Treatment Guideline Chart

Vertigo is having a sensation of spinning of either the surrounding or within oneself but physical movement does not exist.

It may be secondary to different causes that may be determined by numerous factors eg timing and duration, aggravating conditions or associated symptoms.
Central vertigo originates from the central nervous system (brainstem or cerebellum). It is uncommon but more serious and should be ruled out immediately.
Peripheral vertigo originates from the labyrinth or vestibular nerve.

Vertigo Treatment

Surgical Intervention

Meniere’s Disease

  • Surgery is recommended if conservative and medical treatments have failed and the disease is severe

Endolymphatic duct/sac procedures and sacculotomy

  • The procedure exposes the endolymphatic sac and duct with the aim of improving endolymph drainage
  • Commonly done in Meniere’s disease patients with intact hearing
  • Control of vertigo has been reported in 75-80% in an uncontrolled case series
  • Low risk of sensorineural hearing loss

Vestibular nerve section or Vestibular neurectomy

  • Vestibular nerve bundle is surgically lysed as it enters the internal auditory canal
  • Relieves vertigo in 90-95% of patients
  • Low risk of sensorineural hearing loss


  • Neuroepithelium of the bony and membranous labyrinth is surgically removed, thus eliminating both balance and hearing function from the affected ear
  • Due to the irreversible hearing loss, this procedure is reserved for patients with intractable symptoms despite pharmacotherapy, and with poor hearing or complete hearing loss on the affected side
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