There are various surgery options for Meniere's disease but they are not considered until after various medications have been tried and have failed. Here is an explanation of the main types of surgery, I have taken a lot of the information from menieres.org as they explain the various surgeries well. I have also looked for other information regarding the effectiveness of the surgeries however there is very little out there that I can find that gives me more detail on the surgeries.
Endolymphatic Sac surgery
This is done under general anaesthetic and involves draining the fluid in the endolymphatic sac to reduce the pressure of the fluid in the sac.
From Menieres.org.
A small incision is made in the scalp in the crease of the ear and the mastoid bone is drilled away to reveal the dura or lining of the brain cavity. The endolymphatic sac is located and pealed away from the dura. The surgery takes about 1½ hours to perform
Endolymphatic sac surgery is suggested when other less invasive treatments have been unsuccessful. Professor William Gibson’s ‘drainage theory’ suggests that attacks of vertigo occur when excess endolymph fluid drains towards the endolymphatic sac. The sinus of the endolymphatic duct is unable to contain all the excess fluid draining towards the endolymphatic sac and a backwash of fluid occurs in the vestibular portion of the ear. When the fluid enters the vestibular portion of the ear, the nerve endings in the balance canal are stimulated causing the attack of vertigo. If this theory is correct then any surgery on the endolymphatic sac would stop the attacks of vertigo by damaging the endolymphatic sac so that it can no longer initiate the flow of endolymph however the vertigo would occur when the sac recovers its function again.
Endolymphatic sac removal surgery does not remove any more of the balance from the affected ear than is lost naturally during the course of the disease. Most patients retain 30-50% of the balance function. Endolymphatic sac removal surgery is a useful option for older people suffering from Ménière’s disease and for those who may develop the disease in both ears. The hearing should already be affected and may further deteriorate after surgery by another 10-20%. The drawback of removing all the balance in one ear is that in older patients there can be a problem balancing using one ear alone.
20% of people will not be helped sufficiently by endolymphatic sac removal surgery but these people can proceed to have the balance destroyed in the ear using gentamicin or by vestibular nerve surgery.
Endolymphatic sac decompression
taken from vestibular.org
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.
From earspecialistperth.com.au
This surgery aims to abolish vertigo but to preserve hearing. The operation has been carried out since 1926 with many variations which include; removal of the bone around the sac (decompression); the insertion of a shunt or tube into the sac; and the removal of the sac altogether.
Following surgery, hearing may fluctuate or even improve in a few cases; however in the natural course of Ménière's, the trend is a gradual decline in hearing. Successful relief of vertigo occurs in about 60-80% of patients in the short term but most well performed studies indicate a recurrence of symptoms over longer periods and vestibular nerve section may be required. For these reasons, SS is not frequently carried out in Professor Atlas’ practice.
According to a study on the long term effects of sac decompression surgery vertigo was completely controlled in 88% of patients in the 2nd year, in 73% in the 12th year and in 70% in the 13th year, the study details can be found here http://www.ncbi.nlm.nih.gov/pubmed/23273764
Grommets
From menieres.org
A grommet is another name for a tympanostomy tube. Grommets are inserted into the eardrum to allow air into the middle ear space. There should be air in the middle ear space because it is connected at the back of the nose to the Eustachian tube. It is thought that it is possible that the pressure in the two systems might be different and grommets will allow that pressure to equalise.
Since the fluid inside the inner ear is actually exposed in terms of the pressure change to the small membrane called the round window membrane, it is possible for changes in pressure in the middle ear to affect the pressure in the fluid compartments. So there is a theoretical reason why putting a grommet in could affect the cause of the disease. The tube itself is made in a variety of designs. The most commonly used type is shaped like a grommet. If it is necessary to keep the middle ear ventilated for a very long period, a “T”-shaped tube may be used. Materials used to construct the tube are most often plastics such as silicone or Teflon.
A grommet can be useful for disorders of the middle ear (the space behind the eardrum) and is commonly used for glue ear in children. Of all the surgical interventions, the simplest is the grommet insertion. Like all of the surgical interventions it is controversial and many people feel that it does not add any real evidence of success. Nonetheless there are patients who do seem to enter remission following grommet insertion. As long as no harm is done, and putting a grommet in should not do any harm, then it is an option. It’s also integral for patients who want to use the Meniett device.
Can't find any numbers for effectiveness of grommets??
