Management of vertigo in patients with syphilis: is endolymphatic shunt surgery appropriate?

Endolymphatic shunt surgery has been suggested as a means to relieve vertigo caused by syphilis in patients unresponsive to conventional medical therapy. We reviewed results of endolymphatic shunt surgery on vertigo and hearing in six patients with syphilis. We found no relief of vertigo in four patients who qualified for this measure and no improvement in hearing. Histologic review of temporal bones from three patients with syphilitic hydrops revealed syphilitic involvement of the endolymphatic duct system. This may explain why endolymphatic shunt surgery may not be beneficial.