Twelve years' experience in the surgical treatment of vertigo

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Abstract
When vertigo from any peripheral cause fails to recover spontaneously or to respond adequately to medication and physiotherapy, and the patient is incapacitated by his symptom, surgical treatment should be considered. The choice of operation is based primarily on the overall state of hearing and the age of the patient. In older patients with very poor auditory function in the diseased ear, sacculotomy has much to offer as a means of quickly terminating an abnormal afferent labyrinthine input to the brain stem, without the risks of postoperative morbidity associated with classical labyrinthectomy. In patients with useful hearing, surgical treatment should start with an attempt to regulate the volume of endolymph by simple decompression of the saccus endolymphaticus. An attempt to drain or shunt the saccus should not be made because this is likely to be harmful to its function and carries unjustified risks of serious complications. For those with useful hearing in whom decompression fails to control vertigo, vestibular nerve section is a reliable final solution.