Once grommets have been inserted you can then use a Meniett device –
http://www.ncbi.nlm.nih.gov/pubmed/25346252
Positive pressure therapy for Meniere's syndrome/ disease with a Meniett device: A systematic review of randomised controlled trials. The four RCTs compared 123 patients with the Meniett device against 114 patients with the placebo device from four RCT's over a follow up period of 2 weeks to four months. There was a significant overall 61% reduction in the frequency of vertigo in both groups [mean no vertigo days per month of 8 to 3]. However, this reduction was not significantly different between the two groups in any study or on meta-analysis [mean difference in vertigo free days between Meniett and placebo device of 0.77 days over a 1 m period (95% CI -0.82, 1.83) p=0.45]. There was also no substantive data to support a greater reduction in the severity of the vertigo or any other outcome with the Meniett device compared with the placebo device.
Labyrinthectomy
From menieres.org
A labyrinthectomy is a surgical procedure which destroys both the hearing and vestibular functions of the inner ear. It is performed either by drilling out the bone and removing all of the labyrinth (known as an osseous labyrinthectomy), or by opening up the inner ear and destroying some of the soft tissue within it. There is about a 95-98% success rate of ending vertigo attacks with the labyrinthectomy. Deafness also needs to be taken into consideration as this condition destroys the hearing function and a labyrinthectomy will not usually be offered if there is still good hearing in the affected ear.
According to research done and published on pubmed.gov approximately 24% of the test group still had vertigo after the surgery
According to anther piece of research done on quality of life after labyrinthectomy 98% had improvement in quality of life except on questions pertaining to memory and hearing loss. http://www.ncbi.nlm.nih.gov/pubmed/16985479
Neurectomy
From menieres.org
The vestibular neurectomy is usually only offered as a last resort to the most severely affected patients. If repeated endolymphatic sac surgery and/or gentamicin fails and if there is still useful hearing in the ear then the neurectomy may be considered as an option. It requires expertise and training to do a vestibular neurectomy. A cut is made behind the ear, the soft tissue is taken away and there is a window of bone removed behind the ear. The lining of the inside of the skull has to be cut open to show the brain. The brain is bathed in spinal fluid which is drained away. As it drains, the brain moves to reveal the hearing and balance nerves going from the brain to the ear bone. Little bits of adhesions are cleared so the hearing and the balance nerves can be defined. There is conveniently a thin blood vessel running along the line that separates the hearing part from the balance part (nature is very helpful in that respect) and this helps the surgeon decide which one to cut. The balance nerve is cut, preserving the hearing nerve. It is important to understand that there is an inherent risk of cutting the facial nerve as this is also in the same place as the hearing and balance nerves.
Endolymphatic Sac surgery
This is done under general anaesthetic and involves draining the fluid in the endolymphatic sac to reduce the pressure of the fluid in the sac.
From Menieres.org.
A small incision is made in the scalp in the crease of the ear and the mastoid bone is drilled away to reveal the dura or lining of the brain cavity. The endolymphatic sac is located and pealed away from the dura. The surgery takes about 1½ hours to perform
Endolymphatic sac surgery is suggested when other less invasive treatments have been unsuccessful. Professor William Gibson’s ‘drainage theory’ suggests that attacks of vertigo occur when excess endolymph fluid drains towards the endolymphatic sac. The sinus of the endolymphatic duct is unable to contain all the excess fluid draining towards the endolymphatic sac and a backwash of fluid occurs in the vestibular portion of the ear. When the fluid enters the vestibular portion of the ear, the nerve endings in the balance canal are stimulated causing the attack of vertigo. If this theory is correct then any surgery on the endolymphatic sac would stop the attacks of vertigo by damaging the endolymphatic sac so that it can no longer initiate the flow of endolymph however the vertigo would occur when the sac recovers its function again.
Endolymphatic sac removal surgery does not remove any more of the balance from the affected ear than is lost naturally during the course of the disease. Most patients retain 30-50% of the balance function. Endolymphatic sac removal surgery is a useful option for older people suffering from Ménière’s disease and for those who may develop the disease in both ears. The hearing should already be affected and may further deteriorate after surgery by another 10-20%. The drawback of removing all the balance in one ear is that in older patients there can be a problem balancing using one ear alone.
20% of people will not be helped sufficiently by endolymphatic sac removal surgery but these people can proceed to have the balance destroyed in the ear using gentamicin or by vestibular nerve surgery.
Endolymphatic sac decompression
taken from vestibular.org
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.
From earspecialistperth.com.au
This surgery aims to abolish vertigo but to preserve hearing. The operation has been carried out since 1926 with many variations which include; removal of the bone around the sac (decompression); the insertion of a shunt or tube into the sac; and the removal of the sac altogether.
