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Clinical Characteristics of Benign Recurrent Vestibulopathy: Clearly Distinctive From Vestibular Migraine and Menière's Disease?

van Esch, Babette F.*; van Wensen, Erik*; van der Zaag-Loonen, Hester J.*; Benthem, Peter Paul G. van; van Leeuwen, Roeland B.*

doi: 10.1097/MAO.0000000000001553

Objective: We aimed to systematically investigate the clinical characteristics of benign recurrent vestibulopathy (BRV), vestibular migraine (VM), and Menière's disease (MD) and to assess whether clinical symptoms exist that are unique to BRV.

Study Design: Prospective cohort study.

Setting: Tertiary referral center.

Methods: Between January 2015 and November 2016, patients were prospectively recruited at a specialized dizziness clinic. Patients were included if they met the diagnostic criteria for BRV, VM, or MD which was evaluated by simultaneous consultation of an otorhinolaryngologist and neurologist. All patients received a comprehensive clinical examination that included vestibular tests and pure-tone audiometry. A questionnaire was designed to systematically document symptoms of the three vestibular disorders.

Results: A total of 122 patients were included in our study, 65 (53%) were females in whom 29 (24%) were postmenopausal. The mean age was 55.5 ± 13.7 years and the mean age of onset of vertigo attacks was 49.2 ± 14.8 years (n = 119). Forty-five (37%) patients had a clinical diagnosis of BRV, 34 (28%) of VM, and 43 (35%) of MD. No symptom could be identified which was specifically linked to BRV. In patients with BRV, similar to those with VM, we found a female preponderance (p = 0.05 in BRV, p = 0.001 in VM). Patients with VM reported significantly more often a positive history of motion sickness (p = 0.01). In addition, canal paresis was most profound in patients with MD (p = 0.001).

Conclusion: We found no clinical characteristics that were distinctive for BRV. However, we did find several distinctive clinical features for VM and MD which may assist the physician in their history taking.

*Apeldoorn Dizziness Centre, Gelre Hospital, Apeldoorn

Department of Otorhinolaryngology—Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands

Address correspondence and reprint requests to Babette F. van Esch, M.D., Apeldoorn Dizziness Centre, Gelre Hospital, Albert Schweitzerlaan 31, 7334 DZ Apeldoorn, The Netherlands; E-mail:

The role of each author during manuscript preparation: B.F.v.E. helped conduct and acquisition of data, analyze data, writing the manuscript, and approved the final manuscript.

E.v.W. helped design the study, drafting the manuscript, and approved the final manuscript.

H.J.v.d.Z.-L. helped analyze data, drafting the manuscript, and approved the final manuscript.

P.P.G.v.B. helped design the study and approved the final manuscript.

R.B.v.L. helped design the study, drafting the manuscript and approved the final manuscript.

This work was supported solely from institutional and/or departmental sources from the Apeldoorn Dizziness Centre, Gelre Hospital, Apeldoorn, The Netherlands.

The authors disclose no conflicts of interest.

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