Surgery for vertigo

Surgery for vertigo

A surgical solution for vertigo

Surgery forms one of the main pillars of the management of patients with vertigo, dizziness and balance disorders. It is usually indicated for specific inner ear or nerve peripheral conditions. In most patients, medical treatment, including dietary advice, lifestyle modification and vestibular rehabilitation exercises, is usually adequate. Psychological support is always essential. Some conditions, however, can only be corrected with surgery.

What is the aim of surgery for vertigo?

Surgery aims to stabilise, correct or destroy abnormal vestibular function. By performing surgery, the brain may have a better chance to adapt to a stable vestibular condition. In most cases, the aim is to stop vertigo attacks that may lead to dizziness, nausea, vomiting, dizziness, loss of balance and a risk of falling.

The vestibular system can be compared with a twin-engine aircraft, where the engines represent the vestibular organ in the ear and the pilot the brain of the patient. With one dysfunctional, misbehaving engine, it is often necessary to turn off the faulty engine so that the pilot can stabilise the aircraft

What does surgery for vertigo entail?

In some conditions, the decision to perform surgery is straightforward. A persistent leaking perilymph fistula (PLF) is an example. Other conditions, for instance, Meniere’s disease, may only require surgery if conservative treatment measures fail. On the other hand, surgery for vertigo may be an early option for a pilot with Meniere’s disease who cannot fly with the diagnosis nor take medication.

Who performs surgery for vertigo?

Some of the procedures can be performed by a general Ear-nose-and-throat specialist(ENT), but most procedures require specialised training as a neurotologist. Dr Hofmeyr is trained and experienced in performing all the surgical procedures for vertigo.

Surgical procedures for vertigo

The following include some of the surgical options that can be offered for vertigo:

  • Myringotomy and grommets.
  • Intratympanic administration of gentamycin or steroids.
  • Eradication and addressing ear diseases such as infections, tympanic membrane perforations and cholesteatoma.
  • Endolymphatic sac decompression and shunt.
  • Removal of vestibular schwannomas (acoustic neuromas).
  • Repair of superior canal dehiscence (SCD).
  • Occlusion of semicircular canals for BPPV.
  • Correction of perilymph fistulas (PLF).
  • Surgery for vestibular paroxysmia.
  • Labyrinthectomy.
  • Vestibular neurectomy.

Will I lose my hearing with the surgery

In some procedures, hearing loss can occur. Many options to manage hearing loss include hearing aids and cochlear implantation.

Vestibular rehabilitation after surgery

Surgery for vertigo may affect the vestibular system, which helps with balance, spatial orientation, and visual stability. This surgery can disrupt the signals the vestibular system sends to the brain, resulting in dizziness, instability, and vertigo.

Vestibular rehabilitation is a type of physical therapy designed to address these symptoms and help individuals regain their balance and sense of stability. Through targeted exercises and techniques, vestibular rehabilitation can help retrain the brain to rely on other sensory inputs to maintain balance and compensate for the changes in the vestibular system caused by surgery. Dr Hofmeyr will indicate the need for vestibular rehabilitation and arrange the referral.

Vestibular implants

A vestibular implant is a device that can be surgically implanted to help restore balance and stability in individuals with severe inner ear disorders or vestibular dysfunction. The implant directly stimulates the vestibular nerve to signal to the brain and help regulate balance.

While research and development of vestibular implants is ongoing, they are not commercially available as they are still experimental. Clinical trials and studies are being conducted to test these devices’ safety and efficacy and determine the best candidates for implantation.

Ultimately, the goal of vestibular implants is to provide a new treatment option for individuals who do not benefit from traditional therapies for balance disorders and to improve their quality of life. Further research and advancements in the field may eventually lead to the availability of vestibular implants for clinical use

The final decision

The decision to perform surgery should never be taken lightly or before proper investigations have been performed, and not if more conservative options have not been exploited.

surgical section of the vestibular nerve
After surgical section of the vestibular nerve, the facial nerve (F) and cochlear nerve (C) are still intact.
Left sided translabyrinthine selective vestibular nerve
Labyrinthectomy and vestibular neurectomy (v) Facial nerve (f)