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Recovery from VNS typically involves an overnight stay in the intensive care unit followed by a 3-7 day hospital stay. Patients often experience a severe attack of vertigo after surgery that gradually improves. The quicker the patient is up and walking, the faster the recovery. Recovery tends to be more rapid with younger patients. The return to work is usually within 4-8 weeks. Following surgery, it is important for the patient to enter an active vestibular rehabilitation program in order to promote central compensation and restore vestibular function as quickly as possible.

Patients who opt for this surgical procedure typically:

• Suffer from unilateral Meniere's disease
• Have severe vertigo which is refractory to previous treatments
• Have serviceable hearing

Many young people opt for this surgical procedure despite its invasiveness and potential for complications since there is a high rate of hearing preservation and control of vertigo is virtually guaranteed. The percentage of patients with significant vertigo control at 2-5 years is 91-93%.

Many patients report that even years after surgery, they may still feel dizzy with a rapid head turn or if they step off a curb. If vertigo persists after VNR, the patient may benefit from treatment with intratympanic gentamicin.

Because of the important role played by the vestibular system in the unaffected ear in restoring balance, surgeons are very selective regarding this procedure for elderly patients who have a higher rate of medical conditions that may affect central compensation and restoration of balance. Like labyrinthectomy, VNS is contraindicated in bilateral vestibular disease since surgery under these conditions could result in oscillopsia and permanent imbalance.

While the greatest advantage of VNS is the high rate of success for controlling vertigo and preserving hearing, the primary disadvantage is that it is major surgery and is, therefore, associated with more operative risks than other procedures.

Although complications are not common, they may include:

• Bleeding
• Infection
• Sensorineural hearing loss (10%)
• Persistent vertigo (3-7%)
• Facial nerve injury with resultant facial paralysis (0.1%)
• Change or loss of sense of taste
• Risk of cerebrospinal fluid leakage and meningitis are higher with this procedure than with others

Complication rates are lowest when the procedure is done by otologic surgeons or neurosurgeons that have substantial training and experience with this procedure. It is also important that the hospital staff that cares for the patient after surgery also have experience with patients undergoing VNS.

While some clinicians recommend VNS after failed endolymphatic sac surgery, others recommend this surgery after treatment with intratympanic gentamicin has failed. There are no professional guidelines regarding the point at which this surgical procedure should be chosen as the next treatment option.

A study published in Otology and Neurotology in February 2007 comparing hearing loss following treatment with vestibular nerve section or intratympanic gentamicin concluded that although vertigo control was excellent after each treatment, hearing loss was significantly greater following intratympanic gentamicin than with vestibular nerve section.

To read more about this study, please click on the following link: http://www.ncbi.nlm.nih.gov/sites/entrez?Db=PubMed&Cmd=ShowDetailView&TermToSearch=17255880&ordinalpos=17&itool=EntrezSystem2.PEntrez.Pubmed.PubmedResultsPanel.PubmedRVDocSum