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For chronic, severe vertigo that is refractory to all treatment or for severe vertigo attacks secondary to medical conditions other than debris in the endolymphatic fluid, such as acoustic neuroma or Meniere's disease, surgery may be required. Surgical options for vertigo include:

• Singular Neurectomy
• Posterior Semicircular Canal Plugging
• Vestibular Neurectomy

Singular Neurectomy

Surgical neurectomy involves cutting a tiny branch of the vestibular nerve. This is sufficient in some people to prevent symptoms even if the debris continues to strike the cupula in the semicircular canal. Successful surgery results in permanent relief from symptoms of vertigo. In some patients hearing loss, tinnitus, and/or dizziness can result from the surgery. Some patients' anatomy is such that the location of the nerve prevents it from being reached or cut.

Posterior Semicircular Canal Plugging

In this procedure a mastoidectomy (surgical removal of the mastoid bone) is performed to expose the posterior semicircular canal and the canal is packed with a material to seal it off. This prevents erroneous information from the semicircular canal from reaching the nerve that would otherwise relay the information further along the central nervous system. This procedure has been reported to be successful in most patients. Some patients may suffer some permanent hearing loss as a complication of this procedure.

Vestibular Neurectomy

Vestibular neurectomy is performed if hearing is normal but vertigo is severe due to injury to the vestibular nerve rather than to debris floating in the endolymph. In this procedure, the nerve that supplies the posterior semicircular canal is cut to prevent distorted information from reaching the brain. Hospitalization lasts a few days and vertigo takes several weeks to disappear. Complications of this procedure may include:

• Hearing loss
• Tinnitus - ringing in the ears
• Spinal fluid leakage
• Facial nerve weakness
• Meningitis