Endolymphatic sac surgery for Meniere's disease: experience with over 3000 cases.

The foregoing discussion has attempted to substantiate and clarify the six propositions outlined at the outset in light of the author's personal experience. In sum, the following points are emphasized: Employment of ESS for treatment of intractable Meniere's disease in cases where the sac is definitively delineated, the real sac lumen entered, the sac's integrity preserved, and sac enlargement technique is employed has an approximate 90% chance of achieving complete or substantial control of vertigo in the short run (2-3 years). Although there seems to be little likelihood of pushing the short-term rate of vertigo control obtainable with ESS significantly beyond the 90% mark, there is still room for improvement of longer-term control of Meniere's disease symptoms, either through modification of surgical procedure or, as the author recommends, through treatment at an early stage of the disease. The efficacy of ESS almost certainly has a definite, although presently ill-understood, pathophysiologic basis and cannot be purely attributable to a placebo effect. Regardless of limitations and uncertainties surrounding Meniere's disease and treatment of it, ESS is indisputably both safe and highly effective and, in the author's opinion, continues to be the preferred treatment for medically refractory Meniere's symptom-complex.