Surgical Intervention

When medical therapy fails, surgical treatment is indicated. Two distinct strategies have been employed. One is directed toward enhancing endolymph absorption and the other is to decrease vestibular function.

Endolymphatic Sac Surgery – In principle, endolymphatic sac surgery is a non-destructive, surgical manipulation of the endolymphatic sac aimed at increasing fluid drainage from the inner ear. This approach is controversial and has been shown by Thomsen et al. to be non-specific and not significantly different from placebo.¹²

Vestibular Nerve Section – This surgical technique decreases vestibular function, either by denervation or destruction of the affected ear. Denervation by transcranial section of the vestibular nerve is a successful method for vertigo control, usually preserving hearing but at greater surgical risk and cost than labyrinthectomy.¹³

Chemical labyrinthectomy – This treatment has recently become widely used because of its associated low cost and low risk.¹⁴ For unilateral cases, intratympanic gentamicin reduces vertigo by decreasing peripheral vestibular function on the affected side but with a 30% risk of hearing loss. For bilateral cases, intramuscular streptomycin has been used.¹⁵ All destructive procedures result in decreased vestibular function on the treated side, which most patients consider a fair exchange once central compensation has stabilized their balance function. 

Labyrinthectomy – Surgical removal of the labyrinth is a procedure performed in cases where the hearing can be sacrificed or is already lost. The contralateral ear will provide hearing and balance providing it is not affected by the disease or other conditions.

None of the current medical or surgical treatments improves hearing or alters the natural degenerative course of the disease. The absence of a satisfactory and specific non-destructive method to control vertigo and restore hearing has stimulated continuing research aimed at correcting the pathophysiology of the ear. A non-invasive method to restore intra-labyrinthine fluid homeostasis in this condition is highly desirable.

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