Chapter 9
Surgical Treatment

Dennis Poe, MD
Mass Eye & Ear Infirmary
Boston, Massachusetts

Most people with vertigo will be able to adequately control the condition through conservative medical treatments. There is a small percentage of patients in whom medical therapy will not sufficiently control their attacks of vertigo and for whom surgical options will be considered. Surgery and office procedures are invasive in nature. Anything invasive generally has the potential for more side effects or risks compared to medical treatments. It’s natural that you and your doctor will want to exhaust all possible medical treatments for your condition before considering surgical options.

Surgery is intended only for the forms of inner ear disorders that cause repeated attacks, spells or paroxysms (intense attacks) of vertigo. Frequent attacks of vertigo may lead to chronic disequilibrium. If the attacks can be stopped, then the brain and vestibular system have a chance to recover and compensate over time, hopefully leading to resolution of the disequilibrium. Patients with chronic disequilibrium, but no active vertigo attacks, have a compensation problem that won’t be helped by surgery. In fact, surgery could worsen their chronic compensation difficulties by altering the status of the balance system and adding to the disequilibrium.

When the inner ear is subjected to intermittent irritation or injury, it will result in an acute disturbance in your balance. This disrupts the vestibular nerve outputs from the affected inner ear and puts it into conflict with the information being received by the brain from the other normal inner ear. This conflict in information is confusing to the brain and causes a profound disturbance in the vestibular system that we perceive as vertigo. Once the attack of vertigo ceases, you may feel immediately back to normal if the spell was brief or mild. You may also feel quite a lot of imbalance or disequilibrium for minutes, hours, days or even weeks after such an event. The length of time it takes to recover your balance after a vertigo attack depends on how severely it may affect your inner ear, how much permanent damage done may occur, and how well you tend to compensate.

Your balance is maintained by the brain coordinating inputs from the vestibular systems of both inner ears, your vision and your sensation of position and touch in your legs (proprioception). Your compensatory abilities depend on the remaining elements of your balance to cover up the weakness in your one balance nerve. If you’re in good condition and exercise regularly, your compensation abilities will be better than someone inactive, elderly or with problems involving vision and proprioception.

Each time a vertigo attack occurs it’s as though a monkey wrench has just been thrown into your balance machinery. The amount of damage done by the monkey wrench determines how quickly you can regain your balance. This process can be expected to take some time. Exercising and working on your balance can speed your recovery. I always emphasize to patients how important it is to . . .