{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T22:32:20Z","timestamp":1783636340288,"version":"3.55.0"},"reference-count":37,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Differentiating M\u00e9ni\u00e8re\u2019s disease (MD) from vestibular migraine (VM) remains difficult because current diagnostic frameworks are predominantly clinical and incorporate pure-tone thresholds, risking incorporation bias. We asked whether speech discrimination scores (SDS) alone can separate MD from VM at the patient level and whether adding a prespecified vestibular marker, the caloric\u2013vHIT dissociation, pattern A (abnormal calorics with normal horizontal vHIT), improves performance. Methods: In a retrospective cohort (2015\u20132018) including definite MD (n = 60) and definite VM (n = 40) by B\u00e1r\u00e1ny\/ICHD criteria, we trained patient-level logistic regression models with 5-fold out-of-fold validation and in-fold preprocessing. To avoid incorporation bias, PTA was excluded from all models. Predefined feature sets were as follows: (1) SDS-only (bilateral SDS), (2) CalHiT-A-only (Yes\/No; canal paresis \u226522% with horizontal-canal vHIT gain \u22650.80 in either ear), and (3) SDS+CalHiT-A. Discrimination was assessed by ROC\u2013AUC with bootstrap 95% CIs; calibration and decision-curve analysis (DCA) are reported. An exploratory model encoded SDS as \u201caffected\/healthy.\u201d Results: The SDS-only model achieved AUC 0.866 (95% CI 0.787\u20130.937). CalHiT-A-only yielded AUC 0.674 (0.561\u20130.778). Adding CalHiT-A to SDS did not improve discrimination (SDS+CalHiT-A AUC 0.844 [0.760\u20130.913]). The exploratory \u201caffected\/healthy\u201d SDS encoding underperformed (AUC 0.801 [0.706\u20130.882]). CalHiT-A was significantly more prevalent in MD than in VM (56.7% [34\/60] vs. 17.5% [7\/40]; Fisher\u2019s exact p = 1.49 \u00d7 10\u22124). Calibration favored SDS-only, and DCA showed the highest net benefit for SDS-only across thresholds p = 0.05\u20130.40. Conclusions: Bilateral SDS alone provides robust, well-calibrated discrimination between MD and VM and outperforms CalHiT-A and the affected\/healthy SDS encoding. In this cohort, vestibular test dissociation did not add diagnostic value beyond SDS at the patient level, supporting SDS-centered diagnostic workflows while reserving CalHiT-A for adjudication and phenotyping rather than primary classification.<\/jats:p>","DOI":"10.3390\/jcm15051908","type":"journal-article","created":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T09:45:12Z","timestamp":1772531112000},"page":"1908","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Patient-Level Modeling of M\u00e9ni\u00e8re\u2019s Disease vs. Vestibular Migraine: Performance of Speech Discrimination and Caloric-vHIT Dissociation"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1192-5901","authenticated-orcid":false,"given":"Nicol\u00e1s","family":"P\u00e9rez-Fern\u00e1ndez","sequence":"first","affiliation":[{"name":"Department of Otorhinlarynglogy, Cl\u00ednica Universidad de Navarra, Marquesado de Santa Marta 1, 28027 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorea","family":"Arbizu","sequence":"additional","affiliation":[{"name":"Department of Otorhinlarynglogy, Hospital Universtario de Navaarra, 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1007\/s00415-025-13291-x","article-title":"Diagnostic challenges in vestibular migraine-clinical differentiation from Meni\u00e8re\u2019s disease and discrepancies with current classification criteria","volume":"272","author":"Huppert","year":"2025","journal-title":"J. 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