Editing Ménière's disease (section)

=== Surgery ===
If symptoms do not improve with less invasive approaches and for cases where the condition is uncontrolled or persistent and affecting both ears, surgery may be considered.<ref name=See2016/><ref name="Foster2015rev" /><ref name=":0">{{Cite journal |last1=Lee |first1=Ambrose |last2=Webster |first2=Katie E |last3=George |first3=Ben |last4=Harrington-Benton |first4=Natasha A |last5=Judd |first5=Owen |last6=Kaski |first6=Diego |last7=Maarsingh |first7=Otto R |last8=MacKeith |first8=Samuel |last9=Ray |first9=Jaydip |last10=Van Vugt |first10=Vincent A |last11=Burton |first11=Martin J |date=2023-02-24 |editor-last=Cochrane ENT Group |title=Surgical interventions for Ménière's disease |journal=Cochrane Database of Systematic Reviews |language=en |volume=2023 |issue=2 |pages=CD015249 |doi=10.1002/14651858.CD015249.pub2 |pmc=9955726 |pmid=36825750}}</ref> 

==== Endolymphatic sac surgery ====
Surgery to decompress the [[endolymphatic sac]] is one surgical approach that is sometimes suggested. Three methods of surgical endolymphatic sac decompression are sometimes suggested – simple decompression, insertion of a shunt, or removal of the sac.<ref name="Lim" /> There is some very weak evidence that all three methods may be useful for reducing dizziness, but that the level of evidence supporting these surgical procedures is low with further higher quality investigations being suggested.<ref name="Lim">{{Cite journal|display-authors= 3| last1=Lim|first1=Ming Yann|last2=Zhang|first2=Margaret|last3=Yuen|first3=Heng Wai|last4=Leong|first4=Jern-Lin|date=November 2015|title=Current evidence for endolymphatic sac surgery in the treatment of Meniere's disease: a systematic review|journal= [[Singapore Medical Journal]] |volume=56|issue=11|pages=593–598 |doi= 10.11622/smedj.2015166| issn= 0037-5675 |pmc= 4656865 |pmid= 26668402}}</ref> There is a risk in these types of surgical procedures that the shunts used in these surgeries are at risk of becoming displaced or misplaced.<ref name="Foster2015rev" /> For those with severe cases who are eligible for endolymphatic sac decompression, a 2014 systematic review reported that in at least 75% of people, EL sac decompression was effective at controlling vertigo in the short term (>1 year of follow-up) and long term (>24 months).<ref name="PMID24751747">{{Cite journal|last1=Sood|first1=Amit Justin |last2= Lambert |first2= Paul R. |last3=Nguyen|first3=Shaun A.|last4=Meyer|first4=Ted A. |display-authors= 3| date=July 2014|title=Endolymphatic sac surgery for Ménière's disease: a systematic review and meta-analysis |journal= [[Otology & Neurotology]] |volume=35|issue=6|pages=1033–1045|doi=10.1097/MAO.0000000000000324|issn=1537-4505|pmid=24751747|s2cid=31381271}}</ref>

==== Ventilation tubes ====
Surgical implantation of eustachian tubes (ventilation tubes) is not strongly supported by medical studies. There are some tentative evidence of benefit from [[tympanostomy tubes]] for improvement in the unsteadiness associated with the disease,<ref name="Walther2005Rev" /> conclusions about how effective this surgery is and the potential for side effects and harms is not clear.<ref name="Har2014" /><ref name=":0" />

==== Other surgical interventions ====
Destructive surgeries such as vestibular nerve [[labyrinthectomy]] are irreversible and involve removing entire functionality of most, if not all, of the affected ear; as of 2013, almost no evidence existed with which to judge whether these surgeries are effective.<ref name="Cochrane2013surgery">{{Cite journal|last1=Pullens|first1=Bas|last2=Verschuur|first2=Hendrik P.|last3=van Benthem|first3=Peter Paul|date=2013|title=Surgery for Ménière's disease|journal=The Cochrane Database of Systematic Reviews|volume=2013 |issue=2|pages=CD005395|doi=10.1002/14651858.CD005395.pub3|issn=1469-493X|pmid=23450562|pmc=7389445}}</ref> The inner ear itself can be surgically removed via labyrinthectomy, although hearing is always completely lost in the affected ear with this operation.<ref name="Cochrane2013surgery" /> The surgeon can also cut the nerve to the balance portion of the inner ear in a [[Vestibular nerve|vestibular]] [[neurectomy]]. The hearing is often mostly preserved; however, the surgery involves cutting open into the lining of the brain, and a hospital stay of a few days for monitoring is required.<ref name="Cochrane2013surgery" />