Objective To compare the hearing and vestibular function in patients with vestibular migraine (VM) and Ménière's disease (MD), so as to identify and diagnose the two diseases. Methods The clinical data of patients with VM or MD, who were treated in the Department of Neurology, Jing'an District Zhabei Centre Hospital of Shanghai from Jan. 1, to Dec. 31, 2016, were retrospectively analyzed. All patients received pure-tone audiometry, video head pulse (VHIT) and videonystagmography (VNG) tests within 2 weeks of onset, and the results were compared between the two groups. Results A total of 31 patients with VM, including 7 males and 24 females, had an average age of (53.52±13.80) years old. Seventeen of 31 cases (54.8%) were abnormal in pure-tone audiometry, showing sensorineural hearing loss; and 13 cases had bilateral symmetry high frequency mild to moderate hearing loss. VHIT test was abnormal in 5 cases (16.1%). There was no spontaneous nystagmus in VM patients by VNG test, while position nystagmus existed in 4 cases (12.9%) by positioning test. Ten cases (32.3%) were abnormal in the saccade test, 8(25.8%) were abnormal in the smooth tracking test, 13(41.9%) were abnormal in the optokinetic nystagmus test, 12(38.7%) were abnormal in the caloric test, and no case was abnormal in the gaze test. A total of 31 patients with MD, including 17 males and 14 females, had an average age of (55.48±12.32) years old. All cases had unilateral low to medium frequency sensorineural hearing loss by pure-tone audiometry. VHIT test was abnormal in 9 cases (29.0%). There was one case (3.2%) showing spontaneous nystagmus by VNG test, and no position nystagmus was found. Six cases (19.4%) were abnormal in the saccade test, 8(25.8%) were abnormal in the smooth tracking test, 6(19.4%) were abnormal in the optokinetic nystagmus test, 13(41.9%) were abnormal in the caloric test, and no case was abnormal in the gaze test. There were significant differences in the results of pure-tone audiometry, positioning test and optokinetic nystagmus test between the patients with VM and MD (all P<0.05). Conclusion Compared with MD patients, patients with VM showed lower abnormal rate of pure-tone audiometry, with more having bilateral symmetry high frequency hearing loss, and higher rate of abnormal results in positioning test and optokinetic nystagmus test. Pure-tone audiometry, positioning test, and optokinetic nystagmus test can provide references for the differentiation of VM and MD.