To measure and analyze the clinical and epidemiological characteristics of patients and healthy controls with enhanced eye velocity responses as well as evaluate their relationship with endolymphatic hydrops related diseases. Cross-sectional clinical study. Tertiary hospital. Three hundred sixty three participants allocated to patients (310) and healthy control (53) groups were collected on first time visit to neurotology unit. Diagnostic. Video head impulse test records, clinical diagnose, and variables and demographic data were used to get cross tables, a general linear model, diagnostic epidemiological parameters, and machine learning variable importance evaluation methods. All the statistical tests revealed a significant association between enhanced vestibulo-ocular reflex (VOR) and diagnostic categories (p < 0.001). Chi-squared residual and machine learning analyses showed Menière's disease as the main associated diagnostic category, whereas the lowest residuals and gain values were found in the control group. Enhanced VOR as a diagnostic sign of Menière's disease had a sensitivity of 42.59% and a specificity of 86.32%, with an odds ratio of 4.68 (p < 0.001). There is a significantly higher prevalence of enhanced VOR responses in patients with Menière's disease, central origin vertigo, otosclerosis, and vestibular migraine than in those with other neurotologic diseases and controls. Our study found that enhanced VOR are not pathognomonic of hydrops-related diseases and the diagnosis should not solely be based on these and instead take into context other clinical and examination findings.