Surgical treatment

Surgery usually is reserved for patients with severe Ménière's disease refractory to medical treatment (1):

Procedures which conserve hearing in Meniere's disease:

• endolymphatic sac decompression:
  • the endolymph sac lies on the posterior surface of the petrous bone
  • decompression is performed by mastoidectomy and drained
• division of vestibular nerve - may be done in association with a neurosurgeon; the vestibular nerves are approached through a middle fossa craniotomy. There is significant morbidity associated with this procedure and a risk of postoperative epilepsy (2)
• ultrasonic destruction of the vestibular end organs - the lateral semi-circular canal is exposed by mastoidectomy and ultrasound applied

Total labyrinthectomy destroys inner ear function thus causing deafness but usually, relieving vertigo. It should only be undertaken if there is unilateral Meniere's disease and hearing loss is severe.

Seemingly irrelevant procedures have been found to be effective, for example the insertion of grommets, although symptoms may return when the grommets are taken out.

Reference:

• (1) Swartz R.Treatment of vertigo. Am Fam Physician 2005;71:1115-22, 1129-30
• (2) Prescriber (September 2001); 73-83.