Meniere’s disease (MD), or idiopathic endolymphatic hydrops, is a debilitating disorder of the inner ear, characterized by a triad or tetrad of periodic true vertigo, wax and waning tinnitus, oscillatory progressive low-frequency hearing loss, and aural fullness. Similar to MD, migraine is characterized by headache attacks with symptoms that include nausea, vomiting, photophobia, osmophobia, and phonophobia. Despite epidemiologic studies suggesting associations between migraine and MD, few have investigated the frequency of phonophobia in patients with MD.

For a study published in Acta Oto-Laryngologica, Alia Saberi, MD, Fataneh Bakhshi, PhD, Tina Taherzadeh Amlashi, MD, Sepehr Tohidi, MD, and I evaluated the frequency of phonophobia in MD, as well as other migraine symptoms, among adults with definite MD and healthy sex- and age-matched controls. Participants provided demographic data and other clinical features, including age of vertigo onset; family history of migraine, MD, or episodic vertigo with or without auditory symptoms; signs of migraine (including headache, photophobia, phonophobia, osmophobia, and aura); and clinical manifestations of MD.

Among those with MD, the frequency of migraine headache was 16%, compared with only 5% in controls. A positive family history of migraine was seen in 63.7% of migrainous patients with MD, compared with 12.1% in others with MD. Positive family history of migraine was the only significant determinant of migraine presence in patients with MD. Phonophobia frequency in patients with MD was 88.4% overall, 54.5% in those with migraine, and 89.6% in those without migraine.

Among patients with MD, the higher frequency of phonophobia in those without migraine suggests it may be an independent symptom in MD. If we consider the acute attacks of MD as “labyrinthitis” spells, the presence of phonophobia in MD may be explainable. Due to other more significant, and perhaps more annoying symptoms—such as vertigo, roaring tinnitus, or hearing loss— many MD cases do not “declare” the presence of phonophobia. Hence, it may be important to add the fourth or fifth symptom of phonophobia to the remaining classic triad or tetrad of MD.