Following surgery, hearing may fluctuate or even improve in a few cases; however in the natural course of Ménière's, the trend is a gradual decline in hearing. Successful relief of vertigo occurs in about 60-80% of patients in the short term but most well performed studies indicate a recurrence of symptoms over longer periods and vestibular nerve section may be required. For these reasons, SS is not frequently carried out in Professor Atlas’ practice.
According to a study on the long term effects of sac decompression surgery vertigo was completely controlled in 88% of patients in the 2nd year, in 73% in the 12th year and in 70% in the 13th year, the study details can be found here http://www.ncbi.nlm.nih.gov/pubmed/23273764
Grommets
From menieres.org
A grommet is another name for a tympanostomy tube. Grommets are inserted into the eardrum to allow air into the middle ear space. There should be air in the middle ear space because it is connected at the back of the nose to the Eustachian tube. It is thought that it is possible that the pressure in the two systems might be different and grommets will allow that pressure to equalise.
Since the fluid inside the inner ear is actually exposed in terms of the pressure change to the small membrane called the round window membrane, it is possible for changes in pressure in the middle ear to affect the pressure in the fluid compartments. So there is a theoretical reason why putting a grommet in could affect the cause of the disease. The tube itself is made in a variety of designs. The most commonly used type is shaped like a grommet. If it is necessary to keep the middle ear ventilated for a very long period, a “T”-shaped tube may be used. Materials used to construct the tube are most often plastics such as silicone or Teflon.
A grommet can be useful for disorders of the middle ear (the space behind the eardrum) and is commonly used for glue ear in children. Of all the surgical interventions, the simplest is the grommet insertion. Like all of the surgical interventions it is controversial and many people feel that it does not add any real evidence of success. Nonetheless there are patients who do seem to enter remission following grommet insertion. As long as no harm is done, and putting a grommet in should not do any harm, then it is an option. It’s also integral for patients who want to use the Meniett device.
Can't find any numbers for effectiveness of grommets??
Once grommets have been inserted you can then use a Meniett device –
http://www.ncbi.nlm.nih.gov/pubmed/25346252
Positive pressure therapy for Meniere's syndrome/ disease with a Meniett device: A systematic review of randomised controlled trials. The four RCTs compared 123 patients with the Meniett device against 114 patients with the placebo device from four RCT's over a follow up period of 2 weeks to four months. There was a significant overall 61% reduction in the frequency of vertigo in both groups [mean no vertigo days per month of 8 to 3]. However, this reduction was not significantly different between the two groups in any study or on meta-analysis [mean difference in vertigo free days between Meniett and placebo device of 0.77 days over a 1 m period (95% CI -0.82, 1.83) p=0.45]. There was also no substantive data to support a greater reduction in the severity of the vertigo or any other outcome with the Meniett device compared with the placebo device.
Labyrinthectomy
From menieres.org
A labyrinthectomy is a surgical procedure which destroys both the hearing and vestibular functions of the inner ear. It is performed either by drilling out the bone and removing all of the labyrinth (known as an osseous labyrinthectomy), or by opening up the inner ear and destroying some of the soft tissue within it. There is about a 95-98% success rate of ending vertigo attacks with the labyrinthectomy. Deafness also needs to be taken into consideration as this condition destroys the hearing function and a labyrinthectomy will not usually be offered if there is still good hearing in the affected ear.
According to research done and published on pubmed.gov approximately 24% of the test group still had vertigo after the surgery
According to anther piece of research done on quality of life after labyrinthectomy 98% had improvement in quality of life except on questions pertaining to memory and hearing loss. http://www.ncbi.nlm.nih.gov/pubmed/16985479
Neurectomy
From menieres.org
The vestibular neurectomy is usually only offered as a last resort to the most severely affected patients. If repeated endolymphatic sac surgery and/or gentamicin fails and if there is still useful hearing in the ear then the neurectomy may be considered as an option. It requires expertise and training to do a vestibular neurectomy. A cut is made behind the ear, the soft tissue is taken away and there is a window of bone removed behind the ear. The lining of the inside of the skull has to be cut open to show the brain. The brain is bathed in spinal fluid which is drained away. As it drains, the brain moves to reveal the hearing and balance nerves going from the brain to the ear bone. Little bits of adhesions are cleared so the hearing and the balance nerves can be defined. There is conveniently a thin blood vessel running along the line that separates the hearing part from the balance part (nature is very helpful in that respect) and this helps the surgeon decide which one to cut. The balance nerve is cut, preserving the hearing nerve. It is important to understand that there is an inherent risk of cutting the facial nerve as this is also in the same place as the hearing and balance nerves.