Endolymphatic sac shunt, labyrinthectomy, and vestibular nerve section in Meniere's disease.

Medical treatment for Meniere's disease is effective in controlling vertigo for approximately 85% of patients. However, when disabling vertigo continues, surgical therapy is indicated. Several surgical approaches are performed to control the symptoms of peripheral vestibular disorders refractory to medical measures, each procedure having many technical variations. Surgery is usually reserved for patients with disabling vertigo. Here, the authors discuss surgical options for vertigo control in Meniere's disease and review the literature on outcomes of these management options. The authors discuss endolymphatic sac shunt (ie, endolymphatic mastoid shunt), vestibular nerve section, cochleosacculotomy, and labyrinthectomy. When looking at data based on patient ratings, the authors find that surgery improves vertigo in endolymphatic sac shunt, vestibular nerve section, and labyrinthectomy groups and improves imbalance for the endolymphatic sac shunt and vestibular nerve section groups. Labyrinthectomy and translabyrinthine vestibular nerve section both offer excellent control of intractable vertigo. However, patients undergoing translab yrinthine vestibular nerve section are more likely to show improvement in imbalance and functional disability. This outcome is more likely for diagnoses other than Meniere's disease. There are potential prognostic factors that can be helpful in the preoperative or postoperative counseling of patients undergoing surgical treatment of vertigo. Patients who rate themselves as more disabled before surgery are less likely to achieve the best outcomes. Several other factors, such as duration of disease, contralateral tinnitus, eye disease, and allergy, may play a role.