Decision making in vestibular neurectomy.

Indications for vestibular neurectomy have traditionally included intractable Meniere's disease, chronic vestibular neuronitis, vestibular hydrops, and posttraumatic vertigo. Between 1990 and 1993, 28 retrosigmoid vestibular neurectomies were performed for various peripheral vestibulopathies for which medical management failed. These were divided into two groups: Meniere's disease and non-Meniere's disease. The non-Meniere's disease group included the diagnosis of vestibular hydrops and chronic vestibular neuronitis. Results were analyzed by using the 1985 American Academy of Otolaryngology (AAO) criteria for Meniere's disease. Statistical analysis revealed a highly significant difference (chi 2 Fischer, p = 0.001), with the Meniere's group being highly successful and the non-Meniere's group being unsuccessful. We conclude that retrosigmoid vestibular neurectomy is a safe and effective modality for the management of Meniere's disease for which medical management failed. Patients with non-Meniere's vestibulopathies should be treated with other modalities.