatment

MAV:

“Treatment is usually straightforward, but can be quite complex. When the episodes are quite infrequent and not terribly severe, no treatment may be necessary. A good patient education may suffice. In our experience, a period of migraine associated vertigo may last months to a few years, but is seldom a recurring problem for more than a year or two.

For those with symptoms which recur in a disruptive pattern, we commonly find trigger issues which are manageable. For example, high stress which affects sleep patterns is common. For those patients, medications which promote sleep and improved stress management are often helpful. Antidepressants can be helpful…

Many suggest dietary manipulation such as eliminating chocolate, hard cheeses, alcohol and monosodium glutamate but our experience is that these are of uncertain value. Of course, alcohol can itself be a headache trigger, but we do not see it is MAV trigger.”

Meniere’s: (no treatment discussion, since it’s not a Meniere’s article).

Conclusion: “In summary, when recurring vertigo has a defined onset and a duration of hours to days, especially without ear-specific symptoms, migraine is a common cause. To be more definitive, a careful history and investigations of hearing and balance function and imaging of the brain are required.”

 

Summary/highlights of NIH article.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5019886/

Published: 2016



Hearing loss:

MAV: Tinnitus, aural fullness, and hearing loss increase (from 14% to 50%) in a study of MAV patients over an average of 9 years. Hearing loss remains mild and decreases much slower than MD.

Meniere’s: Hearing levels decrease significantly to a mean of 50–60 db in 5–10 years, and loss is more rapid than MAV.

(0 to 20 db represents normal hearing. The higher the db level the greater the hearing loss.)


Frequency of Vertigo Attacks

MAV: Most patients still have vertigo in the long run. (Study: 87% had recurrent vertigo over 9 years).

Meniere’s: Have fewer attacks as time goes on. (Study: After 14 years vertigo totally resolved in 50% of patients and somewhat resolved in 28%) (Study: Retrospective studies of 8,000 MD patients, show overall decrease in attacks over time.)



Effect of Gentamicin Injections:

Unpublished Study: Injection given to both patients with and without migraine history. Once the gentamicin began deadening the nerve...migraines were triggered in several migraine sufferers, but not in those without. This suggests that damage to inner ear can affect things deeper in the brain, i.e. MD/Hydrops can cause MAV. (If I'm interpreting the article correctly - Pupper)


Migraines in Meniere’s Sufferers:

‘MD patients have been found to be twice as likely to have migraine compared to those without MD . And, interestingly, those with migraine are more likely to have earlier onset and bilateral hearing loss from MD… Clearly, the relationship between MAV and MD is beyond that of chance alone."


General Conclusion

There is not enough evidence to definitively link MAV and Meniere's disease in a mechanistic way, but awareness of the blurred lines between the two disorders may assist in clinical diagnosis and treatment...

The reason MAV and MD look so much alike in some cases, yet quite dissimilar in others, is that we do not yet truly understand the pathophysiology (i.e. cause or process) of either disease…The arguments for a common cause for MAV and MD are provocative and feed our desire for an all-encompassing solution, but there is evidence that aspects of MAV and MD can be very different from one another...

As of yet, it is unclear if migraine or another trigger is the initiator of both MAV and MD, if MAV causes MD, if MD causes MAV, or if the two simply occur in parallel due to an indirect cause with many degrees of separation...

We do not wish to dishearten physicians who treat patients with dizziness by suggesting that MAV and MD are far too difficult currently to distinguish and properly diagnose. In fact, we believe that the diagnostic criteria for definite MAV and definite MD are clear and useful and that patients often can be appropriately classified into either category...

The difficulty lies within the probable categories, which leave much to be desired in achieving specificity in differentiating between MAV and MD… Our need to assign diagnoses even to patients with uncertain ailments and our need to categorize illnesses for the sake of satisfying patients' desires for therapy have put us in a position of both authority and skepticism."

 

Just more info/reiteration/clarification from a different source:

From "Practical Neurology.com" By: Terry D. Fife, MD. 32 years experience as a practicing neurologist.

http://practicalneurology.com/2009/09/PN0909_02.php/

After a long article that frustratingly seemed to say that distinguishing MAV from Meniere's is virtually impossible, we finally get the following:

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"Some patients with MAV experience randomly occurring vertigo lasting one to six hours in a pattern much like that seen in Meniere’s.

During spells of MAV, the vertigo may lead to nausea but if the patient is completely prostrate with recurrent vomiting, it somewhat favors Meniere’s.

Patients with MAV are also afflicted by nausea and movement intolerance but generally of a lesser severity than with Meniere's.

The best way to distinguish MAV from Meniere’s is by the presence of unilateral muffled hearing, tinnitus and fluctuating hearing all on the same side.

Hearing test results are generally normal in MAV but can show fluctuating and eventual permanent low frequency hearing loss in Meniere’s.

Vestibular loss caused by caloric testing (blowing air into ear) on the affected side also strongly favors Meniere’s over MAV.

Early in the course of Meniere’s, hearing and vestibular function may still be normal, making it more challenging to separate these two conditions that are not mutually exclusive."

 

Yes, that's why they're called highlights, I called myself a dumbass, and included the links.

 

James, it's ok. In the other thread you started I simply posted the link to this one without any comment because I was tired. Just posting the link probably came off the wrong way.

Anyway. I think there's enough of a difference between symptoms that in most cases MAV shouldn't be THAT hard to tell from non-MAV Meniere's.

But then my opinion is lay and colored by my growing cynicism with the medical community.