Endolymphatic sac enhancement.

Endolymphatic sac enhancement surgery has proved, over the last several decades, to be a conservative and relatively safe procedure for patients in whom extensive empirical medical therapy has failed. The operation can usually be done as an outpatient procedure or with a one-night postoperative stay, and it has relatively low morbidity. Up to 90% of patients exhibit significant improvement of their episodic vertigo after the operation. Destructive procedures such as labyrinthectomy and vestibular neurectomy are reserved for rare cases of failure of the endolymphatic sac enhancement and are not offered to patients as a primary surgical alternative. Wide decompression of the mastoid and sigmoid sinus is of paramount importance in achieving an adequate endolymphatic sac enhancement. At the end of the operation, meticulous attention should be given to cleaning bone dust and debris from the wound and to stopping all bleeding and bony oozing. Wide opening of the posterior aditus and facial recess is usually necessary to prevent postoperative aditus block. In the postoperative period, scrupulous attention should be given to wound healing; if infection develops in the wound, aggressive antibiotic therapy should be administered to prevent labyrinthitis that could result in deafness.