When is surgery necessary?
When medical treatment isn’t effective in controlling vertigo and other symptoms caused by vestibular system dysfunction, surgery may be considered. The type of surgery performed depends upon each individual’s diagnosis and physical condition.
Surgical procedures for peripheral vestibular disorders are either corrective or destructive. The goal of corrective surgery is to repair or stabilize inner ear function. The goal of destructive surgery is to stop the production of sensory information or prevent its transmission from the inner ear to the brain.
A labyrinthectomy is a destructive procedure used for Ménière’s disease. The balance end organs are removed so that the brain no longer receives signals from the parts of the inner ear that sense gravity and motion changes. The hearing organ (cochlea) is also sacrificed with this procedure.
Vestibular nerve section
A vestibular nerve section is a destructive surgery used for Ménière’s disease. The vestibular branch of the vestibulo-cochlear nerve is cut in one ear to stop the flow of balance information from that ear to the brain. The brain can then compensate for the loss by using only the opposite ear to maintain balance.
A chemical labyrinthectomy is also known as transtympanic or intratympanic treatment or gentamicin infusion. This is a destructive procedure used for Ménière’s disease. An antibiotic called gentamicin is introduced into the middle ear and absorbed via the round window. The drug destroys the vestibular hair cells so that they cannot send signals to the brain.
Endolymphatic sac decompression
Endolymphatic sac decompression is a stabilizing procedure sometimes used for Ménière’s disease or secondary endolymphatic hydrops to relieve endolymphatic pressure in the cochlea and vestibular system. A variety of techniques exist. One method involves allowing the sac to decompress by removing the mastoid bone surrounding it. Other methods involve inserting a shunt (a tube or strip) into the endolymphatic sac so that, theoretically, excess fluid can drain out into the mastoid cavity or other location. The effectiveness of decompression techniques in controlling vertigo remains in doubt.
Oval or round window plugging
Oval or round window plugging is a stabilizing procedure sometimes used for repair of perilymph fistulas. Openings in the oval and/or round windows are patched with tissue taken from the external ear or from behind the ear so that perilymph fluid does not leak through the fistulas.
Pneumatic equalization (PE) tubes
Pneumatic equalization (PE) is a stabilizing procedure sometimes used for treating perilymph fistulas. A tube is inserted through the tympanic membrane (eardrum) with one end in the ear canal and the other in the middle ear, to equalize the air pressure on the two sides of the eardrum.
Canal partitioning (canal plugging)
Canal partitioning is a stabilizing procedure sometimes used for treating BPPV or superior semicircular canal dehiscence. The problematic semicircular canal is partitioned or plugged with small bone chips and human fibrinogen glue to stop the movement of endolymph and foreign particles within the canal so that it no longer sends false signals to the brain.
Microvascular decompression is performed to relieve abnormal pressure of the vascular loop (blood vessel) on the vestibulo-cochlear nerve.
Stapedectomy is a stabilizing procedure sometimes used for otosclerosis. It is accomplished by replacing the stapes bone with a prosthesis.
Acoustic neuroma (vestibular schwannoma) removal
This procedure involves the removal of a noncancerous tumor that grows from the tissue of the vestibular branch of the vestibulo-cochlear nerve.
This procedure involves the removal of a skin growth that starts in the middle ear and that can secrete enzymes that destroy bone and surrounding structures.
Ultrasound is applied to the ear to destroy the balance end organs so that the brain no longer receives signals from the parts of the ear that sense gravity and motion changes.
Cochlear dialysis is a stabilizing procedure sometimes used to promote movement of excess fluid out of the inner ear by filling the scala tympani with a chemical solution.
Read Dr. Timothy C. Hain, MD’s article: Surgical Treatment of Vertigo