Purpose <p>Menière’s disease (MD) and vestibular migraine (VM) are two of the most common episodic vertigos. Both are diagnosed by clinical history, manifestations and for MD a typical pattern of hearing loss audiometrically confirmed is needed. The description of concomitant cochlear symptoms during acute VM attacks makes the differential diagnosis between the two conditions challenging. The aim of this study was to assess if the presence of cochlear symptoms withing vertigo attacks always address towards MD or if they may also be found in definite VM.</p> Methods <p>We performed a narrative review of the most recent literature on cochlear symptoms in probable and definite VM.</p> Results <p>Hearing loss is variably reported in the range from 5.9% to 46.7% of VM patients. Concomitant or interictal tinnitus between acute episodes of VM have been reported in the range 17.8% to 69% as well as for ear fullness (10.9% to 51%). Migraineurs more often show a deterioration of the hearing level, and mild and symmetrical hearing loss at high frequencies is a common finding, without or with only minor progression over time. Tinnitus and ear fullness do not have a standard presentation and both can be present as accompanying symptoms of an acute VM episode or during the interictal phase.</p> Conclusion <p>Hearing loss, tinnitus, and aural fullness are common accompanying features of VM but do not reflect precise patterns and can occur in a variable manner. Episodic vertigo associated with cochlear symptoms does not necessarily suggest MD, and VM should also be taken into consideration.</p>