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• Low risk of hearing loss
• Low risk of loss of vestibular function (balance)
• Low incidence of complications

Though complications are infrequent, they may include:

• Bleeding
• Infection
• Hearing loss (5%)
• Persistent balance problems (50%)
• No improvement in vertigo attacks (approximately 40%)
• Facial nerve injury with resultant facial paralysis (0.1%)
• Change or loss of sense of taste
• Cerebrospinal fluid leak (rare)
• Meningitis (rare)

Despite the controversy surrounding this procedure, responses to surveys of neurosurgeons and ear surgeons indicate that it is still the most commonly performed procedure for controlling vertigo attacks in Meniere's disease.

Some patients with bilateral Meniere's disease who suffer from intractable vertigo are also candidates for endolymphatic sac surgery since all inner ear organs remain intact and the risk of additional hearing loss is low. This surgical approach may also benefit some elderly patients with Meniere's who may be at high risk of falling due to other medical issues and cannot undergo other surgical procedures that may increase vestibular dysfunction.

Ablative Procedures

Ablative procedures involve destruction of inner ear organs and are reserved for patients with severe, intractable vertigo who do not respond to any medical treatment. Ablative procedures control vertigo in over 90% of cases, however, some cause deterioration of hearing and balance function in the affected ear. As a result, some of these procedures considered only for patients who have hearing loss in addition to severe vertigo.

Ablative procedures include:

• Labyrinthectomy
• Intratympanic gentamicin (chemical labyrinthectomy)
• Vestibular nerve section

Labyrinthectomy

A labyrinthectomy is a surgical procedure that destroys the balance organ (labyrinth) of the affected inner ear in order to prevent vertigo attacks. This operation takes about 1-2 hours and has been considered the "gold standard" of procedures to control vertigo as it alleviates symptoms in 95% of patients. The major disadvantage of this procedure is that the patient is guaranteed to be deaf in the operated ear since labyrinthectomy virtually destroys the inner ear.

Candidates for this surgical option include:

• Patients with unilateral Meniere's disease who suffer from:
  • intractable vertigo
  • severe-profound hearing loss
  • very poor word recognition
• Elderly patients in good medical condition with limited hearing in the affected ear who may opt for this surgery because of its safety and simplicity

Before a labyrinthectomy can be performed, the patient must undergo testing to confirm the unilaterality of the Meniere's disease and prove that the second ear is healthy and unaffected since it will play a major role in central compensation of balance. If a labyrinthectomy is performed on a patient with bilateral Meniere's disease, it may cause:

• Oscillopsia - a visual disturbance where objects in a person's visual field seem to swing, move back and forth (oscillate), jerk, or wiggle.
• Permanent imbalance since there is no opportunity for an unaffected vestibular system (from the contralateral ear) to promote central compensation

Complications of labyrinthectomy are not common but may include:

• Bleeding
• Infection
• Change or loss of sense of taste
• Facial nerve injury (2%)
• Cerebrospinal leakage (3%)
• Meningitis

The hospital stay is usually 1-3 days with return to work in 4-8 weeks. After surgery, patients will usually experience severe vertigo for several days. Like with the other surgical procedures, the quicker one gets up and moves about, the faster the recovery begins.

Intratympanic Gentamicin