Surgery For Vertigo

The Surgical treatment of Vertigo :

Vertigo is often referred to as "incurable." However, nothing could be further from the truth. It is important to know that in general the treatment of vertigo depends upon the treatment of the cause. The failure of treatment is often due to failure in identifying the cause.

Meniere's disease is the commonest treatable cause of vertigo. Though the treatment is essentially medical, surgery is indicated in certain selected cases which do not respond to medical therapy. It is sometimes better to undertake a step-wise approach to treat this benign but debilitating disease.

Medical therapy is successful in 75% of cases.

Following failure of medical therapy, the first step is CHEMICAL LABYRINTHECTOMY, in which a small incision is made in the ear drum, a ventilation tube is inserted, and then medications poured down the tube until the desirable end point is reached. This is successful in about 75% of cases treated.

The option offered to the patient is ENDOLYMPHATIC SAC DECOMPRESSION. The postulated cause of Meniere's disease is an increase in the endolymphatic pressure. Therefore it stands to reason that a procedure that releases the "pressure valve" of the inner ear would improve the patient's symptoms. This is a simple operation, which, if done correctly, offers a good result to over 80% of the patients. There are controversies regarding its usefulness, and the jury is still out regarding its place in the management of Meniere's disease, but the vast majority of surgeons accept that this is a useful procedure with limited morbidity, and is valuable in the treatment of Meniere's.

Finally, the gold standard treatment of unilateral Meniere's disease is MINIMALLY-INVASIVE RETROSIGMOID VESTIBULAR NERVE SECTION. This means that the nerve to the organ of balance and hearing is cut. This is the treatment of choice when the affected ear has no useful hearing, as it involves sacrifice of the hearing of that ear. However, in our hands we suggest this as a last resort to those who have useful residual hearing in the affected ear.

As it can be noted, ultimately over 95% of patients presenting with the symptom of vertigo can be treated quite satisfactorily, allowing them to enjoy a sufficiently productive and normal way of life.