Surgical treatment of vestibular disorders: a narrative review

Since most vestibular disorders are controlled by medical treatments, surgical options are rarely required. However, there are several vestibular lesions in which surgery can fix the underlying pathophysiology, or should be considered when patients do not benefit from medical treatments. Those diagnoses are labyrinthine fistula, perilymphatic fistula, superior semicircular canal dehiscence syndrome, vestibular paroxysms, rotational vertebral artery syndrome, refractory benign paroxysmal positional vertigo, and intractable Ménière disease. Many surgical options may produce irreversible changes in the vestibular system as well as hearing function. So, accurate diagnosis is paramount for appropriate treatment. In addition, a thorough understanding of disease pathology and the natural course of the condition are essential, as are the experience and judgment of the surgeon, which significantly influence treatment outcomes. Also, it should be noted that surgical procedures are not always successful in controlling vertigo or dizziness. Except in cases of dizziness caused by tumors or inner ear fistula, the role of surgery in treating vestibular disorders is primarily to control symptoms rather than to eliminate the underlying disease. Therefore, most patients should be managed surgically only when medical treatments fail or when surgery is deemed more effective. Before proceeding, patients must fully understand the surgical objectives, potential outcomes, and possible complications. This review provides surgical options for vestibular disorders, emphasizing accurate diagnosis, patient-centered decision-making, and the potential risks of each surgical procedure.